Understanding and Controlling Stuttering.
THIS IS THE BOOK I wish I could have read many years ago, back when I started high school as a teenager with a severe stuttering problem. I had stuttered since age four, but adolescence was when the agony really began. Although I started as a straight-A student, winner of the school science fair, and president of the freshman class, my struggle with stuttering soon turned my life into a nightmare of frustration, embarrassment, shame, anger, and even doubts about my own sanity.
Through elocution lessons, I had developed a fine speaking voice and the ability to act out roles in front of audiences with perfect fluency. This convinced me that there was nothing basically wrong with my vocal mechanism. However, in ordinary speech, my stuttering was becoming worse than ever. What could explain this paradox? And what could account for the tendency to stutter more in some situations, or on some words, than others? Was my problem all "psychological"? Was I neurotic or crazy?
Thus began my personal quest to understand and control my stuttering. Over the next three decades I read books on stuttering and psychology, volunteered for experiments and studies, and submitted to a wide range of treatments. These included speech therapy at a number of university clinics, psychological counseling, and many years of intensive psychoanalysis (based on the then-prevalent notion that stuttering was caused by unconscious emotional problems). None of these did very much to resolve my stuttering.
I finally quit psychoanalysis in frustration, because of the analyst's insistence that the cause of stuttering was purely psychological, without any physiological component. However, I did not fare much better with various behavior-type therapies - such as those using the miniature metronome or the "airflow" technique. I hated the monotonous and unnatural sound of these "artificial fluency" methods and found that I soon relapsed back into stuttering. Furthermore, these approaches did not give me a satisfactory understanding of why I stuttered, or exactly how the psychological and physical factors interacted to cause stuttering in some instances but not in others.
At the moment of stuttering, it seemed as if a mysterious "switch" was thrown that caused a vise to clamp down on my speech. I suspected that the "switch" was physiological in nature, but that it was tripped by psychological factors. I hoped that, by discovering the exact mechanism involved, I would have a rational basis for understanding and controlling the problem.
After terminating all therapy, I continued to search for the answer through personal experimentation, extensive review of medical literature, and consultations with professional researchers in the fields of laryngology and speech pathology. I studied hundreds of books and articles on not only stuttering, but also related areas of anatomy, neurology, and speech production. I met with researchers at the Temple University Speech Department and the Pennsylvania Hospital Department of Laryngology, and corresponded with other experts around the United States. On one occasion, I had a fiber-optic tube inserted through my nasal passage and down my throat to obtain videotapes of my larynx in action.
Through these efforts, I found what I believe to be the physiological "switch" to my stuttering. It is called the Valsalva mechanism - a neurologically coordinated combination of muscles in the larynx, mouth, chest, and abdomen. Its normal function is to assist us in exerting strenuous physical effort or in forcing things out of the body (as in defecation). However, if we mistakenly activate the Valsalva mechanism during our effort to speak, I believe it may cause a forceful blockage of airflow or an interference with phonation - two of the basic, underlying elements of stuttering.
This mechanism perfectly described the symptoms I experienced during stuttering. It explained why stuttering was more likely to occur when I felt the need to "try hard" to speak or to "force out" the words. It was also consistent with nearly all the facts I knew about stuttering, both through my own observations and my reading. However, I could find nothing about the Valsalva mechanism in any of the literature on stuttering - except for a few studies in Czechoslovakia that were later brought to my attention.
Spurred on by the thrill of discovery, I proceeded to formulate what I called the "Valsalva Hypothesis." Briefly stated, it shows how stuttering may result from a neurological confusion between two normal bodily functions - the voice and the Valsalva mechanism. I first mentioned these ideas in a short article, "Finding My Way Out of the Woods," which appeared in the January 1985 issue of the National Stuttering Project's newsletter, Letting Go. A longer paper, "Stuttering and the Valsalva Mechanism: A Hypothesis in Need of Investigation," was subsequently published in the December 1985 issue of The Journal of Fluency Disorders.
Although the Valsalva Hypothesis has not been tested scientifically, and therefore has been neither proved nor disproved, it provides a "working hypothesis" which explains the complexities of stuttering better than any other theory I have seen.
The more I worked on my hypothesis, the more the contradictions and paradoxes of stuttering made sense. After a lifetime of frustration and confusion, the pieces of the puzzle were finally falling into place. Through these insights I was, for the first time, able to get a "handle" on my problem. I was able to develop exercises and approaches to speech that increased my fluency dramatically. My speech improved to such a degree that I was soon able to function comfortably in the highly stressful and speech-intensive position of a trial lawyer - a goal that I had dreamed of for many years.
Having
found the Valsalva Hypothesis to be of great value in my own case, I was
eager to learn whether it might be helpful to other persons who
stuttered. My desire to share
and test these ideas led me to the National Stuttering Project (now known
as the National Stuttering Association), a non-profit self-help
organization. With the help
and encouragement of its Executive Director, John Ahlbach, I founded the
Philadelphia Area Chapter of the NSP in January
1985. I led the chapter and facilitated its self-help/support
meetings for the next 15 years. In
1996, I was elected to the NSP's Board of Director and became Chair of its
Advocacy Committee.
It
was also my pleasure to work with Robert Gathman, the president and founder
of Speak Easy International Foundation, Inc., headquartered in New
Jersey.
Over
the years, I have met hundreds of people who stutter - not only at our local
chapter meetings, but also at workshops and conventions of the NSP/NSA, Speak
Easy International, the Canadian Association for People Who Stutter, and
international conventions for people who
stutter. I have
In
August 1992, I presented two workshops on the Valsalva Hypothesis at the
Third International Convention of People Who Stutter, held in San Francisco,
where I also introduced a special preliminary edition of this
book. The first completed edition
of this book was published in 1994.
In 1995, I was invited
to give a major presentation and workshop at the World Congress for People
Who Stutter, held in
Linköping,
Sweden. I subsequently adapted
my Sweden speech into an article, "The Valsalva Mechanism: A Key to Understanding
and Controlling Stuttering," which I published on the
Internet. That article has elicited
enthusiastic e-mail from hundreds of stutterers all over the world - many
declaring that the Valsalva Hypothesis described their stuttering experience
more precisely than anything they had ever encountered.
This has been the first
book to deal with stuttering in terms of the Valsalva
Hypothesis. It is intended primarily for the adult or adolescent person
who stutters, but hopefully it will also be of interest to therapists and
others concerned with the problem.
It does not offer any quick and easy gimmicks to "cure"
stuttering. Instead, its approach
requires that we first gain a thorough understanding of what stuttering
is and why we do it. Only then are we ready to master the principles of
controlling stuttering.
Based on insights gained
from the Valsalva Hypothesis, this book will present a comprehensive view
of stuttering, including both its physical and psychological
aspects. It will show how these
factors may interact to cause and perpetuate stuttering through the
"Valsalva-Stuttering Cycle." In
this way, we shall attempt to explain virtually every aspect of stuttering
behavior, its paradoxes, its causes, and its
treatment. We shall analyze
the symptoms and circumstances of stuttering, the development of stuttering
in childhood, the influence of heredity and neurological factors, and the
physical and psychological conditions that tend to increase or reduce
stuttering.
These discussions have
been organized with the lay reader in mind, starting out as simply as possible
and then gradually introducing more and more complexity as we go
along. To ease the way, I have
tried to avoid scientific jargon and to explain the physiological aspects
of speech in simple, everyday terms.
Likewise, I have chosen to use the ordinary English alphabet - instead
of the scientifically preferred phonetic alphabet - in representing the various
sounds of speech. (I hope that
professional speech-language pathologists will not find this too
disconcerting.)
We shall then proceed to
discuss the strengths and weaknesses of existing therapies, point out the
elements that many of them have in common, show why most stutterers tend
to relapse, and indicate ways in which therapies might be made more
effective. Finally, we shall
suggest an experimental program of self-therapy that incorporates both physical
and psychological techniques aimed at controlling the Valsalva mechanism
and breaking the stuttering cycle.
Readers' responses to previous printings of this book have been overwhelmingly positive. I have received numerous reports, from all over the world, of individuals improving their fluency through Valsalva Control. The South Korean Speech and Hearing Association went so far as to publish a hard-cover translation of this book in Korean. Although scientific studies have yet to be conducted, I have personally seen Valsalva Control produce dramatic results in a clinical setting.
Of course, there is no guaranty that any method will bring fluency to everyone. It would be extremely presumptuous to claim that anyone will be "cured" of stuttering just by reading a book. However, if this book helps even one person to get a better handle on his or her stuttering, it will have served its purpose.