Health Stammering is Not a Disease

"Mu..mmm..mum..mummy! We wa.wa.wa..won the mmm..mmmatch!" Mrs. Sharma's body tenses up whenever she hears her 10-year old son stammering. She becomes desperate herself, when Amit gets stuck on a word and struggles so hard to speak it out. His young-er brother speaks absolutely normally which makes it even more difficult for Amit. Mrs. Sharma : "Sometimes, a class-mate might tease him and that makes Amit feel as if he is abnormal. Last year he used to come home crying. He speaks quite well with everyone at home or with some of his friends. He has no difficulty when he sings or recites from memory. But when the teacher asks him to read in class, he breaks down into severe stammering. The problem is especially noticeable when he is excited or angry. Talking on the telephone is also difficult for Amit. From the time he was 4 years old and had started stammering, we had mentioned it to our pediatrician but he advised us not to worry because it would disappear when Amit reached 6 years of age. Now, 4 years later, the problem is in fact increasing. I feel helpless".  

There are more than 45 million people in the world today who stammer and approximately 10 million live in India . Stammering is predominantly a 'male' condition (80% of all stammerers are male) and it usually affects the first-born male child. A significant majority of stammerers (65%) have a family history of the disorder; usually the father who stammers or speaks at a rapid rate. Nearly always, stammering starts before the child is 5 years of age. If left untreated, it peaks in severity around the age of 10 to 18 years and then begins to stabilize or fade away as the stammerer grows older. 

A stammerer knows precisely what he wants to say but cannot, for the moment, say it because of an involuntary repetition, prolongation or cessation of the speech sound. Research suggests that the disorder might be caused due to a 'neurological mistiming' during the act of speech which leaves the stammerer confused about when exactly to say the word he wants to say. Speaking is not merely the movement of the tongue but involves a fine coordination of both mental and physical processes. Like all other physical actions, the act of speech is the result of neuro-muscular coordination which involves the transmitting of electro-chemical messages from the brain to the appropriate muscle groups. For everyone of us (non-stammerers and stammerers alike), this neuro-muscular system sometimes trips and fails especially during moments of inadequate emotional control. Haven't we all found the quality of our speech delivery changing with our feelings as we experience thrill, anger, fear, joy or other such strong emotions? For the stammerer, this 'tripping' occurs much more frequently than it does for normal speakers. Whenever he faces what he perceives as a 'feared' situation, the stammerer adopts a mind-set which triggers off spasms of speech-blocks. Such fears can also center around certain speech sounds or even certain people.

Actually, all stammerers have periods of fluency when they are emotionally relaxed but revert back to dysfluent speech under stress. Answering the roll call in class, speaking on the telephone, talking to someone in authority, speaking in a group, attending a job interview, etc. are some such pressure situations which might cause an increase in stammering behavior.

One more of the unusual facts about stammering is that even the severest stammerer can sing fluently without any speech blocks. This is because when we sing a song, we know exactly when to say the words and there is no ambiguity in our minds about this timing. In conversational speech however, we cannot bank on any such cues but as normally fluent speakers, most of us do not need these cues. However, without these cues, a stammerer's speech becomes disoriented, because of his 'wrongly tuned' neurological speech-timing system. He experiences difficulty in maintaining a smooth forward flow of words in the sentences he speaks. Frequently repeated, these instances of stammering arouse fear in the mind of the child who stammers. With growing years, these fears keep snowballing until the stammerer begins to experience tremendous frustration, anxiety, shame, embarrassment, even guilt every time he opens his mouth to speak. He begins to recoil from speaking. The smirks on the faces of his listeners which his speech sometimes elicits do nothing to help his self confidence. In every other respect, except speaking ability, the stammerer is a completely normal human being, as good or bad as the rest of us. In fact most stammerers are sensitive and intelligent people. 

Scientists have yet to pin-point the exact cause of stammering. In ancient times, the condition was attributed to every possible source including sometimes the devil himself. One can only guess the varieties of tortures undergone by stammerers in their quest for speech fluency in those days. Even now, stammering has remained a confusing speech impediment for the sufferer as well as for those who have attempted to cure it through medicines. 

One stammerer poignantly asks : 
I can see
I can hear
I can sprightly walk.
Why do all my problems surface When I try to talk?

In their desperate search for fluency, many stammerers in India subject themselves to a myriad of so-called treatments ranging from swallowing vile concoctions to allowing themselves to be pierced with needles and cut with knives. Actually, such treatments hold no relevance to the problem of stammering and only cause greater frustration in the long run. 

Some psychiatrists might prescribe tranquilizers in the belief that relieving stress would help speech fluency. Such drugs usually complicate, rather than resolve the issue and are strongly de-recommended for the treatment of stammering by most speech pathologists. 

Dr. Peter Rosenberger, M.D., Director, Learning Disorders Unit at Harvard Medical School, Boston says "Since the increase in stammering during anxiety is a common experience, it might be assumed that drugs that relieve anxiety would be beneficial. However, minor tranquilizers have been tried many times without success".

Hypnosis has also shown unpromising results in the treatment of stammering. A few stammerers who might become fluent while under a trance invariably return to stammering when out of the hypnotic state. 

Yoga and meditation might really hold the key to solving the problem of stammering. With the greater sense of emotional and intellectual balance that these disciplines promote, the stammerer might find them of tremendous help in his attempts to develop 
better control over his speech.

Dr. Edward Conture, Professor of Speech Pathology at Syracuse University, New York, talks about what causes stammering :

"Things that cause stammering may be, and probably are, quite different from the things that keep it going, aggravate or worsen it. For example, if you mishandle a knife, you may cut your finger. The knife causes the cut and initial pain. Salt rubbed into the cut makes the pain continue or even worsen it but the salt does not cause the cut". Dr. Conture says, scientists "...still haven't found the 'knife' that causes stammering. However, we do know something about the 'salt' that keeps it going, makes it worse or aggravates it". 

These are aspects which can be changed through self-therapy to help the person overcome his speaking difficulty.

Speech is one of our body's strongest habits and stammered speech is also a habit. Stammering is not a disease and therefore, it cannot be treated through medicines. The stammering child or adult has to be helped to develop a new, more fluent manner of speech through an intensive re-orientation program which focuses on modifying his physical manner of talking as well as changing his mental attitude towards the problem. 

Case-History :

Mohan, a 24 years old electronics engineer, has been stammering ever since he can remember. The eldest son in his family, Mohan had a bad time at school because his speech was the focus of many unkind taunts from his classmates. As he entered college, he became an emotional loner and his stammering became so severe that he could not get even one smoothly spoken sentence out. "Answering questions in class or even saying the word 'present' during roll call was an impossibly difficult task" says Mohan, "I avoided speaking with anyone new and clung to one or two chaps whom I'd known at school."

During his years at IIT, Mohan took control of his problem and practiced at changing the manner of his speech. With some professional help and regular self-therapy, he was able to develop fluency in most speech situations. Mohan still stammers off and on. "I think that's because I've not really been sincere with my self-therapy exercises for the last 2 years. I've been busy at work and in any case, my stammering doesn't bother me as much as it did when I was in college. I've come to terms with it". 

In India where even today, stammering is considered funny; where the comedian in our films still stammers in search of cheap laughs, one of the primary goals of The Speech Foundation, India is to disseminate correct information about this baffling speech condition and suggest ways to overcome it. 

Another one of its goals is to suggest how non-stammerers should react when they encounter a person who stammers. 

Many of us might experience a feeling of embarrassment when we converse with stammerers; some of us look away while others go ahead to complete their sentences for them. In talking with a stammerer, the following hints might be of help:

  1. Listen to what is said, not how it is said.

  2. Be patient and don't hurry the person talking.

  3. Try to maintain natural eye contact. 

  4. Simplistic advice ("breathe properly", "don't worry", "don't be afraid", etc.) though well- meant is not always helpful.

  5. Stammerers have difficulty when talking but don't assume they are stupid or confused about what they are saying.

  6. Many stammerers have difficulty when they speak on the telephone. Please do not hang up if the caller is taking longer than usual or if he is silent for a while.
    Stammerers usually try and hide their speech problem from their listeners. This attempt at camouflage is counter-productive because it only acts as psychological 'fuel' for even more speech-blocks. If the stammerer is open about his speech difficulty, he experiences lesser stress and is able to speak with greater control. 

In the final analysis, stammering can be overcome if the sufferer seeks scientific, professional guidance and is ready to work towards achieving speech fluency through regular practice of therapeutic techniques. It certainly cannot disappear by ingesting some magic potent!    


More by :  Dr. Ajit Harisinghani

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