Those of us who don't stutter are at a disadvantage. We are always looking at stuttering from the outside. It is tempting to try to understand the disorder from this outside point of view; it would then be amenable to observation and empirical analysis. But many stutterers over many years have made it clear to me that stuttering is much more than what can be seen on the surface. Indeed, they tell me that the surface behavior is relatively unimportant. The real essence of this disorder is what you cannot see -- what goes on inside the person who stutters. The experience of stuttering is therefore, according to those who should know best, at the core of the problem. Repetitions, blocks, prolongations are no big deal. It is the dread of anticipated difficulty, the shame of exposing a "defect," the fear of seeing a listener's eyes widen in disbelief and shock, the anger and frustration at not being able to say what you want to when you want to, the belief that almost anything, even silence and occasionally even death, would be better than stuttering that are the real demons that ride, cackling with malevolent glee, on the shoulders of people who stutter.
These demons of experience have a profound effect on behavior too, motivating avoidance behaviors, insidiously suggesting that the stutterer stall for time, struggle, force out words, back up to say a word one more time so that he can "get it out correctly," look away so that the listener's look of disdain, incredulity, or pity need not be experienced.
A recent thread on the STUTT-L discussion list has been about comparing the speech of nonstutterers who are highly disfluent with stutterers, and it has been clear that the presence or absence of disfluencies is not what is critical about stuttering. Even in the frequency with which disfluencies occur, there is considerable overlap, with some nonstutterers presenting more frequent disfluencies than some stutterers, although of course the trend is for stutterers to have more disfluencies than nonstutterers. Still, a clear distinction cannot be based on frequency. Similarly, the distinction between normal and abnormal cannot be set clearly by the type of disfluencies, since nonstutterers also show repetitions, prolongations, and vocal blockages.
If, instead of trying to find a behavioral distinction between stutterers and nonstutterers, we look at the difference between the internal experiences of the two types of speakers, the disctinction is instantly clear. The nonstutterer typically does not even notice his disfluencies. He does not experienced them at all, unless some oddity calls them to his attention. But for the stutterer they are salient above all else at that moment. A source of fear, frustration, shame, loathing, and anger, they loom larger than anything else, huge, swollen, a figure of such magnitude that it can block out all other experience. For many stutterers, at the moment of the stuttering block nothing else is important. The reaction is nothing less than catastrophic. So, it seems evident that the reaction of stutterers to disfluency is the major distinction between the disorder and the normal phenomenon. Indeed, it is all about experience.
What is experience? It is our senses, dancing through time. I hear something, look up, recognize, nod knowingly, think, and as I am thinking, notice that the light is beautiful in the evening, particularly as it is reflected on the puffy clouds to the west, and it reminds me of a trip I took many years ago to a beautiful place, and my heart warms to the memory, but then a sudden itch focuses my attention on the middle of my back and I squirm to reach it, finally rubbing it up against the back of my chair, feeling the satisfaction, and I settle down until a friend greets me from across the way and I respond, wondering if he still has that problem with his mother-in-law, but there isn't time to find out about that because a glance at my watch tells me that I must make an appointment and must get up and start walking and as I do the sun warms my cheek and a light breeze cools my forehead. And so it goes, a rising and falling, a brightening and fading, as our senses encounter the environment in the cycle of experience. A slow dance through time.
As experience flows along, we play a major part in what and how we experience. We orient ourselves to something that seems interesting. We bring it into the foreground of our awareness. We destroy those things that make us uncomfortable and banish them from our awareness. We dwell on those things that are pleasant, holding them as part of our experience until they become boring or something else intervenes. There is a vast background of events in our surroundings, but we do not experience all of them. Instead, we respond to one thing, call it forth and make it vivid as a figure, deal with it until we reach a completion, then we let it fade back into the background. All experience consists of this continuous ebb and flow as we create and recreate our own awareness. It is our dance.
The Role of Time
Time is critical in experience. Experiences are happening now, at this moment, including memories of the past and current plans for the future. But we never experience the actual future or past; we are always now. Our experience is limited to what our senses, our memories, or our imagination bring as an offering to the mind. We can never experience another place without going there. We can imagine, but that is here with us now. We can remember, but that too is here with us now.
Time is the measure of all experience. It is true that an experience takes time, but time is more central than that. It is the striking feature of existence. It precedes space. Space, and the objects in it, also occupy time. Time permits objects to exist within it. It will flow anyway, whether the rock crumbles or remains solid.
We say that time passes as we experience the world around us, but it is the other way around. We pass through time; it was here first. Ours is a brief visit. Time only marks our passing with the slow rhythmic brightening and fading of experiential figures, a waltz of awareness.
Speech time is different -- quicker and packed more tightly with experience. It is no waltz. We can say in one second a sentence that is packed with information or emotional significance. We normal speakers sense this quickness when we can't think of what to say next and fill the awkward three-quarters of a second with a neutral sound so that our listeners won't assume that we are done. In speech the dance of experience is a jig, and it is much easier to get out of step. Stutterers of course feel more of this because their stumbles usually take longer. Time measures all experience, but the for speech it counts in milliseconds.
The Cycle of Experience for Stuttering
So what is it like to experience stuttering? Of course those of us who don't stutter can never really know. But we can listen to our clients. And if we listen carefully we will hear them telling us about the cycle of experience in stuttering.
"Of words and the murder of words, he dreamed,
Whose very syllables are the sounds of fears" (Bobrick, 1995)
wrote Benson Bobrick in his youth. Alan Dugan, quoted by Bobrick, also wrote of speech and time:
"Courage: your tongue has left
its natural position in the cheek
where eddies of the breath are navigable calms.
Now it locks against the glottis or
is snapped at by the teeth,
in mid-stream: it must be work
to get out what you mean:
the rapids of the breath
are furious with belief
and want the tongue, as blood
and animal of speech,
to stop it, block it, or come clean
over the rocks of teeth
and down the races of the air,
tumbled and bruised to death." (Dugan, 1961)
Some cannot tolerate the bruising and, as Jock Carlisle put it "go off into the detached trance with which so many blocked stutterers remove themselves mentally from the intolerable situation" (Carlisle, 1986). Memories of past humiliations often haunt stutterers' minds. Carlisle noted that "even pictures of objects or types of places or people associated with stuttering in the past can trigger a stuttering phase" (Carlisle, 1986).
Marty Jezer, in his recent book, describes his internal experience in asking directions of a stranger. "Hello," I begin, "can you give me directions to ...," and then I feel something change in her. Perhaps it has nothing to do with me: lost in thought before I approached her, she perceives my question as an interruption, which irritates her. Or perhaps she's late for an appointment and doesn't want to stop to answer my question; what I'm sensing is her feeling of indecisiveness: Should she stop to give me directions or ignore me and seem rude" Whatever the reasons, I immediately sense the distraction of my listener and interpret it as disinterest in me. In an instant my confidence drops, my anxiety spikes, and my fluency turns to stuttering. My listener may react to my stuttering with compassion. By paying attention to me, she shows a willingness to hear me out. My confidence rises again, my anxiety drops, and some fluent words come out. On the other hand, a listener may react to my stuttering with confusion (thinking to herself, What's wrong with this guy" Is he some wacko about to hit on me?). I sense her apprehension and instantly interpret it as negativity toward my speech; my emotions take a nosedive, and the stuttering becomes irreversible. (Jezer, 1997, pp. 14-15)
Reading these words, I am acutely aware of the internal life of the stutterers I have known. Some wrestle with fear, trying to press it to the mat, immobilize it so that it cannot rise again, but the tense power of fear is ever ready, and a moment's inattention will allow it to leap from your grasp and seize you by the throat. Others have to quell their own anger at the rudeness of their listeners, talking themselves down to a place where they can be civil. Others feel shame. Not the momentary embarrassment that they have made a mistake, but the deep sense that they themselves are a mistake, a permanent blot on society's page, something to be scraped away. They look down and away, not wanting to make the eye contact that connects them to the social world. These feelings rise and fall in the dense time of conversations, coloring over social life with a wash of rancid colors.
For many stutterers conversation occupies more time than it does for normally nonfluent speakers; there are too many anticipations of the future and too many memories of the past to fit into the fleeting moments of conversational speech. One young man I worked with commented that stuttering was like playing three games of chess simultaneously. Just saying the words was one game, hard enough when your vocal tract seems to have a mind of its own, and that mind sullen, balky and willful as a two-year-old. The second game was one he played with his listeners, watching to see if they could understand him through the banging of extra syllables and the rasp of prolonged sibilants, or if they realized that he was simply stuttering, not having a seizure or a heart attack, or if they would be nervous for him, feel sorry for him, mistakenly think he was making a joke, or just get impatient with the time he was taking and nod off. The third game was one he played with himself, assessing his recent performance on a difficult word, anticipating the word that approached, already only four syllables down the line, wondering if he should change to an easier one, knowing that such a substitution would likely make him more afraid the next time, and balancing that against the unpleasantness of getting really stuck.
If, as it has been said, speech binds time, stuttering tries to undo the ropes, letting time get away. And as it runs away, the stutterer finds himself also at loose ends, unhitched from the conversational shore, adrift somehow, and the wind rising. It can be a scary experience this casting loose from speech-bound time, and often enough the speaker thrashes around trying to find something solid to hold on to. Others let themselves drift with the tide until they are washed back to the shore. Carlisle describes this beautifully: "While a stutterer is frozen in a block, people can slam doors, shout 'Fire' or tell him that he has won a lottery, with no response whatsoever. I used to plan the next day's activities and remind myself to pay bills and complete my income tax return during long blocks, while my audience patiently or impatiently waited for speech to continue."
But for most stutterers episodes of disfluency only create additional pressure to make up for the time that stuttering has drained away. The clock ticks remorselessly on, yet the information that speakers expect, generated by the fluent brain, piles up, logjammed in the stutterer's mouth, and somewhere a spring coils tighter with each passing millisecond. Eventually, when the words begin to flow again, this spring unwinds rapidly, shooting out syllables in a staccato burst, and the listener is knocked off balanced by the sudden shift.
There are many ways that stutterers experience their disorder, probably as many different ways as there are people who stutter. In each case, however, some aspect of the background becomes figural, then fades and gives way to another aspect. And, probably, in speech time this happens quickly. From things my clients have told me, I think that the words, sounds, listeners, and situations that evoke stuttering have acquired additional stimulus value by virtue of the fact that stuttering has been experienced in association with these events in the past. This is simple conditioning. But from an experiential viewpoint it takes on a different caste. Suppose that a stutterer has in the not too distant past stuttered on a number of words beginning with the sound /s/. The behaviorist would judge rightly that the sound may have acquired the capacity to provoke an emotional reaction. From the experiential point of view, a word beginning with that sound is far more likely, as a result of past experiences, to emerge as a figure from the background of upcoming words. It will loom large, and if the past experience has been particularly unpleasant, it may seem ominous. The same would be true for listeners, or speech situations. Depending on the past experience, these events will appear more or less important to the speaker. But other events also bear on the quality of such a figure. Past experiences with other feared sounds will also color the perception. Someone who has tended in the past to stutter on sounds that have loomed up like this will feel a sense of impending difficulty. The past seems to be about to repeat itself. Other present events may shade this experience in a number of ways: the nature of the listener -- friend, stranger, speech therapist; the presence of other listeners, the time of day, the level of fatigue of the speaker, current attempts to control stuttering with therapeutic techniques, in short whatever factors are relevant for this particular speaker, at this moment, will sum together to influence the quality of the experience. Positive associations may mitigate the difficulty just as negative ones exacerbate it. And all this flows forward in the speed of speech time.
The Role of Development In Experience
Children of course do not experience the world in an adult way. They know less. And importantly they do not always know about the knowledge of others. They are small and lack adult power, although they have a certain and clear power over adults. They think in the way we call "child-like," innocent, honest, often careless; casting less of a shadow, their world is lit more brightly, and their experiences are flavored with the spice of magical thinking. Not knowing fully what reality is they may hold it at arm's length. Children have their own values. What is important, interesting, tasty, beautiful, or funny is not the same as it is for adults. So, when they organize their experience, they bring forth from the background different figures than adults would choose. They laugh at jokes that adults think are stupid. They are fascinated for weeks with something that adults have long since decided is boring or nonproductive. They have a different relationship with their bodies too, finding new things in them, taking the perfection for granted, amazed at what they can do at times.
Time is different for children too. Stretched out, it passes slowly by like sailboats on a distant horizon. Many new things can happen in a day and so a day is a long time, a week eternity. Time measures experience for the child as much as it does for the adult, but the beat is different. Time does not pass at the same warp speed it does for adults.
As they grow children's values and sense of time gradually change into adult forms. But the adult memory of childhood experiences is sometimes confusing because of these changes. I remember doing things as a child that are incomprehensible to me now. Once, at the age of nine, I vandalized a neighbor's house while the neighbor was away. I threw rocks through nearly all the windows and caused a fair amount of damage (which I had to pay for after I was caught). I had no grudge against the neighbor; in fact I hardly knew him. Looking back, I cannot understand what motivated me to perform senseless destruction on someone else's property. It is as if I were a different person living in a different world. In a sense I was. But today I am still puzzled by it.
I think that one of the reasons that stuttering has been difficult to treat is that the memories of early experiences struggling and forcing through words are lost and confused by this change from child-like to adult ways of experiencing events. The adult feels only the compulsive urge to fight with the stutter; he can't remember the frustration he felt at three that motivated that struggle. He may still be frustrated, but it is a different experience now, one taken as an adult.
And it is the same for the tricks that the schoolchild learns when he is "chasing the fluency god." The adult may know that these tricks are no longer helpful, but the memory of teasing, of feeling defective as an eight year old, of wanting to be liked by friends, has morphed into an adult form. The nymph remembers the pupa only dimly, and the larva not at all.
The Role of Development in the Experience of Stuttering
When children first begin to stutter they are blithely uncaring about the repeated words and syllables in their speech. Just as they accept after a whimper the sudden sit-downs and tumbles while learning to walk, they accept the bumpy repetitions or sticky blocks. But if they have something really important to say -- and eventually they all do -- or if in their family language plays a central role in family life, or if they have a low tolerance for frustration, or they just have a powerful drive to communicate, they begin to experience these bumps and stickings as more than another routine tumble on the word-path. They begin to experience these moments as barriers to accomplishing their goal of communicating and they begin to struggle with the words, trying to force them out by pushing through the repetitions or blocks. But pushing only makes the repetitions become faster and the individual units shorter. The more rapid oscillations are slightly less under control. Similarly pushing against the blocks makes them last even longer. The attempt to seize control of the experience has backfired into a loss of control. And the frustration only grows. And fear may arise too, for the experience of a loss of control is a powerful and frightening one. Some children begin to experience shame too, perhaps because their struggles are frightening to their parents, and the child is ashamed to be scaring their parents. The experience of repeating words and syllables has changed because the disorder, which is what it has now become, has begun to create itself. It is the experience of early blocks and repetitions that goes awry. The repetitions and blocks don't change by themselves; they change because the child's experience with them causes him or her to react and tame, with force and will, the wild tongue, the errant lip, the balky throat.
In the beginning, stuttering can change very rapidly as the child's reactions lead to new behaviors and feelings. He may accidentally discover that sudden or rhythmic movements help him escape from blocks and the early secondary behaviors develop directly out of the experience of frustration. But then there is a settling and the behaviors, thoughts, and feelings seem to stabilize for a while. During the early school years, the child may be teased, or he may see without the outside "help" of teasing peers that his speech is not just different but abnormal, that it is noticed by others. At this time in life, when the child is just discovering the importance of peer relations, feeling abnormal is desperately painful, and anything is preferable to the shame and humiliation that stuttering brings. The child's experience of stuttering at this age is simply awful. Nothing could be worse. So, naturally enough, anything that provides some relief is better, and the child learns "tricks" that provide any fluency, however brief and at whatever cost.
By adulthood, many beliefs, perceptions, and values have changed. Typically, the stutterer has "come to terms" with the disorder, more or less. He, or she, is more familiar with it, possibly more comfortable with it. The idea of finding "tricks" has often given way to the idea that "tricks" are counterproductive. And of course, the adult has a different view of the world, different kinds of relationships with others, a better sense of his place in the world, and possibly a sense of spirituality as well. These differences shape all of our experiences.
In summary, at any given moment, each stutterer is doing more than just performing behaviors, he or she is experiencing the many events occurring around and within him, differently according to the person's age, shaping each experience based on many past influences, anticipations, and current events, lifting out of the background specific elements and dealing with them in a way designed to further the goals of the moment. And all of this is happening quickly. Even when the stutterer is not talking, thoughts and feelings that are part of the disorder may become figural. It is not surprising that brainscans show differences between stutterers and nonstutterers even during silence. Stuttering is all of those things that comprise experience related to stuttering. The behavior is a part of it, but many other aspects of the stutterer's experience -- values, beliefs, thoughts, perceptions, feelings, during speech and at other times, are important, probably more important, aspects of the disorder. Stuttering is not so much a disorder of the production of speech, although that is the focus of it, it is a disorder of the experience of speaking.
Implications for Assessment and Treatment
If stuttering is a disorder of the experience of speaking, then we ought to be doing much more to assess and treat it than we currently are. We should first introduce into our assessment procedures techniques that will enable the person to tell us more about his experience of speech and stuttering. Through paper and pencil tests, projective tests, and deep interview, we should be trying to learn as much as we can about the client's personal experience with the disorder. We should, as Van Riper advised decades ago, put the stutterer's behaviors in our own mouth and see what it is like, insofar as we can, to stutter the way the client does.
I think that we can accomplish most of what we need to in assessment by listening to the client actively, carefully, and with a deep respect for the validity of their experiences. But, typically, this is not done. Most clinicians evaluating a stutterer, child or adult, administer a formal test that quantifies severity and describe the client's hierarchy of difficult speech situations. They make no attempt to assess the client's internal experience of stuttering.
In treatment, we should be trying to modify not just the behavior but the experiences that the person has with speech. We should help the stutterer learn new ways of perceiving speech, develop new beliefs about speech, work through the feelings that accompany talking, and remove the toxic thoughts that can poison his or her experience. This is a tall order for a speech therapist, and I submit that it is too much for the speech therapist to do alone. Two changes are necessary. The first is more training in the psychotherapeutic skills that are essential for assessing and treating such a complex problem. Referral and team therapy with a psychotherapist is also possible, but it will never achieve the unity and continuity of having one therapist trained in the relevant elements of both disciplines.
The second change has to do with the client's role. The kind of change I am suggesting clients need to make -- a sea change in their personal experience of speaking -- can happen only if the client has a central role, and the leading role, in the process. This means giving up forever the medical model that so many of our training institutions still teach. In dealing with stuttering at least, the speech therapist should not see himself or herself as the person who has "the answer" and will convey it to the client for their benefit. The client also has answers and they will be important to consider because they will based on his or her personal experience. We SLP's need to stop seeing ourselves as the people holding power in the therapeutic relationship. We still have lots of work to do, recording, stimulating, provoking, supporting, validating, prodding, listening, modeling new attitudes, and creating little experiments to aid the client's discoveries. But we need to give to the client control over the goals and practices of therapy. When this happens, we will, I believe, discover that most stutterers have the means to deal effectively with their disorder. Of course, they will still come to us wanting us to give them a "treatment," but our job will be helping them learn that they can treat themselves.
Bobrick, B. (1995). Knotted Tongues: Stuttering in History and the Quest for a Cure. (New York: Simon & Schuster).
Carlisle, J. (1985). Tangled Tongue: Living with a Stutter. (New York: Addison-Wesley)
Dugan, A. (1983). New and Collected Poems. (New Haven: Ecco Press)