"Some stutterers have a substantial deficit and will need to struggle heroically to gain control, and will need to monitor almost continually to maintain control over their unruly system," Boberg said. "Other stutterers with less neuropsychological involvement may be able to gain speech control rather quickly, switch to automatic pilot and maintain those gains with little effort...."
"It will no longer be appropriate," Boberg concluded, to aim for 100% fluency or control.... We are now recognizing that most stutterers, who start therapy as adults of teens, will likely have to work at controlling their stutter for many years, if not their entire life."
More and more speech pathologists, frustrated by the number of clients who go through therapy and either are not helped or are helped for a while but then, out on their own, quickly relapse, agree with this view. Dr. Eugene Cooper, the chair of the Department of Communication Disorders at the University of Alabama, who, in his early days as a therapist focused on what he believed to be the psychological cause of stuttering, now concludes that "there are different types of stuttering, that stuttering results from multiple, co-existing, and interactive physiological, psychological, and environmental factors, and that not all of stuttering is curable." Dr. Cooper has coined a term, "Chronic Perseverative Syndrome" -- or "CPS" -- to identify the approximately one in five who have disfluency problems in childhood and who, because of the severity of their core problem, will never be totally fluent, except, perhaps, through lifelong struggle.
I believe that I am among the one in five who, in Dr. Cooper's estimate, fit the CPS diagnosis. I believe that I will always stutter and will always have to work on my speech in order to make it more palatable to my listeners and to myself. That my difficulties in therapy have now been recognized as having an objective cause, is a great relief to me. . . .
The idea that stuttering is, for some people, incurable, strikes some stutterers and therapists as defeatist. Cooper himself has been accused by colleagues of presenting a "doomsday message" and, by claiming that for some a cure is impossible, violating professional ethics. The idea that stuttering might be caused by an organic neurological flaw is similarly contentious. On an internet discussion group on stuttering, I, and others who believe in a neurological cause, have been accused of rationalizing our own failure at therapy, and looking for an excuse not to try and improve our speech. At an NSP workshop on holistic therapy, one speech pathologist assailed proponents of CPS for giving up on their clients. All children are born perfect, he insisted, and all stutterers can achieve fluency if they want it badly enough. In other words, those who don't become fluent have no one to blame but themselves. I don't buy that and neither should you.
What people believe about the cause of stuttering has nothing to do with what stutterers can do to improve their speech. Those who argue for a neurological cause do not dismiss the importance that psychological and environmental issues play on stuttering. A neurological disfunction creates the predisposition to stutter. Stress-inducing psychological and social (environmental) factors bring the actual incidents of stuttering on. John Harrison, with his hexagonal paradigm, is correct in showing the interaction of learned behaviors on the physiological flaw. The first incidents of stuttering in childhood may be a direct result of neurological miswiring. But the experience of childhood stuttering transforms speech, which should natural and easy) into an abnormally difficult psycho- emotional nightmare. And it's that nightmare, different in content for each individual stutterer, that creates the psycho- emotional environmental stressors that bring about the actual stuttering. With some who stutter, the neurological defect is great while in others it is slight. One can work to improve oneself at all the other learned hexagonal points and still end up with a core stuttering problem. Others who stutter may have only a minor neurological glitch but deep psycho-emotional problems as a result of their mild stuttering. What Boberg and Cooper are saying, and what I believe, is that even with the best speech therapy, psychological counseling, stress management, and the mutual support and inspiration that comes from participation in self-help, some of us are still going to stutter. Just as there are many fluent people who are miserable, chronic stuttering doesn't preclude one's living a useful and happy life.
I may fail the fluency test most every time I open my mouth, but I'm pretty satisfied (and sometimes astonished) by what I've done with my life. . . .
Stutterers of my generation grew up ignorant about our disability. We didn't have internet discussion groups, self-help groups, or phone pals to help us. Therapists knew very little about what they were doing, raised false expectations and made promises they couldn't fulfill, and blamed their failures on the clients.
Times have changed. Early intervention can do wonders for preschoolers. Parents are no longer made to feel guilty for their child's stuttering; nor do they need to feel helpless as their child struggles. There is a lot parents can do to help their children overcome early childhood fluency problems. Success is not sure-fire, however. Some children, even with good therapy and understanding parents, will end up like me, chronic stutterers. But there is no longer a need to feel despair or be isolated. There's less rivalry among therapists and their programs now and more willingness to learn from what their clients are telling them. The best therapists have learned to integrate different forms of speech therapy. A program of precision fluency may work for one client; while another might respond best to stuttering modification. More and more therapists are coming to understand that perfect fluency is not always a helpful goal. And that psychological counseling may be necessary to prepare a stutterer for beneficial speech therapy. Most important of all, a stuttering community now exists to provide guidance and support for children and their parents and for adults who stutter.
That's not to say that all is perfect. There's a lot of bad advice emanating from pediatricians and psychologists who still think stuttering is a form of neurotic behavior, or that if you don't talk about stuttering, the child will outgrow it. Despite a lot of dedicated speech/language pathologists, few SLPs are adequately trained in stuttering therapy, and in many public school districts, speech therapy is inadequate.
It took me most of my life to learn about stuttering and to come to understand my own speaking disability. Knowledge of stuttering is now available to anyone who cares to look for it and listen.