Stuttering remains an enigma. These days, however, we seem to understand it better. Today I will attempt to enhance an effective management of stuttering. I'd like to share with you factors gained from many of the leaders in the field. Many are now deceased. These contacts, most of which began in the decade following WWII, afforded me a glimpse into their thoughts about stuttering that might be expanded in the ensuing years. I kept in touch with these friends. Some of what I absorbed from them greatly increased self-understanding allowing me to propel forward toward the goal of recovery from stuttering.

My focus today, is on fully-developed adult stuttering. Information I have acquired from these different individuals might be listed under the heading of "theories of alleged causes of the disorder". However, theory has its place. It seems to account for why therapy for adults may fall short of a complete elimination of stuttering behavior. Before I go any further, I'd like to share with you my own experience with stuttering. It occurred suddenly at the age of thirty-two months, after significant blood-loss from a nasal hemorrhage in the mountains. This was followed by a 300 kilometer car trip home over the roads typical of the year 1928. On awakening the next day, my family was horrified to hear me emitting jargon, despite my apparent good speaking a day or two before. It had the symptoms of a stroke. The physician ordered bed rest for several days. Eventually, meaningful words appeared, interspersed with frequent spasmodic interruptions. I have always supported an organic neurological view of what underlies the anomaly.

While on this point, I'd like to cite my friend, the late Renato Segre. He was born in Italy but lived the majority of his life here in Buenos Ares. He was a neurosurgeon and served as president of the then - World Association, dealing in Speech with some parts concerning Speech Pathology. Our first encounter was in France after a conference in Alicante Spain. We met on Mallorca Island and shared an excursion in my rented car. He told me that stuttering was a neurological abnormality.

Dr. Segre was a largely recovered stutterer as well as a top neurosurgeon. He spoke four or five languages. Unfortunately, in my late 1970's visit to this city, he had suffered a severe stroke that left only the Spanish language functioning. I will always recall my last visit with him. It was at his apartment that had a bird-cage-type elevator. As I peered upward from the descending elevator, I could see him in a great struggle attempting to say "adios" to me. I doubt this was due to stuttering. I am sure it was a result of the stroke. That was the last time I saw my friend, Dr. Segre.

I would like to share a little bit about my early life concerning stuttering. My first recollections of it began around age four. An important point is that my family observed me through the windows playing with cats or dogs. I was fluent when talking to the animals but the minute a human arrived I would begin to stutter. A silent movie film from 1931 shows me blocking, with forced facial movements, when attempting to describe a squirrel climbing up a tree.

About that same time, I was taken to see Mrs. Mabel Farrington Gifford, who was Chief of Speech Correction for the state of California. I remember seeing her in her studio and having to repeat a story that she had recited to me. I received the Gifford method of therapy, applied by various clinicians, through my elementary school years. We were taken out of class and assembled with others in our own speech room and were put through relaxation exercises. We spoke well in that controlled environment but when one of us would begin to stutter, he or she was told to focus on becoming calm. It was implied therefore, that it was wrong to stutter and should be prevented. I spoke rather well in most of those sessions but I would collapse outside, especially when having to recite in class or being under any communicative pressure. The telephone had been an obsessively feared situation. This may be true for most stutterers.

My stuttering frequently bothered me and at age eighteen I began attending private therapy with Mrs. Gifford. She said she had developed an inner calmness, from what she had learned from European authorities, in particular Emil Coue of France and his associates at his school of auto-suggestion. She recovered from stuttering at age twenty-seven. She believed that with positive suggestion applied in the correct way, we could overcome whatever had made us stutter, due to her theory of the subconscious mind. I remember practicing often and I enjoyed being with her. She had the power to make the devil himself feel good.

I participated in that therapy for a year or so before hearing of Mr. Waldo Coleman, who was in his sixties. He had improved a great deal under Mrs. Gifford's therapy. I understood that Coleman had meetings for adult stutterers in his office most Monday nights and I began attending them. I stuttered violently in those particular situations because I was by far the youngest, the most naive, and I felt very insecure. I produced only two or three words a minute with constant bodily struggles. Some people suggested that Mr. Coleman exclude me from the group but he kept me in the group and I will always be grateful. Somehow I gained control of myself after a year or so and I achieved an improvement in speech in that overwhelming situation.

I then began to learn new concepts from reading the works of Dr. CharlesVan Riper who played an important part in my life. I never had direct therapy from him nor was I signed up in his clinic at Western Michigan University; however I was around him a lot, often visited, and heard him when he would lecture at national and state conferences. In reading his books, I learned that one didn't have to keep trying to prevent stuttering. That was something I had done often, only to stutter more. I had tried to hide it by using substitution and avoidance. This eventually backfired. It was like putting a lid on Mt. Vesuvius. The steam constantly emitting from its crater must not be suppressed. If it is, lava will build up inside and hasten an eruption. Van Riper recommended that a person confront situations when they stuttered badly. One example was being forced to say my name. It often took almost a minute of contorted spasmodic blockages to pronounce it.

Around that time, I had attended a meeting where we were asked to introduce ourselves. This threw me into absolute fits and I stood there helpless, struggling, with everyone looking at me. Afterwards, I went home, read Van Riper's book again and realized what I should do. I should try to look at myself in the mirror and attempt to duplicate the way I stuttered at that meeting and try to vary that, by seeing if I could stutter in a more streamlined way. I experimented with this for a couple of weeks, knowing that the same meeting would again occur. Sure enough, this happened. However, this time I had worked at it and had found that I could change the form of my stuttering. I had gained control of it. This, looking back was a critical point in the beginning of my "recovery". I found that it was possible to stutter straightforwardly which lessened the penalties and looks from the people who had heard it.

At this time I would like to cite Dr. Wendell Johnson. I met him when I was in Iowa in the summer of 1947 for speech therapy. I was in the clinic that was also supervised by Dr .Joseph Sheehan, about whom I will speak later. Dr. Johnson had improved his speech a great deal by then but he was still stuttering a fair amount using what we call the "Bounce" pattern. This pattern is a voluntary repetition of initial syllables of words. If I'm speaking now and I want to say "It is a fine day today," I might say "It is a f-f-f-f-f-fine day to-to-to-day." Dr. Johnson taught the course Speech Pathology with about 75 students in the class. He was a good lecturer despite his frequent interruptions in speech and always appeared quite relaxed. Wendell possessed good writing skills. His first book entitled Because I Stutter, which appeared in 1930, is a fine example of describing what a severe stutterer undergoes.

In writing the book, he believed that if he could establish unitary dominance in one hemisphere of his brain, he would cease to stutter. He found out later, that this was not true and spent many years trying different things to improve his speech. It was mainly his having met a man named Alfred Korzybski that influenced his thinking along the lines of using appropriate words to describe his speech behavior. This meant that the self language he had used to portray his behavior to himself had a great influence on what that behavior would manifest. In other words, rather than merely using the word "stutter," use the word to describe what you are doing to interfere with your speech. For example: A person might say, "I press my lips shut." Then, use a problem-solving type of language such as "I focus on relaxing my lips when I talk."

Dr. Johnson established a way of thinking among the speech pathology field that essentially said that stuttering was the result of mislabeling the normal deficiencies that occurred in childhood. His theory has largely been put aside in recent times but it had a tremendous influence on the field of stuttering. I have found it useful to employ a type of language describing what I'm doing in speech. I think it has been a good supplement that paves the way for further improvement. Wendell Johnson became very fluent in later years; he spoke essentially normally with occasional repetition.

Being in Iowa set up many future situations where I met, came to study with, and read the writings of various authorities in the field of stuttering. One of them was Dr. Lee Edward Travis, considered the "Father of Speech Pathology," having been initiated in mid-1920. He was the founder of the department at Iowa. It was to him that Wendell Johnson and Charles Van Riper had come for study and therapy and the non-stutterer Bryng Bryngelson came to take his Ph.D. The well-known theory of stuttering called Cerebral Dominance was formulated at Iowa by Dr. Travis and Dr. Orton. From being in Iowa, I had developed many contacts in the field and from them I learned things that later proved useful in finding new pieces to expand the clarity of the puzzle of stuttering.

Lee Travis had left the University of Iowa in 1938 and had gone to U.S.C in Southern California, where I undertook graduate studies a decade later. He had previously made a complete shift in his thinking about therapy and stuttering. While not totally divorcing himself from the Cerebral Dominance theory, he decided to focus on exploring repressed emotional conflicts as the possible chief culprit in throwing off a safer balance of dominance in one's brain. This called for deep psychotherapy as the manner of uncovering these conflicts. Dozens of stutterers underwent these procedures with many persons spending up to 300 hour-long sessions on a couch verbally pouring out whatever they were thinking and feeling.

I was one of the subjects in this huge undertaking, starting at age twenty-four and finishing almost three years later, after more than 250 sessions with Dr. Travis himself. This procedure was fascinating but after completing the session I stuttered almost as much as when I started. However, it was beneficial in many aspects of my life and I coped better with challenge and stress. On my last session with him, I expressed support for his writings in his 1931 book entitled Speech Pathology that cited neurologic anomalies as causal factors. I did not endorse his psychoanalytic concepts as the basic factor in stuttering.

These concepts appeared in books of the 1950's and 1960's, written in part by Travis. However, I noticed that beginning in the 1970's he went back strongly to his original thinking. This had been clearly exemplified by the first sentence of the chapter on stuttering in his 1931 book, which read: "In general, stuttering is a deep-seated neurophysiological disturbance." In his last writing, done in the mid-1980's, he indicated that the reactions and feelings of a stutterer are resulting consequences of a fundamental root cause of the disorder and that currently there is no elimination of the real possible cause. Drugs being prescribed for stutterers are giving indicative leads that may some day achieve our hoped-for goal. Brain surgery, one potential solution, is too risky to undertake.

However, at this point, I feel obligated to share something of importance: I had read a handwritten letter, by the widow of a then recently-deceased man in his sixties, who had been a severe stutterer for most of his life. I witnessed his obvious speech problem on the only occasion that we had met. The letter indicated that following brain surgery to remove a tumor from his brain, he stopped stuttering and spoke fluently for his final nine months of life. My efforts to obtain more information on this matter have failed. I had hoped to reach family members or co-workers who might have been around at that time.

By mentioning Dr. Charles Van Riper and Dr. Lee Edward Travis, I've referred to the two men that had the most influence on me as far as my degree of recovery from stuttering has been. I think I owe Dr. Van Riper explicit gratitude because he allowed me to see what to do about the actual overt symptom itself and to understand that I could modify it. I do believe that my Freudian free-association-type of psychotherapy from Travis was beneficial but by itself it would not have reduced the severity of my over-all disorder.

The previously-mentioned Dr. Bryng Bryngelson served as a therapist for Van Riper when he went to Iowa around the year 1930 and was practically speechless. Bryng initiated voluntary stuttering, which loosened his speech and lessoned the severity of his blocks. This laid the foundation for him to become a "fluent stutterer." Dr. Bryngelson helped to wash the windows of my mind. He had confronted me after I had completed a catastrophic speech at the American Speech and Hearing National Meeting in 1956. I displayed symptoms as severe as they had been much earlier in my life. As I was leaving the hall he said, "Young man, you exhibited everything I have said about this. You cannot convince me that this is not neurological disintegration." His well-known statement that the "Stutterer is performing according to the dictates of his organism" certainly held true for me on that occasion.

The public sometimes asks, "why does a stutterer sing without difficulty?' Personally, I have a hunch that it has to do with the communicative pressure involved when a person talks. The moment a stutterer begins to speak he is committed to transmit a message to the listener. Once begun, he or she must continue to talk for the message to be understood; there is no turning back.

A person in the field who became famous was Dr. Joseph Sheehan, who had stuttered severely. I first met him at the University of Iowa for the Summer Session Speech Clinic in 1947. His speech was good then, with only slight remnants of behavior that had been so severe. His major emphasis was on reducing avoidance. . . especially of speech situations and of words. He felt that most adult stuttering therapy was focused on suppressing and trying to prevent moments of blockage. He favored working to modify the behavior by developing smoother ways to stutter. He compared stuttering to an iceberg, saying that the overt symptom formed the smaller part of speech at the top of the iceberg but the larger more destructive part was submerged. Therefore work had to be done on how one felt while speaking. These factors included self image, attitude, fears, guilt, shame, etc., which form the submerged part of the iceberg.

I used to think the solution to stuttering would be similar to finding the right combination to open a lock. Once it was opened, the person would not stutter anymore. This has been proven to be completely false. Normal speaking has a lot of bobbles in it. I find it interesting that some people dislike talking on the telephone and that public speaking is said to be the most dreaded fear of all. Such situations are harder for many who stutter. Perceived stress in a speaking situation is of prime importance.

Another person whom I came to know at the end of his life was Dr. Charles Sidney Bluemel. He was a Denver Psychiatrist, who originally lived in England, came to the U.S. and attended some charlatan schools back around 1906. Bluemel became disgusted with the con artists and initiated a campaign against them. He began to study speech disorders and read everything he could find in French, English and German about stuttering. One lesson I learned from Dr. Bluemel was that in order to speak well you have to think clearly. He put emphasis on the fact that we don't breathe our way to good speech, we think our way to good speech and that the mind broadcasts to the mouth. When I was reducing the severity of my overt blockages, mainly by the system advocated by Dr. Van Riper, I was left with a lot of non-rhythmic, sloppy speech, going from one pot hole to the next, while talking.

I was stuttering far less than I had but I was left with a poor example of speech. I began learning to speak in whole phrases, sentences and thoughts. This had been taught chiefly through Dr. Bluemel. Another thing he said was that it would take several lives to learn how to live. I think this is true in dealing with stuttering. We have to execute a certain amount of trial and error within ourselves in order to gain knowledge of what seems to apply to us regarding the procedures we need to follow.

Robert West was a well known specialist in the field of stuttering. He was originally a faculty member of the University of Wisconsin and I met him in the early 1950's. He was a fascinating man who spoke slowly in a deep voice. I asked Dr. West, "What do you really think about stuttering?" He had a very rich deliberate laugh, and he said "HUH, HUH, HUH, HUH, second cousin to petit mal epileptic fits, huh, huh, huh!" I have never been able to disassociate myself from that explanation. He further elucidated by declaring the likely cause of stuttering as being a weakness in the nervous system and that it is perpetrated by a continuation of that cause, a morbid awareness of stuttering or most probably a continuation of both of these factors.

One day Dr. West shared a concept that rang a bell with me and there is a lot of truth in it. He explained instinctive speech vs. acquired speech. By that he meant that instinctive speech was the basic rhythm pattern underneath all utterances with the acquired part being the specific languages, which are the words and the sounds. A good example of this would be to use a comparison of the sea. When a person looks at the sea from a mountain top there are swells in the water. They might be a kilometer apart, or they might be a hundred meters apart but within each swell there are countless waves. I believe we can make an analogy about the basic underlying pattern of speech by saying it's like a swell in the sea, and the articulation part, the words and sounds, would be like the waves within the swell.

A victim of a severe stroke may be left with only a grunting sound without any sense to it. That would be an example of the instinctive level of speech. The core of the break that manifests itself in a stutterer occurs in that deep underlying and basic level of oral communication, the instinctive part of speech. A stutterer may be stuck on a "d" sound but the required assemblage toward production is impaired due to a mal-function at a deeper level.

I had heard of a girl who stuttered severely until she was around age nine and spoke normally for some decades after that. A traumatic event occurred that caused her to go back to the same pattern and severity of stuttering that she had displayed years earlier. An example of the return of behavior thought to be eliminated would be the case of a Frenchman of sixty, speaking English without an accent. Originally, up to age seven, he spoke only French and claimed that he had totally forgotten all French, unable to speak in that language any longer. Under a deep hypnosis, correctly spoken fluent French flowed from his mouth.

I compare this to a cement sidewalk that is being laid down. A child comes along and lays his hand on the fresh cement and the hand print becomes solid. How is that solved? A person has to pour new cement on top of the old cement. The handprint could be dug out but we can't remove those parts of the brain that might have stuttering recorded in them. We would have to apply a new coat of cement and everything would look normal until a sand storm arrives. If it is a moderate storm, it might wear down the cement sufficiently to reveal a finger of the hand. But if it were a violent storm, it might wear the cement down and the imprint of the hand would again be revealed. I think this is very similar to what we encounter with stuttering. My past experience has been that in certain speaking situations there is accumulating anxiety or sudden stress occurring. Likely-stored, old stuttering imprint patterns can erupt as fast as a Chinese firecracker. The sequential explosions that follow can be thought of as representing the suppressed stuttering motor patterns exploding in a flash. Dr. George Kopp, one of the early scientists exploring stuttering, would no doubt call this a re-appearance of "psychomotor speech patterns."

Conrad Wedberg, author of the 1937 book, The Stutterer Speaks, wrote that while the cause and cure are unknown, the road toward recovery for an adult stutterer is made accessible only after a person started to explore a personal quest for self-knowledge. He ended it by saying that he stuttered because of the way he felt at any given time. He also stated that cures are never 100% but could be as high as 99%. It is still a mystery. During one's life, a person needs change as circumstances change. These would dictate the best approach to stuttering at that moment, in someone's life. A person should always keep in mind the Credo from Science: "Structure precedes function in the development of a human", therefore any fault in the structure will affect the function emitting from it.

It was the writings that I had read, and then later personally having known Lee Edward Travis, that had given me a meaningful understanding of the physiological aspects involved in this condition. As I originally said, it was Charles Van Riper, a student of Travis, at Iowa, who initiated my first valid options in order to alter my overt stuttering behavior. This resulted in what I prefer to call "wiggle room". I was allowed to stutter and became less "shut in by walls." Until that time, all of the therapy I had received involved preventing stuttering from occurring, so the implication was that it was wrong and something to be avoided and hidden. Dr. Van Riper had mentioned to me years ago that he felt self-help groups would serve a stutterer well. He was not completely satisfied with certain therapies, including his own. If people, who had largely recovered, were able to serve as models for those who felt helpless, much benefit would be gained. He had intended to find means to increase the amount of recovery possible in confirmed adult stutterers. Self-help groups had provided mirrors for me to see myself better and to gain from others experiences in coping with this baffling disorder.

Barry Guitar of the University of Vermont has formulated three helpful goals of therapy for the advanced stutterer. Number one: Talk naturally in your usual way, without using voluntary control. Most stuttering is intermittent and does not comprise the majority of one's speaking. Number two: When necessary, learn to introduce better responses to stuttering and learn how to apply voluntary direction for such moments to your speech mechanism. Try to keep the speech-flow moving forward. Number three: If you feel that you will stutter anyway, learn to do it as gracefully as possible.

Something that had proven helpful to me in the past was written by Harry Heltman, a professor at Syracuse. He felt the four most important things for creating a better chance for an adult stutterer to recover would be the following: Number one: Having a successful speaking experience. Regardless of how this happens, as long as it is a successful speaking experience it will tend to create a base toward further progress. Number two: Diminish expectancy of stuttering. Number three: Improve social ability to interact with other people. And number four: Increase confidence. These four things to professor Heltman seemed to be the necessary ingredients for improvement in speech, and a successful march toward the path to recovery.

Dr. Bluemel had said he did not make major improvement in his speech until he was in his sixties. He had learned to be kinder to himself keeping his inner-self language and thoughts on the positive side as often as possible.

Bryng Bryngelson, whom I've already spoken about, said something very meaningful. He proposed that truth is a direction and we keep working toward the destination. Think about that for a moment.

I'd like to conclude this speech by summarizing in a loose sense, my credo with regard to stuttering. It recapitulates what I've learned in regard to theory and therapy that I felt might be applicable to my individual situation. This applies to different times in my life when I had different needs. First of all, it is safe to say that no one knows the cause of stuttering and no one knows the cure. However, Professor Vivian Siskin, of the University of Maryland, has cited the important points comprising a good recovery from stuttering: Being able to say what you want, when you want, comfortably and spontaneously without the mental baggage of worry about listener reaction, fear of stuttering and dread.

Finally, we may never reach the wall representing truth completely, but we can move our hand half way to the wall without being able to grasp it fully. But the joy of living and substance behind a durable recovery, involves the spirit of moving forward, toward what ever may be defined as the truth.