The Relevance of Speech Therapy: A Physician's Viewpoint

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Re: role of the amygdaloid circuits and the hippocampus

From: Darrell Dodge
Date: 10/21/02
Time: 9:56:41 PM
Remote Name: 198.81.26.166

Comments

Hello Nathan:

Thanks for your reply. I was trying to keep my responses in the realm of language suitable for the lay person. (That's why I used some concrete examples of how conditioning might work in stuttering.) However, there are some descriptions of brain activity that are very difficult to pull off without delving into concepts in which the general public is not usually knowledgable. I appreciate the difficulties and think that your discussion of explicit and implicit memory systems will be helpful for readers.

I think that our ideas about the role of emotion and stuttering diverge somewhere in the following:

>This same type of process is thought to >contribute to the expression of anticipatory >anxiety. Anticipatory anxiety is a result of >stuttering and is cultivated by previous awkward >social situations where one has felt embarrassed >stuttering in the presence of others – a >conscious thought process. Over time, repetition >transforms these memories to the procedural >type – an unconscious thought process.

The emotional impact of stuttering is much more than "embarrassment." And the emotional reactions underlying stuttering are not just a result of public speaking problems. The loss of control and alarm reactions associated with stuttering are much more than "thoughts" (conscious or unconscious.) Double-faulting in tennis is something that can result in embarrassment. Speech is something much more significant and basic for humans because it is literally something we must do to survive. The impact of stuttering on the child is far more immediate than you suggest. This is indicated by the swift, almost catastrophic, progress that the development of stuttering can take. Survival threats like the loss of speech control and facility can result in the creation of deep implicit emotional memories in the amygdaloid/limbic system and their linkage with explicit situational memory associations is virtually instantaneous. And when they are reinforced over weeks, months, years, and decades, they are very difficult to overcome. In fact, I actually suspect that for many children, the conscious thoughts about stuttering may be developed *after* the implicit emotional memories have been laid down and reinforced.

It is extremely important, for the clinician's credibility, to be aware of the permanent and indelible nature of some of these reactions, because most stutterers, no matter how far they progress (and that can be very far indeed), will have some significant residual stuttering.

If your example were totally true, then the many stutterers who participate in Toastmasters activities (including myself some years ago) would find that the extinguishing of their embarrassment of and performance anxiety about speaking would (over time) result in a virtual cure. It helps, of course, but not as much as one would hope.

I do agree very much with the thoughts in your final paragraph:

>Being unconscious, however, does not make >anticipatory anxiety permanent or untreatable. I >presented the concept of brain plasticity, in >part, to give encouragement to those who stutter >and provide some understanding how therapy can >change the structure and function of the brain. >This change can occur whether the mental >processes are conscious or unconscious.

Thanks again for your patience with my continual challenges.

Best regards,

- Darrell Dodge, M.A.


Last changed: September 12, 2005