About the presenter: Huang Haiyin, Chinese, male, born in May, 1963. He has been a doctor of internal medicine for 17 years. In the past ten years, he published two papers on stuttering, and 12 papers on his own academic field in authoritative Chinese periodicals. Huang Haiyin is currently a physician in charge of the department of integrated traditional Chinese and Western medicine, Shanghai Pulmonary Disease Hospital. The picture, taken in the late spring of 1988 in front of the emergency room of Jingshan Hospital, Shanghai Medical University, documented one of his most memorial moments. when Huang Haiyin had been able to work as a doctor in the ward and clinic. If he could succesfully work in the emergency room which was the last and the most rigorous trial, he would be thought as a qualified doctor and get a full recovery from his chronic stuttering. Before going to the emergency room, he had this picture taken to express his resolution. He was not certain if he would succeed or fail, but you could see the composure and confidence in his eyes.

You can post Questions/comments about the following paper to Huang Haiyin before October 22, 2002.

One chronic stutterer's path to fluency and his supposition

by Huang Haiyin
from China

It is said that one out of four children who stutter become chronic stutterers when they grow up. (Perkins, 2000) The current therapies for stuttering are less promising for adults than for children. Furthermore, successfully treated persons continue to have a high risk of relapse. How to treat adult stutterers (chronic stuttering) more effectively is considered a challenging task worldwide. Since progress in the treatment of chronic stuttering made by conventional methodology is slow, learning about successful experiences from those who consider themselves recovered or improved from chronic stuttering is vital to discover the ultimate solution of this disorder.

My stuttering began at the age of ten. During the time no one knew that I was a stutterer, because I only stuttered on some specific syllables which were difficult for me to pronounce, usually at the beginning of a sentence. I found a method to overcome the block by stamping my foot. As an excellent pupil, I was often called upon to make a speech or tell a story in primary school, and I could manage to speak fluently in front of the hundreds of people. However, in the years that followed, my difficult syllables grew in number and the severity of stuttering increased little by little. When I was thirteen, my English teacher sneered at me in the class: "Do you have a big tongue?" I was very embarrassed. Year by year, I became a reticent young man, afraid of speaking in public. After my admission to Shanghai Medical University, I was worried about future as a doctor who stuttered and my stuttering grew much worse. I even stuttered severely when talking with my close friends or my parents. By this time I had become a severe chronic stutterer.

At that time I came to a clinic held by Zhang Jinghui, then one of the foremost practitioners specializing in the treatment of stuttering in China. It was 1983 and I was 20 years old.

It is estimated that there are more than 6 million stutterers in China. There was no department of speech pathology in any university in China then (so far as I know, the situation remains unchanged until now). Stutterers could only be treated by a small number of practitioners who recovered from their disorder of stuttering. The practitioners were often experienced and knew stutterers' psychology very well from their own experiences. Some of them had thoughtful theories or views on stuttering. Stuttering was generally thought as a psychological disorder, and treatment of stuttering took two forms: psychological therapy and pronunciation techniques(including slowing the rate of speech, easy onset of phonation, speaking with rhythm and so on).

Zhang had been treating stuttering for several decades. He ingeniously created the concept of stuttering disease which was defined by him as stuttering accompanied by fear of stuttering. According to him, the overwhelming majority of stutterers were ill with a stuttering disease. He proposed that the main therapy for the disease of stuttering was psychotherapy, and the key of psychotherapy was "permitting stuttering unconditionally."

Together with about fifty stutterers in a classroom, I listened to the lectures of Zhang and practiced his instruction for one month. His treatment did work. My stuttering decreased significantly (especially within the classroom). Moreover, I marvelously made a ten minutes speech in the classroom without any stuttering. However, I maintained my improvement for only a few months. After returning to my daily life, I could not withstand the pressure and severe stuttering returned. When I entered a teaching hospital as an intern between 1984 and 1985, the severity of my stuttering had reached its peak: speaking was always a difficult task for me, often accompanied by a slight headache. Every syllable seemed a difficult syllable. I had almost completely lost my ability to associate with other people (I was basically mute), and was unable to associate with patients. I felt that I could never be a doctor because of my stuttering. It seemed that I would remain a basically mute person for the rest of my life.

Then came a young psychologist, Dr. Sun Zhongxian who was sympathetic with me. Although Dr. Sun had not treated any stutterers before, he thought that relaxing exercises might help me. The relaxing exercises included respiration adjustment, Chinese calligraphy and listening to relaxing tapes. An electronic biofeedback machine showed that the temperature of my hand was rising slightly but steadily while doing relaxing exercise , which was an objective index of the state of my relaxation. Surprisingly, my stuttering decreased by means of these relaxing exercises combined with some pronunciation techniques. I could have short conversations with close friends and collect a complete case history from a patient for the first time! This proved a turning point in my recovery from chronic stuttering. Although still a severe stutterer, I regained confidence and kept doing relaxing exercises regularly. However, the relaxing exercises were found ineffective when I was under higher environmental pressure, such as collecting a history of illness from a patient in the emergency room of the hospital, reporting a case history to doctors who were my superiors, or making telephone call within hospitals.

I successfully developed my own psycho-adjustment method which played a fundamental role throughout the course of my recovery. Whenever I stuttered, I would talk to myself: "isn't it funny? It will do no harm to me." In doing so, I never gave up to adversity and kept practicing. The whole process became a more pleasant experience instead of an unpleasant one.

In about four years time, one step at a time, I was able to work as a doctor in the ward, at the clinic, and finally in the emergency room. I gradually recovered while my personality became better. At this time, and for the past 16 years I have been working as a doctor of internal medicine. Besides daily clinical work, I can give lectures and speeches fluently before hundreds of people. Moreover, two of my articles on the management of stuttering were published in authoritative Chinese journals and I participated in the on-line conference on stuttering held by Judy. Kuster last year.

Recently, I was astonished to find some heartening information on the Internet by two Americans, Jack Menear and John C. Harrison, both of whom claim to have successfully recovered from chronic stuttering. Reading their material, from a different culture, and from a county halfway around the world from me, I have discovered that we share many of the same ideas without prior consultation! My case is similar to theirs; only perhaps I overcame more difficulties because the conversion from a stutterer who chose to be mute to a doctor engaged in clinical work may have required greater courage and skill to withstand the high pressure involved in medicine. My belief that there are chronic stutterers who have the potential for fluency has been further strengthened. I am glad to exchange views with friends all over the world.

First of all, the current widely used term stuttering promotes confusion by being too vague and unspecific. Dr. William Perkins pointed this out in his new book Tongue Wars: By calling it stuttering, I was confusing abnormal, involuntary blockage (stammering) with normal linguistic repetitions, hesitations, and prolongations(stuttering). Syllable sound disfluency is not only the operational definition of chronic stuttering, the clinical problem, it also defines transient stuttering characterized by recovery without treatment, which is also found in normal disfluency. John Harrison classified five kinds of stuttering: pathological disfluency, developmental disfluency, bobulating, blocking and stalling. Our research efforts may be more productive and our intervention more effective if we focus on very specific behaviors. I believe that what Harrison labels blocking and stalling is closely linked with chronic stuttering.

What kind of chronic stutterers have the potential for fluent speech? There is a very important characteristic in common among the overwhelming majority of stutterers: stutterers never or seldom stutter when talking to themselves (soliloquizing), regardless of pitch, loudness, duration, inflection and intonation. However, if someone is near the stutterer or the stutterer is conscious of the possibility that their speech can be heard by other people, stuttering appears instantly. This was certainly true for me. For example, when I was an intern at a teaching hospital, I could not utter any word in front of other doctors or patients in the ward. But after returning to my dormitory where no one else was present, I spoke fluently. I was able to say whatever I wanted to say, like a completely normal speaker. I was still the same person. What magic power turned a chronic stutterer into a fluent speaker in such a short time?

I once asked a famous Chinese practitioner who engaged in the treatment of stuttering for about 60 years about this marvelous phenomenon. He replied that this phenomenon is in common among the overwhelming majority of stutterers he knew. It seemed that the different circumstances (whether some people were listening to or around the stutterer or not) determined the fluency of the stutterer. But what is the essential difference between the two conditions? To me there seems to be only one answer: the stutterer's psychology. And I believe this kind of stutterer has the potential to speak fluently. If we can adjust the stutterer's psychology to the condition where he soliloquizes, a state without fear or avoidance, stuttering will be eliminated. To reach this ideal state voluntarily is not an easy task, but we can manage to approach the state as closely as possible. This has been proved by my success and other successful examples. Therefore, I conclude that if a chronic stutterer speaks fluently when he talks to himself, that stutterer has the potential to speak fluently at other circumstances, no matter how severe his stuttering is. Only the stutterers with real neural flaw who still stutter when soliloquizing are not included but in my opinion , they only represent a small portion of adults who stutter.

It is generally believed that many forms of stuttering (including chronic stuttering) are genetically determined, and one of the leading theories about the cause of stuttering is a physiological anomaly. A question may be raised: can chronic stuttering be effectively treated without changing the physiological anomalies? I agree that chronic stuttering may be related to some genetic predisposition, such as demanding perfection, introversion in their disposition and character, weak coordination of different components of the speech mechanism and so on. However, the genetic factor alone is not strong enough to cause and aggravate chronic stuttering. Frankly speaking, I still stutter at times on a few difficult syllables , which suggests that my stuttering is genetically determined to some extent, but my stuttering no longer prevents me from explaining my ideas clearly and makes no trouble with my job as a doctor. It is different from my stuttering of 17 years ago in nature and severity, because I am no longer harassed by fear of stuttering.

In my opinion, there are two main factors that contribute to the development of chronic stuttering: a genetic factor and what I call a "psychological obstacle." At first the psychological obstacle results from the genetic predisposition to stuttering and in turn the psychological obstacle aggravates stuttering . Only when the genetic factor combines with the psychological obstacle (such as fear or avoidance of speaking), does chronic stuttering take hold, As a consequence, stutterers fall into a vicious cycle and cannot get out of the abyss of chronic stuttering. I think that the psychological obstacle is extremely important because it can greatly aggravate chronic stuttering and result in loss of the ability to communicate, as it did in my own case. Although the genetic factor cannot be changed at the present time, but we can greatly improve chronic stuttering by removing the psychological obstacle, as well as by relaxing exercises to decrease tension, and by pronunciation techniques to ease speaking.

Some people may argue that psychotherapy is an old therapy for stuttering and its efficacy proved of limited value, especially for chronic stuttering. Why do you still advocate such an outmoded therapy? I agree that the extant psychotherapies have much to be desired. For example, Zhang Jinhui's psychotherapy did not help me much and many of the stutterers he treated relapsed. However, I believe that psychotherapy based on the principle "to permit stuttering unconditionally" is in the correct direction, though it failed to remove the psychological obstacle from chronic stutterers. It is true that there is no causal relationship between the psychological factor (such as fear of stuttering) and stuttering, but the psychological factor has a strong influence over stuttering.

Why is chronic stuttering so difficult to recover from? Because of the difficulties in removing the psychological obstacle has been greatly underrated. Like a conditioned reflex, the fear for stuttering has been strengthened again and again during past painful experiences and is deeply rooted in the sub-consciousness. I suspect that the fear has been so firmly memorized in the brain that some biochemical changes at a protein or RNA level might have taken place. Therefore the failure of conventional psychotherapy is predictable. My personal experience suggests that in addition to correct psycho-adjustment techniques, practicing speaking in everyday life was equally important. (Relaxing exercises were also very helpful for me as a severe chronic stutterer). Only by unremitting practice, can the memory of fluent speech gradually replace of painful memory of stuttering. In the same time the biochemical materials in memory of fluent speech are produced and stored in the brain. In doing so, the memory of fear is eliminated little by little over a long period of time. When the painful memory of stuttering is completely replaced by the memory of fluent speech, the psychological obstacle is removed successfully, and recovery of chronic stuttering ensues.

The recovery of chronic stuttering may be a process which is to some extent decided by the understanding and fortitude of the stutterer himself. In a sense, the relationship between a speech-language therapist and a chronic stutterer may be more like that between a trainer and a player. By correct orientation of the trainer and persistent endeavor of the player, they can walk out of the labyrinth of chronic stuttering.

In summary, I believe most chronic stutterers have the potential to speak fluently. However, my conclusion is based on reasoning and limited to a few successful cases. Its reliability has to be confirmed by strictly controlled clinical trials.

Perkins, William, Tongue Wars: Recovery for Stuttering Athens Press (2000)

You can post Questions/comments about the above paper to Huang Haiyin before October 22, 2002.

August 31, 2002