What is Stuttering?
Stuttering is a condition which affects the fluency of speech. The symptoms generally display either through repetition of a part of word, i.e. would you like to d-d-d-dance, or through the speaker blocking on particular words, i.e. my name is {extended pause} Daisy. It is quite common for both these general symptoms to display simultaneously, i.e. my name is {extended paused} D-D-D-Daisy, especially if the stutterer tries to force the words out to break the block. These overt symptoms may also be accompanied by physical expression of embarrassment such as blushing, avoiding eye contact, etc., and sometimes also by physical tics such as spasmodic jerks as the stutterer tries to force the words out. As well as these overt symptoms, there are almost always covert symptoms such as avoidence and word substitution. The stutterer will often avoid speaking situations where they feel they may stutter, or even when they are speaking they may substitute one word for an easier word if they feel they are going to stutter on the former word. This can go as far as making up a new name if they feel they are going to stutter when giving their own name! For the purposes of this page, and in general throughout this site, the term disfluency will be used to cover all the symptoms of stuttering, whether overt or covert.
The words stuttering and stammering may now be used interchangeably. In the past, stuttering has been identified with a disfluency in enunciated speech while stammering was identified with blocking where a person is unable to enunciated any spoken word at all. There were sometimes seen as different conditions, though of recent years they are now universally seen as symptoms of the same condition.
Sheehan1 (1970) defines stuttering as a disorder of the social presentation of the self. He sees it as essentially a conflict revolving around self and role, and states that therapy should be role specific. He further claims that the stutterer typically experiences no difficulty when alone and that the stuttering behaviour requires both a listener and a speaker.
I would disagree with this definition. I have sometimes experienced difficulties in fluency when reading aloud to myself when completely alone. However, I do recognise that there may be other people for whom disfluency is only experienced in a social context, and thereafter only in specific circumstances. Every stuttering problem is individual and while the symptoms may be similar, they are unlikely to be identical between different stutterers. This is why any therapy or cure may need to have a personalised bespoke element to be effective. Ipso facto, any current definition of stuttering should be defined by the symptoms and not the causes which are possibly multifarious and still largely nothing but conjecture at this point in time.
I would define stuttering as a speech impairment where the speaker has difficulty in forming fluent speech to a greater or lesser extent depending of the severity of the condition and the specific situation in which he or she is trying to enunciate. Note that context is a much broader term than a role theory of speaker and listender. I then define two categories of disfluency in the context of stuttering: general disfluency and specific disfluency.
General Disfluency
General disfluency is disfluency associated with general non-optional dialogue. Non-optional dialogue is defined as a speaking situation which the speaker either chooses not to avoid or is not able to avoid. For example, a speaker may always choose never to avoid dialogue with close friends or family, regardless of the fact that they may experience disfluency of speech. Another example could be a work situation where the speaker is required to make a spoken presentation in circumstances where they are likely to experience disfluency. If the speaker resigns to the fact that they have no option than to comply the situation falls into the general category. Whether there is a choice or not is solely determined by the speaker, based on his or her assessment of the situation.
Specific Disfluency
Specific disfluency is associated with optional dialogue. Optional dialogue is defined as a speaking situation which the speaker feels he or she can choose to avoid if they so wish. This can include introducing yourself to a person you don't know, choosing to ask someone for directions, etc. To contextualise the difference between general and specific disfluency, in the example of the presentation outlined above, if the speaker feels that they have the option of refusing to give the presentation then the categorisation changes to specific disfluency. Therefore, the demarcation of a episode of disfluency into either general or specific is very much defined by the individual personal take on the situation.
In the presentation example, the speaker may feel that they do have an option to refuse to make the presentation even though, to give an extreme example, they could be potentially dismissed for failing to meet the terms of their contract of employment. Therefore the situation falls into the specific category. Another person could recognise that the consequences of refusal are too potentially devistating to allow for such a choice and resigns themself to probable disfluency, this then falls into the category of general disfluency (the symptoms of stuttering have been assessed as being a lesser evil to other consequences).
In contrast to general disfluency, the effects of specific disfluency are twofold: the speaker can still experience disfluency if they do in fact choose to speak; the additional effect is that the speaker may expend significant time and energy contemplating whether he or she should speak, weighing up the consequences based on their own perceptions (a sort of game theory). In general disfluency, only the former effect is experienced as the speaker has not given him or herself the option of avoidence. While the two effects can be mutually exclusive in some circumstances, in other situations they may seem to be experienced cotertainmously. For example, a speaking situation is not avoided but the speaker does not say exactly what he or she wants to say, or the speaker engages in dialogue but seeks to terminate the conversation as soon as possible to minimise the risk of disfluency.
As explained above, specific disfluency does not seem to always involve a complete avoidence of speaking. Therefore, speakers can only really be stated to be experiencing general disfluency if as well as not avoiding a speaking situation, they in fact also say everything they want to say, and use all the words they want to use without substitution or other tricks. In contrast, general disfluency never involves the speaker making a choice about what to say or whether to speak. If they need to enunciate feared words to communicate what they want to say they will not avoid or try to substitute these words, but will continue to talk regardless of any disfluency experienced. If they experience a long block they will just wait until it finishes!
In general, all situations should be defined into one or other of the disfluency categories: if there is any element of choice or potential avoidence, the situation should be defined under specific disfluency. However, it may not always be as clear-cut as that. For example, suppose a day-long meeting is scheduled, and it begins under the parameters of general disfluency where the speaker contributes exactly what they want to do regardless of any disfluency. Suppose that towards the end of the day, a senior manager which the speaker fears then joins the meeting and the speaker begins to avoid making contributions for fear of disfluency. In these circumstances, the meeting should be broken down into two separate sub-meetings for the purpose of defining fluency, demarcated by the point when the senior manager appeared on the scene. Note that specific disfluency is defined by what the speaker feels they should say; if the arrival of the senior manager meant that specific pertinent issues needed to be discussed within a limited timescale, the speaker may decide that something they were going to say is now relatively unimportant given the changed circumstances of the meeting. The same goes for contributions in general; the speaker only experiences disfluency if something they feel needs to be said is not being said. There is no need to say something just for the sake of doing so; no-one is impressed by people who speak at meetings just for the opportunity to hear their own voice! However, in this regard, the stutterer needs to be very honest about how he or she defines such circumstances and should not try to mislabel disfluency on the basis that they had nothing important to say
By its nature, specific disfluency is relative. In the presentation example, the speaker may not completely avoid the whole situation but may try to avoid constituent parts. For example, say the presentation the speaker had been asked to make also, by virtue of being the first presentation at the briefing, involved making a sub-presentation introducing all the other speakers sitting at the front table. The speaker may make up an excuse such as work pressures mean that there is is a chance that they will be momentarily late to the briefing and that as such it would make more sense to have another person make the introductions and that he could make the second presentation instead.
Symptoms of Disfluency
Note that the disfluency experienced in either general or specific disfluency may be greater or lesser than that experienced in the other category. The stuttering experienced in general disfluency is by no means less extreme than examples of specific disfluency. There can still be a sense of foreboding when a situation of general disfluency is anticipated; the difference is that a fatalistic attitude is taken to anticipated disfluency which strangely enough can be no bad thing. In the context of the presentation example, the stutterer is unlikely to be particularly looking forward to having to give the presentation; however, in situations categorised under general disfluency, the stutterer has resigned themselves to the probable appearance of the symptoms of disfuency, but has just decided that they will have to deal with them if they occur. In contrast, scenarios involving a choice, may also exacerbate a cycle of fear; the stutterer is likely to think more about the situation in advance as there is the possibility of avoidence. They may also begin to make value judgements: are the potential symptoms of disfluency worth the kudos attained by giving the presentation in the first place? The anxiety this generates may exacerbate the disfluency.
On the basis of a strict application of the definitions above, it unlikely that any stuttterer will experience general disfluency all the time, and they are likely to slip back in specific disfluency from time to time. If a stutterer is experiencing a significant amount of disfluency, there is a great temptation to limit the amount of speaking where at all possible; the stutterer may still communicate their point but using the mimimum amount of dialogue. In a conversation, they may make a number of contributions, but not at such a level that they would do so if totally fluent. On the other hand, being verbose is not always a quality that is appreciated by all. General (rather than specific) disfluency, if to be seen as a goal, should be assessed on the basis of an optimum value rather than a absolute basis.
An approach which tries to categorise more and more speaking situations under the parameters of general disfluency is the Sheehan theory of Voluntary Stuttering. If a stutterer manages to move much of his or her speaking life under the auspices of the general disfluency, which is somewhat comparable to the aim of voluntary stuttering in making the stutterer comfortable with his or her disfluency, they may reach a stage where their stuttering, and their perception of it, no longer becomes such a big deal. In tandem, their fluency may also generally improve as the anxiety associated with their stuttering diminishes. By removing the symptoms specifically associated with specific disfluency, the stutterer may now be in a position to concentrate his or her personal resources on the causes of general disfluency.
Similarily, given the relative nature of specific disfluency, it can be possible to work on incremental change so more and more choices are removed from the equation. This can be a preliminary process to making the jump to general disfluency. To paraphrase Joseph Sheehan, this is akin to floating the submerged iceberg up towards the surface.
Causes of Stuttering
There has never been a definitive answer to the question of what causes stuttering. Heredity factors are often mentioned. Physiological causes have been suggested, as have neurological causes. While it may not be possible to define specific causative factors, it can be useful to keep all these factors in mind when experimenting with remedies. The most important thing is success with regards to therapy, the causitive factors, though it would be interesting to know them, can be relatively unimportant if relief from the symtoms of disfluency is achieved (as long as the relief is more than momentary).
Issues relevant to stuttering may include the below (please note that inclusion in the list below in not indicative of any link with stuttering). Many of the items are included as some people may perceive a connection, however tenuous such a connection might be :
Footnotes:
1: Joseph G.Sheehan, Stuttering Research and Therapy, p.277 (Harper & Row, 1970)