Everyone who stutters stutters differently. Some stutter by repeating the first sound of their words but are generally able to move forward in their speech without huge blocks of tension- filled silences and gasps for air. Others who stutter have tension-filled silences. "My vocal chords are so tight," one woman says, "that I feel like I'm being strangled when I speak." Still others will block after they begin their voicing. They get stuck on one sound and no matter how hard they try, they cannot move past it. Still others stutter with a soft stutter. When they are having difficulty speaking, they sound like an engine idling -- an engine with fouled sparkplugs, defective timing, or, more likely, a burned-out clutch. Their motor is running but there is no forward progress, they can't seem to get their speech into gear and move from the stuttered sound to the intended word.
Some people who stutter look like kids who have been in cold water too long -- they are unable to effectively control the movement of their mouth, and their teeth are uncontrollably chattering. When I was young, I often had this pattern. Kids at summer camp who heard me stuttering would ask me if I was cold. I'd press my arms across my shoulders, start shivering, and acknowledge, through chattering teeth, that "I g-g-get c-c-cold easily."
For others the problem seems to be located in their jaw; their lower jaw seems to have come unhinged from their mouth. If they could only stabilize that wayward part and keep it in the position that it is supposed to be in, they would not stutter. But that's easy to say and, for a stutterer, difficult to do. For people who stutter, when they are stuttering, have no control over the mechanics of speech. They may know what to do and, even as they are in the midst of a stuttering block, be thinking about what they ought to be doing to get through it. But thinking isn't doing. It is as if there is a decisive split, a cut cord, so to speak, between mind and body, between brain and lips, mouth, tongue, larynx, and jaw. In my life as a stutterer, I have done all of the above. In addition, I often hold my breath even as I am trying to speak. I know that it is physiologically impossible to speak while holding one's breath -- just try it. No matter how much I strain to make a sound, all that comes out is the forced spasm of my futile effort.
In the middle of a speaking block, we stutterers sometimes look as weird as we sound. And it bothers us. Indeed a good part of the stuttering problem is caused by our physical effort not to stutter. Some speech pathologists refer to this as the "secondary characteristics" or "symptoms" of stuttering. They describe "primary characteristics" as the normal disfluencies of childhood speech. Young children, even those who end up perfectly fluent, often stumble on words. These early instances of stuttering are not necessarily associated with tension or stress, and the children don't consider themselves to be having a speaking problem. "Secondary symptoms" or "characteristics" begin to occur when children become self-conscious of their speaking difficulties. The secondaries are the tricks we stutterers use in order to avoid a block or break out of one that we are already into. These tricks have nothing to do with proper (that is to say "normal") speaking techniques. They are the very opposite -- desperate acts of forced speech that, in their aggregate, intensify the primary characteristics of childhood stuttering into severe, chronic stuttering. . . .
The visible symptoms of chronic stuttering are a mishmash of secondary stuttering characteristics. Adult stuttering is marked by the bad habits these adults picked up when they were young in order not to stutter. For example, when stuck in a block with lips pressed closed or jaws clamped shut, the proper, common- sense thing to do is to draw back, relax the jaw and gently open the lips so air can come out and carry the words forward. But if we were able to control our speech in the middle of stuttering block, we wouldn't be stuttering. What we do instead is try to blast through our blocks by brute force. And if we tense our muscles, contort our faces, and push hard enough on our articulators, we believe that we'll break through the block -- and we probably will.
Some blocks are so severe that body language has to be called in to play. For example, many of us learn to jerk our face up and down or back and forth in order to muster the physical force to get through a block. Or we approach speech as if we are throwing a bowling ball, using facial tics, shoulder shakes, and other kinds of body language to achieve the strike of fluent speech. One stutterer, I am told, would swing his arm around like a windmill in order to build momentum to get him through expected blocks. "You had to stand back so you wouldn't get clobbered," a friend recalls. Another "would spill out a huge string of words" in preparation for getting through the word he was intending to say. Asked to give his name, he would say a half dozen sentences about his name before he would actually say his name. When speaking on the phone, I can usually break a block by stomping my feet, pounding the desk, or moving my body back and forth like an Orthodox Jew does when he is dovening (praying). Concerned with how I look to others, I would never use such spastic body movements in public. But on the phone where no can see me, I will do whatever it takes to blast through my blocks in the hope that I will at least sound as if I'm fluent.
People who stutter will do anything not to stutter. I know people who claim to stutter but who never do. Covert or secret stutterers stutter internally, or so they say. They live in constant emotional turmoil, fearful always that they might utter a disfluent word. I never understood why covert stutterers called themselves stutterers until, at a self-help meeting, I met a man who I will call Murray. As far as I could tell, Murray was completely fluent. He never stuttered or showed any sign of stuttering in the dozens of self-help meetings we attended together. The only evidence that he was a person who stuttered was his faithful attendance at these meetings. His presence sometimes made me angry. Why was he there? Everyone else at the meeting was trying, sometimes with much difficulty, to overcome obvious chronic disfluency. Murray's fluency came easy, too easy. What was he overcoming? What was his problem?
One evening he showed up at the meeting at the edge of tears. He had to talk to us and share his anguish. On the way to the meeting he had stopped at a MacDonalds. There was a line at the counter, and he felt pressure to hurry with his order. Ordering a Big Mac, he stuttered on the Mac. He felt humiliated, marked. He felt exposed, as if everyone on the line behind him, as well as the smiling teenager who took his order, knew his secret, that he had defective speech, that he was a stutterer. Who has it easier, I wondered, as I heard his story: a severe stutterer like myself who knows that he is probably going to stutter not only on the Mac, but on the french, the fries, and the c-c-cup of c-c-coffee? Or a person who is so afraid of stuttering that each instance of disfluency brings about a personal crisis?
Many stutterers do what covert stutterers do and attempt to disguise their stuttering by anticipating words that they feel might give them trouble. They then substitute words they feel confident they can say without stuttering. That's why many stutterers develop large vocabularies -- and often speak with muddled syntax. Proper grammar is often thrown by the wayside when perfect fluency is what the stutterer is after. There are times, however, when there are no synonyms to describe a basic need. There isn't a person who stutters that hasn't gone into a restaurant and ordered something that he didn't like because it was preferable to ordering something that he liked but couldn't say -- a hamburger and a coke, for example, when what was really wanted was a cheeseburger, medium rare with lettuce, tomatoes, onions, french fried potatoes, and a chocolate malt. I lived as a teenager in White Plains, N.Y., but often bought train tickets to Hartsdale, N.Y. because the "wh" sound in White always gave me trouble. There were no buses or taxis from the Hartsdale train station as there were from the larger White Plains station, but walking four miles home was preferable to me than stuttering in front of the ticket seller in Grand Central Station. The God of Stuttering is a wicked jokester. Had I lived in Hartsdale, I would likely have had trouble saying the "H" sound and would have chosen to buy a ticket for White Plains. I eventually gave up using word substitutions (especially when I stuttered on the word substitutions) and stuttered my way to White Plains or wherever else I had to go. Try as I might, there was no way for me to fake or hide my stuttering.
Dr. Kerr, who promised to cure me in a fortnight, had one good idea. He stressed, and made me repeat it over and over again, "I must have complete control of my mind. I must have complete control of my mind." And in everything but speaking I do seem to have control of my mind. I'm coordinated and intelligent. I can pat my head and rub my belly which, I'm told, is more than one recent President of the United States was able to do. One thing that attracted me to the NIH neurological research was my belief that something happens inside my brain that makes it difficult for me to exercise control over my speaking mechanism. Whenever I try to visualize what's in my head, I get a picture of scrambled eggs. That's not so startling. Have you ever seen a picture of the brain? OK, if not scrambled eggs, how about tightly packed links of breakfast sausages? When I picture the brain in terms of my speech, I always think that I'm a short-order cook making breakfast in a diner. Whenever I am having difficultly speaking, it feels as if my brain is heating up and my thought processes, especially those concerning speech, are becoming scrambled. The orderly passage of time gets jumbled. If I were a computer, an error message would flash on the screen saying either "System Overload" or "System Breakdown." As a breakfast rather than a cybernaut, however, the feeling I have is of a griddle over-heating. The toast is burning, the egg yolks are breaking, and the bacon is spewing hot grease into the fire. The cook, that's me, is in a panic, trying to deal with every thing that is going wrong and, in a frenzy of frantic motion, dealing with nothing.
Another indication of an over-agitated mind is my difficulty with time. I do not understand -- or perhaps I cannot accept -- the lateral movement of time. A clock ticks in an orderly and regimented fashion. One second passes and then another and another, and each is defined by an exact measure. But my urge is to always telescope that time into itself (as in the submariner's term, "down scope") and speed it up. People with a normal sense of time can count "one, two, three, four, five" in an orderly systematic fashion. I, on the other hand, would count out five as "one, two, threefourfive." In this, I am typical of a lot of stutterers who want to finish what they have to say as soon as they start to say it. I may start off in control of my speaking technique, but the middle gets muddled as I rush to achieve the relief that can only come from finishing whatever it is that I have to say. The sequence of words collapse upon themselves. My urge is to blast through my words as fast as I can, to make a sandwich of them, to compress them together. It would seem, in this state of mind, that I have no respect for what I want to say. My words are like garbage, ready for the landfill, waiting to be compacted.
Here, too, I usually know what is happening and I know what I need to do to liberate my speech and allow my words to soar. Indeed, when I get into this rushed sequence, I can be telling myself, even as I am racing through my words, to slow down. But thoughts don't stop me. My stuttered speech is like a runaway bulldozer, rolling over all signs of caution.
My compulsion to compress time is replicated in other things that I do. The best example is when I'm standing before a urinal; then I feel compelled to flush the toilet even before I'm finished with what I am standing there to do. Even when I want to wait until I'm finished, I can't. Somehow I believe that the sooner I flush, the sooner I can leave and get on with my life. But no matter how fast I am in turning the knob or jiggling the handle, I cannot leave until I'm finished. And so it is with speech. I am determined to finish what I'm saying even before I give myself a chance to say it.
But I'm probably being too harsh on myself. If a neurological dysfunction creates the predisposition to stutter, what seems to ignite the dysfunction -- what throws the normal working of the brain out of whack -- is the excitation that results from psychological or physical stress. This is true not only for stuttered speech but for virtually every kind of human endeavor that requires motor coordination and is done interactively; that is, before an attentive audience. For example, a basketball player sinks jump shot after jump shot in practice when no one is watching. She's got her moves down, her soft touch, everything coordinated, perfect concentration. In a game situation with the pressure on, with the crowd screaming and opposing players bumping and jostling her and waving their hands in her face, she will do well to make 40% of her shots. The same dynamic applies to golfers who putt perfectly in practice but often choke when the game is on the line, and when they are conscious that people are watching. Musicians who are beginning to master their instrument will hit clinkers in a concert on notes that they'll hit perfectly during rehearsal. It's the same dynamic for people who stutter, only that all the stress that's engendered by public performance seems to fasten on their speaking mechanism.
For example, sitting alone in a room reading aloud to myself, I am usually fluent. Alone, I can be speaking gobbledygook -- no one has to know. But when people enter the room and I become aware of their presence, my stress shoots up. With listeners, I'm transformed into a performer with something to communicate, my words take on weight. My listeners, the way I perceive them, also becomes my critics, listening to how well I'm speaking in addition to responding to the substance of what I have to say. I try and concentrate on my reading and ignore their presence. I tell myself that they are not listening; and perhaps, they aren't. They may be distracted, lost in their own thoughts - - it's only my perception (and my egocentricity) that leads me to believe they are listening to me. Nevertheless, the environment in which I am speaking is totally changed by their presence and, in reacting to that change, the neurological biochemistry controlling my speaking mechanism changes also. All of a sudden I lose the confidence and the concentration that comes so easily when I know no one is listening.
A neat bit of transference is taking place here. It's easy and all too common to project my own negative attitude towards my stuttering on to my listeners who may be more interested in the content of my speech than in my fluency. Listeners, studies have shown, are often more tolerant of stuttering than we stutterers' are wont to believe. A clock within us is always ticking: Is what we have to say taking too long? Are we discomforting our listeners. My listener may not care about the fluency of my speech. I'm the one who is the critic. Even as I'm speaking, I'm monitoring how I'm speaking, how the listener is reacting to my speaking, and, additionally, how I'm reacting to my perception of the listener's reaction. Is the pursing of his lips a reaction to the tension in my voice? Why did he blink? Why is he averting his eyes? Why is he covering his face with his hand? Does my stuttering shock him or make me look grotesque? Is his shifting his weight away from me negative body language, a sign of boredom? Sometimes I see inside, or imagine that I see inside, the minds of my listeners.
My fluent friends tell me that they, too, pay attention to how listeners react to their speech, and that their self- consciousness about their speech restricts their own self- expression. In a sense, then, even fluent people suffer from a form of internal stuttering. But the speech mechanisms of fluent people can successfully process this stress-induced sensory overload and they do not stutter when they speak. The complexity of speech-inspired mental activity is unique to people who stutter. Speech for stutterers can be as mentally strenuous as an Olympic competition and as complicated as playing three chess games all at once.
Yet, as with everything, it's not neat and simple. We're all different and some people perform better under stress. There are athletes like Larry Bird and Michael Jordan who come through when a game or the season is on the line. The excitement of the game makes them more focused on what they have to do and, as their concentration increases, they are able to shut out all distraction. In a similar way, there are people who stutter in informal conversation but get focused and become fluent when they are up in front of a room talking to a crowd. But troublesome feelings like anxiety and fear are not the only causes of stress. I'm often calm and focused in a tense situation. When I panic, it can be as a result of fear and anxiety, but also as a result of over-stimulation and excitement. But my speech operates in a world of its own. And the slightest outside stimulus ("excitation feedback," as Richard Harkness calls it) -- all it has to be is another person entering a room -- causes my speaking mechanism to go awry.
Speech stress falls and rises with every subtle change in the social environment. For example, I want to ask a stranger for directions. I approach someone who seems to have a friendly and sympathetic vibe. I feel confident and start off fluently.
"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; she was lost in thought before I approached her, and she perceives my question as an interruption, and is irritated by that interruption. Or perhaps she's late for an appointment and doesn't want to stop to answer my question, and what I'm sensing is his own feeling of indecisiveness -- should she stop to give me directions or ignore me and seem, by his standards of conduct, rude? Whatever the reason, 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. She pays attention to me and shows, by his attentiveness, a willingness to hear me out. My confidence rises again, my anxiety drops, and some fluent words come out. On the other hand, my listener might react to my stuttering with confusion (thinking to herself, what's wrong with him? Is this some whacko or a masher about to proposition me on the street?) I sense this negativity in an instant; my emotions reverse themselves and I begin to stutter.
Measuring stress, if we were to do it, would create a printout much like a heart cardiogram. Our level of stress would be changing every millisecond as we are stimulated by and react to our surrounding environment. But the stimuli and their effect on us would be rooted in past experiences as well as in present reality. How stress affects us is genetic, learned, and existential. That is, each of us is programmed by our genetic code to react to different kinds of stress in differing ways. As we grow up and experience stress, we learn to cope, adapt, and otherwise respond to it in new, inventive, self-destructive or self-protective ways. These learned behaviors mesh with our genetic code and alter the way we respond to what's happening around us. Each moment of experience encompasses more stressful situations -- and this, too, gets added to (and changes) our response mechanism. And I'm sure this is just the half of it....