I have not built a new model or treatment of stuttering. I do not want to treat stuttering, and I do not want to discover the etiology. I want to describe the social meaning of stuttering and I will propose a new one, because the present meaning hurts stutterers.
At the beginning of this century, stuttering has two social meanings:
It looks like stuttering does not belong to human nature. Stuttering seems to be unnatural, something added to our nature. I want to present a new construction of stuttering named Transfluency. We should change the social meaning of stuttering, because the present one harms the stuttering community. Below I indicate some behaviours which were constructed as deviant and pathological (or medicalized) but afterwards, society and physicians reconstructed them as common and even healthy behaviours. Therefore, illness and deviance are social constructions.
- Stuttering is constructed as a deviant behaviour, because stuttering is an uncommon behaviour. Stuttering is dramatically different from the accepted speech pattern, the fluent one.
- Stuttering is constructed as a pathological (or medicalized) behaviour, because stuttering is classified as a mental disorder.
Social construction of illness and deviance.
Pathological behaviour in the 19th century. I suggest an example of what was considered pathological a behaviour in the 19th century. This behaviour was medicalized in the 19th century, and demedicalized in the 20th century. [Medicalization consists of considering a phenomenon as a clinical entity (alteration, disorder, or disease) consistng of a set of symptoms. Demedicalization proposes to view the phenomenon as a manifestation of human diversity, not as a pathological symptom].
Pathological behaviours in the 19th century. A broad range of deviant behaviours has been medicalized and classified as mental disorders in the last century. In fact, the list of mental disorders has dramatically increased in the last century: in 1942, there were 112 disorders (DSM I); and in 1994, 374 (DSM IV). During last century, some uncommon behaviours were classified as mental disorders, such as child abuse, chronic drunkenness, learning difficulties, hyperactivity, and so on. The increase of mental disorders is due to medicalizing deviant behaviour. Biomedicine usually conceives deviant behaviour as pathological, and therefore, medicalizes it. Thus, some behaviours are constructed as pathological and afterwards, society reconstructs them as non-pathological, such as escaping from slavery, onanism, sexual orientation, or hemispheric dominance.
- Drapetomania. Drapetomania was supposed to be a mental illness some slaves suffered. An American doctor, Mr. Samuel Cartwright described the main symptoms and treatment in a famous paper in 1851. The behaviour considered pathologic was the fact that some black slaves wanted to be free and therefore, tried to scape. The doctor stated slaves had to feel good and safe in their owners' farms because they could work, feed themselves and sleep in a bed. The treatment prescribed was beating the slaves with large sticks. So, the will of freedom and the fact of running away was medicalized in the 19th century. Today, drapetomania is constructed as an example of scientific racism.
Requirements for demedicalizing a phenomenon
Why are some behaviours demedicalized? When are they demedicalized? What requirements do they satisfy? I believe there are three requirements for demedicalizing a phenomenon. A phenomenon is demedicalized when 1) medicalizing harms the community, 2) treatments are not effective, and 3) different terms define the phenomenon.
Medicalizing harms the community. DSM-IV-TR classifies stuttering as a mental disorder, and specifically, a communication disorder. Classifying stuttering as a communication and mental disorder produces undesirable side effects. I have noted several side effects.
Treatments are not effective.
At the beginning of the century, Le Huche (2003) counted more than two hundred treatments for stuttering. Although there are many approaches to stuttering therapy, practically all patients and therapists have experienced failure of treatments for every client. In Spain some speech therapists do not even treat adult stuttering for ethical reasons.
A therapy is significant if it produces more effectiveness than a placebo treatment. There is no empirical and scientific evidence to support the effectiveness of treatment for adults who stutter. Two years ago, a Spanish Agency carried out a complete report on the clinical therapies on stuttering, and concluded that there are not clearly effective treatments for adults who stutter.
The stuttering community has spent a lot of money searching for fluency, and very few have gotten significant results. According to my personal research, taking part in self-help groups is often more effective than treatment. Therefore, I conclude medical treatments are not relevant to stuttering.
- Stigma. Stigma is the main side effect of medicalizing stuttering. Classifying stuttering as a communication and mental disorder harms the social identity of this community. Goffman refers to spoiled social identity as "stigma". In this sense, stuttering is considered a social stigma.
In other research, I describe how biomedical praxis produces a stereotype that stigmatizes stutterers. Biomedical praxis has created a stereotype that conceives stutterers as nervous people, introverted, insecure, tense and shy.
The content of the stereotype comes from the praxis of the main biomedical disciplines that have dealt with stuttering: speech therapy, psychoanalysis, clinical psychology, and neuropsychology.
- Secondary side effects. Biomedical construction of stuttering has produced other secondary but harmful side effects as:
Stigmatized populations internalize the stigma. Stigma means suffering and pain. The stuttering community internalizes stigma, which produces suffering, because the personal identity feeds on the social one.
The personal identity of stutterers is built on suffering. In addition to a weak self-concept, three harmful feelings invade the personal identity of stutterers: shame, guilt and fear.
Stutterers see every day that stuttering means mockery and laughter; the fluent speaker often perceives stuttering wrongly and thinks for example: "you have a problem with your way of speaking," "there is something wrong with you." "you experienced a trauma in your childhood." The stutterer feels pain every day.
Biomedical praxis produces stigma, which means suffering. I conclude that medicalizing stuttering damages the personal and social identity of the stuttering community, because stutters internalize the stigma.
- Does not offer any lasting understanding.
- Stutterers maintain hope throughout their lives to find treatments or pills, especially young stutterers and their parents.
- Many stutterers do not accept stuttering and themselves, because it is very hard to accept a mental disorder which is stigma.
- Many stutterers live in the closet, hiding their stuttering.
Different terms define the phenomenon
In other research, I have proposed new terms that come from anthropology, sociology and social psychology to explain stuttering,
terms as deviance, social construct, stigma, social identity, stereotype, personal identity, coming out, transfluency and so on.
Stuttering can be described in non medical terms.
Stuttering is a phenomenon which could be demedicalized.
Since medicalizing does not offer benefits and causes a great deal of harm, I propose demedicalizing stuttering. Demedicalizing means looking at a phenomenon as an expression of human diversity, but not as a pathological symptom or a deviant behaviour. Stuttering is human nature, and probably will never be eliminated or modified. This new understanding of stuttering requires constructing a new term. I have chosen transfluency. Transfluency is a non pathologic speech pattern.
Some behaviours have been demedicalized in the last two centuries, as drapetomania and being left-handed. Like them, stuttering is very resistant to treatment. Like them, stuttering is a natural attribute of the person, as the race and hemispheric dominance.
Transfluency is a speech pattern dramatically different, but as human - or as natural - as the fluency. Both cannot be modified significantly because both are part of human nature. Transfluency is a natural speech pattern.
Definition of transfluency The construct of transfluency proposes that the speech of people who stutter is not pathological or deviant. Thus, transfluent speakers are not patients or sick people, who require clinical treatment.
The transfluent community does not need treatment and is not worried about their speech pattern. Stutterers who accept themselves, speak openly and live freely, every time and with everybody, and are no longer stutterers but rather are transfluent speakers. They do not stutter but have a transfluent speech pattern.
Transfluency is an attempt to dignify stuttering, because stuttering is a stigmatized condition.
Transfluency is a new speech pattern which modifies the social meaning of stuttering and we must work to dignify its singularity and to carry out the Transfluent project.
Coming out. The three main characteristics of the stutterers' closet are: lies, secrecy and silence. Coming out means eliminating lies, secrecy and silence.
Stutterers who "come out," break the taboo of stuttering, and try to change the darkness of the closet into transparency and authenticity. I purpose that coming out reduces stigma and suffering. Coming out dignifies the stutterers' life: no more stigma, no more conflict, no more being laughed at or mocked, no more irrational beliefs regarding stutterers and stuttering, no more social disapproval.
From all messages collected in my fieldwork, this is the most important one.
WE HAVE TO COME OUT OF THE CLOSET AND DIGNIFY STUTTERING. FLUENCY IS NOT THE MOST IMPORTANT THING. When I truly understand these new ideas I appreciate how my life is turning to the better, WITHOUT IMPROVING MY FLUENCY, it should be noted.
This message illustrates coming out. It is the process some stutterers begin in self-help groups, and, to a lesser extent, in virtual groups.
The stuttering community must come out of the closet everywhere and every time, to carry out the personal and the political aims of the process. Acting this way, stutterers will dignify stuttering and suffering, and the stigma will finally disappear. Coming out dignifies stuttering and the stuttering community. When a stutterer comes out of the closet he does not stutter but simply has a transfluent speech pattern.
Self help groups are the best place to start the process of coming out.
In self-help groups, stuttering is not a pathological symptom or a deviant behaviour and so, it is dignified. In self-help groups, stuttering becomes transfluency.
- Stuttering is very resistant to clinical modification.
- Stuttering in adults seems to be an irremediable attribute of humankind, as are other attributes which have been demedicalized: the need for freedom (drapetomania) or hemispheric dominance (left-handedness). Stuttering belongs to human nature and thus, is not a pathological symptom.
- I propose demedicalizing stuttering and the construction of the term Transfluency to designate stuttering. Demedicalizing means conceiving a phenomenon as a distinctive feature or a manifestation of human diversity. Transfluency is a natural speech pattern or in other words, Transfluency is a speech pattern as human as fluency.
- Demedicalizing and dignifying stuttering requires us to carry out the process of "Coming out." Coming out dignifies stutterers because it transforms their way of life into an authentic and transparent one, which allows him to participate in communication and human contact.
- Self-help groups are becoming the most adequate social spaces to start the process of "Coming out."
- And if turns out in the future that biomedicine discovers the cause of stuttering and if it turns out to be irremediable what would have been the good of medicalization? And what about the harm that has been caused and the hopes that have been dashed?
- Let's consider the reverse situation: can a fluent speaker become a stuttering speaker? I don't think it's possible. In the same way, I believe most adults who stutter can never become a truly fluent speaker.
You can post Questions/comments about the above paper to the author before October 22, 2009.
SUBMITTED: August 15, 2009