Health
Breaking the Sound Barrier
Stutterers don’t have to resign themselves to the silent life—there are ways to tame the tongue’s madness.
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Kenneth Kidd’s research at Yale’s Human Genetics Center supports previous findings that stutterers are usually male (the sexual predominance has varied in studies from two-to-one to ten-to-one), and that the disorder clusters in families. In his national sample, Kidd finds a 20 per cent incidence of stuttering among the fathers and brothers of stutterers but only a 5 per cent incidence among mothers and sisters. Other research indicates that when once identical male twin stutters, there is a 90 per cent chance that the other one will, and this includes twins separated at birth and raised by different families. As strongly as this evidence indicates a chromosomal culprit, it does not impede studies that suggest environmental influences on stuttering. A correlation of stuttering to gender cannot be interpreted as purely genetic; I have no doubt that some stuttering comes about as a result of the intense pressures some parents place on their sons to be successful. But these external stresses probably pull a preexisting genetic trigger in certain cases. Neurologist David Rosenfield, director of the Stuttering Center in Houston (a joint project of the Baylor College of Medicine and Methodist Hospital), ventured to say that if not for my genotype, I might have developed a rash, a twitch, or ulcers instead of a stutter. As Isaac Davis, Woody Allen’s character in Manhattan, says, “I don’t get angry, I grow a tumor.”
The continuing mystery about the causes of stuttering demands some rather eclectic approaches to diagnosis and treatment. Few of the therapeutic techniques seem to have changed since I was a teenager, but the speech pathologists’ laboratories are now full of hardware and software, as if Professor Henry Higgins has redone his Pygmalion parlor in high tech. Speech pathology’s leap into electronics is evident at the University of Texas Speech and Hearing Institute in Houston, a research center that also offers therapy to children and adults with speech problems.
Because it is easier to control a child’s stutter than an adult’s, pathologists are trying to identify speech problems before they grow into stubborn maturity. The institute has begun this detective work at the very onset of human speech in an experiment it is conducting with a local hospital to computerize the birth cries of infants, and researchers hope that these voiceprints will indicate oral dysfunctions awaiting the nonverbal newborn. I asked the institute’s director of computer services, Charles Mitchell, if I could see what my voice would look like on a printout, and he obliged, handing me a microphone that plugged into the computer, which banked three walls of an enormous room. I half-sang “aah” onto a tape, and now have my own voiceprint as distinctive as my thumbprint.
The new diagnostic precision may help us understand individual language breakdowns, but it cannot guarantee freedom of speech for a stutterer. That comes only out of successful exchange between pathologist and patient. How fluency is finally wrung from the stutterer is as much a mystery as stuttering itself. Speech therapists seem generally reluctant to talk about the details of individual cases, and I interpret their reticence as a wise concession to the unknowns of their profession. Speech therapies often don’t transfer from patient to patient, and what happens in a clinic can be exasperating: some stutterers totally confound their therapists by stuttering terribly between sessions yet speaking fluently in therapy. Successful cases convince me that there is an element of wizardry at work.
Dan Kelly, a speech pathologist at the Houston institute, says that while curative research on stuttering continues, the emphasis is now on maintenance and modification. Kelly is modest, for his work with adult stutterers, as I saw it on before-and-after videotapes, is remarkable. Within four weeks he had somehow elicited perfectly understandable, albeit droning, speech from a young man whose stutter had rendered him incomprehensible. I remember being mortified the first time I heard my stuttering voice on a primitive tape recorder; the videotape fast-forwards stutterers into a world of sight as well as sound that makes their impairment even more painfully obvious. By watching themselves on television sets, though, stutterers begin to recognize their “avoidance behavior” (the habitual nervous gestures and verbal clutter that stutterers develop to deal with speech blocks) and learn to modify that behavior into one that is more conducive to relaxed speaking.
The objective of behavior modification are to unlearn stuttering through basic training in verbal formations and flow, to confront the stutterer with the sounds, words, and situations he has come to fear, and to teach him that articulation comes with relaxation and total control of pulse, respiration, and perspiration, all of which are known to increase as stutterers are called upon to speak. Behaviorists teach stutterers to exhale into worlds and to breathe deeply between them, which not only relaxes the diaphragm and throat muscles but also has a tranquilizing effect. The exercises may seem awfully basic—a deliberate recitation of phrases like “ev-ery good boy de-serves fa-vor” does assume the mindlessness of chanting—but if performed regularly in a confidence-building and relaxing environment, they can indeed rehabilitate stutterers.
Sessions are sometimes conducted with several stutterers, an increasingly popular approach that centers on the old-fashioned notion of teamwork. The inability to speak isolates a person in this prattling world, which is reason enough for speech therapy to include some kind of counseling—if not in a group, then on a one-to-one basis with a therapist (who need not be a psychologist). I wish I had had some contact with other stutterers, people with whom I could have shared the awful moments when I could not respond to a traffic cop, ask to be excused, or get past my opening remarks in an oral book review.
My belief in counseling for stutterers is so strong that I am suspicious of speech pathologists whose explanations of stuttering stop at the somatic. Martin F. Schwartz of the New York University Medical Center puts stuttering down there with indigestion in a book brazenly titled Stuttering Solved. Schwartz claims that his “airflow technique”—whereby an audible sigh before speaking opens the windpipe and loosens the vocal cords—makes it impossible to stutter. The suggestion of a gassy sign to get the process going smoothly is ludicrous; Schwartz sounds like a guy who would administer a sharp blow between the shoulder blades to expel words from a blocked stutterer. But nonsensical maneuvers can be inexplicably effective at breaking out of blocks. A deep breath can be as much of a placebo as yanking on an earlobe, removing eyeglasses, or humming, so if Schwartz’s technique works for some (he has conducted successful workshops in Texas), I should not complain. Schwartz’s colleagues may cringe at his book, which promulgates false hope for cure, but they acknowledge that he has customers who don’t stutter when they say they’re satisfied.
Some neurologists have advocated prescribing haloperidol, a potent anti-psychotic drug. This walloping tranquilizer is effective in some cases of severe stuttering, but no wonder: it slugs the nervous system, and not without side effects that can be especially dangerous for children. I would rather stutter than be in a glassy-eyed, drooling stupor, but a stutterer who has tried everything else may choose to risk this kind of chemically induced relaxation.
Having found voice, whether through behavior modification, psychotherapy, or medication, a stutterer must wean himself from therapy: a plodding monotone achieved in a clinic, while fine for saying “One, please” at a box office, will never do at dinner parties. Sometimes fluency is accompanied by trauma, an ironic climax to therapy that befalls those so dependent on the meticulous procedures in a clinic that they cannot cope with communicating in day-to-day situations, and this balking often requires follow-up counseling and treatment.
The sad fact is that many adult stutterers must do without therapy altogether because of the lack of programs suitable to most working schedules and budgets. It is difficult to tell your boss you are taking a couple of hours off for speech therapy, especially if he or she already feels smug about having “hired the handicapped.” And it is a rare medical insurance plan that covers speech therapy, an hour of which can cost as much as comparable time with a psychiatrist.
I have stuttered more while working on this article than I have in years, so I reason that the more aware I become of my speech, the more likely it is to fall apart. As soon as someone remarks that they cannot believe that I am a stutterer, I start stuttering under what must be the power of suggestion. Otherwise, if it is out of mind it is out of mouth, and I am giving way to loquaciousness that may well be overreaction to having been verbally lame for so long. But speech is dear, and when I tumble into a relapse, which can happen at the most relaxed of dinner parties, my reaction is to clam up and conserve my supply of whole words—a shift in a single evening from talkative to quiet that probably distresses my host more than it does me. If we were all struck dumb tomorrow, stutterers would agonize less than other people, for we have learned to be wary of verbal excess and are among the first to appreciate silence.
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