My therapy-plans with stutterers have turned a full circle since when I began my work as a speech pathologist in India - way back in 1977. I returned from the US with a Master's degree in speech pathology and a CCC-Speech to boot. However, I must confess that while I knew what to do with most of the other speech disorders I encountered, I found myself at sea when stuttering cases came my way. I can laugh about it now, but I took my cases through a gamut of accepted therapies and even through some not-so-recognised procedures. I'll tell you about a few of them and then take you away from these stories towards what, I believe, is a good, workable stuttering-management plan; the one I use today with many of the young adult stutterers who come to me.
QUACKERY in the Wild, Wild East :
From the well-organized environs of California State University (Northridge)'s Speech Clinic where lessons-plans were supervised, reports filed, and procedures discussed, I found myself in a wilderness of my own when I started work in India. What little I knew about stuttering-therapy was basically defeatist in nature. My young, inexperienced mind reasoned that if Charles Van Riper and Jon Eisenson could not get over their own stutter, what therapy was everybody actually talking about? Weren't the gurus telling us that stuttering cannot really be 'cured'? I remember advising my clients to avoid all kinds of quack remedies while all the time an inner voice asked me : "Aren't you a quack too? Your master's degree does not really make you any better than these other guys, only more expensive! You can't cure it either."
And what quackeries I saw!
An old man in the Kemp's Corner cemetery (in Mumbai) who said his snakes would cure stuttering. I'm not kidding. This guy was wearing a long black wollen garb (in the heat!) with many pockets, each of which had snakes of varying poison-potency. Yes, snake-bites for stutterers! He claimed the weak, non-fatal poison would affect the nervous system and relax the tense stutterer who would then be able to speak normally! Only 50 rupees a bite! (that's around 1 US dollar). I waited around for an hour and then a young guy walked to the snake-man and actually wanted a bite which a thin brown snake delivered under the guy's tongue! (That was when I started stuttering!) Don't ask me if this treatment worked but the bitten customer seemed happy enough. Snake-venom in controlled doses is known to cause a feeling of euphoria.
Road-side doctors in India offer everything from special stones to be placed under the tongue while speaking to 'powerful' potents which can contain anything from simple glucose or cinnamon powder to oil from crushed wild lizards (I saw that in a himalayan town).
Ayurvedic and homeopathic doctors offer medicinal remedies while some allopathic MDs advice tongue-tie release surgery or even tonsillectomy. There is a wide-spread belief here in India that stuttering is a disease and needs to be 'cured'. Cases are generally referred to Ear, Nose, Throat Specialists, or pediatricians who usually advice that the problem be ignored and that it would go away of its own accord.
But all this is probably no different from the days of the wild, wild, west in America when the travelling doctor with his wagon-load of remedies sold all kinds of treatments.
Has the "treatment" for stuttering in India progressed any further from what it was so many years back when placebos ruled the roost and counseling was limited to what mama said as she milked the cows?
Well, yes. It has come a long way. As an undergraduate student, I was told that there is nothing 'physically wrong', that there was no organic cause for stuttering; it was all behavioural. But today, it appears that the 'seed' of stuttering might one day be found hidden in the person's genetic (DNA) make-up - everyone here is finally saying that stuttering usually has neurological origins which are then compounded by psychological factors. There is mention of the act of speech in ancient hindu texts (from before 1000 bc) which say that speech is the most powerful of all human actions. It can move worlds!
Speech is actually a trinity of actions (i.e. three forces are involved) and this trinity comprises of three essential elements which are :
The Birth of Thought:
With many stutterers, thoughts about what they want to say become polluted with doubts about how they are going to say them. These doubts are directly related to the importance of the situation. Often, the stutterer finds himself juggling with so many elements. Avoiding 'difficult' sounds, replacing words, keeping cool, desperately involved with not stammering. With so much jugglery going on in the stutterer's mind, his speech will convey not ease but tremendous effort whether or not he stutters. Keeping the mind cleanly focussed on the essence of what he wants to communicate can be aided through meditation.
Meditation basically aims at stopping the internal dialogue that constantly goes on in the mind. Doubts, decisions (about what to say and what not to say), such tremendous conflicts that confuse the stutterer need to be calmly and lovingly stilled and this is achieved through the process of regular meditation. So the stutterer is encouraged to learn meditation techniques and begin to spend 30 minutes each day stilling his mind and enjoying the feelings of calmness and tranquility which result from these techniques. The ancient technique of Vipassana was re-discovered by Buddha 2500 years ago. Vipassana centers exist all over the world. Beginners are enrolled in a 10-day residential course during which complete silence is observed. Meditation begins at 4:00 am and participants are guided towards becoming aware of the various sensations that move through our body. In silence, one is encouraged to focus one's attention first on the movement of breath. Become aware of the various neuro-muscular events that are happening all the time. This technique is not specifically meant for stutterers as such. Anyone can benefit - but I do encourage my adult clients to enroll and undergo this tough ten-day course. The vipassana centers charge no fee at all for any of the varying degree of courses - even accomodation and food are completely free. The are vipassana centers all over the world. More information can be obtained from their website http://www.dhamma.org/
Another ancient hindu technique which has gained world-wide recognition is the science of Yoga. Yoga has outlined specific physical exercises which encompass both the mind and the body aspects and help improve neurological-balance. This helps the stutterer to channel his nervous energy from acting in 'spurts and jerks' towards becoming smoother and more relaxed. Yogic exercises need to be learnt from an experienced instructor. The benefits are that the stutterer begins to speak in a less-strenuous manner and learns to operate 'below' the "trigger-point". By trigger point, I mean the level of neurological-tension which when crossed results in his system going haywire and out of control and evidencing various behaviours such as tremors, tics, eye-blinks, uncontrolled movements, etc. Most stutterers are desperate for speech fluency and it is this feeling of desperation that keeps them enmeshed in the problem. Some sessions are devoted to preparing a foundation for therapy and one of the pillars is drop desperation. Another is to not focus all the time on the fruits of one's efforts. Many stutterers measure their progress by counting the number of speech-blocks they have on any given day and then feel elated or depressed as the case might be. Stop being clerical about measuring success - in fact, don't measure it at all. Only in retrospect can one say that "yes, six months back I had many more speech-blocks than I have today" but too much involvement with measuring gains can be counter-productive. In fact, stuttering is such a slippery problem that the more one tries to control, measure or "catch" it, the more it escapes away from our grips. Therefore, the focus of my therapy is not to remove stuttering but to increase speech fluency. And it is this intention that counts. I cannot push out the darkness (stuttering) but I can certainly switch on the lights in the room. That the darkness goes away is incidental. It's the light I was focussing on. So we work with changing the mental focus from an involvement with stopping stuttering and move to develop good speaking habits. But as we all know, it's the attitude that finally counts…"the mind behind the mouth" as it were. So much of my therapy is intertwined with focus on attitude. In this endeavour, I take a lot of help from the Bhagwad Gita - the most ancient of all hindu scriptures which enumerates a philosophy of living life like a winner. I also use many techniques suggested by the "new-age gurus" or motivational facilitators like Anthony Thomas, Wayne Dyer, Deepak Chopra and of course Ajit Harisinghani(said he modestly!).
So my therapy for stutterers is an amalgamation of eastern and western techniques which could be itemized as: