By William D. Parry, Esq.
Understanding and Controlling Stuttering.
GUIDED BY the Valsalva Hypothesis, we have been able to fit together many pieces of the stuttering puzzle. Where once lay a confusing jumble of seemingly contradictory facts and theories, an understandable picture of stuttering is now emerging. While still hypothetical and incomplete, this vision has the potential to lead us out of the "stutterer's quandary," described in Chapter 2, and to alleviate our frustration over the maddening paradoxes of stuttering. Furthermore, it may lay to rest any stigma, any feelings of guilt or shame, any doubts about our worthiness as human beings.
As we have seen, the Valsalva mechanism may play a key role in stuttering behavior. If confused with speech, this normal bodily function might cause excessively forceful closures of the mouth or larynx and delays in phonation - two of the basic symptoms of stuttering. The many other varieties of stuttering behavior (described in Chapter 10) could then be explained as attempts to avoid, postpone, or conceal these underlying blocks.
Our hypothesis suggests why we may instinctively block airflow and build up air pressure in an attempt to force out words as if they were "things." We can now understand why this feels like the necessary thing to do - even though it makes fluent speech impossible.
While the Valsalva mechanism is only part of the total picture, it may help us link many of the other pieces together in the proper perspective. Through the Valsalva-Stuttering Cycle, we have seen how the one's activation of the Valsalva mechanism might be prompted by the anticipation that speech will be difficult or that extra effort will be needed. This may explain why stuttering occurs in some situations more than others, and why it usually hits hardest on the most important words.
Other factors may also fit into this picture, insofar as they contribute to the anticipation or perception of difficulty. For example, some stutterers' speech might be affected, to varying degrees, by neurological impairments (either inherited or suffered in utero or thereafter) or emotional problems. Even when the initial difficulty is due to a neurological weakness, the Valsalva-Stuttering Cycle may describe the individual's learned reaction, which may greatly aggravate the symptoms.
Not every stage of stuttering involves the Valsalva mechanism. As discussed in Chapter 13, a child's earliest disfluencies may arise from a number of factors, such as delays in the neurological development of speaking skills, emotional stress, or excessive demands for good speech. We then saw how the child's effortless, whole-word repetitions might gradually progress into forceful blockages, bringing the Valsalva mechanism into play.
The child - already accustomed to using the Valsalva maneuver when exerting effort or expelling bowel movements - may instinctively assume that words can be forced out in the same way. As noted in Chapter 12, this display of effort could also be the child's way of telling his parents: "You can't punish me for stuttering. Look how hard I'm trying to please you!"
Continuation of this behavior during certain critical years of childhood may influence the development of nerve pathways in the brain. The pathways linking speech to the Valsalva mechanism might be strengthened by constant use, while those for fluent speech may remain underdeveloped. In this way, the tendency to involve the Valsalva mechanism in speech would become permanently "wired" into the stutterer's brain.
The Valsalva Hypothesis also suggests new ways of approaching many of stuttering's mysteries. For example:
| The fluency enhancing effects of certain speaking techniques and auditory conditions might be traced to their effect in counteracting various steps in the Valsalva-Stuttering Cycle (as analyzed in Chapters 17 and 18). |
| The tremendous predominance of males in the stuttering population might be related, in some degree, to sexual differences in the Valsalva mechanism (as suggested in Chapter 13). |
| There may be some connection between certain anomalies found in stutterers' brain function, such as bilateral speech, and their tendency to confuse speech and the Valsalva mechanism (as noted in Chapter 16). |
The Valsalva Hypothesis also provides insights that may improve our control of stuttering. In Chapters 19 through 21, we saw how various types of therapy could be explained in terms of their effect on the Valsalva-Stuttering Cycle; how many competing forms of therapy have certain elements in common; and why relapses may occur when stutterers "try hard" to use fluency techniques and thereby activate the Valsalva mechanism.
Our hypothesis views most developmental stutterers as having the basic capacity for reasonably fluent speech. The major problem, in our view, is usually not a lack of ability to speak, but rather an interference with that ability by the Valsalva mechanism. (Even for the person whose speech is affected by neurological impairments, using the Valsalva mechanism to force the words can only make matters worse.)
Therefore, our approach to fluency does not concentrate on retraining the speech mechanism, but rather on controlling the Valsalva mechanism. Our suggestions for Valsalva Control include both physical and psychological aspects, as seen in the Fluency Cycle. Although we have incorporated a number of fluency methods from the past, they are now intended for the specific purpose of relaxing the Valsalva mechanism and breaking the Valsalva-Stuttering Cycle.
No speaking technique can, by itself, guarantee fluency. However, there is still value in practicing speaking skills. By improving our underlying speaking ability, we can increase our self-confidence and strengthen our nerve pathways for speech. This, in turn, may help to reduce our anticipation of difficulty and our urge to activate the Valsalva mechanism.
One of the practical advantages of Valsalva Control is its compatibility with other forms of stuttering therapy. Therefore, one need not rely exclusively on this approach. Various elements of Valsalva Control can be selected to improve or supplement other treatment programs, and to deal with the tendency to relapse.
It is truly amazing that researchers have paid so little attention to the Valsalva mechanism, given its potential for explaining so much about stuttering. One reason, I suspect, is that they have viewed it merely in terms of the laryngeal closures that typically occur during an ordinary Valsalva maneuver. Because the larynx does not always close in this fashion during stuttering, researchers may have simply assumed that the Valsalva mechanism was not involved.
In contrast, we have taken a much broader view of the Valsalva mechanism. As we demonstrated in Chapter 6, it can stimulate forceful closures in the mouth as well as the larynx. We have also raised the possibility that neurological preparation for a Valsalva maneuver might interfere with the normal prephonatory tuning of the larynx, thereby delaying phonation and interfering with speech.
I recognize that the Valsalva Hypothesis is still only that - a hypothesis - and that considerable scientific research is needed to establish the true role of the Valsalva mechanism in stuttering. As previously suggested, this research might include EMG studies of muscular activity in the Valsalva mechanism during stuttering; testing the effect of Valsalva relaxation on fluency; exploring the neurological relationship between speech and the Valsalva mechanism; and searching for neurotransmitters or other chemicals that may trigger the Valsalva maneuver.
Because I am not a speech pathologist and don't have access to a speech lab, I can't obtain this data on my own. My only avenue has been to explain my hypothesis and its ramifications as comprehensively as possible, to explore these ideas with other persons who stutter, and to try to stimulate speech pathologists to pursue the necessary research.
Whether or not one accepts my hypothesis, I can see no scientific justification for refusing to investigate the Valsalva mechanism. Researchers have delved into countless aspects of stutterers' behavior and physiology - rarely on the basis of any theory that would explain as much about stuttering as the Valsalva Hypothesis. Unfortunately, it's not likely that the scientific community will undertake this task any time soon, given the fact that research money is scarce and speech scientists already have enough trouble getting their own projects funded.
Although the scientists have not yet confirmed the validity of the Valsalva Hypothesis, we who stutter need not wait. We can informally experiment with it ourselves. We can be our own researchers, our own subjects, using our minds, bodies, and speaking experiences as our laboratories. While this approach may not be "scientific," it's all that we have - and all that may really matter.
Persons who stutter are frequently the victims of ridicule, discrimination, and negative stereotyping. As with many forms of prejudice, the underlying causes may include ignorance and lack of understanding.
The general public has
no comprehension of the physiological forces that block a stutterer's
speech. Most people cling to
the popular notion that stuttering is caused by
"nervousness." Studies indicate that this is due to people's tendency
to equate stuttering with their own moments of disfluency - which may have
been prompted by nervousness, fear, uncertainty, or emotional
conflict. They assume that the
stutterer is experiencing similar feelings - only more
so. Consequently, they may view
stutterers as being "nervous," slow, ineffectual, indecisive, or mentally
unstable.
Attempts have been made
in recent decades to disabuse people of the notion that stuttering is an
"emotional problem." In its
place, the public has been offered a picture of stuttering that refers instead
to possible neurological and hereditary
causes. While this view may
remove the stigma of mental illness, it may also leave a negative impression,
in some minds, that stutterers are hopelessly brain-damaged or inherently
defective.
The Valsalva Hypothesis
avoids the stigmas that might be associated with both the extreme "psychological"
and "neurological" viewpoints by providing an explanation that emphasizes
the stutterer's basic normality.
We can now talk to people more confidently about stuttering.
We need not hem and haw about
its mysterious and unknown causes (which may seem potentially sinister to
some people). We don't have
to tell them that we were psychologically screwed up as children or that
we have abnormal fears of speaking, a possible brain deficiency, or vague
inherited defects. Now we have
a hypothesis that makes things a lot
easier. We can honestly tell
people:
"No one knows the cause of stuttering for sure, but there is a new
hypothesis that seems to explain it as well as
anything. Stuttering may be
largely due to a neurological confusion between two basically normal bodily
functions - speech and the Valsalva
mechanism. When I anticipate
that speaking may be difficult, I may have a tendency to activate the Valsalva
mechanism, which is something everybody normally uses to help them exert
effort or to force things out of the body."
We might even demonstrate by having our listeners do the hand-pulling
exercises described in Chapter 6, to experience how the Valsalva mechanism
works. They can then personally
feel the pressure in their own larynx, lips, and tongue and imagine how this
could interfere with their own
speech. Having experienced
the physiological force behind stuttering, they may feel less dubious
about our mental health and more comfortable about our
problem. We can now go on to
share a lot more about the stuttering experience.
Research has confirmed
that the persons who stutter are subject to negative stereotypes, which have
significantly harmed their employment and promotion
opportunities. These negative views of persons who stutter are shared
by almost all groups studied þ students, teachers, employers, parents,
even speech-language pathologists.
Even worse, studies show that persons who stutter also believe
these stereotypes - and tend to behave
accordingly. It seems that people
who stutter are not only victims of the stereotype, but they themselves may
help to perpetuate it.
Ironically, the negative
image of stutterers may be made even worse by our attempts to avoid or to
disguise our stuttering. For
example, rather than acknowledging a block, we might pretend that we have
forgotten the word, can't decide what to say, or don't know the answer to
a question. Or we might engage
in inappropriate word substitutions or
circumlocutions. While we may
think we have fooled people by doing this, we really
haven't. We have merely confirmed
the stereotype that stutterers are hesitant, indecisive, or
stupid.
In terms of listener reaction,
research has shown that trying to hide our stuttering is actually the worst
thing we can do. Studies
have shown that listeners have a much more favorable impression of stutterers
who acknowledge their stuttering than of stutterers who do
not. Listeners also have a more
favorable reaction to actual stuttering blocks, repetitions, and prolongations
than to the kind of interjections (um's and ah's, etc.) that we often use
when we try to avoid stuttering.
Therefore, if we are to
break the negative stereotypes, we must accept and acknowledge our
stuttering. We must come "out
of the closet" and let employers and others know that stuttering is no stigma
and nothing to be ashamed of.
Of
the many obstacles faced by people who stutter, perhaps the most costly is
employment discrimination.
I am convinced that this discrimination against stutterers is at least
as pervasive as racial or sexual
discrimination. In some ways
it is even more insidious, because: (1) stutterers are a much smaller minority
with less political clout; and (2) many people feel justified in assuming
that stuttering is a legitimate job disqualification or a sign of
incompetence.
The occurrence and impact
of discrimination may vary from person to person depending on a variety of
factors - such as the severity of stuttering, the kind of work, and the
marketability of the individual's other
skills. Some stutterers say
that they have never encountered employment
discrimination. Many people
have achieved success despite their
stuttering. Given a chance,
people who stutter have distinguished themselves in all walks of life - including
business, law, medicine, science, literature, entertainment, and even politics.
Nevertheless, for persons not so fortunate, employment discrimination continues
to be a problem with serious consequences.
During my 15 years as a
National Stuttering Association chapter leader and then as Chair of the NSA's
Advocacy Committee, I have heard from stutterers who try to hide their stuttering
on the job for fear of being fired, who suffer harassment or unfavorable
evaluations by intolerant supervisors, and who have been denied promotions
to supervisory positions or jobs that involve speaking or dealing with the
public. I personally felt the
sting of employment discrimination early in my legal career, when I was openly
rejected by firms because of my stuttering, despite my academic
qualifications.
Our
right to equal opportunity should not be conditioned upon our
fluency. Every person who stutters
should have the right to accept his or her own stuttering - and to insist
that employers judge them solely upon their ability to perform the essential
requirements of the job in question.
A pretext commonly used by employers to reject stutterers is the job requirement of "excellent oral communications skills." Often this has been invoked simply because the job occasionally involved answering the telephone or speaking to people. Employers must learn that (except in the most severe cases) persons who stutter are capable of adequate - and often very effective - oral communication, regardless of their disfluency. If stuttering disqualifies them from every job that involves some speaking or use of the telephone, they will be excluded from vast areas of the job market - and particularly from the most desirable jobs.
The greatest obstacle to
communication comes when people feel compelled to hide their stuttering
out of fear of reprisal. For
employers to demand fluency as the price of one's job only creates a vicious
spiral of stress and anxiety that makes stuttering worse.
In fighting stuttering
discrimination, we can each be our own best
advocates. We can begin
by:
|
Rooting out our own negative
stereotypes and feelings of shame about stuttering; |
|
Presenting our stuttering
in a positive, open, and straightforward way, without trying to hide behind
annoying and self-defeating avoidance behaviors; and |
|
Educating employers and
the public about the nature of stuttering, to help them feel more accepting
of it, and to show how intolerance only aggravates the
situation. The Valsalva Hypothesis
might help in this regard. |
As a last resort, we may
pursue legal remedies to challenge acts of
discrimination. In the United
States, a number of state and federal statutes now purport to outlaw
discrimination against persons with handicaps or
disabilities.
The Americans with Disabilities
Act of 1990 ("ADA") is a federal statute that bans discrimination "against
qualified individuals because of a disability, in regard to job application
procedures, hiring, advancement, discharge, compensation, job training, and
other terms, conditions, and privileges of
employment." It currently applies
to employers with 15 or more employees.
The Rehabilitation Act of 1973 provides protection for handicapped
individuals employed by federal agencies or employers receiving federal funds.
Other employers may be covered by various state
laws. Each statute has its own
specific terms, applicability, and procedures, which must be followed
precisely.
I appreciate the fact that
many people who stutter dislike being called "handicapped" or
"disabled." Of course, we
know that stuttering need not be a
handicap. But the purpose of
these laws is to protect us from discrimination by people who aren't so
enlightened. To qualify for
legal protection, we must therefore be open and "up front" about our
stuttering. The worst mistake
would be to try to hide your stuttering in a way that truly interferes
with your job performance (such as by not talking, avoiding the phone,
etc.). This might give the employer
a legitimate excuse for firing you - even if stuttering itself wouldn't
be.
Unfortunately,
discrimination cases are usually very hard to win, even for experienced
attorneys, so they should not be undertaken
haphazardly. As in other disability
cases, the threshold question will be whether the individual's stuttering
qualifies as a "disability" as defined in the relevant
statute. This determination
must be made on a case-by-case basis and is subject to many legal
technicalities.
Because stuttering is such
a complex and misunderstood disorder, stuttering discrimination cases must
be carefully planned and prepared in order to avoid potential
disaster. My greatest fear is
that poorly prepared cases will result in unfavorable judicial opinions,
which will then be followed by courts in other cases and seriously damage
the rights of all persons who stutter.
It would be a tragedy if we allowed the popular prejudices and
misconceptions about stuttering to become enshrined as judicial precedent,
leaving millions of persons who stutter without legal
protection.
In
this book, I have described my own way of understanding and controlling a
problem that had tormented me since
childhood. With the help of
the Valsalva Hypothesis and Valsalva Control, I was finally able to get a
handle on stuttering and change my life.
However,
I don't claim to have "found the answer" for
everyone. Because stuttering
is such a personal matter, the only "answer" that really counts must be
discovered by each individual who
stutters. We must each find
our own way "out of the woods."
While seeking to improve
our fluency, we must also remember that fluency is not the meaning
of our existence. As we have
seen, the quest for perfect speech is unrealistic, unnecessary, and ultimately
self-defeating.
We may never reach the
point where we are absolutely fluent all the
time. Ingrained in the nerve
pathways of our brains, stuttering may linger with us, to one degree or another,
throughout our lives.
Nevertheless, we can understand
stuttering to the extent that it no longer torments us, and we can control
stuttering to the extent that it no longer interferes with our ability to
communicate effectively with others.We now have an exciting opportunity to
transform our speaking experiences into something far easier and more enjoyable
than ever before.
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