Stages of Coping:

A Stutterer's Journey from Denial to Integration

Louise Heite

1. Introduction

I stutter. It is a simple sentence, but at twenty-five I could not have written those two bald words without putting myself through an immense amount of emotional turmoil. It is possible that I could not have written them at all, and I know I could not have spoken them. Now at twice that age I have made friends with that simply-stated truth, and have integrated it into my life and self so that it no longer forms a barrier to or excuse from meeting the world on my own terms. It is almost irrelevant. I have passed a milestone birthday and looked back over that passage, and I am prepared to share some observations of myself and of some other chronic stutterers that I have made along the way. (1)

I should say a bit about myself before I go further, to try to alleviate justifiable doubts about the value of what might seem at first glance to be yet another "How I Got Better" narrative. I am a social historian and archaeologist by training, and have spent much of my working life engaged in the observation of people and societies both nearby and somewhat distant. My training and subsequent experience have involved deep critical observation of myself for prejudice and assumption, which can and do interfere with the understanding of both historical and anthropological process. I am also a writer and visual artist on the side. I have publication and exhibit credits sufficient to give me the hubris, if not the honest confidence, to attempt to explain and mediate an experience that is at once both intensely internal and personal, and also shared and perhaps predictable, at least within the limited population of people who stutter.

I dare to step outside my field of objective and formal expertise because I believe deeply that my subjective and informal expertise contains kernels that might sprout and grow into useful strategies for helping others, especially other adult stutterers, to come to terms with a condition that can be devastating, and even in its mild form is a constant source of irritation. I offer up my observations with respect, however, and in a spirit of inquiry for the love of it.

In the very early spring of 1996, I found The Stuttering Homepage on the Internet. That installation introduced me to a most extraordinary and dynamic virtual community of stutterers and others interested in the phenomenon, gathered in the ether from their scattered locations, which stretch from the near side of hither to the far side of yon. In the time since I have learned a lot about myself, of course, but beyond that and more usefully, I have had an opportunity to observe and to learn from the collective behaviors of this community through the media of interest lists and virtual communication. (2)

To people in the fields of speech correction and counseling, it may sometimes seem as if there is a stutterer on every street corner. But that is not the case: we who stutter are a tiny sliver of the population. Moreover, the ones in therapy or who participate in self-help organizations, and who are thereby in contact with a community of stutterers are a sliver of that sliver. I would venture that most people who stutter live in near isolation from others who do. Ordinarily there is little opportunity to observe stutterers in groups of more than a few at a time, or to get a sense of group behavior of a large number of people who stutter in interaction with one another. To a degree, the Internet has altered that situation.

The Internet-based community of stutterers is almost certainly not truly representative of the whole population, as internet users on the whole are self-selecting, overwhelmingly white, mostly male, and better educated than the mythical average. That community also probably encompasses a maximum of fewer than a thousand individuals worldwide, which is a paltry percentage of the estimated three million stutterers in the US alone. Still, the community spans a wide range of adults and some younger people, probably a wider range than one is likely to find in almost any physical setting. The Internet's simulated immediacy lends a naturalness and spontaneity to their exchanges that more traditional kinds of mass communication lack. For those reasons, it is possible to observe the interaction of individuals with each other, and with their particular community as a whole, to a degree and over a period of time that is probably not possible in the real world. From these observations it is possible to begin to derive some generalities which allow a better understanding of what it really means to be a person who stutters.

The main topic of conversation on the Internet, one is tempted to say "of course," is how to live with a speech impediment. It seems clear from the nature of these exchanges that the process of dealing with a stutter, learning to function with it, around it, or despite it, and trying to lose it, is a process that occurs in each individual in distinct and predictable stages. It doesn't take long before even a casual reader of the interest lists can spot the person making his or her first tentative, reluctant, denial-laden steps into the half-hidden world of stuttering, or the opposite number, the old-timer who has been through a dozen therapies, read two dozen books, and tried three dozen home remedies, and has decided that the best way to deal with his or her chronic problem after all is a big smile and a sense of "prideful humility." (3) In between there are scared people, angry people, hopeful people, depressed people, and obsessed people. The behaviors seem to lie on a continuum. In that way, the process of coping with stuttering is not that different from many other circumstances that progress through a person's life in a more or less predictable order.

2. The idea of stages: learning, grief, and "recovery"

The concept that life progresses through defined and predictable stages is hardly new. The Greeks of antiquity codified the idea in the riddle of the sphinx: "What is the creature that goes on four legs in the morning, two in the afternoon, and three in the evening?" In the middle years of this now closing century, Dr. Benjamin Spock injected the idea of stages of childhood into the public mind where it took root and became an integral part of popular culture. Author Gail Sheehy gathered up the researches of many scholars a generation later , and delineated stages of adulthood in a compelling and accessible popular book. In so doing she extended the concept to all areas of life. (4)

Three processes which involve staged development seem to bear particularly on the process of accommodating a stutter. In it, they are intertwined and influence one another, to produce a whole that may be more than the sum of its parts. These processes are the learning curve, the mourning of loss, and what has been called "recovery" in the treatment of socially destructive behaviors such as addiction and compulsive neuroses. I have some arguments with the full implications of that last analogy which are discussed below in a more appropriate place. Suffice it to say that there are enough points of similarity to this process in the process of coping with stuttering that "recovery" in this specific sense is a useful construct and well worth including in any discussion of staged accommodation.

2.1 The Learning Curve

The learning curve is a familiar concept. Although it was originally the possession of pedagogues, it now occupies an honored place in common conversation. It describes the rate at which people acquire new knowledge or skill. In the beginning of the process, once the individual has recognized the need to learn about something, the acquisition of knowledge is very rapid. It levels off as the student first quickly and then more gradually acquires all the knowledge available at a given time, or pushes his or her skill level to its physical limit. The learning curve touches on all progressive endeavors to one degree or another.

Although people tend to conceptualize the learning curve as something that can be fitted neatly to a logarithm, it is really not a smooth curve. In practice, it is iterative and sometimes doubles back on itself, as people advance, lose their nerve or misplace a skill and back up, try again a little differently, and move on. Plateaus are common, and sometimes frustrating, both to the student and to the teacher. These plateaus are important times of consolidation and rest, however. During the plateaus, the student internalizes and masters the new knowledge or skill while gathering strength to take on the challenges of moving into the next stage. Mastery of one stage makes way for the person to tackle the next, in a process of constant if irregular growth. Failure to master a stage almost always precludes mastery of subsequent stages.

The process of accommodating a stutter involves a great deal of learning. From the earliest stages of recognition to the final stages of integration, or much more rarely, "cure," the stutterer accumulates knowledge about himself; the particular nature of his impediment; the environment and its effect on his speech; techniques of articulation, monitoring, and management; and a host of other learnable details. At particular stages in the process of coping, a stutterer may immerse him- or herself in the literature of speech correction, theater, psychology, metaphysics, or neuroscience, among others. But eventually, the stutterer's personal resources will be stretched to the limit, and new knowledge becomes hard to find. The way the individual shapes the learning curve to his or her own life and circumstances can have far-reaching effects on how well he or she copes with the impediment, and whether or not one can reach a stage of psychological equanimity that may -- but need not -- involve losing the stutter altogether.

2.2 Stages of Grieving

n 1969, Elisabeth Kubler-Ross (5) articulated an analysis of the grieving process that has had a deep impact on the way that people today conceptualize coming to terms with any loss or setback. Although Kubler-Ross' original description concerned the process of grieving the death of a loved one, its application has been expanded, and its stages have been applied to all sorts of situations requiring adjustment to adversity. Stuttering, and the adjustment to disability in general, are among them. (6)

In its short form, the outline of the stages of grieving includes denial, anger, depression, and eventually, acceptance. As with the learning curve, the apparent linearity of the process is largely but not entirely an artifact of language. Although the stages do move in a progression, the progression is by no means absolute, neat, or consistent. The way a given person moves through the stages, whether or not he sticks or moves quickly, whether or not he moves efficiently or vacillates, is determined by the individual's makeup, and the importance, and to a degree the irreversibility, of the loss . However, the important point is that a person who has experienced a loss or setback must progress eventually through all of the stages if he or she is to come to terms with the situation. (7)

It is also important to note that in the case of stuttering, the loss being mourned is not necessarily the loss of fluency per se. Particularly when considering adult developmental stutterers, they have probably been disfluent so long that there is little of new loss to mourn . However, the stutterer must some time mourn in a large sense the loss of a dream, the death of the self-concept as a fully fluent individual, capable in all ways, and the full equal of his fellows in all interactions - in short, he must mourn for the fluent speaker who does not exist. One member of the Stutt-L interest list posted the following after completing a job interview in which she discussed her stuttering straightforwardly with her interviewers: "The issue for me is ... my stuttering and how I experienced it yesterday...I found myself in a contemplative state, and sort of at the edge of emotional lability...It feels like I am grieving a loss...perhaps a loss of a perceived ideal of self?" (8) (Link to Full Text)

The other important loss which the adult stutterer experiences is a loss of potential status and position within his or her immediate community, and the loss of efficacy and self-respect that goes along with the loss of status. This perception of loss stands a good chance of reiterating itself in small and large ways every time the stutterer enters a new environment. It makes little difference in terms of the dynamics of loss whether that is a fairly permanent environment such as a new job or new neighborhood, or a very temporary one such as going shopping or visiting another town.

Denial, anger, and depression, which form the bulk of the grieving process, are very debilitating emotions. In a person whose disability is severe enough to reinforce these emotions daily, the depression may be extraordinarily long, and extraordinarily deep. It is not enough to cope with grief once and move on: in a sense even a well-adjusted chronic stutterer must face a lifelong process of grieving on a low level. Indeed, if a stutterer is going to encounter problems in coping and find that he cannot continue the process, it will probably happen in the stages where grieving is a dominant characteristic.

2.3 Stages of recovery

There are many conditions that have both real and perceived negative social consequences that are amenable to resolution in a staged and rather formal process of recognition, confrontation, and accommodation, or in a somewhat popular term, "recovery." Some of these conditions, including abusive and addictive behaviors, have very real effects on innocent family members and bystanders, while others have extreme consequences primarily for the bearer. Stuttering is among the latter, along with phobias, eating disorders, and other noncriminal compulsive behaviors. I will not, and am not equipped, to venture into the thorny thicket of whether or not stuttering is a neurosis like a phobia, or the product of an innate or acquired organic deficiency like an addiction, or some combination thereof: it is enough that the stutterer endures many of the same emotional processes and social penalties that impose themselves upon those who suffer these other disorders.

Among the things stuttering has in common with compulsive and abusive disorders are that it is involuntary, and that it produces great shame in the bearer (9) . The origins of that shame puzzle me, although I have felt it myself. Stuttering by itself does no physical or material harm to anyone, even to the stutterer. The shame is entirely a social phenomenon, and it is quick and deep. The social consequences of stuttering are often very much out of proportion to the seriousness of the offense. They may be largely self-inflicted but are never entirely so. Although listener reactions to a stutter can range from benign acceptance to deep and sudden revulsion, the adult stutterer has usually experienced enough of the latter over a lifetime that he or she is wary, and especially vulnerable to small slights.

Shameful behavior, or behavior that is perceived as shameful, produces denial, and often self-loathing. The stutterer, like the addict or the phobic, must acknowledge the loss of voluntary control over a very fundamental aspect of his or her behavior. Whatever its ultimate origins, the stutterer at the moment of the stuttering event has lost control of his speech, every bit as completely as an alcoholic or a person with an eating disorder has lost control of his or her consumption. Until the stutterer can bow his head and gracefully acknowledge the power of the stutter to disrupt his life, he will never be able to deal with it successfully.

But the rarity of full recovery from stuttering in adulthood tends to mitigate against classifying it with compulsive disorders. Unlike most of those, stuttering is hardly amenable to the removal of access through abstinence and reeducation; nor is it necessarily the result of faulty analogy and poor social adaptation as in a phobia. For many (if not most) stutterers, a stuttering event almost always contains some small element of surprise. Although the stutterer may know what conditions are likely to trigger his stuttering, those triggers are not usually as reliable as either a substance abuser's physical dependency or a phobic's specific fixation. In fact, the specific triggers of a stuttering event are often changeable and fluid. This fluidity may make the concept of staged recovery only partially applicable to stuttering.

3. The stages of coping

The stages of coping with stuttering which I propose have some characteristics of all of these processes. First, the learning curve manifests itself as the stutterer acquires knowledge about his or her condition (including speaking skills) and internalizes that knowledge. Many stutterers are extremely knowledgeable. In fact, as a whole the community's hunger for knowledge is voracious and insatiable. But there comes a time when the individual has met his physical limit, and new knowledge is difficult to find. Then the learning and skill-building level off, and the obsession with learning more either formalizes itself into scholarship, or it dwindles into a background interest which informs rather than drives.

Second, the confirmed stutterer must mourn the fluent speaker who is not, an idealized self who seems stillborn and trapped somewhere in the limbo of the unexpressed. It is very important that the stutterer find a way to complete this mourning process, moving through denial to acceptance and laying aside both resentment and sorrow. It is important too to divorce the stutterer's sense of self from the potential for daily loss of status, as the stutterer renews that loss every time he or she stutters in a new environment.

Finally, like others who engage, or seem to engage, in a disruptive behavior, the stutterer bears a stigma that carries sometimes extreme social penalties including contempt and shunning. However, unlike a substance abuser or compulsive gambler, the stutterer seldom does real harm to anyone except perhaps to him- or herself. The load of shame which social penalties place upon the stutterer's shoulders is often quite disproportionate to the offense, and the stutterer needs to learn to actively reject this assignment even as he or she accepts and accommodates the fact that the impediment often does create unease and confusion in the listener.

3.1 The seven stages

I should like to propose seven stages of coping which can occur over the lifetime of the confirmed adult stutterer, as he or she recognizes and learns to accommodate his or her impediment. Of course, even as we talk of stages, we must remember that the process is an irregular continuum. But the behaviors at these stages seem to be fairly stable and fairly consistent.

The stages I propose, in order, are denial, recognition, aversion, resignation, acceptance, self-acceptance, and integration. There probably are further stages beyond integration -- compassion comes to mind as a possibility -- but the peaceful soul and practical mindset of those who have integrated their stuttering wholly into their lives should be a sufficient goal for many a tormented stutterer.

While these proposed stages define periods of relative stability, one must remember that growth occurs at the boundaries. Progress is irregular. Nobody moves through all of the stages without much vacillation and emotional effort, and one can often display behaviors which are characteristic of several stages at once. Still, one stage or another will probably dominate each person's attitudes and behavior at any given time. Some may find a transition too painful to endure and become paralysed for a while. Some will backslide and try again later, and some lucky ones will awaken with a revelation that has carried them over the rocky places into the next stage with little difficulty or emotional cost. Some people will stick at a particular stage and never move beyond it, and others may seem to skip a stage altogether. One may linger here and hurry there, but taken over a lifetime, the sequence has a cast of inevitability.

3.2 The characteristics of each stage

3.2.1 Denial

It seems absurd to talk about denial in the context of stuttering, because a stutter is so often so obvious to everyone, including the stutterer himself, who may focus on the impediment to the exclusion of most of the rest of the surrounding world. In most cases, the period of denial is very short indeed, and some never really knowingly experience this phase (10) . Most stutterers are diagnosed in childhood, and certainly the majority of those who continue to stutter past childhood evidence severe enough symptoms that the act of denial would appear to be impossible without engaging in elaborate psychological gymnastics. But denial is a normal reaction to the expression of socially unacceptable behavior. It is also the first step in the classic description of the process of grieving.

Some people do escape diagnosis, and some, with the unacknowledged assistance of those around them, actively avoid it. Denial is probably more common than we realize. A mild stutterer without elaborate secondary behaviors or lengthy blocks can often hide, and hide from, the condition. Just as an unacknowledged alcoholic unable to face up to dependency will use linguistic tricks and metaphor to avoid confronting himself, a stutterer in denial will bury his or her impediment under such rubrics as "shy" "reserved" or "sensitive." In some places and in some families, such descriptors are considered far more desirable than the honest but merciless word, "stutterer" with its connotations of deficiency, helplessness and clumsy ineptitude. When pressed, these people will admit to being "occasionally clumsy," "flustered," or "momentarily confused." They "get their tongues tangled" or "trip over their teeth", or some such wording that carefully skirts the concept of stuttering. To their listeners the "moments of confusion" may often seem to run headlong into one another, and the "occasional clumsiness" can appear to be lengthy and constant. But to call such a person a stutterer would attack the foundation of his or her self-concept, and it is likely that the person would soundly reject such a nomination.

This is the stage at which I was in my middle twenties, when I found myself in work situations that increasingly required me to speak spontaneously before the public, and quite unable to fulfill that requirement. This included teaching an unpopular but required undergraduate state history class as a graduate student. In that unforgiving light I had to begin to come to terms with something that I had silently half-acknowledged long before but never confronted honestly, nor recognized for what it was. Parents can and do contribute to this kind of denial, by not realizing what is going on; by denying themselves that there is a problem; or by refusing to do anything, hoping that in time it will go away by itself. Perhaps that has its uses, as the child may be spared the self-consciousness that almost always accompanies the diagnosis of a disabling condition in childhood. However, denial is an imaginary world, into which reality may intrude at any time. Most who deny that they have a speech problem probably do so rather superficially . Theirs is a life of continuous watchfulness.

It is hard to find confessed examples of denial. By definition, people at this stage do not come forward to be counted. I am the only one that I am absolutely sure of, and I know that only in retrospect. Mine was an extremely disfunctional family in which most problems were met with denial, until they produced violence. The following is an excerpt from a journal which I wrote when I was trying to come to terms with some very unpleasant memories, and it explains perhaps better than any cold analysis ever could the menatlity of denial. It was written in the second person to try to place a little distance between my grown-up self and the eleven-year-old me.
Sometimes you want to talk of the things from the silences, the things that frighten you: the hate, the shame that you think you have caused, the sadness... But often the words will not form, although the thoughts are complete. Even when you can make yourself speak of these things, Mother
dismisses your worries as if they were all imaginary...
(Full text)

The community of stutterers and speech professionals functions on a folklore that all stutterers know that they are, but that is not necessarily true. I have met a number of people whom I strongly suspect are in denial to one degree or another. Certainly some mild stutterers are so unconscious of their speech that denial is a viable behavior. But even people with a moderate stutter can live a troubled life of denial, supported by a conspiracy of politeness or fear that prevents them from ever confronting, acknowledging, and dealing with their problem. People in denial will not seek treatment: they cannot. They will never be available for observation, except as something brings them hard up against the reality, and they pass, willingly or not, into the next stage, which is recognition.

3.2.2 Recognition

Recognition and denial can exist side by side in the same individual. One could argue that in order to deny a condition one must have at least a subconscious awareness of it. There can be great vacillation, and even occasional self-confrontation. Recognition is a passage. As a person passes (or is dragged) through the process, the signs become clearer and clearer that one is indeed a stutterer. The cry of "I can't be one of those!" begins to ring hollow, and sooner or later one must acknowledge the cold, hard truth.

Recognition imposes itself early upon most stutterers, with the aid of parents, siblings, and associates who cannot help but react to the child's dysfluency. The child himself may well recognize that something is amiss, and some do that when they are very young. Others are thrust rudely into recognition by some outside force: a teacher, a tease, a chance overhearing. This poem by Gören Sunnevi, translated by way of Icelandic from its original Swedish, describes the devastation of being suddenly and publicly forced to confront the fact of stuttering (11) :

I was nine years old, it was turning Fall
when my stutter took sail
without my even noticing
myself Like a thunderbolt
from a clear blue sky, one
winter's day, the teacher
sent me to the speech teacher
in the middle of class, I walked
across the empty schoolyard
all alone, I stuttered.

Yet for others, myself included, recognition is an extraordinarily long and slow process of extreme vacillation. It took me a very, very long time to own and acknowledge what I now know must have been absurdly obvious to most of the people around me. Imposed recognition may or may not fall upon fertile ground. A child, and even an adult, confronted for the first time with identification as a stutterer, may retreat into a deep denial that prevents their being able to benefit at all from whatever help may be imposed upon them, let alone be able to seek it on their own. Some may focus themselves, and devise more or less effective strategies to conceal and "overcome" their stutter, as I did when by raw chance I overheard my mother discussing my hitherto unnamed impediment with a neighbor when I was in grade school. If the strategies are at all effective, and mine were, they can facilitate a backslide into denial - but it will never be as secure a denial as before.

The subject of stuttering never came up in my presence when I was a child, though there is circumstantial evidence that my parents were aware that something was amiss. It was four years between my first accidental encounter with the concept of possibly being "one of those", and my second. In the seventh grade I met another stutterer face to face for the first time, and the encounter was an intense experience which left me mentally reeling but which gave form to the formless difficulty in speaking which had continued to trouble me. I retreated from this experience with a vehemence which surprises me in retrospect. (Illustrative text)

Although recognition is the first step on the learning curve, people early in the process will be shy. It will not take much at all to send them skittering, as I did, back into the familiar haven of denial. They may take on especially challenging tasks, to prove to themselves that they are not "one of those." In high school, I discovered that I was a good reciter. Drawing on some intense early-childhood training, I regularly presented lengthy and complex monologues in school variety shows. I also became something of a smart-alec, as I discovered that a talent for punning and sarcasm could permit me to participate in class discussions on my terms, and not wait for the dreaded pointing finger. However, despite continuous urging from some teachers and from my parents, I carefully sidestepped such activities as debate, forensics, or public speaking class. My secret was mine, and it was buried under an enormous edifice of stage presence and raw desperation.

As recognition matures, people become curious, if not necessarily brave. Even intelligent adults will sneak information, or arrange to stumble over it. At this stage it was very, very difficult for me to discuss stuttering, the very concept stuck in the brain before it even got to the speech system. When people in the throes of recognition do approach a speech professional or another source of information, they may do so in ways that minimize the exposure of their self-image. My initial difficulty teaching undergraduates sent me to my university's teacher development service for pointers. I rejected speech therapy after only a single visit which left me unimpressed, and instead developed a teaching style that did not depend on my being a riveting speaker. It is effective in small classes and seminars, so I was able to postpone for a very long time taking the next step.

A person who has trouble with recognizing their status as a stutterer may also hesitate to seek help to the point of paralysis. I carried a magazine clipping which contained the National Stuttering Project's address in my wallet for years, until I lost it. It was a good two decades before I established contact with that organization despite the fact that I knew all along that it probably would benefit me. Others protect themselves in other ways, sometimes eloquently expressing denial even in the act of asking. One speech professional with a lot of presence on the Internet has commented privately on the lack of capital letters in some of the initial inquiries she receives from people looking for advice. (12) Apparently even the anonymity of the Internet is not protective enough for some people in the first tentative stages of exploring this fragile subject. For myself, the Internet's remoteness and ease of access made it possible to begin at last to examine, in a safe place, the details of a condition I had come to acknowledge a long time before, but still continued to fear.

There is another face to recognition which every stutterer has to deal with, no matter how mild or how severe the impediment. That is the recognition that stuttering is socially unacceptable. This recognition can be devastating. The social costs of stuttering are not only practical but emotional, in terms of isolation and the devaluation of the stutterer's self-image. The practical costs often involve underestimation of the stutterer's native abilities which are masked by the stutter. Many, if not most, stutterers can recount in painful and intense detail a key event that brought home to them how undesirable stuttering is. A young man whose stutter drove him into a nearly suicidal depression recalled his first realization that stuttering carries social penalties:

"My first experience with the emotions associated with stuttering changed my life forever. I have yet to forgive the people who brought that hell into my life...I started to read. I had trouble; no words would come out. This was what I expected and I didn't think anything of it until T- D- and D- M-, two of my classmates, started to laugh and point at me... I don't remember volunteering to answer questions before that time, and I'm sure I never did after that dreadful experience..." (13)

3.2.3 Aversion

The struggle between the ideal self and the reality that stares back from the mirror every morning is hardly limited to those who stutter. It is a constant struggle to one degree or another for everyone. Who has never averted their eyes from a sudden confrontation with a reflection of him- or herself that appears to be too fat, thin, tall, short, dark, or fair, for the current ideal? The small vanity of that aversion can easily become pathological when one must learn to accommodate a disability such as a stutter. As with any disabling or negatively-perceived condition, it takes a while to get used to the threat that one will never be able to achieve an ideal, or even an ordinary, standard.

Aversion carries with it two of the most destructive emotions in the human repertoire, envy and self-pity. These ugly twins harry and torment the aversive stutterer in every human exchange, as he or she compulsively compares himself or herself to an impossible, glib and fluent, ideal self, and comes out wanting. Aversion is the most dangerous of the stages. It is also the noisiest. It is a powerful negative reaction, whose resonances color the stutterer's every living moment. It receives constant outside affirmation as listeners, strangers and intimates alike, show their own aversion to the imposition of the stutterer's impediment upon their lives. If the stutterer makes the common mistake of believing that people are repelled by the one who stutters and not by the stutter itself, he risks great psychological harm.

Aversion may be active or passive. It makes some intuitive sense to argue that retreat into a second level of denial, as I did in high school, is a form of passive aversion. Where the severity of the impediment renders higher-level denial impossible, passive aversion can take the form of a certain tough-guy cockiness, or of aloofness, which may protect the ego but keeps the individual from forming important relationships, achieving goals, or making contacts, or even following one's heart on a career path. This illustrative quotation is from Stuttering, a Life Bound Up in Words by Marty Jezer (Basic Books 1997).

"My way of coping with my disfluent speech was to deny that I had a disability. When people would ask me about my stuttering, I would give them my best smile and say, sure I stutter but it doesn't bother me at all. This was my pat answer for more than 40 years. The truth was that my stuttering was the defining fact of my life. If I couldn't hide the fact of my stuttering, I could at least try to conceal the suffering that it was causing me." (14)

As stultifying as passive aversion is, the active forms of aversion are far more devastating. Self-pity and envy eat holes in the soul. There is a lot of injustice collecting in this stage, as well as a lot of giving up, and the attendant guilty conscience. Self-pity tends to include a much self-loathing: "If I am one of those, I must be a pretty terrible person. Oh, poor me! " A child of my acquaintance stated that her stutter made her "not human." One young man in the throes of aversion stated to me that he "hated normal speakers." When confronted by another stutterer who was extraordinarily rude to him, turned his anger inward in an illogical and broad-brushed description of all stutterers, including himself, as rude and insensitive.

This stage can make people aggressive and even offensive in their attempts to displace the social consequences of their disability, or to demand retribution from a society that they feel is unfair and cruel. In a few cases, it may produce a kind of confrontational activism. The effectiveness of that kind of effort is debatable, but it provides the individual with at least a superficial release from the feelings of rejection which aversion feeds upon. Unable to move past the stage of aversion, the in-your-face confrontationist seeks opportunities to expose both real and imagined slights, and demand apology for them in the name of stutterers everywhere. This behavior often produces more revulsion than the stutter itself ever did, but those who express their aversion in this extroverted way are usually unable to distinguish the difference.

It is easy to fixate at this stage, and to become bitter and isolated. Aversive stutterers engage in a great deal of howling and posturing. They may refuse therapy, or find it to be ineffective, or perhaps pointless, as I did. Adolescents, compelled as they are to meet their reference group's every expectation, may be especially vulnerable to feelings of aversion.

A sense of victimization is pervasive among aversive stutterers. Many of the unpleasant characteristics which are associated with the elusive "stutterer" persona, such as timidity, shyness, and isolation, derive from this sense. The involuntary nature of stuttering, and its resistance to treatment, probably do a lot to reinforce the sense of victimization, quite regardless of whether the stutterer receives encouragement or rejection from the surrounding environment. The stutterer knows that he or she has not deliberately done anything that warrants the revulsion and distaste that arc from the listener's eyes when he stumbles into a verbal pratfall. He cannot accept that what seems to be distaste may be mere puzzlement, because all too often it is not. He feels put upon and unjustly held guilty for a totally involuntary action. Older views of the cause of stuttering, which plant it firmly in the field of Freudian neurosis, do little to alleviate this sense of undeserved guilt and pervasive victimization.

People in this, and in the next stage, are obsessed with finding "cause" and "cure." The aversive stutterer is a prime target for quacks, quick-fixes, and "stutter-doctors" of all stripes. They are among the noisiest and most frequent contributors to the Internet-based interest lists. Their constant and unrelenting search for the key to their disability takes up miles of endless and repetitive conversation and speculation. They talk of "fluency pills" and they speculate interminably on what life would be like if they suddenly became fully fluent. They set impossibly high goals, and when they fail to reach them, they fall into pits of dejection that can be a worse handicap than the stutter ever was. These people envy and lust after complete fluency with such passion that they can't recognize that there is really no such thing even for brilliant orators without much practice. They will reject suggestions that content is more important than delivery. And tragically, this intensity and the constancy with which they monitor their speech tends not to alleviate but to exacerbate their stutter.

Aversion spurs the learning curve. People are especially compelled at this stage to learn as much as possible, and particularly to learn techniques that may allow them to rid themselves of their stutter. The deep motivation of aversion seems to be one of the reasons that, in the short run, nearly all stutterers benefit from some therapy, and nearly every therapy no matter how absurd seems to benefit some stutterers . Desire is a very powerful master, which can move a person to extreme feats. Unfortunately, it is also a fickle master, and today's triumph often degenerates rapidly into tomorrow's even more abject aversion

The discomfort of this stage may be enough to spur some persons to achieve fluency or a very close approximation of it by sheer hard work, but I would submit that that is a fragile and tentative fluency. Certainly , my own was terribly subject to disruption by circumstance including simple physical tiredness. For these people, the underlying issue of aversion remains unresolved. A case study found on the Stuttering Homepage describes very well the aversive stutterer's mental and emotional anguish even when the illusion of fluency is successful (15) .

Aversion resembles in many ways the stage of anger in the grieving process. It is also similar to the stage of confession and humiliation that are a part of staged recovery processes. As it progresses, aversion can produce depression which can require hospitalization and can even occasionally become violent. That is especially true if the stutterer turns his or her aversion inward and becomes lost in his grief. This occurs often enough, and is devastating enough, that it probably deserves to be studied as a separate sub-phenomenon of the whole complex of stuttering behaviors.

Among the community of stutterers and speech professionals, Charles Van Riper's suicide attempt is something of a legend. But less eminent persons as well fall into that pit. I have had contact with two young men who were near suicide due to depression associated with their severe and unresponsive stutters. All of these examples involved young adults, confronting despair induced by a belief that their impediment would prevent their ever attempting, let alone achieving, a successful and happy life.

This kind of despair is by no means a phenomenon of our time, as the life of the English Romantic period essayist Charles Lamb (16) illustrates. Although he was an honor student, Lamb was refused admission to university because he stuttered too badly to enter the clergy, the only way a bright young man of poor means could gain entrance. He went to work as a clerk in his mid-teens, but at nineteen was hospitalized for madness for six weeks.His correspondence with his friend and schoolmate Samuel Taylor Coleridge is very full of the kind of deep lamentation of isolation and loneliness empty of hope that fills the complaints of depressed stutterers two centuries later. Illustrative text.

3.2.4. Resignation

Resignation is the first step back into reality for the aversive stutterer. It is a natural progression as the intemperance of aversion plays itself out. Although it begins in the anger and depression of aversion, it represents the foundation stone of subsequent acceptance, integration, and for the fortunate few, cure. It often overlaps the prior stages, as the classic stages of grieving include both denial and rejection, which is similar in many ways to aversion. But unlike the prior stages, the stage of resignation implies fuller recognition of the fact of the stutter, and of its possible permanence -- and it promises acceptance.

There is grief in resignation, but it is not the active grief that drives the stage of aversion. The resigned stutterer does not grieve for fluency per se, as one cannot mourn that which one has not had. The grief, rather, is for the dream of fluency, of the elusive normalcy, or even excellence, in that which has been denied.

Resignation represents the slowing of the learning curve. In some ways it is similar to the stage of bowed humility which marks the turning point in staged recovery. The stutterer has applied hard-learned therapies, and read every available word on stuttering; he has sought out one cure after another, or has devised this or that technique to suppress and avoid the stutter, and all have left him floundering as before in a sea littered with the flotsam of his broken verbiage. He may have howled at God, or cried "Unfair" to whoever would listen, or demanded retribution. At its worst, he has looked into the pit, and only on its brink has he retreated from the ultimate end of his despair. In resignation he is sitting on a stone, catching his breath, and assessing what he can do now with all that apparently useless knowledge -- and how he can negotiate the world with a mouthful of stutter.

Some important changes in attitude occur as the stutterer progresses from the turmoil of aversion to the relatively benign surrender of resignation. The most important of these changes is a realization, perhaps a rather emotionless realization, that one is probably going to stutter for a long, long time. There is a profound sadness to this surrender of the quest for normalcy, but at the same time, there is a profound sense of relief.

The depth of sorrow that attends the stage of resignation can be astounding, especially early in the process. The death of a dream can produce its own whirlpools of depression so that at its inception, resignation sometimes appears to be a seamless whole with aversion. It is probably the disappointed and resigned stutterer who leaves therapy, and who condemns the failure of science and specialization to relieve him or her of a lifetime burden, or else who takes upon himself the mantle of failure.

Resignation may also be precipitated by relapse after a temporary "cure" brought on by any of several more or less successful training methods and therapies. The tone of the people on the Internet interest lists who have tried a cure and failed is often bitter, resentful, and resigned. They have had that elusive prize in their hands, and lost it, and feel as if that loss has marked them forever. The following quotation illustrates how failed therapy can precipitate resignation.

...I was released from therapy in Fall of 90 with the understanding that I have completed my therapy successfully and now I could go out and conquer the world!

The next year was the realization of the cruel reality that things had not really changed all that much. I still was helpless in many situations, in fact I had started to stutter a lot more in some situations than I did earlier. What made things worse was that now I would analyze each and every stuttering episode to death and come out blaming myself entirely for the failure of not using my techniques.

My Life as a Stutterer by Asim Kahn (17)

The resigned stutterer may become more interested in the "cause" of stuttering than in its "cure," which may seem extraordinarily elusive at this stage. The dream dies hard, though, and although the tone is less shrill, and the seeking less intense, the resigned stutterer still tends to hope against hope that he or she is mistaken, that the failure is temporary, and that there might in fact be a "solution." The resigned stutterer is not unlike the person bereft of a loved one, who half-hallucinates the sound of a voice, or a missing face (18) . The search for fluency has been a big motivating factor in these people's lives, it is not an easy one to lay aside.

Although it is easy and tempting to describe both aversion and resignation in highly dramatic terms, these phases both can be relatively gentle. My own passage into resignation was a curious feeling, as I had not had a particularly devastating period of aversion, though it was very long and evasive. In fact, my period of resignation was inextricably bound up with the realization that many of the issues of my unbeautiful childhood, including stuttering, would probably never be resolved in any concrete way. With the acceptance of that reality, I felt free to acknowledge my stutter openly, and to grieve gently for it and for all the things that had moved with it. (Illustrative text)

The stage of resignation is a lonely one. There is little written describing it, yet the resigned statement, "I know that I will always stutter" appears over and over again in the self-help literature and on the discussion lists. There seems to be little other open acknowledgment of this stage, though, despite that it is a vulnerable and sorrowful period.

A very large portion of the general advice available for stutterers in public sources, the Internet among them, seems designed particularly to help people reach the end of this period of grieving and its attendant discontent, and to achieve the next plateau, of acceptance. The tone is somewhat relentlessly cheerful, and that certainly has its place. Seldom indeed does anyone openly acknowledge that there is something tragic about the loss of the dream, or that there is sorrow in admitting that one very well may never meet even a common standard of fluency. Still, until the individual is ready to bow his head in a resigned acceptance of his situation and then move on, no amount of encouragement will make a difference. He or she will be bound by the lethargy of mourning. Until this stage has run its course, there will be no further progress.

3.2.5. Acceptance

As stated, much of the self-help literature in stuttering is directed towards achieving the stage of acceptance. Acceptance carries with it a tone of hard-nosed realism. There is an almost fierce cheeriness to acceptance, which stands in sharp contrast to the lassitude of resignation and the last steps of grieving. It is a benign stage, for in this stage the stutterer stops chasing fluency, and begins to come to terms with what it really means to be a person who stutters.

This is the first step in the consolidation of the various staged behaviors. It is a new plateau upon the learning curve. There may not be a lot left to learn, but there is much skill to develop, and much bad habit to shed. The raw humbling of the previous stage begins to melt, and in its soft waters the "prideful humility" that informs the integrated stutterer's self-concept begins to take root.

People at this stage talk a lot about stuttering in a rather abstract manner. It is an "it", neither a master nor a subject; it is a presence which does influence but does not always determine the course of one's life. Much retrospection may occur at this stage, as the stutterer looks over every detail of his or her life, to find the moment when they passed the divide, from speaker to stutterer, and the process by which it happened.

The stutterer may explore ways to distance himself from his impediment. When I reached this stage, I named my stutter "The Incubus," in wry honor of the Medieval belief that stuttering was caused by a parasitic demon, or incubus, which attached itself to the stutterer's soul, a kind of spiritual tapeworm. I still use the term as a private joke, and for variety in language, but the compulsion to distance myself has diminished considerably in recent years. Some with more severe impediments may explore the use of various appliances which may aid in promoting fluency, while others may reenter therapy with a new and productive attitude that promotes something resembling success. On the other hand, people who have fairly mild stutters and good coping skills may decide, as I did, that it is probably not worth the effort.

It is no longer so difficult to seek information in a sensible and above-board way, if there is information left to seek, nor is it difficult to talk about stuttering. But the search is more detached, more intellectual, and less desperate than the search that begins in the stage of aversion. The pleasure it brings is the understanding of a circumstance which is at least for the time being an indelible part of the stutterer's life. It is not a lusty quest after a solution to the stuttering problem. An excerpt from a recent exchange on the Stutt-L interest list illustrates this stage very well: (19)

What's made the biggest difference for me, however, is that I've learned to accept myself as a person who stutters. So I no longer worry about whether I'm going to stutter, and this has enabled me to speak more spontaneously. One side effect is that I actually speak more fluently than I did when fluency loomed large in my life, perhaps because abandoning the fluency quest has reduced my tension levelƒ J... M..."
"Hi, J... I also agree with your recent post. I think in the last couple of months I have really begun to accept the fact that I stutter and have found out that the more I accepted it and became comfortable with it, the better my fluency became..."

People who have entered the stage of acceptance seem to feel compelled to share their pleasure in making peace with their stutter, and they try hard to encourage their fellows who are still in the unhappier stages to cross the divide as well. Here is an excerpt from an essay by John Harrison. Its infectious good will is typical of the attitude of stutterers who have come to accept their stutter:

I eventually got over the stuttering problem. But it wasn't simply because I worked on my speech. I also worked on my ability to have fun while I was speaking. That took the pressure off the performance, got me in touch with myself, and transformed the experience into something positive. I have since wondered why having fun is not universally recognized as one of the most powerful catalysts to change... (20)

Link to full text.

It is in the stage of acceptance that the message that the impediment may not really matter very much after all finally penetrates. The stutterer loses his dread of stuttering publicly. The concept of learning to "stutter fluently" seems no longer to be an oxymoron. Certainly there will be repercussions, but in this stage, the stutterer is able to divorce himself or herself at least somewhat from the listener's startled reaction, and plunge ahead with the business at hand.

Sometimes the process is helped along by an unexpected encounter with fate. Van Riper(21) described his encounter with a wise and insightful old farmer. The encounter provided the key that enabled him to first accept his stuttering, and then to revolutionize thinking about the disorder and to lay the foundations for modern stuttering research and therapy. Illustrative text

A sudden awakening need not be as dramatic as Van Riper's, though. The event that led me to full acceptance of my own stuttering was a stint teaching elementary and younger high-school age children in a remote Icelandic fishing village. Two of my students, several years apart, were stutterers, and the pain and difficulty that their speech caused them moved me deeply. Both were on their own in dealing with their impediments, as there were no speech therapists for several hundred miles. As a teacher, and as the only adult with whom these children had regular contact who might be expected to understand what they were going through, I could not in good conscience refuse to try to reach out. But in order to do that, I had to accept in a very public way that I stutter too. Illustrative text


Although "cause" may be just as fascinating to the person who has accepted his or her stutter, "cure" is no longer necessarily a driving force. Rather, the accepting stutterer tends to think in terms of "accommodation." These people are able to make jokes about stuttering, and recount without much pain their most embarrassing moments.

Nevertheless, despite a generally accepting attitude towards stuttering, the stutterer at this stage can be easily thrown off center. Telephones, public speaking, and other difficult situations may well discombobulate, even as the accepting stutterer seeks opportunities to challenge himself by participating in such organizations as Toastmasters. (23) People at this stage are usually able to retain some equanimity even in the face of adversity, though, and to regain their composure fairly quickly. Small, and large, triumphs are the meat of much crowing and a source of some truly gratifying memories. It is upon the foundation of acceptance of the fact of stuttering that the next stages may be built. There is joy at this stage. Illustrative text

3.2.6. Self-acceptance

Self-acceptance marks a midway pause between the newfound liberty of acceptance and the dignity and quiet calm of real integration. It can be hard to spot the boundaries among these three stages, but over their course, there is a falling off of the sense of adventure, and a mellowing of the near-missionary intensity of the person who has newly accepted his stutter and wants to spread the gospel of spiritual release that accompanies that acceptance. It has now come time to get busy with the rest of life.

As I moved from acceptance into self-acceptance, I found that I truly didn't care whether I stuttered or not, although a lot of years of the habit of using my homemade and very useful management and fluency skills tend to make me careful. Also, I did, and do, try to show some consideration for the ease of others. In a lecture or other situation of that nature, I take care to slow down and speak deliberately, the same way I try not to burp, and don't eat peas with my fingers. Good manners and an appropriate dignity became my goal, not the avoidance of stuttering, or the illusion of fluency. Although I still find the startled look on the face of a person who hears me stutter for the first time to be frightening and unpleasant, it is not usually the hot iron through the heart that it has been in the past.

3.2.7. And finally, integration

The stage of integration is internal and deeply personal. There is probably no real difference in external behavior between the stage of self-acceptance and the stage of integration. But there are some differences that bring peace to the soul, and that finally render the impediment impotent to do lasting, or even significant temporary, harm to the stutterer. While the desire for fluency remains, it is wistful and not compelling. There are other more important stars to chase. To people still sunk in the quest for fluency, this and the immediately previous stages may seem to be a kind of giving up. It is not; it is qualitatively as different from giving up as night from day.

Integration includes a full acceptance of both the disabling nature of the condition, its likely permanence, and a willingness to accept the reality of its consequences, without feeling damaged or demeaned or diminished by it. That last clause is the operative one. I believe I have largely achieved integration, but it has not been that long since I found my hands shaking as I tried to type the word "disability" in reference to stuttering. However, honesty demands its due. When I could finally own the fact that I do sometimes need to take special precautions, and that I often must ask small favors of tolerance from the people around me, I felt as if I had laid down the last bundle in a large and ungainly burden.

What lies beyond? I won't know until I get there, but I wonder if the next stage is compassion. The integrated stutterer is the voice of caution and common sense on the interest lists. He is motivated by the compassionate but sometimes vain hope that he can ease the path of those who are not as far along, Illustrative text that he can spare them some of the agonies of failed therapies and pointless searching that he has survived.(24) I have been a recipient of that compassion. The gift of understanding and of subtle, kindly encouragement in the face of unwitting inconsideration has moved me deeply. But more important for my own understanding of the power of compassion, I have had the deeply moving and enriching experience of being able to act as a mentor to two young people who stutter. Watching them grow, one in person and one by email on the internet, has brought home in a way that nothing else could ever do how important it is to be there for them, to show rather than tell, to demonstrate rather than lecture, and to share rather than preach.