When my father took me to the opening of the Manned Spacecraft Center in Houston, I wasn’t about to let anything, least of all my shyness, get in the way of meeting the original astronauts. I was determined to collect the signatures of all seven spacemen and my taciturn offering of pad and pen was working fine until Alan Shepard asked my name. My reply, “V-V-V-Vance,” embarrassed my famous listener as much as it did me. All I could think of on the way home was that a person must not stutter while talking to Mission Control. I had blown my chance of becoming an astronaut.
I have stuttered for as long as I have talked, never catastrophically, with the “blocks” that cause facial contortions, but with enough clutter and hesitation that I learned early to curtail or sidestep conversations. As is the case with many young stutterers, my speech began to flow more smoothly at about age fifteen, and people I have met in the ensuing fifteen years are often surprised to learn that I ever stuttered at all.
The speech therapy I got in grade school, usually conducted weekly at a corner table in the library, was not particularly inspired. Semester after semester, bewildered therapists made me listen to goofy recordings, had me recite to a metronome ticking so slowly that I would run out of breath in the middle of words, and tried to guess whether I was hyperactive, which I was not. One woman played “Ronnie the Fire Engine” and “Sammy the Snake” records for me, but r and s sounds were not my problem. None of this was totally useless, but it undoubtedly made me aware that my speech was different, which only compounded my growing fear of speaking. And returning to class probably nullified any benefit I was getting from therapy. The whole time I was in elementary school, teachers banished speech-impaired students to the lower-rung reading group, no matter how superior our non-oral language skills may have been. When I asked my fifth-grade teacher why I always made a C in reading, she replied, “Well, Vance, you do stutter.”
By the time I entered junior high school, I was resigned to a nonverbal life and was beginning to realize that certain options would not be open to me. I knew I could never be a disc jockey, an auctioneer, the President, or even a used-car salesman, and I had just stuttered my way out of the space program. Not that my parents had any of these occupations in mind for me, but they were getting worried. It is best not to call attention to a child’s stutter; however, my runaway speech, and figuring out how to tame it, became something of a family project. I am convinced that we did the right thing at home by bringing it out in the open. Besides, how long could we pretend not to notice that I would let the telephone ring rather than pick up the receiver and try to say “Hello”?
My parents summoned a private therapist to the house but promptly dismissed him after he announced what stutterers always hear: my only problem was that my mind was racing ahead of my mouth or—less flattering—vice versa. I discovered that I didn’t stutter at all when I sang, so I longed for a life to be like the musicals. We put buttons under my tongue in a futile and funny update of Demosthenes legend, but they kept me from singing and made me gag.
I continued a long and difficult relationship with the telephone, that medium in which you are only what you sound like. One of my sister’s boyfriends hung up on me after what must have been a full minute of “shhhhh” in my attempt at “She’s not here right now.” That embarrassing incident stands as my worst moment as a teenage stutterer, but another bout with the telephone finally prompted me to get serious about mending my broken speech. After overhearing a sputtering call I made to our newspaper carrier, my mother handed the phone back to me and commanded me to reenact the conversation. The directive seemed irrationally punitive at the time, but it turned out to be the proper catalyst. I realized at last that my grace period had expired. I perceived the moment as my last chance to do something about stuttering and hence was motivated to approach conversation with a new sense of caution, to remain cool during crises, and to devise a series of tricks to bypass words that wouldn’t budge.
The sudden exits I have learned to make from words—simple switches, such as “bring” to “take,” “I” to “me,” or “may” to “can”—do not enhance eloquence or build vocabulary or enforce good grammar, but the sacrifices are unimportant. What matters is getting through a sentence, even if I have to lead into a statement with a prolonged “mmm” or “uhh” to get it going. At an early age I developed a disregard for syntax that often leaves literate listeners incredulous. If I have trouble with, say, “Let’s go to a movie,” I might have to hurdle the l with a weird rearrangement such as “A movie [fake pensive pause], let’s go to a movie.” Should the l still not shake loose, I may try “How about a movie?” or the more petulant “I want to go to a movie.” Since stuttering can occur midsentence as often as it does at the beginning, there are escapes to be made at the last second: “How about a m-m-m-m [pause] going to a movie?” Or I will quickly change to “film”. Then there is my unsubtle technique of consonant-dropping—“ello” for “hello”—which probably strikes people as an odd desire to sound cockney. As an illustration of the capriciousness of stuttering, to this day I cannot say “statistics.” It is the first syllable that trips me, but I have no trouble with the abbreviated “stats.” Many stutterers constantly block on the st sound, and it is a cruel etymological joke that the word “stutter” should be onomatopoetic. Working around or wresting free of contrary words provokes private self-congratulations that only stutterers can appreciate. To beat or camouflage stuttering, I still ram through sentences and crash through threatening words, sometimes talking like a speed freak. People don’t understand when they tell me I talk to fast that I don’t dare slow down. Houdini had to work fast too.
Having to settle for Coca-Cola due to fleeting inability to say “Dr Pepper” is not my idea of tragedy, and my stutter would never be considered a dread disorder. My occasional stuttering and the speed of my speech may annoy some people, but that is the price I pay for self-taught fluency. I have wondered how I might speak had computer and video-tape technologies been available when I first began to stutter, but I am comforted by the knowledge that I can rely on the sheer velocity of my speech for a rapid-fire order at a crowded delicatessen or to get me through other hostile or high-pressure exchanges.
Many speech therapists like to point out that there are no cured but only controlled stutterers, a distinction that compares us to junkies. “Controlled” implies that I can lose control, and I sometimes do. I often wonder why my stutter suddenly reasserts itself and I am not alone in that curiosity: stuttering still baffles the therapists, pathologists, neurologists, psychologists, and physicians whose business it is to understand the disorder.
Uttering a single word is a feat of staggering neuromuscular complexity and deep cerebral mystery. Speech involves an array of exquisitely coordination and ill-understood activities performed by the brain, respiratory system, vocal organs, and facial muscles. The faculty is ours alone. Kenneth K. Kidd, a geneticist at Yale University, explains that in attaining speech our species has actually risked choking to death. The descent of the pharynx and tongue into the throat, a development essential for speech, crowded the passage so much that the human trachea, or windpipe, cannot take in food and air simultaneously. The conclusion from this is that speech, so crucial to our success as a species, has evolved slowly and with considerable difficulty and risk, so it shouldn’t be surprising when it breaks down in a significant number of individuals. Two million American adult stutterers are evolutionary evidence that the kinks of speech are still being worked out.
Physiological and psychological problems intertwine in stutterers in such an intricate way that it is difficult, if not impossible, to isolate a root cause, if in fact one exists. Physical malfunctions, such as erratic reflexes in the larynx or misfirings of the neurons that coordinate the speech organs, can cause stuttering. Those speech pathologists who describe stuttering as neurotic are suggesting that a person’s anxieties may cause rapid respiration, a tightening of the muscles in the throat, or other nervous reactions that can choke speech. Others reason that since speech is learned, so is stuttering, and these “environmentalists” warn that the normal sputterings, or “minimal dysfluencies,” of children may culminate in full-fledged stuttering behavior that they later must “unlearn.”
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.