STUTTERING RECOVERY Personal and Empirical Perspectives
This page intentionally left blank
STUTTERING RECOVERY Personal and Empirical Perspectives
Dale F. Williams, Ph.D., CCC-SLP
2006
LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS Mahwah, New Jersey London
This edition published in the Taylor & Francis e-Library, 2008. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.” Copyright © 2006 by Lawrence Erlbaum Associates, Inc. All rights reserved. No part of this book may be reproduced in any form, by photostat, microform, retrieval system, or any other means, without prior written permission of the publisher. Lawrence Erlbaum Associates, Inc., Publishers 10 Industrial Avenue Mahwah, New Jersey 07430 www.erlbaum.com Library of Congress Cataloging-in-Publication Data Williams, Dale F. Stuttering recovery : personal and empirical perspectives / Dale F. Williams. p. cm. Includes bibliographical references and index. ISBN 0-8058-5734-6 (cloth : alk. paper) ISBN 0-8058-4771-5 (pbk. : alk. paper) 1. Stuttering. 2. Stuttering—Treatment. RC424.W495 2005 616.85’5406—dc22 ISBN 1-4106-1724-6 Master e-book ISBN
I. Title. 2005051041 CIP
To my wife Misty, for maintaining such patience during (and with) the writing process. It couldn’t have been that easy. To my children Brennan, Blaine, Cayley, and Caysey: If my life’s work elicits in you only indifference, hey, there’s a lot that’s OK with that. To Dale L., Christel, Sue, Pete, and Andy, because a funny family never hurts. And, finally, to the terrific storytellers in the stuttering support group that meets at Florida Atlantic University and to anyone else who is wrestling with this mysterious disorder, whether or not you choose to seek help.
This page intentionally left blank
The journey is the reward. Chinese Proverb
This page intentionally left blank
Contents
U
Acknowledgments
xi
Prologue: Start Here
xiii
1
What Is Stuttering? What Is Recovery?
2
Eighth-Grade English Class
11
3
How to Read Research (and Non-Research)
16
4
An Empirical Investigation: Analyzing the Effectiveness of a Self-Help Application Method for Treating Stuttering
32
5
Recovery and Therapy
36
6
The Depo
52
7
Support Groups
61
8
The Meeting
68
9
The Stereotyping of People Who Stutter
75
1
ix
x
V
CONTENTS
10
A Visit From St. Notker
83
11
Listeners
92
12
Stories of Listeners
101
13
Friends, Family, and Significant Others
117
14
The Family Dinner
126
15
Self-Improvement Is Worth the Risk
130
16
The Match of a Lifetime
137
17
Odds ’n Ends
144
18
The Bottom Line
161
19
Questions for Discussion
165
20
Other Essays
176
References
185
Quotation Source List
197
Author Index
199
Subject Index
205
Acknowledgments
U
In addition to those cited in the dedication, I would like to single out some individuals who read some or all of the chapter drafts, sometimes unknowingly, and offered everything from encouragement to specific editorial comments. These include Vikesh Anand, Tom Bachman, Klaas Bakker, Mike Brady, Gary Cohen, Susan Dietrich, Joe Donaher, Peter Dugan, Leslie Kirchoff Fauquet, Steve Hood, Judy Kuster, Jeff Lewis, Ken Logan, Fred Murray, Bob Quesal, Peter Ramig, Nan Bernstein-Ratner, Junior Tereva, Deena Wener, and all of the unnamed reviewers who tendered comments throughout the process (even the critical one—I’d ask what the deal is with you, if you hadn’t been right about so many things). Allow me to also acknowledge Kimberly R. Brinkmeyer, Cynthia Core, Ali Danesh, Rebecca Elman, Barb Fries, Luanne Hopkins, Nancy Lewison, Robert F. Kidd, Karen McCormack, Bill Murphy, Michael Schenker, Ron Taylor, John Tetnowski, and Scott Yaruss, all of whom helped me locate information I needed but couldn’t find myself. I guess my mom was right in her repeated comment regarding my good fortune in having an attached head. I wish to thank both Carlos Diaz and William Palmer for their contributions to this book. And Deb, thanks for the quote and know that you are greatly missed. I thank the other contributors as well, but promised I wouldn’t name them. At Lawrence Erlbaum Associates, several people deserve recognition: Bonita D’Amil, Derek Fiore, Victoria Forsythe, and Nadine Simms among them. I should also thank Mr. Erlbaum himself, given that he’s the one
xi
xii
V
ACKNOWLEDGMENTS
who OK’d all of this. Special thanks go out to Sponsoring Editor Cathleen Petree, who saw this project through from beginning to end, including answering all of my dopey questions with both patience and unrolled eyes. Finally, I thank all colleagues, students, clients, parents, support group participants, list serve posters, and everyone else who floated ideas out there for me to think about. This includes the guy in the local tennis league who shared numerous opinions about stuttering during changeovers. If I left anyone out, I’m truly sorry. Please remember the potential I apparently have for misplacing my own head and let me know that I forgot you. With any luck, there will be a next time and I’ll get to you then.
Prologue Start Here
U If I ruled the world, this book would not be necessary. That’s because recovery from stuttering would be far easier than it is today. Of this, I would make certain. How? Well, I haven’t worked out all the details yet, but I would begin by enacting the following laws. · Those who offer pedestrian advice such as “Slow down,” “Think before you speak,” and “Take your time” would be subjected to one full day with a really obnoxious person following them around and shouting out simplistic instructions (“Hey Joe! Having trouble with that budget report? Just write down what you want to say! Then print it!”). · Those who bully, tease, interrupt, or finish the sentences of people who stutter would be dressed in Cleveland Browns colors, flown to Pittsburgh, and dropped off at the nearest Steelers bar. The interpretation of this law would be broad enough to include those who mimic stuttering in private, waiters who audibly sigh to let stuttering individuals know they are taking too long, and people who grunt while listening, so breathless with anticipation are they to begin talking at the first inkling of a pause. · Therapists offering quick-fix solutions would be forced to enroll their own children in expensive private schools where teachers claim to impart all the necessary knowledge in two convenient 60-minute sessions, then spend the remainder of the kids’ educational years lambasting them for not implementing the knowledge properly. · Support group attendees who hijack meetings to push their personal cures would be sentenced to spend 48 hours in an elevator with a car salesman needing just one more deal to make quota.
xiii
xiv
V
PROLOGUE
· Condescending listeners would be required to continue nodding their heads and smiling until such time as they are sold as bobbleheads. · Employers who don’t hire the stuttering applicant because he or she makes them uncomfortable would be immediately placed under the supervision of an Alaskan wolverine and forced to spend their workdays eating ferns and avoiding bite wounds. In cases where a wolverine is not available, an ’80s hair band will serve as an adequate replacement. · Those who question or blame the parents of stuttering children would serve lengthy sentences for unsolved crimes they clearly had nothing to do with. · Stuttering individuals who falsely claim to be “cured,” “fearless,” “covert,” or whatever the next flavor-of-the-month designation is would be forced to watch themselves on videotape until such time as they figure out what these terms do and do not mean, or until they willingly hire someone to spray paint the word DENIAL on their scalps, whichever comes first. · And finally, any pediatrician who cites an 80% spontaneous recovery rate as evidence that worried parents need not seek help for their disfluent child would be greeted with the following scenario at the end of the workday. “There are five cars remaining in the parking lot—yours and four others. “One of the five cars you see has been wired to explode on ignition. “You must either (a) take your chances and drive home or (b) turn around, go back inside, call every mother in town, and admit that maybe a 20% likelihood is not one to mess around with.”
Unfortunately, I don’t run the world. Worse yet, I have seen scant evidence that those who do plan to implement the aforementioned laws. Until such time, then, recovery from stuttering will continue to be an uphill trek. Fortunately, however, there is help available. Research on recoveryrelated matters such as treatment and support groups is published so regularly that people in the field no longer even pretend to have read it all. Equally instructive are the experiences of those who have attempted to clear some of the barriers to recovery. If they are anything like me, they have stumbled on to an insight or two along the way. The book you are holding presents research, experiences, and even fiction (explanation to follow) pertaining to recovery from stuttering. To understand how it came about . . . well, I don’t recall exactly how it came about. I do remember: · Being handed a story written by a colleague, who told me that his
stuttering clients were thrilled at how they identified with the main character,
PROLOGUE
V
xv
· Giving the story to some of my clients and being asked why I never
did anything interesting like this before, · Being told by a colleague (a different one) that an essay I had written
had inadvertently helped a client better understand the long-term goals of his therapy, · Thinking about recovery and having copious discussions—in person, via e-mail, and over the phone—with speech-language pathologists, people who stutter, parents, spouses, and researchers. And, most importantly, I remember that, while thinking, discussing, and picking the brains of those smarter than me, there were several conclusions that emerged repeatedly. 1. Recovery from stuttering is a crucial concept for speech-language pathologists and their clients to grasp. 2. Recovery as a concept is about as easy to grasp as a goalpost slathered in Crisco (trust me on this one). 3. For a given individual who stutters, some elements of recovery are pertinent, whereas others are basically political debates—fun to talk about but functionally useless. 4. At least partly because of 2 and 3, recovery is often poorly understood, even by those who most need to understand it. 5. The implications of this misunderstanding are as widespread as birthday cake on a toddler’s face. 6. I need to stop writing similes. 7. Without a clear conception of recovery, therapy can progress toward a hazy place, one where objectives are vague and/or tasks inappropriate for a given client. 8. As treatment goals evolve differently for the speech-language pathologist, the client, and those in the client’s support system, bare-knuckle brawls (well, disagreements) can develop between individuals who should be working together toward the same ends. For example: a. Speech-language pathologists may view recovery in terms of meeting formally stated long-term therapeutic goals; b. Clients might consider themselves adequately recovered when they can say what they want to say without worrying about how they say it; c. Significant others might be concerned that their stuttering loved ones not let disordered speech stand in the way of reaching their full potential which, in most families I know, means leader of the free world or a job where you can get relatives free stuff.
xvi
V
PROLOGUE
9. If speech-language pathologists could gain a clearer understanding of the entire stuttering experience, they could develop better goals for therapy. What’s learned in stuttering management textbooks—for example, improving attitudes, increasing speech naturalness, averting violence against boneheaded listeners—would be clearer. There would be a better sense of when to stop therapy for a disorder that cannot be cured, always a tricky endeavor. 10. Stuttering clients aren’t off the hook here either. They often come to therapy with unrealistic expectations. Although certainly understanding how encompassing stuttering can be, they may be guilty nevertheless of searching for a simple solution. As one member of the local support group phrased it, “They want the grail without lifting the pail.” I didn’t really understand it either, but I’ve chosen to interpret it as people who stutter get too wrapped up in the pursuit of a quick cure when they should instead be searching for answers to more realistic questions. By that, I mean questions such as: · How do I live with this disorder? · In terms of diminishing it, what’s the best I can hope for? · What’s my plan for getting there?
Such questions bespeak an attitude toward recovery in which it is seen not as a goal, but, rather, a process. The attitude is similar to that of the slothaholic (a word I made up to mean the opposite of workaholic) who forces himself to finish this paragraph before checking his e-mail for the 37th time today. In other words, the condition can be effectively managed, yet still be very much present. Similarly, many people who stutter are recovering, but few achieve full and complete recovery (i.e., are cured). So why would this be their goal? One idea resulting from these ramblings was to compose a book that could both provide accessible information and stimulate discussion on recovery from stuttering. Upon considering this idea, I concluded that writing a book would be a lot of work and that I would think about it later. I did, however, attempt to initiate recovery-related discussions in therapy sessions. The attempts were notable only in their ineffectiveness. Why this is, I am not certain, but I did feel that the issues needed to be explored in spite of my ineptitude. This feeling led me to search for reading samples that could be used in the same manner as my colleague’s story. Fortunately, I found some good discussion starters and, for many clients, this technique turned out to be a useful means of addressing aspects of stuttering—emotions, avoidance behaviors, difficulties talking to women (my clients have very specific priorities)—that they normally did not wish to discuss with me.
PROLOGUE
V
xvii
This initial success put me on the lookout for good readings. And although I found much of value, sometimes I did not find exactly what I was looking for. I became quite annoyed until someone pointed out to me that materials are not published solely for my benefit. Even so, my annoyance continued to simmer when I noticed that even the most effective essays had a significant drawback: They took real work to find. With a sigh, I realized it was time to take the book idea off the shelf. Given my beliefs that usable material on recovery had already been written but that more was needed, my goal in writing this was twofold: (1) provide additional information on recovery-related issues and (2) make my essays look better by aligning them with good ones. Regarding the latter point, I included a chapter (Chap. 20) that references and summarizes other writings appropriate to this topic. The result (this book) is an attempt to address issues of recovery independently while at the same time realizing how overlapping they can be. Or, stated in a way that actually makes sense, each chapter focuses mostly on one issue, but there are some places where I try to provide a more global viewpoint. The book is written for people who stutter, their significant others, and speech-language pathologists. My hope is that it will be read, reflected on, and discussed within and between all three groups (and, when it’s not, that it be kept on the shelf between Van Riper and Bloodstein as if it belongs there). The chapters alternate between informational papers and stories, as both can, in their own ways, illuminate the different aspects of recovery. Before you begin, just some serious notes on the less serious chapters (the stories). Most are based on firsthand accounts of people who stutter; some (e.g., Chap. 4) are clearly not. The exceptions will (hopefully) be obvious to the reader. The firsthand accounts are either personal stories or those collected from others who stutter. For purposes of confidentiality, it was necessary to rid the latter stories of identifying information. Rather than leave gaping blanks in the written accounts, I chose to fill these voids with new details (read: stuff I made up) to keep flow of the story going. In all cases, however, the final draft was approved by the individual who related the account, on the bases that (1) the spirit of the story was not violated and (2) I agreed to stop calling at 3 a.m. to request this approval.
This page intentionally left blank
Chapter
1
What Is Stuttering? What Is Recovery?
U
He still lives, that boy, afraid his words will break like ice between his teeth. Reading round-robin waiting for his turn to speak, he tried to squeeze the trigger of his mouth and nothing fired. That boy still lives far from the warmth of words his older self now knows. —William Palmer The Boy Inside
It is a disorder of unknown cause or cure, but endless speculation and confusion. Perhaps because of these reasons, stuttering has always been difficult to define. Yet this is where we must begin. After all, in order to examine recovery related to a particular disorder, one must be clear about what that disorder is. Or, as one local support group participant put it, “You can’t talk about recovering if you don’t know what you’re recovering from.”
1
2
V
CHAPTER 1
As might be expected with such an elusive disorder, there is no uniform definition of stuttering. Exactly which symptoms should be considered characteristic of the disorder are open to debate (Brutten & Shoemaker, 1967; Perkins, 1990; Van Riper, 1982). Still, while there are many definitions, nearly all include the overt behaviors of prolonged and repeated speech units. For the average listener, these speech breakdowns are what characterize the disorder. For the speech-language pathologist, they are the basis of stuttering; it cannot be diagnosed without them. For people who stutter, however, the disorder is far more than disfluency. It is also anxiety, worry, guilt, shame, self-consciousness, and a host of other auxiliary features. It is energy spent trying to hide disfluencies, be it via bodily movements, the rephrasing of utterances, substituting words, or any number of other behaviors that individuals have employed for this purpose. In other words, people who stutter deal with not only their speech, but also with secondary behaviors, emotions, attitudes, and fears about speaking. In a now famous analogy (at least within my circles), Sheehan (1997) characterized stuttering as an iceberg. That is, the visible portion is actually quite small relative to the entire disorder. Looking at it from a different perspective, read the following descriptions and determine which person has the bigger problem. Person A presents one-second prolongations and/or repetitions in 10% of speech when talking to friends. Person B is afraid to make friends because of the shame associated with speaking. In other words, what is the real disorder? Is it disfluency or is it the anxiety, embarrassment, and other components that lead one to withdraw? Yaruss (1998) defined stuttering in terms of impairment (the speech disruptions), disability (inability to perform specific communicative tasks), and handicap (failure to fulfill everyday needs, be they occupational, economic, or social). This design indicates how the disorder can extend far beyond disfluencies. In fact, one could argue that the impairment is of concern to the individual only because of the resulting disability and handicap. Of course, the manifestation (not to mention the amount) of impairment, disability, and handicap varies from person to person. Stuttering is, if nothing else, a highly individualized disorder. Still, there is commonality in its development that may help to explain its complexity.
WHAT IS STUTTERING? WHAT IS RECOVERY?
V
3
DEVELOPMENT OF STUTTERING Stuttering usually begins during the preschool years (Shapiro, 1999). As the onset is typically gradual, it takes time for parental concern to develop. However, because early stuttering is episodic (Gregory, 2003a), whatever worries parents develop may soon dissipate. When the problem becomes too big to ignore, parents often ask the pediatrician for advice. A common response from pediatricians is that 1) stuttering is normal and, 2) if ignored, it will go away on its own. Although the first point is false and the second controversial (see section entitled Stuttering: What it is not in this chapter), for the present discussion it is important to note that parents have been advised to ignore their child’s struggles with speech. For a time, the child stutters without concern, taking little notice of parental reactions (or lack thereof). At around the age of 7 years, however, awareness increases as stuttering children begin to show anxiety about their speech difference (DeNil & Brutten, 1987). By then, parents are still, for the most part, disregarding it, save for the occasional advice to “slow down” or “think about what you want to say,” usually delivered out of frustration. Between these extremes are frowns and fleeting looks of disappointment that parents may be unable to uniformly hide. Whether their discontent is aimed at the child or at themselves is immaterial. What is important is that the reactions serve to increase the speech-related anxiety. The child realizes just how wrong it is to stutter. Because of the child’s shame, the parents’ guilt, and the pediatrician’s original advice, stuttering is not discussed within the household. With increased age, the child often becomes progressively more pleased with the family’s unspoken pact, as he or she prefers not to think or talk about this despised condition. Of course, by that time, the stuttering is quite apparent, so the situation takes on an almost ridiculous tone as people ignore an obvious part of their daily experience. It is the emperor’s new clothes in reverse: Everyone knows it is there, but no one acknowledges it. Because the topic is off-limits at home, the child cannot ask his or her disappointed parents for help. Unfortunately, this time of increased awareness of stuttering and its consequences coincides with the ages during which teasing typically begins (Noll & Carter, 2004), a problem that only increases with age (Dickinson, 1999). Thus, it is unlikely that the child will confide in peers about what has become an embarrassing condition. Given no alternatives, it becomes the child’s problem to solve, alone. Initial solutions typically involve eluding the stutter. Children learn early that actions such as hitting the table and blinking the eyes help propel words that get stuck. Behaviors designed to avoid stuttering emerge as
4
V
CHAPTER 1
well. Answering with “I don’t know” is a common avoidance. So is evading speech altogether. These secondary behaviors are so universal that they are considered part of the stuttering experience (Conture & Kelly, 1991). As the term secondary implies, the behaviors follow a primary source (that is, the disfluencies). Obviously, without the prolongations and repetitions, there would be no need to evade or hide them. Still, this term should not be used as evidence that these behaviors are somehow a lesser part of the disorder of stuttering. They are not secondary in the sense that a limp is secondary to a broken leg (i.e., mend the leg and the limp goes away with it). Rather, many of the emotional aspects are secondary more as a child’s self-doubt is secondary to teasing by peers. The source perpetuates the symptom and vice versa. Unfortunately, the effectiveness of secondary behaviors is only temporary. This leads to two problems. The first is that the behaviors are often maintained after their effectiveness has diminished. In the long run, then, secondary behaviors can become strange and seemingly purposeless maneuvers that serve to further complicate the stuttering problem. For example, a child struggling with a word may simultaneously bang a fist on the table, blink, and engage in additional actions that at one time effectively masked the stuttering. Thus, one distracting behavior (the disfluency) has multiplied into several. Another problem with secondary behaviors is that their temporary effectiveness is seductive. Social penalties associated with stuttering need not be paid when no one can detect its presence. Thus, the child is reinforced for the behaviors and they increase in frequency. Although the momentary helpfulness of secondary behaviors is very real, so is the long-term damage. In using these behaviors to mask their stuttering, children continually associate stuttering (and all the fears and emotions that accompany it) with new words and situations. For example, the child who substitutes words as a secondary behavior might use the term automobile because it is easier to say than car. In time, this child will likely have difficulty with automobile. If he or she continues to substitute words, eventually vehicle, ride, and every other word or phrase that can be used to designate a car will likely present difficulty. Thus, the child goes from one problem word to many. As the stuttering worsens, the family cabal of silence strengthens and generalizes. The child or adolescent who stutters is often unwilling to discuss his or her condition with anyone, family or otherwise, and is even less likely to joke about it. Speech can become the most intensely personal aspect of this individual’s being. Even events tangentially related to stuttering, be it teasing from peers or an embarrassing oral report in class, remain internalized.
WHAT IS STUTTERING? WHAT IS RECOVERY?
V
5
As the emotions become progressively more interiorized, associated behaviors continue to increase. Older children and adults use different types of bodily movements (e.g., tensing of facial muscles, twitching their hands, tapping feet) to escape stutters. To avoid stuttering altogether, they may restructure sentences or substitute easy words for those difficult to produce. This often leads to some unwieldy phrasing (e.g., “a pair of eggs” used to avoid the word two; “this day” instead of today). Other associated behaviors are even more awkward. People who stutter might describe a concept rather than use a feared word. They feign accents, order food they do not really want, give themselves nicknames, purposely mispronounce words, and perform many other unusual behaviors, all for the sake of keeping their stutters secret. In some instances, avoidance behaviors can significantly impact their lives, from being afraid to make friends to turning down promotions because the new job would involve public speaking. Yes, stuttering is characterized by repetitions and prolongations. In the final analysis, however, it is far more than momentary breaks of speech. It is embarrassment, mockery, and loneliness. It is continual self-consciousness about speech, as reminders of past stuttering are present in nearly every utterance and speaking situation. And it is a condition that, to the person experiencing it, often seems beyond conscious control. Metaphorically, stuttering is not just another branch on the tree of life. It is more of a seasoning, a spice that flavors all ingredients in the mix.
STUTTERING: WHAT IT IS NOT Thus far, the focus of this chapter has been on what stuttering is. It is also important, however, to discuss what stuttering is not. After all, it is a condition surrounded by much misinformation. Many stuttering myths have nothing to do with recovery and/or are too ridiculous for discussion (e.g., stuttering is caused by tickling; people who stutter are descendants of the lost continent of Atlantis; stuttering can be cured by talking with a mouth full of pebbles). Others are so important to the recovery process that sections of or entire chapters have been devoted to them (e.g., parents cause stuttering; people who stutter are nervous and shy). This section is devoted to some of the remaining relevant misperceptions.
All Disfluency Is Stuttering Everyone who stutters has listened to non-stutterers declare that they 1) used to stutter or 2) stutter themselves sometimes. Even articles about stuttering are guilty of perpetuating the idea that all children stutter
6
V
CHAPTER 1
(Bender & Small, 1994; Brazelton, 1997), which, in turn, supports the belief that the best plan of treatment is to ignore it. Stuttering is, by definition, a communication disorder and therefore not part of normal development (Alvares & Williams, 1995). Although it is true that all young children present disfluencies, those of normally developing speech are different in quality and quantity from the disfluencies of stuttering (Guitar, 1998). Obviously, normal adult speech is disfluent too, filled with interjections, rephrasing, broken words, and other breaks in flow. However, these momentary bobbles do not call attention to themselves the way that stuttering does. In fact, listeners barely notice them. Moreover, normal disfluency does not carry the emotional baggage discussed above. This is an important distinction. Someone who “stutters sometimes” can no better identify with true stuttering than a weekend flag football player can relate to life in the NFL. It is also worth noting that not all abnormal fluency is stuttering. There are many disorders of fluency that vary from stuttering in terms of onset, development, and symptoms (both overt and secondary). Stuttering seems to be unique in how it infiltrates nearly all aspects of a person’s life.
Stuttering Is Psychological Another common misconception about stuttering is that it is a psychological condition. This myth is partly the result of repressed needs theories, a collection of hypotheses in which stuttering is viewed as the voluntary consequence of neuroses. People are disfluent in order to satisfy unresolved oral-erotic needs of childhood (Coriat, 1928) or because they are fixated at the anal-sadistic level (Fenichel, 1945). Stuttering is thus viewed as a pleasurable, forbidden oral experience or as symbolic diarrhea and constipation, depending on which end of the digestive tract one’s scholarship resides. Such theories are unsupported (Bloodstein, 1993) and no longer widely believed, clear attempts to force a misunderstood disorder into favored orthodoxy. Nevertheless, repressed needs hypotheses do arise from time to time, indicating that some people continue to place stock in them. The harm is in the perception of stuttering as an emotional disorder, cured, presumably, by fulfillment of basic needs. It is worth noting that attempts to eliminate stuttering via emotional counseling have not been particularly effective (Bloodstein, 1981). Related to repressed needs theories is the idea that stuttering results from some emotional occurrence in childhood. Seemingly harmless events, such as moving or changing babysitters, have been offered as causes. More serious situations, such as divorce or abusive parents, have
WHAT IS STUTTERING? WHAT IS RECOVERY?
V
7
also been implicated. In truth, there is little to support the notion that stuttering arises suddenly from one notable event. Again, the onset of developmental stuttering is gradual (Starkweather, 1987). This is not to say that significant events cannot further the development of stuttering. But that is very different than attributing one as the cause. Current theories (e.g., Smith & Kelly, 1997; Wall & Myers, 1995) view stuttering as arising from an interaction of nature and nurture. That is, it appears that certain children are biologically susceptible to stuttering. Such susceptibility, however, requires an environmental agent for manifestation and these agents have not been isolated. More to the point, children are exposed to numerous environmental stressors on a constant basis. Therefore, even if it could be determined that a child’s stuttering began right after Dad doled out some harsh punishment, this does not place the blame squarely on the child’s father. If the child was that predisposed, it is almost a certainty that if the punishment had not brought it out, something else would have. It is also worth noting that disfluent speech of sudden onset is more consistent with psychogenic disfluency than it is with developmental stuttering. Psychogenic disfluency is different from stuttering in terms of overt characteristics; it also responds to treatment faster (Deal, 1980). Thus, stories of disfluent speech beginning abruptly may well be true, but that does not mean that they reflect developmental stuttering. Probably the biggest reason for attributing stuttering to one causal event is human nature or, more specifically, the propensity of people to overgeneralize from minimal data (an idea that is further developed in Chap. 9). If a child’s stuttering began the summer the family stayed with grandmother, then it is surmised that Grandma caused it. In truth, had the child stayed home or gone to camp or been anywhere else, the stuttering may very well have occurred anyway. Of course, none of the evidence against sudden onset will stop people from asking an individual what happened to trigger his or her stuttering. The answer to this question is: nobody knows. The answer to what they are really asking is that the stuttering is nobody’s fault. The other side of the psychological continuum from repressed needs includes the idea that those who stutter are experiencing a sort of mental block, similar to the infielder who can no longer throw the ball to first base. In fact, many people who stutter have voiced this opinion. Usually it is phrased something like this: “I can speak fluently when I’m alone. In other situations too. That proves that I am capable of talking without stuttering. The fact that I don’t do it everywhere shows that it’s all in my head.”
8
V
CHAPTER 1
Actually, this proves and shows nothing, other than stuttering being variable across situations. It is just as easy to attribute this phenomenon to a physical difference than to a psychological one. Within the human brain lie literally hundreds of neural sites and generators involved in speech. The extent to which one site is involved in a given speech sample, or whether it is at all, depends on the circumstances surrounding the speech—the phrasing, emotions, body activity, and numerous others (Webster, 1999). Thus, if stuttering is the result of a microscopic neural deficit—which is entirely possible given that macroscopic damage would affect other motor areas in addition to speech—one would expect it to be situational.
Stuttering Is Simple The search for a simple solution has led to other theories as well. As with the psychological causes, there is little evidence that stuttering originates from any overt physical problem (e.g., a short frenulum), by the mouth moving faster than brain, or even by overanxious parents. Although the exact cause is, of course, unknown, current research indicates that stuttering results from a complex interaction of multiple factors—genetic, linguistic, neuromotor, environmental, and others—as previously discussed. Again, attempts to find a simple solution have led to unfairly blaming people who stutter or their parents.
People Who Stutter Eventually Stop Another common belief is that stuttering eventually goes away on its own. This idea is based on investigations of spontaneous recovery in children. And even this research is equivocal (Curlee & Yairi, 1997; Ramig, 1993b). That is, the actual rate of spontaneous recovery in children is unclear. For those older than preschool age, however, complete cessation of stuttering is rare (Bloodstein, 1981).
Nothing Can Be Done About It At the other end of spectrum from the idea of widespread recovery is the notion that stuttering is untreatable. In support of this idea is the fact that no universal cure exists (Conture, 2001). Also, it is true that some individuals have tried multiple therapies without experiencing any measurable success (Cooper, 1993; Jezer, 1997). Some of these people may even believe that treatment made their condition worse because the optimism experienced at the start of therapy resulted in magnified frustration at its completion.
WHAT IS STUTTERING? WHAT IS RECOVERY?
V
9
Despite the lack of a cure and individual reports of disappointment and dissatisfaction, however, it is also true that effective treatments have been documented (e.g., St. Louis & Westbrook, 1987). In fact, therapy is such an important component to the recovery process that a chapter of this book (Chap. 5) is devoted to it.
What’s True About My Stuttering Is True About Stuttering Stuttering affects no two people the same way. Yet many people who stutter do not realize this variability. The relevance of this misconception to recovery is that those who experience improved fluency might assume that what worked for them will work for everyone else who stutters. They attend gatherings such as support group meetings in order to preach their brand of recovery. Of course, given the variability across people who stutter in severity, reactions, and even possible causes, it is ridiculous to assume that one person’s experiences are universal. And because there is no collective stuttering experience, there is no definitive road to recovery. One argument that often emerges when someone advocates a personal cure is that with enough hard work, anyone can stop stuttering. This is not only untrue, but also insulting to those who continue to stutter, many of whom are effective communicators (Quesal, 1999). People who stutter are not too lazy or ignorant to stop, just as they are not mentally substandard, unable to break a bad habit, or victims of bad parenting.
WHAT IS RECOVERY? Given the number and strength of emotions involved in stuttering, how does one recover? The answer to this question depends largely on the definition of recover. If the question is how does one stop stuttering, my answer is “I have no idea.” Some people stop overt disfluencies as a result of therapy, although they constantly monitor their speech in order to remain fluent. Others stop stuttering spontaneously for reasons even the experts cannot determine with any certainty. As noted, for adolescents and adults, elimination of stuttering (for any reason) is extremely rare. For these populations, it is best to think of recovery in different ways. For example, individuals who put the disorder behind them (or at least no longer dwell on it excessively) may consider themselves recovered. That is, because stuttering is no longer the first thought upon awakening each morning, or the last worry before falling
10
V
CHAPTER 1
asleep at night, these individuals are able to address other aspects of life. They can stop withdrawing and can instead do and say whatever they want (and whenever they want to do and say it). And that, when all is said and done, may turn out to be their biggest accomplishment with respect to speech. Viewed in this way, recovery encompasses not only acceptance and self-esteem, but also seemingly less lofty attainments, such as arrogance, apathy, and an appreciation of imperfection. It is these types of ideals that form the basis of this book.
SYNOPSIS Stuttering includes overt and covert symptoms, both magnified by its course of development. The multitude of possible causal factors, along with people’s differing developmental histories, help explain why these symptoms are manifested in such a wide variety of ways. With all of this in mind, it can be said that stuttering is a complex developmental disorder that is both pervasive and individual. Viewed in this manner, it is clearly not a bad habit, psychological disturbance, or simple speaking breakdown that occasionally happens to everyone. Taking into account the multifaceted nature of stuttering, a single individual’s road to recovery may not be easy to find or to travel. Still, the journey is worthwhile, given that effective communication lies ahead.
Chapter
2
Eighth-Grade English Class
U
Before we begin, let’s be clear about one thing: I hated junior high. Every inch of it. I recall it as one long inside joke with me on the outside, wondering what was so funny. In reality, it was 3 years of awkwardness and self-doubt that I wouldn’t repeat if the offer were made on my deathbed. Was it really all that bad? Was my school as fearsome as what I am about to relate? I don’t know and I don’t care. It’s junior high. It doesn’t deserve pinpoint accuracy. My distaste of junior high began the moment I first entered the school. Seemingly overnight (come to think of it, actually overnight), my previously safe and familiar world was gone forever. I remember that everything looked strange, which was bad enough in and of itself, but which also served as a prelude to more pervasive changes: harder classes, new teachers, and novel speaking demands every hour of the school day. The student body changed as well, the most obvious difference being one of size. My elementary school joined with three others to form a new and larger assemblage of classmates. This propagation, unnerving because it brought forth an increased number of peers unaccustomed to my way of speaking, was compounded by noticeable changes in the students themselves. Girls whom I had grown up fighting, mocking, or ignoring were now adorned with makeup and jewelry. They covered their legs with hip hugger bell-bottoms or nylons. I found them infinitely more interesting than before. These transformations improved their status in my eyes. We were no longer equals.
11
12
V
CHAPTER 2
The boys changed too, but in far less appealing ways. They were bigger and more aggressive. Elbows flew in the hallways. Blossoming thugs refused to alter their paths, forcing others to walk around them. Threats were yelled. Brawls were prevalent. Guys looked for any excuse to fight their way into manhood. “Camaros are nothin’. Trans Am rules.” “Trans Am? They ain’t even cool.” “You wanna fight about it?” And the fights themselves were not the old wrestle-till-someone-saysuncle type characteristic of elementary years. Fists flew. Skin broke open. Students appeared some mornings with faces that were swollen and scarred. Kids who did not want to fight (me, for instance) had to blend to avoid antagonizing anyone or providing anyone with a reason to antagonize them. Such fusion, I later realized, kept me from achieving even modest popularity. But at the time, I was more interested in avoiding physical pain. As one of the smaller kids in school, I was an easy target for anyone in need of a convenient punching bag on which to exhibit his toughness. It was in this environment that I had to leave class twice a week to attend therapy. Of all the crummy things about junior high, this was maybe the worst. I always departed quickly, in order to avert the questioning glances of my classmates. Nothing was more important than hiding from my peers the fact that I was a freak. When they would ask me later where I had gone, I would construct some sort of nebulous lie and quickly change the subject. “Some guy wanted to talk to me about some stuff. I don’t really know what he wanted.” “What did he talk to you about?” someone would invariably ask. “Oh, I don’t remember. Look, it’s not important. What’d you get on that math test?” Some secrets can’t stay hidden forever, of course, which brings me to eighth-grade English class. The incident that occurred there was not unique, either to me or to the general population of people who stutter. In fact, I would gladly place a parlay bet that 1) the majority of stuttering individuals can relate more horrific experiences and 2) I am the only one from the class who remembers even a single moment of that day. Why the memory lingers I’m not sure. Perhaps because it was junior high, when my goal each day was to find the center of the middle row and remain there unnoticed. English class was normally an anxious hour anyway, given that Fink (the teacher, Mr. Finnik) liked to have us read sentences aloud. Although this was a challenging task for all, I always assumed it was most difficult for me, the only student in the class who stuttered.
EIGHTH-GRADE ENGLISH CLASS
V
13
One day the aforementioned Fink surveyed the opposite side of the room from where I was sitting, then asked Melanie Dobberstein, the first student in the first row, to read sentence number one and identify the subject and verb (or whatever the task was that day). Melanie, who fancied herself the class clown, read the sentence as fast as she could. Everyone laughed. Fink, being an individual of self-professed good humor, looked directly at the student seated behind her and joked, “Benny, can you read the next sentence any faster?” Benny read, “Thesignupforlittleleaguetookplaceindad’soffice.” “Beat her by a full second,” said Fink, staring at his watch. “Next.” Around the room it went, eighth graders reading sentences as quickly as they could, for reasons no longer even remotely related to syntax. A clear row-by-row order of performance was established, and I knew I would be reading sentence number 18. I looked at my textbook. 18. Susan and her boyfriend both wanted to go. I experienced a fleeting moment of relief. This sentence did not look so bad. The words I would most likely stutter in other contexts, boyfriend, both, and go, were well into the sentence. By the time I reached them, I reasoned, my speech would be so fast that I would be slurring anyway. My facade was one of confidence. As my turn grew near, I sensed this confidence flow from me like blood through an open wound. I began to feel sluggish and light-headed, but forced myself to study the sentence, to continue the search for possible problems. What I learned that day was that if you look for something hard enough, you’ll find it. The possible rough spot, I concluded, was the beginning. Susan was not a feared word, but starting a new sentence was a feared situation, a weird sort of paradox that might have seemed amusing under circumstances devoid of mounting panic. In any case, I began to review possible strategies. Unfortunately, none of the usual ones seemed suitable: Using an interjected syllable, such as “ah” or “um, Susan . . .” was in-
appropriate under the circumstances, given that I was supposed to be reading the sentence quickly. Replacing Susan with a word I knew I could say fluently was impossible because the class would be reading along silently. Faking an illness would be too obvious in that, by the time I thought of it, the activity had already advanced to sentence 14.
14
V
CHAPTER 2
This was not going well. Somehow, I had to figure out a way past that first word (and figure it quickly). After that, I was reasonably certain I could fly through the rest of the sentence. (Notice that, in all my strategizing, I never once worried about the subject and verb. Not only was I driving myself to insanity, I wasn’t learning anything on the way.) (That lousy Fink.) Anyway, as sentences 15 and 16 were recited, I continued to reread 18, desperate to find a foolproof strategy. I was panicked by the brevity of time remaining, yet longed desperately for the exercise to be over. I could clearly sense my heart beating and feel dampness under my arms. My nerves continued to fray rapidly as sentence 17 was started by the student seated in front of me. Having to think fast, I somehow came up with the following. Just as sentence 17 was being completed, I would begin the initial /s/ in Susan, drawing it out very softly. Then, when Fink nodded at me, I would raise the volume and complete the sound, as well as the remainder of the sentence. It required exact timing, but, hey, I was about out of options. And time. By the time sentence 17 was halfway done, a prolonged “sssss” was coming out of my mouth at what I hoped was an imperceptible volume. I sounded like a leaking tire, but at least I was doing something that seemed constructive. I remember that my mouth was arid, surely a combination of nerves and the steady airflow required of an extended /s/. I was gripping the sides of my desk so hard that my hands had turned crimson. When 17 was finished, Fink said, “You young folks sure can talk fast,” or “Who was the fastest so far?” or—I don’t know what he said, but it completely threw off my timing. Short on air, I was forced to plug the leak and catch my breath. He then said, “Anyway, let’s see, where are we? Oh yes.” He was looking directly at me. I gazed down at my book (which was ridiculous, as by then I had sentence 18 long since memorized) and, in a loud and clear voice, said: “Sssssssssss, Ssssssssusan andherboyfriendbothwantedtogo.” The roar was immediate and reverberating. Every student except me was laughing. Mr. Finnik was giggling without restraint. When the students noticed this, they laughed even louder. For what seemed like hours (maybe 10 seconds or so), I sat with a forced smile on my face, like I was somehow in on the joke. After the noise finally abated, Fink commented, “I’d have to say Benny is still the fastest.” This reignited the bedlam of laughter. Suddenly an adult again, my esteemed teacher said, “All right, all right, let’s move on,” as he waved away the din. “Next sentence.” The student seated behind me did not immediately begin reading.
EIGHTH-GRADE ENGLISH CLASS
V
15
“Ssssusan,” he said with a particularly cutting chuckle. “OK, I’m ready. ‘Republicansandlikemindedindividualswereattheconvention.’ ” Class ended after five or six more sentences. Humiliation did not. During my exit from the classroom, several students approached me, whispering, “Sssssssssss.” I continued to hear it the rest of the school day and as I fell asleep very late that night.
Chapter
3
How to Read Research (and Non-Research)
U
If we knew what it was we were doing, it would not be called research, would it? —Albert Einstein
Advances in stuttering related to recovery (e.g., reports on the effectiveness of treatment techniques) are, for the most part, found in research journals. It follows, then, that anyone who wishes to keep up on such advances needs to read the research. For many, this is an unfortunate circumstance, given that they find research about as easy to comprehend as Winter Olympics color commentators. Remember something though, when you hear seemingly inane chatter like, “Germany II can save critical transition down time if the brakeman gets off the block without gouging the runners.” Although few individuals would comprehend a word of such rambling, everyone still understands the main point of the exercise, that is, to get down the icy track faster than the other sleds. Similarly, the point of most research studies is not that difficult to appreciate. The primary reason for this is that the purpose is overtly stated in nearly every study. In fact, the studies follow a standardized, and, some would say, dry format from start to finish, beginning with a literature review and followed by sections on methods, results, and discussion. An appraisal of these sections will hopefully help the reader solve the riddle of research.
16
HOW TO READ RESEARCH (AND NON-RESEARCH)
V
17
LITERATURE REVIEW Research is supposed to adhere to the scientific method—form, test, and modify a hypothesis. Or, as Robey and Schultz (1993) explain, theory building drives investigation. This means that the basis for research should not be we’ve-got-some-cool-equipment-let’s-hook-people-up-toit-and-see-what-happens. Rather, it is what we know up to now, the current state of theory, that determines what comes next. Ideally, then, the authors of a research study can make a case that their experiment is the foremost investigation to advance our understanding of stuttering at this point in time. In other words, everything that has happened in the past has led us to their experiment. They convince us of this important point via a review of the literature on which the theory is based. Because the literature review is meant to support the study in which it resides, it progresses deductively toward a purpose statement (explaining the purpose of the particular experiment). One result of this general-tospecific succession is that just about anything might appear at the beginning. Adding to the confusion is that this section necessarily includes numerous citations, which can make it difficult to read. Note the following example. For years, people have been examining the disorder of stuttering (Blaine, 2005; Blaine & Blaine, 2001; Blaine & Brennan, 1983; Blaine, Brennan, Brennan, & Blaine, 2002; Blaine, Brennan, Brennan II, Blaine, & Blaine, Jr., 1993; Brennan, 2002; Brennan & Blaine, 2003; Brennan, Blaine, & Blaine, 1977; Brennan, Blaine, Brennan, & Blaine, 2002; Brennan, Brennan, & Blaine, 1987; Brennan, Brennan, Blaine, Blaine, & Blaine, Jr., 2002; Brennan, Brennan, Brennan, Brennan, Brennan, Blaine, Brennan, Brennan II, & Cayley, 2004; Williams, 2003). While much of this literature was written to advance theoretical notions about the disorder (Cayley, 1995; Cayley & Blaine, 1991; Cayley, Blaine, & Brennan, 2002; Cayley & Brennan, 1999; Cayley, Brennan, & Blaine, 1993; Cayley, Brennan, Blaine, & Cayley, 1944; Cayley, Brennan, Blaine, Cayley, & Caysey, 2003; Williams, 2003), other researchers have focused on therapeutic techniques (Caysey, 2002; Caysey & Blaine, 2004; Caysey & Brennan, 2000; Caysey, Brennan, & Cayley, 2001; Caysey, Brennan, Cayley & Blaine, 2000, Caysey, Cayley, Brennan, Brennan, Blaine, & Caysey, 1999 . . . The numerous articles cited may have little in common, other than they are all related to the same general topic of stuttering. It is even possible, in fact, that some have only slight relevance to the study they are introducing. So why are they there?
18
V
CHAPTER 3
If questioned, the author would likely put forth variations of the following claims: A broad overview provides a historical foundation for the theory un-
der test. Classic studies form a basis for present research. After the introduction is balanced with a discussion of the study’s relevance, the reader will understand how it adds to the overall knowledge base. Cynical observers might point out additional benefits of this format. For one, it gives the appearance that the authors have read numerous articles, even if in reality they only skimmed the abstracts. Second, they had ample opportunity to cite their friends, which one day could lead to reciprocation. Third, the accepted format for introducing a research study allows the authors to reference their own research. In many cases, it can even be cited it alongside the field’s most seminal works, suggesting that it belongs there. Much has been written on the topic of stuttering (Travis, 1931; Van Riper, 1973; Williams, 2002) . . . Note that nothing about this citation format gives away that I am grouping the genesis of a major theory, a landmark treatment text, and a reminder I wrote to myself in the margins of my lecture notes to make my anecdotes sound unrehearsed. Finally, the introductory paragraphs provide a place for the authors to mention articles with which they are unfamiliar or even dislike. This is an unfortunate albeit sometimes necessary evil of the publication process. Once a manuscript is submitted for publication, it is sent to experts in the field for review; often, these reviewers suggest that the author cite specific articles. The topic is worthwhile, but needs to be couched in a historical context, i.e., how does it further the landmark work of Frick (1999, 2001), Frack & Frick (2000), and Frick & Frack (2002)? Rather than risk annoying a reviewer by asking who Frick and/or Frack are, or waste time wondering which one the reviewer is, the authors might decide to include these works in the introduction. Thus, the authors can appease a reviewer without actually allowing the studies in question to interfere with the present one.
HOW TO READ RESEARCH (AND NON-RESEARCH)
V
19
It is worth noting that extraneous information added to placate reviewers is not limited to citations. Non-sequiturs appear throughout research articles. For example, when reading a study, you might come across a paragraph similar to this one. Because people who stutter present auditory processing differences when compared to nonstutterers (Dietrich, Barry, & Parker, 1995), it is possible that there is an underlying system difference related to both disorders. On the other hand, it should be noted that there were people treated by Frick and Frack (2002) who did not fit this pattern. Actually, it shouldn’t have been noted. But now you know why it was. Despite the potential for self-aggrandizement, the review process is a necessary element of the scientific method. Some (Bartley, 1984; Herbert et al., 2000) even view it as the most important feature of science. How better to advance a hypothesis than to feed it to ravenous critics who will tear it apart and leave the remains for theorists to reconstruct into a (hopefully) superior form? Does that mean the reader can trust the infallibility of published research? Read on.
PURPOSE The whole point of the introduction/literature review is to lead to the study’s purpose, a statement of how the outlined theory will be put to test. Given that the introduction becomes more specific as it progresses, the purpose statement can be thought of as the final point of specificity. For example, an introduction of stuttering becomes neurological research on stuttering, which leads to physiological research, which falls nicely into neurophysiology, which brings the reader to neurophysiologic research with equipment the author knows how to use, which, finally, results in the purpose statement for this particular study. Although the actual statement should be quite specific, purposes tend to fall under three basic categories. 1. Research to help determine the cause of stuttering. These statements are largely theoretical. For example, the following statement would fit nicely at the end of a literature review: . . . it follows from theory, then, that stuttering would interfere with subjects’ neurophysiology under test conditions. The purpose of the present study is to determine whether sample groups of adults
20
V
CHAPTER 3
who do and do not stutter differ with respect to alpha wave suppression under visualized speech conditions. 2. Research on the effectiveness of treatment methods. Writers generally bend over backwards to make these sound practical. Buzzwords are numerous. . . . Since treatment efficacy research clearly indicates that systematic and regular practice leads to improved performance on all of the aforementioned outcome measures, subjects who receive such practice should present greater therapeutic progress than those who do not. The purpose of the present study is to determine whether focused practice results in improved performance on objectives related to established outcomes. 3. Works written because the author needs a publication. These purpose statements are similar in form to those already mentioned, but they are far simpler in scope. . . . The literature is unclear with respect to how the general public would verbalize its feelings about people who stutter. We decided to address this lack of clarity in the present study, the purpose of which was to summarize answers from the first five people we saw to the question, “So what’s the deal with people who stutter?”
METHODS Whatever the purpose statement is, it generally concludes the introduction and paves the way for the next section, the one that describes the methods used to test the theory. Journals leave no mistaking where one ends and the other begins, as the methods section starts right under the heading Methods. Methods are necessarily presented in great detail so that other researchers can, if they so desire, replicate the study themselves. Unfortunately, this specificity may turn readers glassy-eyed as they plow through procedural descriptions, trying to absorb a general idea of how the experiment was set up without spending excessive time and energy concentrating on sentences like “Respiratory, electroglottographic, and air flow signals were digitized at 1000 samples per second by a 12-bit analog-to-digital conversion board.” This section should not, however, serve as a cue to stop paying attention, given the importance of the methods used to achieve the stated purpose of the study. Readers of research often pontificate on the topic of validity, wondering aloud whether the researchers really accomplished what they set out to accomplish. The Methods section is the focus of such pontification, the place where validity can be established. For example, determining genetic influences on stuttering by tracking gene markers would be far different to doing so by asking people, “Anyone else in your
HOW TO READ RESEARCH (AND NON-RESEARCH)
V
21
family stutter?” Moreover, it does not require excessive concentration to figure out research methods. For most, the trick is to lose the wall of resistance to anything scientific. Yes, it can be complex. So can a lot of things. Many will say they cannot keep such complexities straight, yet these same people can describe in great detail why the tight end went in motion on the fake screen on third and ten with 2:32 left in the second quarter. Or why Misty was crying when Bud responded with “Ditto” to the statement “I love you.”
RESULTS The Methods section is followed by the presentation and analysis of the study’s raw data. This section, headed Results, is where the researcher reports numbers, statistical analyses, and concrete observations of what happened when the authors’ hypothesis was put to test. Sounds good, right? I mean, what could be more objective than that? A lot of things, actually. Think of Results as the scripture reading before the sermon—a carefully selected foundation on which the subsequent message will be based. Although there is nothing inherently wrong with this sequence, there is, unfortunately, room for creative foundation building. See, there are many ways to present results. The means by which it is done in a given study might depend on whether or not the authors have a theory they are just dying to tell you about (see discussion in Park, 2000). And, believe me, many do. In fact, it is often possible to accurately predict the study’s conclusions knowing only the title and author’s name. The following list demonstrates different ways in which the same results can be reported. The descriptive data indicate that the sample consisting of people who stutter
scored lower on all tests than did the nonstutterering group. However, when t-tests were applied to the sample means, it was found that none of the differences were statistically significant. One obvious trend from the data is that the subjects who stutter scored consistently lower on all tests than did the nonstutterers. In fact, in all cases, these differences approached statistical significance. The first example informed the reader what happened. When the data were eyeballed, there appeared to be a trend. But when it was analyzed, the trend was not a meaningful one.
22
V
CHAPTER 3
In the second example, the writer is also reporting what happened, but in this instance, the trend is made to appear consequential. The problem with this example is that, by the author’s own criterion, the differences between the groups are not meaningful. That is, the author defined a difference as group means that vary to a statistically significant degree. That didn’t happen. Instead of simply noting that, the author decided to change the rules. Now the reader is told that any difference is suitable. It is equivalent to the NFL commissioner having a rooting interest in one of the Super Bowl teams, watching that team fall behind 14–3 late in the fourth quarter, and declaring that, starting three hours ago, touchdowns will count a point apiece while field goals will tally ten. Notice also that if the author leaves out the second sentence, the motive is even less apparent. One obvious trend from the data is that the subjects who stutter scored consistently lower on all tests than did the nonstutterers. Now the reader is being told that statistical analyses need not be applied (or at least not reported). Just take the author’s word that the difference is really a difference. This same strategy can be manifested in other forms. The following examples show the same results reported three ways. Significant results were found for variables A, B, and C (p < .05). Analysis of
variable D did not indicate a significant difference (p > .05). Significant results were found for variables A, B, C (p < .05), and D (p < .10). Significant results were found for variables A, B, C (p < .05). In addition, significance was approached for D (p = .09). Before running any statistical analysis, an author will set a significance level, indicating the probability that any differences found could have occurred by chance alone (Neale & Liebert, 1986). In these instances, the level was set at .05 (a 5% probability, which equates to a 95% likelihood that the differences were real and not random). Using this very standard criterion, significant differences were found for three variables. Period. In the first example, the author says so. In the second, the significance level is changed in order to get a fourth difference. The third example is a little better than the second in that the author does not overtly fudge the significance level. It is likely, however, that the results are reported as such because, in the Discussion section, the author intends to sell the reader on four differences, not three.
HOW TO READ RESEARCH (AND NON-RESEARCH)
V
23
DISCUSSION The Discussion section exists for exploration of the study’s import. Prior to this section, the authors have given the reader an overview of current theory and research (literature review), the means by which they attempted to add to this body of research (methods), and what happened during this attempt (results). What’s left is to tie it all together, to explain how the current results complement present theory. In other words, what do the results mean? The interpretation of data can be a tricky business. For example, there is the problem of directionality (Neale & Liebert, 1986). Does A cause B or does B cause A? Does team camaraderie lead to winning or do teams that win tend to get along? Do differences in brain function cause stuttering or does stuttering influence how the brain functions? The answer might be none of the above. Sometimes there is a third variable influencing both A and B (Neale & Liebert, 1986). Does the presence of mittens cause an increase in car accidents or does a larger number of wrecks cause people to wear mittens? Probably neither, at least in any universe that includes an as yet unmentioned factor—snow—that could be responsible for both. Similarly, correlations between stuttering and concomitant disorders of auditory processing (Williams & Saul, 1996), articulation (Conture & Caruso, 1987), or language (Cullinan & Springer, 1980) might not reflect a causal relationship but, rather, some difference in the system that influences both. To be fair, directionality and third variable issues are difficult to assess. The same cannot be said for other forms of misinterpretation, however. We have all heard that, with statistics, anyone can say anything. Actually, inventive conclusions do not even require any statistics, as the following old joke illustrates. Two boys are playing football in Austin. Suddenly, one is attacked by a rabid Rottweiler. Thinking quickly, the other boy rips a big board off of a nearby fence, wedges it down the dog’s collar and twists it, breaking the dog’s neck. A reporter happens to be strolling by. He sees the incident and rushes over to interview the boy. “Young Texas Longhorn Fan Rescues Friend From Vicious Animal,” he starts writing in his notebook. “But I’m not a Texas Longhorn fan,” the little hero replies. “Sorry. Since we’re in Austin, I just assumed you were,” says the reporter. Crossing out his notes, he starts again. “Little Texas A & M Aggie Fan Rescues Friend From Deathly Attack.”
24
V
CHAPTER 3
“I’m not a Texas A & M fan either.” Puzzled, the reporter looks at the boy. “I assumed everyone who lives in Texas was either for the Longhorns or Aggies,” he explains. “What team do you root for?” “I’m an Oklahoma Sooners fan,” the boy replies. The reporter starts a new sheet in his notebook and writes, “Little Redneck Okie Kills Beloved Family Pet!” Of course, it is not just football rivalries that are subject to skewing. In a similar fashion, research findings can be viewed in a variety of ways. Take, for instance, a previous example of reported results: The descriptive data indicate that the sample consisting of people who stutter scored lower on all tests than did the nonstutterering group. However, when ttests were applied to the test means, it was found that none of the differences were statistically significant. The Discussion would, ideally, include a statement that no evidence was found of differences between groups and an examination of how this progresses or detracts from current theory. In this way, the results of the investigation have provided a legitimate foundation for the authors’ conclusions. Unfortunately, the ideal is not always the reality. If it were, I’d be fabulously wealthy and Bill Gates would be wrestling with issues of theory building. The reality here is that a shaky foundation is sometimes used to support a straw house. If the results are reported in a deceiving manner, expect the Discussion to follow in kind, likely spelling out the authors’ pet beliefs and favorite theories. Here are two additional examples from the previous discussion of results. One obvious trend from the data is that the subjects who stutter scored con-
sistently lower on all tests than did the nonstutterers. In fact, in all cases, these differences approached statistical significance. Significant results were found for variables A, B, C (p < .05). In addition, significance was approached for D (p = .09). What these examples have in common, as noted earlier, is that nonsignificant results are reported as meaningful. In fact, it is quite possible that the author will treat them exactly as he or she would have had they been significant, particularly in a Discussion section where numbers need not be listed. For example:
HOW TO READ RESEARCH (AND NON-RESEARCH)
V
25
One obvious trend from the data is that the subjects who stutter scored consistently lower on all tests than did the nonstutterers. In fact, in all cases, these differences approached statistical significance. The obvious question raised by these data is why the stuttering subjects were inferior with respect to every measure taken in this experiment . . . Actually, the more obvious question is this: Given that the authors did not find any differences, using their own ground rules for what constitutes a difference, why are they acting as if they did? The answer is that the authors simply know a difference exists and want to tell us about it. The problem is that they did not provide evidence for its existence. Believe it or not, fitting the results to the discussion (rather than vice versa) is even done when no differences are found whatsoever. In this instance, the reader may come across a sentence such as: Descriptive data indicate that the groups are roughly equivalent in their scores, a result unsupported by previous research. This raises the question of how this experiment differed from earlier ones. Perhaps it was ages of the subjects under test. Indeed, when the four oldest subjects are compared to matched control group subjects, distinct differences emerge. Nice try. But, again, a researcher is not allowed to create one set of rules and then play by another. Stated differently, one cannot set out to compare adults who do and do not stutter, then throw out the subjects who do not fit the predetermined conclusions the author wished to discuss. Can a real difference exist even if statistical significance is not reached? Sure. Any system based on probability is subject to some flaw. In fact, when authors report “mixed results,” they are often referring to differences that sometimes reach significance and sometimes fall short. For example, studies comparing how adults who do and do not stutter visually process language are mixed with respect to group differences (Hand & Haynes, 1983; Hardin, Pindzola, & Haynes, 1992; Moore, 1976). So is processing somehow related to stuttering? Quite possibly, it is. At the very least, it is a relationship worthy of additional exploration. It is perfectly legitimate to view mixed results from a body of literature in this manner. But that is far different than failing to find a difference in a single study and claiming that one exists nonetheless. Whether it is done fairly or unfairly, the discussion includes what the author feels the results mean and whether they support the current state of theory, add to it, or force reanalysis of it. This leads to a concluding sentence, which, more often than not, is a call for further research. For example:
26
V
CHAPTER 3
In attempting to determine the efficacy of the treatment program I named after myself, it appears that more questions were raised than answered. Thus, future research should focus on the types of clients best served by this treatment as well as its long-range efficacy. As far as I’m concerned, the inventor of the call for future research deserves to be immortalized in platinum. This helpful device can be utilized whenever the discussion gets so thick with theory that the author cannot find his or her way out. In addition to that, it can be dropped in if the author simply gets tired. In fact, it works best when both conditions are present. Even better, it doesn’t have to make sense. . . . This raises the obvious question of why the present study found A when each and every other study found B. Of course, the answer is impossible to determine at this time. Perhaps future research can examine issues of methodology and data collection procedures as they relate to sample variance. Or: This concludes the section on how to read research. Future investigation may one day add to our understanding of this important topic, as well as providing a suitable conclusion.
HOW TO READ NON-RESEARCH Obviously, there is much written on the topic of stuttering aside from that in research journals. Given that much of this material is not peer-reviewed or even much concerned with the scientific method, it should be divorced from the problems previously outlined, right? No, not right. Not even close. Actually, much of the material reviewed for this chapter presents the same problems and more. There are additional common themes as well, some of which are cause for concern. Others are well beyond concern. They are cause for running as far and as fast as possible. One of the most disconcerting commonalities is anti-intellectualism, a disregard for those who pursued the education and professional training necessary to research and treat stuttering. Disdain for those with conventional training takes many forms, from contempt for recognized experts in the field to a reliance on undefined “common sense.” Teach yourself to be careful when you come upon variations of the following phrases.
HOW TO READ RESEARCH (AND NON-RESEARCH)
V
27
Like Galileo, my ideas challenge the establishment. So-called experts might not like me, but remember that they have a vested in
terest in maintaining the status quo. It is likely that my idea is so good because I didn’t study in the field. I don’t need to run studies. I stutter. That makes me a walking laboratory. What I do works. The happy faces of my clients tell me all I need to know. I don’t stutter when I’m alone or talking to my dog. So common sense tells me it’s not a physical problem or I’d be doing it all the time. That’s how I know it’s mental.
Let’s start with Galileo. Questioning stodgy and stale ideas can lead to positive outcomes, particularly when those holding the ideas have not experienced an original thought since their last show ’n’ tell. Challenging such individuals can be so worthwhile in fact, that it might one day result in a college football playoff. The problem, of course, is that simply defying old theory is insufficient evidence of a new theory’s viability. Remember that for every Galileo, there have been thousands of bad ideas, many of which were explained to only padded walls. It is interesting, not to mention ironic, when ideas that do not advance theory are nevertheless proclaimed as progressive (Hebert et al., 2000; Scott, Clark, & Brady, 2000). Often in these instances, the ideas’ proponents fall victim to one of the benchmarks of anti-intellectualism, the “maverick syndrome” (Saul, 1989). Numerous individuals who have been reprimanded, left unhired, criticized, or had their views rejected claim that their troubles are due to their insurgency. In all fields of study, countless bad ideas have been defended on the grounds that the originator is a rebel and, as such, subjected to unfair criticism from envious or repressive authoritarians. When someone suggests that there are flaws in the person’s thinking, he or she simply claims to be an iconoclast and, as such, unpopular because of a propensity to challenge authority (Quesal, 1999). This ignores the alternative explanation that there are flaws in the person’s thinking. There are probably countless reasons why unpopular ideas are defended as unfairly outcast. One is simple defensiveness. When a person takes ownership of an idea, he or she tends to protect it like a mother to a child or a face painter to his school’s athletic teams. Thus, when rejected, it is preferable to look for an alternative explanation than it is to admit that the idea is flawed. Attributing the rejection to an admired personality trait is perfect in that the idea’s originators can feel good about both the idea and themselves. This brings me to the second reason for the popularity of the maverick syndrome: Many cultures value boldness and confidence,
28
V
CHAPTER 3
the hallmarks of rebellion (see Chap. 9 for additional discussion of this issue). Thus, people like to think of themselves as rebels. Think about it— when is the last time you heard someone say any of the following? I always did what I was told. When someone gets in my face, I turn the other cheek. I like to think of myself as a yes-man.
Probably never. We tend to boast more about our independence and brazenness. Apparently, non-researchers are no different. In addition to its use as ego-feed, whining can also provide a substantial smoke screen. When the debate can be shifted away from ideas, it is always good for the more ambiguous ones (Green, 1996; Herbert et al., 2000). Even better for the self-proclaimed mavericks of the world, such manipulation is not particularly difficult to do. A: Your ideas are garbage, B. B: You don’t like me. A: This isn’t about you . . . B? Where’d you go? B is gone, telling the world what a nonconformist genius he is, based on the dislike he engenders in the “A”s of the world. Of course, it is possible that a valid concept was unfairly rejected. After all, Galileos do come along. And although there is no comparable story in the field of stuttering, it is true that good ideas have come from those with unconventional backgrounds and varied knowledge bases who looked at matters in new ways. The main point of all this is not that all outside suggestions need be accepted or discarded but, rather, that they should be approached carefully. Being an outsider should render someone neither instant scorn nor instant credibility. There is nothing wrong with raising questions from a fresh perspective. There is in declaring answers from a questionable knowledge base. This raises a question: When current research and theory are ignored, on what basis are the resulting ideas supported? The answers are testimonials and the accounts of the originators (Quesal, 1999), whether it is the proponents’ own experiences as walking laboratories or something they see in their clients’ faces. Such “evidence” is more emotional and, as such, may well be more convincing than data and statistical analysis (Herbert et al., 2000), particularly to consumers desperate for some relief from the struggles of stuttering. Even better, the use of personal accounts allows one to present the good and withhold the bad (Popper, 1965).
HOW TO READ RESEARCH (AND NON-RESEARCH)
V
29
To be fair, experiences and observations are important (Green, 1996), just not as a cover for poor substance. Often, such reports are not only missing objective support, they also display a disheartening lack of knowledge. The example statement implying that research studies need not be done when personal experience is readily available shows an ignorance of one of the primary characteristics associated with stuttering—its individuality. Whereas, generally speaking, some knowledge is better than none, incomplete knowledge leads to trouble when solutions are based on it (Quesal, 1999). We all know that in life, the people furthest removed from a problem have the easiest solutions. When Uncle Sid says, “Just tell her to hit the road the next time she bothers you,” you know this is easy for Sid to say, given that he doesn’t know that the person in question is someone you are dating in secret because she is the daughter of your boss. Similarly, limited knowledge of stuttering allows for definitive statements. Stuttering is filled with intricacies and gray areas. Myths, controversies, and mixed results abound. But if you ignore all that, solutions become rather easy. Unfortunately, simple and direct hypotheses are sometimes worn as badges of honor. This has been going on for centuries, dating back at least to the time of Occam’s razor, a philosophy frequently translated from its Latin origins as “The simplest explanation is probably the right explanation” (Occam’s razor, 2004). Oddly, simplicity has been used as evidence of a theory’s validity (i.e., my theory has to be the correct one because it is the simplest). While Occam’s razor has merit, there are at least three problems with its general use. Most obviously, it isn’t always true. A theory which teaches that people stutter because they don’t think before they speak is quite simple, yet is not in the same area code as the truth. Secondly, theories appear comparatively simpler depending on the reader’s knowledge base. Stated differently, simple is in the eye of the beholder. In the aforementioned attempt to explain variability (the guy who talks to his dog), the speaker knows something about environmental influences (or at least that they exist) and nothing about the neurology of speech. From his perspective, then, the former is a far simpler explanation for stuttering variability. Obviously, one’s unique perspective is a shaky scaffold on which to rest a theory. Finally, Occam’s razor, directly interpreted as “Entities should not be multiplied more than necessary,” may well be intended to instruct theorists to offer explanations that are as simple and direct as possible (Occam’s razor, 2004). That is, give us the easy version, not the more complicated one. This is not only good advice, it is a far different recommendation to choosing the simpler sounding of two competing theories.
30
V
CHAPTER 3
In addition to Occam, another frequent defense of simple theories is common sense. Although there is certainly nothing wrong with common sense, it is insufficient evidence for theory. For one thing, it has more interpretations than Occam’s razor. The theorist who converses with his dog is, after all, offering a common sense argument, based on his knowledge of the subject. To others, his argument may be common, but far from sensible. Regardless of the basis, one of the apparent offshoots of simple theories is guarantees. If stuttering is easy to understand, I suppose the thinking goes, it is easy to solve. Oddly, the simple solutions (based on simplistic theories) often require specialized training to implement. What they often boil down to is that if people do as they are told (generally for a price), they can stop stuttering. This not only implies a universal treatment for a highly individualistic disorder (Quesal, 1999), but also gets the author off the hook for poor results. He or she can take full credit for any therapeutic success (“I showed them how to stop”) while at the same time avoiding any blame for failure (“They didn’t do as they were told”). Finally, non-research is likely to make massive leaps from present theory (Bunge, 1967; Herbert et al., 2000). As a function of the scientific method, research is a step-by-step process designed to improve understanding gradually (Sagan, 1995). When the restrictions of the scientific method are not present, an author can make giant bounds beyond what is commonly accepted. Yes, research often points out the obvious. But that alone should not allow non-researchers to make uninformed rushes to judgment. Good researchers know they don’t have all the answers. What are the odds that non-researchers do? So how does a consumer, who realistically has not the time, resources, or interest to stay abreast of all research trends, know when to believe what he or she reads, particularly when theories and treatments based on pseudoscience will, by definition, appear somewhat scientific? Certainly, it is good to be skeptical of arguments based on antiintellectualism, lacking objective support, or that simply sound too good to be true. But how does one know? After all, people in all walks of life are capable of putting forth solutions that sound viable, yet may be nonsensical. A stockbroker could throw around enough terms like yield, options, and arbitrage to convince me to invest in Edsel Motors. A mechanic could match the name of anything that sounds like an internal engine part with the words leak or crack and I will assume a repair is needed. So how can I expect consumers from varied backgrounds to wade through speech science explanations and discern fact from fiction? Compounding the difficulty is the fact that no guarantee exists that published theories are viable or that treatments stemming from empirical research will be effective (or that those that didn’t will not be). Keep in
HOW TO READ RESEARCH (AND NON-RESEARCH)
V
31
mind, however, that ideas in research journals have at least been legitimized by a peer review process. With that in mind, I offer not a foolproof method of garbage detection, but, rather, a few suggestions. Ask a specialist. A list of board certified specialists in fluency and fluency disorders is available on the Internet (www.ausp.memphis.edu/ sbfd/materials/specialist.pdf) or through the American Speech-Language-Hearing Association. Communicate with consumers and professionals through a local support group chapter. If none is available, try an electronic one, such as Stutt-L. The Stuttering Home Page Internet site (http://www.mankato. msus.edu/depts/comdis/kuster/stutter.html) has instructions for subscribing. Organizations such as the National Stuttering Association and the Stuttering Foundation of America have information on-line and in short, easy-to-read publications. The Stuttering Home Page is another source for information about all matters pertaining to stuttering. Finally, there are resources available in book form. One recent example is Living With Stuttering by Kenneth O. St. Louis (2001, Populore Publishing), with page after page of references, personal accounts, and information to help consumers find the right path.
Hopefully, these suggestions can help readers make informed opinions and decisions. In the meantime, they should be wary.
SYNOPSIS Research related to stuttering recovery follows (to varying degrees) the scientific method in order to advance theory. Although imperfect, this research presents far fewer problems than non-research writings, with their questionable bases and lack of rigorous evaluation. Those who wish to read up on stuttering should know the difference between research and non-research, as well as the idiosyncrasies inherent in both, in order to make informed decisions about what to accept and reject. Those who wish to follow developments in the field from afar require simpler advice: Don’t believe everything you hear.
Chapter
4
An Empirical Investigation: Analyzing the Effectiveness of a Self-Help Application Method for Treating Stuttering
U Over the years, stuttering has been a mystery (overtheyearsstutteringhas beenamystery.com, 2003). While many “therapies” have been attempted, none has demonstrated success (success=cure.org, 2004). Perhaps one reason for this lack of positive outcomes is the dearth of client-focused treatments. That is, both formal and informal therapies, and their corresponding manuals, center on what clinicians should implement, rather than on what clients should learn (A guy named Andy, 2004, personal correspondence). An example of a client-focused technique that has been ignored in the area of stuttering is self-talk. This is true despite the proven track record of this approach. Athletes, for example, have utilized positive self-talk for years (Fowler, Corso, & Herbstreit, 2003). Furthermore, self-talk has been used by other populations as well, ranging from actors (Howard, Howard, & Fine, 1933) to anarchists (Sacco & Vanzetti, 1920). The versatility of this approach is further evidenced by its varied utilization. For example, self-talk can be encouraging (Robbins, 2001), critical (Cowell, 2004), or even emotional (Lombardi, 1966). It can also, of course, involve combinations of these styles, such as tough-love (Schlesinger, 1999). While the value of self-talk is well documented, the term itself may be somewhat misleading. In order to be convinced that personal goals are achievable, one must not only say (i.e., talk) the appropriate words, but also think them (Rodin, 1880). For this reason, many scholars prefer the more encompassing designation of self-help (Williams, 2004), a term that
32
AN EMPIRICAL INVESTIGATION
V
33
will be used henceforth. For the purposes of this study, self-help is operationally defined as the elimination of problems by convincing one’s self that the problems can be and, subsequently, have been eliminated; this process involves both self-talk and thought. Given that the major deficit with stuttering is disfluency (Andy, 2004, personal correspondence; Pete, 1973, personal correspondence), it follows that this is what the person who stutters needs to convince himself or herself not to do. That is, if he or she can talk himself or herself out of it, his or her deficit would be eliminated, a result that would benefit not only him or her, but his or her significant others as well. This straightforward premise formed the construct for a treatment labeled by the present author as A Self-Help Application Method (Williams, 2004). This therapy, referred to by many as ASHAM, is basically a two-part procedure in which the client 1) tells himself or herself not to be disfluent and 2) stops. The apparent advantages of this approach over conventional therapies are numerous. For example, two steps are easier to learn than the many targets involved in most fluency shaping programs (ASHAM Manual, 2004). Moreover, stuttering modification can literally take years before it is effective (Unidentified speaker, personal correspondence, 1999–2004), a commitment that is unnecessary when therapy is ASHAM. Finally, the cost, while high at the start, is actually comparable to conventional therapy when one takes into account the relatively small number of sessions required. While the advantages seem obvious, the therapy has not yet been put to test empirically. The purpose of this study, therefore, is to do a comparative clinical study, thereby acquiring data to help future consumers decide between therapies that are established and ASHAM.
METHODS The subjects in this study consisted of four adults between the ages of 18 and 53. Subject age was determined post-hoc by sawing them in half and counting the rings. For all subjects, the diagnosis of stuttering was made via A Self-Help Application Method Evaluation (Williams, 2004), an assessment instrument commonly designated as ASHAME. Indicators of stuttering were documented on ASHAME Form D: A Self-Help Application Method Evaluation Differential Diagnosis (Williams, 2004). Once subjects were thoroughly ASHAMEDD, they were evenly divided into two sample groups. For 2 weeks, one group was administered conventional stuttering treatment and the other ASHAM therapy. Conventional treatment (CT) was defined as treatment received at a facility
34
V
CHAPTER 4
known to administer conventional treatment. Post-hoc investigation revealed that half of the CT subjects received stuttering modification therapy and the other half fluency-shaping. While numerous scholarly formats have dealt with ASHAM (ASHAM Manual, 2004; Unidentified speaker, personal correspondence, 2003; asham.org, 2004), an overview is instructive here. Upon entering the clinic room, subjects were first directed to tell themselves to stop stuttering. When necessary, this step was broken into sub steps in accordance with published directions (ASHAM Manual, 2004). More specifically, the subject was given a set of index cards face down. When the examiner determined that the time was suitable, the subject was allowed to turn the top card over and silently read the words, “I will not stutter (be disfluent).” For purposes of consistency of administration, each subject was then instructed to read the words aloud until such time as he or she meant it. At that point, subjects were allowed to read the second and final card, both silently and aloud. The latter card read, “Stop!” The dependent variables analyzed for this study were frequency of stuttering, defined as percent of syllable stuttered in the examination room, and client satisfaction, based on published indicators (ASHAM Manual, 2004).
RESULTS Following treatment, subjects were asked to provide a live speech sample to the author. These samples ranged from six to 258 syllables spoken. Frequency measures were recorded in percentages in order to control for this variability. Descriptive statistics show that frequency of stuttering was greater for the CT subjects than for those undergoing ASHAM therapy. While not part of the analysis, it is worth noting that half of the CT subjects actually presented increased stuttering following 2 weeks of treatment. When t-tests were applied to these data, the difference in mean frequency was found to be statistically significant (t = 3.01, p .05). This analysis indicates that the treatment that best reduced stuttering under test conditions was ASHAM. The data pertaining to client satisfaction are also instructive. Unfortunately, the survey forms on which these data were based were not adequately completed by all CT subjects. More specifically, it was deemed by the present investigator that too many items were left blank or answered “N/A.” However, the experimental group members did complete the items. As Table 1 indicates, all indicated that “Yippee” was the term that
AN EMPIRICAL INVESTIGATION
V
35
best depicted their post-treatment emotion, with “Wow” chosen unanimously as the secondary reaction.
DISCUSSION When two modes of treatment were compared empirically, one was clearly more successful in terms of both reducing frequency and maintaining high client satisfaction. The approach for which these claims are made is, of course, ASHAM. This is logical, given the aforementioned evidence of the effectiveness of self-talk. While it would be easy to advocate ASHAM therapy on the basis of this investigation, it is also true that more research is needed. For example, future research questions could center on the specific factors responsible for its superiority. Is it effective because of the ease of learning it? Or is it because overt symptoms are more directly addressed? Also, given the revolutionary aspects of this approach, how can it best be promoted to insure that more speech-language pathologists become trained in its use? Indeed, a more comprehensive analysis of these and other questions is necessary if more clients are to 1) become ASHAMEDD and 2) be administered ASHAM therapy. Finally, despite these compelling results, replications of the present study are needed and are, in fact, being carried out by the present author. Only in this way can a convincing, empirical case be made for ASHAM.
Chapter
5
Recovery and Therapy
U
I’ve gone through treatments here and there. A few worked well for me. But will those few help someone who Might stutter differently? —Mete Schubert A Stuttering Poem
Note: This chapter is an overview of the treatment process and, as such, will likely be more informative to people who stutter than to speech-language pathologists. However, members of the latter group, if they’re anything like me, may salvage something worthwhile from these pages. Nearly every time I read or hear a treatise on therapy, I find an idea that (1) is worth trying and/or (2) I meant to employ, but somehow overlooked. Hopefully, this chapter can trigger some ideas of this sort. Additionally, some therapists might have different perspectives on various treatment-related issues, differences they may want to discuss with their clients who are reading this. Scholars in the field and anyone who read Chapter 1 understand, hopefully, that stuttering (school-aged and beyond, anyway) involves more than occasional breaks of speech. There are also fears, frustrations, anxieties, and all the other leeches lying in wait beneath the surface. In the face of such formidable foes, it follows that treatment should address both the speech and non-speech components of stuttering. But given the complexity, not to mention the individuality, of the disorder, how can this realistically be accomplished?
36
RECOVERY AND THERAPY
V
37
GOALS OF THERAPY The first step in treatment, as with so many processes, is the setting of goals. With stuttering therapy, goal setting is a collaborative practice wherein the speech-language pathologist (SLP) and client discuss what is appropriate, taking into account the client’s wants (and their feasibility), motivation, severity, and any other data or characteristics pertinent to the individual. The SLP explains what is possible, given the limitations of scheduling, the setting, or whatever other confines exist (e.g., intensive therapy would not be possible if the SLP and client were only able to meet once a week). More importantly, the SLP provides professional guidance based on his or her knowledge base, experience, and philosophical perspectives on stuttering. But it is still the client’s plan, and, as such, he or she must be in complete agreement with it (Manning, 1999). In addition to being collaborative, the treatment plan should be dynamic. It is not a contract, but a starting point, a way of applying some initial structure to an imprecise process. It is important that plans be flexible enough to account for probable changes in direction and philosophy. For example, clients might decide that they do not care for the way they sound using certain speech techniques or that they would like to spend more time addressing feared situations. For reasons such as these, goals may well be added, deleted, and/or altered as therapy progresses. What the actual goals are vary from client to client, an obvious result, I suppose, of the considerable variability across people who stutter. Still, if someone asked me to state the primary goal of stuttering therapy, I would answer effective communication. That is, regardless of the techniques learned, clients should be able to say what they want to, not what the stuttering allows (Conture & Guitar, 1993; Hood, 2001; Williams & Dugan, 2002). As long as I’m generalizing, I will also add that there are some broad and overlapping ideas that, I feel, should be common to all treatment plans. And whereas some clients do not need much, if any, work on one or more of these areas, I believe it is important that the statements be part of a therapist’s general philosophical approach and that the client understand each one by the time therapy is complete. These statements are listed here. It’s OK to feel bad about stuttering. It’s OK to feel better about it too. It’s OK to speak (and to stutter). It’s OK to modify your speech. It’s OK—no, it’s a must—to go elsewhere with new skills.
38
V
CHAPTER 5
It’s OK to Feel Bad About Stuttering When describing their stuttering, few clients use the word fun. Some might say (with varying degrees of honesty) that they don’t care about it one way or another. But I have yet to hear anyone compare it to Disney World. Instead, they are far more likely to talk of struggles, anxieties, failures, and embarrassments. They mention words to be feared, situations to dread, and tension that can be both physically and mentally exhausting. And it’s good that they do. Stuttering is bothersome, to say the least, and there is no reason to pretend otherwise. In fact, it is important that clients own up to this truth. After all, no change can take place from a perspective of denial. What’s needed is honesty. Frank identification of stuttering’s negative components can not only reduce anxiety in the short run (Cooper, 2003), but is also the first step to lasting change (Gregory, 2003b; Guitar, 1998; Sheehan, 2003). After all, the whole problem cannot be treated as long as part of it is kept hidden. It is thus important that the SLP and client discuss both the disfluency and the covert experiences that accompany it (Van Riper, 1973). This discussion often begins with open-ended questions, such as the following: What situations are particularly difficult for you? Why do you think these situations are hard? What words are giving you trouble? How do you feel when you’re approaching them? Why do you think your stuttering has gotten worse this past month? How do you react when you are teased about your speech?
Without identifying (and, eventually, addressing) the overt and covert aspects of stuttering, the problem is unlikely to improve and may, in fact, intensify. Ramig (2003) writes of a vicious cycle, whereby emotions such as shame and guilt lead to avoidance, which, in turn, lead to more shame and guilt. This is not only a problem emotionally, but, as noted in Chapter 1, the increased avoidance can also result in added disfluency. It seems, then, that exposing the negativity of stuttering can lead to something positive. The same can be said for discussing frustrations related to therapy (Cooper, 2003). After all, much of what clients learn about the process is not what they wanted to hear: There is no cure, progress is gradual, and tasks may be difficult and/or uncomfortable. The client should feel free to express dissatisfaction associated with these or any other treatment issues.
RECOVERY AND THERAPY
V
39
TABLE 5.1 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s OK to Feel Bad About Stuttering Rationale Negative emotions associated with stuttering cannot be addressed if they remain hidden.
Examples of Goals 1. Client will describe 3 emotions associated with stuttering. 2. Client will list 5 possible solutions for the problem of teasing.
Examples of Tasks 1. Talking about difficult issues related to stuttering. 2. Reading and discussing essays about stuttering. 3. Writing a letter to one’s stuttering. 4. Drawing a picture of one’s stuttering.
Whether the concerns are about stuttering or treatment, it is important that they be discussed in a productive manner. Fortunately for SLPs, there are many good resources available to help guide clients toward the identification and eventual resolution of their concerns (e.g., Cooper, 2003; Crowe, 1997; Shapiro, 1999; Sugarman & Yaruss, 2000). As this book is written for clinicians and people who stutter, detailed description of counseling methods is a tricky area to approach. As Sugarman and Yaruss (2000) note, “If a (person who stutters) is aware that the SLP is using a counseling technique, then the technique is certain to fail.” I will say that, as general rules, the client needs to have an opportunity to talk and the SLP needs to know how to listen. Additionally, both should be willing to go out on limbs, whether this means discussing deep seated emotions, brainstorming solutions, or thrashing out whatever else is relevant to a particular situation (Cooper, 2003; Yaruss, 2004). Because of a client’s denial or inability to formulate emotions into words, or an SLP’s difficulty with basic counseling methods, such discussion might not come easy. In these instances, clinicians can utilize activities designed to bring emotions to the surface (see Table 5.1). Writing letters to one’s stuttering, for example, can be an effective discussion starter, as can reading essays that deal with pertinent issues (see Chap. 20). Clients are sometimes surprised at how identifying (or identifying with) the more covert aspects of stuttering releases emotions they did not even realize were there (Eldridge, 1997).
It’s OK to Feel Better About It Too With identification should come improved understanding on the part of the client. This includes an understanding of his or her own speechrelated attitudes (Sheehan, 2003), listener reactions (Cooper, 2003), and
40
V
CHAPTER 5
the actual stuttering—what happens during breakdowns as well as how the disorder affects goals, ambitions, and quality of life (Cooper, 2003; Sugarman & Yaruss, 2000; Van Riper, 1973). As a bonus, therapy is also likely to be better understood. Improved understanding helps to demystify stuttering (St. Louis, 1999), that is, to make it both comprehensible and manageable. People who stutter often come to therapy with the idea that their disorder is some unwieldy and shapeless force that totally enshrouds them (Cooper, 2003; St. Louis, 1999; Zebrowski, 2003). They cannot begin to examine it because they can’t get hold of it long enough to even catch a glimpse. Systematic and structured examination of one’s stuttering makes the disorder less mysterious and therefore less powerful. The client can see that it is not a random calamity. There are patterns, be it situations where it occurs more or less often, sounds that are easy and difficult to produce, and/or actual disfluencies that are easier and harder to manage. With identification and a little discussion of these patterns (see Table 5.2), an idea often emerges in the head of the client: If stuttering can be comprehended, perhaps it can also be managed. Greater understanding of stuttering has additional benefits as well. Avoidance is less apt to seem like a good idea. In addition, there may be an appreciation of why treatment must be gradual and why it involves moving outside one’s comfort zone. Personalized discussions are also beneficial to the SLP, as they allow him or her to understand what the issues are with a particular client’s stuttering (Gregory, 2003b). Such an understanding helps guide therapy in the right direction. Furthermore, these discussions make therapy more enjoyable for both parties because the sessions are not exclusively drill work. Dialogue about fears, challenges, and successes are welcomed and enTABLE 5.2 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s OK to Feel Better About (Stuttering) Too Rationale Through identification and understanding of its elements, stuttering becomes less powerful.
Examples of Goals 1. Client will list and rank order (from easiest to most difficult) 5 situations in which speechassociated emotion is high. 2. Client will identify and rate the effectiveness (from 1 to 10 where 10 is always effective) of 5 avoidance behaviors.
Examples of Tasks 1. Talking about the variability of stuttering. 2. Construction of hierarchies (e.g., easy-to-difficult words or situations). 3. Reading and discussing essays about stuttering.
RECOVERY AND THERAPY
V
41
couraged (Cooper, 2003; Sugarman & Yaruss, 2000). It is important to note that these sorts of emotional topics are likely to arise throughout the course of treatment. Thus, counseling will be an ongoing process.
It’s OK to Speak (and to Stutter) It is hoped that the exploration of stuttering will eventually lead to selfacceptance on the part of the clients. They must become comfortable enough with the idea that they stutter that change can occur. The initial reason for this is straightforward: Because it is impossible to get better at something without ever trying it, it follows that, in order to improve communication, one has to communicate. The idea here is not that people need to practice speaking in order to learn how to stop their speech breakdowns, but, rather, that they need to talk and not consider such breakdowns as failures. Stuttering is not shameful and it is important that clients not view it as such (Sheehan, 2003; Zebrowski, 2003). Fears of communicating must be overcome if any real improvement is going to take place. Stated differently, if problem words and situations can be approached without trepidation, attitudes toward speaking will improve and avoidance of speech (and life) will diminish. In addition to feared words and situations, people who stutter should become desensitized to the sound and feel of their own speech (Conture, 2001). This is important in the short run (to get them talking, as previously noted) and also long term. Treatment in any form involves changing one’s usual manner of speaking. However well the learned speech techniques are mastered, however, the client must still be willing to speak the new way. Should the speaker be at all self-conscious about speech, such acceptance will not come easily. Open stuttering (i.e., without accompanying secondary behaviors) is one means (see Table 5.3) of confronting the emotional weights associated with speaking. Furthermore, it is easy in the sense that it can be reinforced from the first minute of therapy. For certain clients, the more severe the stuttering, the greater the reinforcement. Some SLPs (e.g., Hood, 2001) advocate voluntary stuttering (stuttering purposely on a word that could have been said fluently) in conversation, assigned speaking tasks, or even contests (e.g., who can produce the most severe or most frequent disfluency) (Dell, 2000; Guitar & Reville, 2003; Williams & Dugan, 2002). However it is done—discussion, joke telling, competitive stuttering, or some other task—the idea is to lift the shame normally associated with stuttering and replace it with a positive experience. In addition to being an effective desensitizer, open stuttering can be an efficient means of addressing secondary behaviors. That is, when the cli-
42
V
CHAPTER 5 TABLE 5.3 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s OK to Speak (and to Stutter)
Rationale In order to improve communication, one has to be willing to communicate.
Examples of Goals 1. Client will use avoidance behaviors with no more than 5% of disfluencies in conversation. 2. Client will voluntarily stutter with one new listener.
Examples of Tasks 1. Open stuttering: Stuttering without employing secondary behaviors designed to mask it. 2. Voluntary stuttering: Stuttering purposely on words that could have been said fluently. 3. Stuttering contests: Who can produce the most frequent or most severe stuttering. 4. Reading and discussing essays about stuttering.
ent speaks without using any “tricks” to not stutter, all of these behaviors are, in essence, being treated at once. Often, however, secondary behaviors require focused treatment, either because they have become habits or because the client feels such shame in stuttering that he or she continues to avoid it, even in therapy. In such instances, the reinforcement being used for open stuttering can be coupled with mild punishers. For example, a simple game in which a point is awarded for each open stutter and a point taken away for each avoidance or escape behavior sends two very clear messages: There is no shame in stuttering. Secondary behaviors are unacceptable.
It’s OK to Modify Your Speech Obviously, therapy must involve some sort of direct management of speech beyond open and voluntary stuttering. For this reason, speech goals will be part of any treatment plan. Such goals are rooted in two possible outcomes: shaping (i.e., achieving) fluency and modifying (learning to manage) disfluency. The process of shaping stuttering into non-stuttered speech may include the use of biofeedback devices such as delayed auditory feedback (St. Louis & Westbrook, 1987), but more often involves step-by-step in-
RECOVERY AND THERAPY
V
43
struction of such fluency enhancing techniques as increased air flow, gentle initiations of voicing, and reductions in speaking rate (among others). The justifications for enhancing fluency (that is, decreasing stuttering) include the beliefs that 1) this is what most clients really want from therapy (Schwartz, 1999; Shames & Florence, 1980; Shenker, Kully, & Meltzer, 1998) and 2) stuttering involves learned behaviors that can be unlearned (Siegel & Gold, 1999) and replaced by those more conducive to fluency. Furthermore, proponents can point to published evidence of the effectiveness of such techniques, even with adults (Andrews, Guitar, & Howie, 1980; Davidow, Crowe, & Bothe, 2004). Despite these reports of success, however, there are concerns about fluency shaping approaches. Some (e.g., Ramig & Dodge, 2005) maintain that the learned therapy targets will not hold up in stressful situations. In addition, many clients report that the techniques result in speech that is limiting (or “robotic,” as one former client termed it) and/or requires too much concentration (Conture, 1996; Kalinowski, Nobel, Armson, & Stuart, 1994; Manning, 2001; Starkweather & Givens-Ackerman, 1997; Yaruss et al., 2002). They would rather take their chances with stuttering. On the other end of the philosophical spectrum is stuttering modification, an approach based in large part on desensitization and easy stuttering. Williams and Dugan (2002) phrased their modification goals as “stuttering in a way you can manage,” “talking without tricks or avoidances,” and “taking charge of the stuttering, rather than letting it continue to run your life.” The major goal of therapy was expressed as, “saying whatever you want to say, whenever you want to say it, even if you sometimes stutter.” These types of goals do not stress (or, for that matter, even mention) fluency, a drawback for some (Ryan, 2003; Shenker, Kully, & Meltzer, 1998), but an omission that is quite intentional. Stuttering modification advocates believe that, because stuttering is not curable (Conture, 2001), it is best managed in a way that lifts the shame, embarrassment, and other barriers to effective communication. If clients are going to speak, the reasoning goes, they are going to stutter; and since they are going to stutter, they may as well become desensitized to it and assume some control over how they stutter. Recent survey data (McClure & Yaruss, 2003) lend some merit to this reasoning, as they indicate client satisfaction with common stuttering modification components such as changing speech-associated attitudes and, to a lesser extent, modifying disfluencies. Besides, stuttering modification advocates have argued, fluency may well be a byproduct of therapy without being a goal (Sheehan, Williams, & Dugan, 2001; Van Riper, 1973). What they mean is that it often improves as a result of stuttering openly. This may be best explained by viewing stuttering as a behavior cued by certain agents in the environment (Brutten & Shoemaker, 1967; Ramig & Dodge, 2004). Once the fear of these
44
V
CHAPTER 5
agents—the words and/or situations that trigger stuttering—is removed via desensitization, they no longer serve as cues to stutter. And it follows that fewer cues could result in less stuttering. I have always viewed this as a central difference between the pure (and perhaps oversimplified) forms of fluency shaping and stuttering modification: The former attempts to rid clients of the emotional baggage by decreasing the stuttering; with the latter, this process is reversed. Despite the outward philosophical differences between the two approaches, both can be effectively merged into the same treatment plan (Dietrich, 2000; Gregory, 1991; Guitar, 1998; Ramig & Dodge, 2004; Tetnowski, 2003). In fact, the fluency shaping and stuttering modification camps are both spreading out so far from their bases that there is nearly as much overlap as there is segregation. For example, fluency shaping techniques are now often part of “integrated” approaches that include such stuttering modification-rooted goals as identification and desensitization (Cooper, 1987; Dietrich, 2000; Gregory, 1991; Guitar, 1998; Latulas, Tetnowski, & Bathel, 2003; Schwartz, 1999). Similarly, stuttering modification approaches utilize techniques from fluency shaping, such as full inhalation prior to speech and gentle onset of voice, to build manageable stutters (Donaher, 2003; Ramig & Dodge, 2004; Sheehan, Williams, & Dugan, 2001). It is even possible to effectively teach techniques from both perspectives to the same client. Kully and Langevin (1999) attempt to bring fluency to its highest possible level while simultaneously teaching clients to modify the “residual stuttering.” With Dietrich’s Tension Control Therapy (2000), clients choose whether to increase stuttering in order to enhance awareness and practice modification techniques, or to decrease stuttering to facilitate certain speaking situations. In programs such as these, clients learn that reduction of stuttering need not fly in the face of self-acceptance. The purpose of the change in speech is not to conceal the stuttering, but, rather, to communicate effectively by speaking in a manner that is comfortable. In fact, it is important that the disfluencies that do occur are managed openly and not hidden. It is avoidance when speech is altered for the purpose of covering up disfluency. Change is acceptable, however, when the speaker is up front about his or her stuttering. So how can a listener tell the difference? Sometimes, it is impossible. Only the speaker knows for certain. This discussion of fluency shaping, stuttering modification, and integrated treatment approaches raises the question of which is best. Unfortunately, there is no one answer to this question. Or, stated differently, given the variability across people who stutter, it is difficult to determine what type of treatment approach will work for a given client. Yes, data exist in support of techniques designed to increase fluency (e.g., Davidow, Crowe, & Bothe, 2004) and those that improve speech-associated attitudes
RECOVERY AND THERAPY
V
45
and modify stuttering (McClure & Yaruss, 2003). But these are group data, not necessarily reflective of any given individual. At a recent National Stuttering Association workshop (Williams, 2003), I asked people to relate the most and least helpful advice they had heard with respect to stuttering (in therapy or elsewhere). Among the responses were the following: Best: Take a breath before speaking and use easy onsets to help flu-
ency. Worst: Worry about fluency. Best: Learn to pause (in order to) slow speech. Worst: Slow down speech. Best: Practice speech techniques. Worst: Focus on speaking.
Clearly, effective techniques are not universal and, just as clearly, treatment goals need to be individualized to each client. It is a rare case, however, where changing speech, by modifying the disfluency, improving fluency, or both, will work without some combination of identification, counseling, and desensitization (Ramig & Dodge, 2005). As a final note, no section on modifying speech would be complete without mentioning the importance of self-monitoring (see goal 3 in Table 5.4). Clients must learn to monitor and, in time, adjust their own speech if and when old behaviors (e.g., hard stutters, avoidance behaviors) return. Self-monitoring is a simple therapy task in that it usually consists of the SLP asking the client to judge his or her own productions (with accuracy TABLE 5.4 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s OK to Modify Your Speech Rationale Tense, disfluent speaking patterns can be replaced with speech that is easier to produce.
Examples of Goals 1. Client will utilize preparatory sets in conversational speech at an 80% level of accuracy. 2. Client will use the targets of enhanced air flow, gentle initiations of voicing, and reduced rate in 90% of conversational speech. 3. Client will self-monitor productions of easy prolongations with 90% accuracy.
Examples of Tasks 1. Client reads words using speech techniques. 2. Client discusses a topic of interest, utilizing techniques while remaining on topic. 3. Ask client to judge his own productions.
46
V
CHAPTER 5
based on agreement with the SLP’s judgments). But while easy to employ, it is nevertheless an important part of the process of modifying speech. In fact, in one review of adult therapy (Williams, 1999), self-monitoring was one of two treatment components consistently associated with success for adolescent and adult clients. The other? Transfer/maintenance. This brings me to the final philosophical statement.
It’s a Must to Go Elsewhere With New Skills Transferring skills to different environments is perhaps the most difficult aspect of therapy (Conture, 2001; St. Louis & Westbrook, 1987). I believe that one reason for this difficulty involves the aforementioned notion of stuttering as a cued behavior. That is, much research has supported the idea that, for a given individual who stutters, certain words and situations are more likely than others to trigger disfluency (Brutten, Bakker, Janssen, & van der Meulen, 1984; Brutten & Gray, 1961; Brutten & Janssen, 1979). There are clinical implications to this. For one, speech will be easy in a clinic room that lacks these cues. Second, once the client exits this safe environment and faces real life, with all its reminders of past failure, implementation of therapy skills will be far more difficult. A key component to moving skills beyond the treatment setting is desensitization—to both the client’s own reactions and those of listeners. Without this particular aspect of therapy, clients are likely to use newly acquired skills with the SLP and no one else. Viewed from another perspective, if the speech-language pathologist teaches only novel speaking patterns to someone who is anxious about the way he or she speaks, the SLP should not be surprised when the individual is reluctant about employing those patterns in other environments. Without desensitization to reactions, there is little chance of transferring success. A home program is one means of extending therapeutic goals to different settings (see Table 5.5). Such programs can take a variety of forms, from word lists for practicing speech tasks to more informal activities, such as reading essays, watching videos, or searching for information on the Internet. It is important, however, that the SLP approve the essays, videos, and especially web sites (Shields, 2000), as many are not helpful or even accurate (see Chap. 3). Transfer of skills can also be aided by simply leaving the treatment room during scheduled sessions. In doing so, clients can employ speaking tasks with a variety of listeners. It is a powerful way to see up close that: 1. speech and/or stuttering does not need to be hidden because 2. most listener reactions are neutral and 3. those that aren’t can be handled.
RECOVERY AND THERAPY
V
47
TABLE 5.5 Rationale, Goals, and Tasks Consistent With the Philosophical Statement It’s a Must to Go Elsewhere With New Skills Rationale Skills mastered in the treatment room are not necessarily mastered elsewhere.
Examples of Goals 1. Client will use preparatory sets in conversation with a new listener at an 80% level of accuracy. 2. Client will complete 90% of home assignments. 3. Client will use the targets of enhanced air flow, gentle initiations of voicing, and reduced rate in 90% of conversational speech outside the treatment room.
Examples of Tasks 1. New listener(s) brought into treatment room to talk with client. 2. As part of home program, client practices speech techniques in different settings and/or with different listeners. 3. Client and clinician conduct therapy outside the normal treatment room. 4. During role-play activity, clinician takes client’s order from a menu. 5. Reading and discussing essays about stuttering.
As with home programs, leaving the comfort of the usual treatment setting allows various locations to become associated with success. Cueing, after all, works both ways. When many settings represent success, fears about failure are reduced. There are also transfer activities that are possible to do in the regular therapy setting. Bringing in new listeners is one way to help the client confront situational fears. If, for example, a teen is susceptible to peer pressure (and what teen isn’t?), including fellow students in therapy can help desensitize the client to the reactions of contemporaries. Another in-session transfer activity is role-play (Susca, 1997). The therapist can take the role of the boss, peer, parent, or whoever else is involved in difficult speaking situations for a particular client. This can serve as an effective step toward 1) confronting cues of past failure and 2) developing strategies for addressing feared situations. Whether one is addressing transfer in or out of the treatment room, it is important for the speech-language pathologist to be the leader in all transfer activities (Ramig, 2003). This includes demonstrating (with new listeners) open stutters, easy voicing onsets, or any other task that the client is instructed to perform. Setting this type of example shows the client that the clinician believes in what he or she is teaching and that there is nothing shameful about speaking differently. As clients begin to habituate the therapy targets, they should be made aware that mistakes will be tolerated and even encouraged (for more on
48
V
CHAPTER 5
this, see Chaps. 13 and 14). Again, the idea is for the clients to keep talking, keep trying. They will make far more progress risking failure than always playing it safe. After all, those who never make mistakes cannot learn from them. On the other hand, those who embrace challenges can eventually progress beyond them (Hood, 2001). Another important, albeit oft unmentioned, component to skill transfer is development of a support system (Ramig, 1993a). This could involve the client’s family and friends, other people who stutter, or both. Although support systems (or, more specifically, support groups) are further discussed in Chapter 7, mention should be made here of their therapeutic value. They provide the client with listeners to help with the transfer of skills (e.g., an atmosphere of acceptance in which to practice speech techniques; observers to monitor use of secondary behaviors) and offer another outlet for expressing the fears, emotions, and frustrations associated with stuttering (Hunt, 1987; Krauss-Lehrman & Reeves, 1989). The SLP can help with the formation of a support system, by, for example, talking to family (or coworkers, friends, etc.), inviting them to therapy, or serving as a resource for support group information (see Chap. 7).
GROUP THERAPY One mode of treatment particularly conducive to support is group therapy. Members of therapy groups often experience a sense of belonging (Rollin, 1987), which aids in the implementation of many phases of treatment. For example, different viewpoints of stuttering allow for better understanding of the characteristics, emotions, and management associated with it (Ramig & Bennett, 1997; Van Riper, 1973). Participants can practice therapy targets with each other (Ramig, 2003). They can monitor each other’s speech and secondary behaviors (Williams & Dugan, 2002). And once a client feels comfortable performing speaking tasks with a peer group, movement to other settings becomes easier. In short, the client becomes motivated by the success of peers and empowered by their support. It is important that treatment groups follow a shaping group format (Leith, 1993) in which participants are encouraged to offer feedback to one another. In this way, each client stays involved throughout the entire session. This format assumes both open and equal involvement. All participants should feel free to contribute, but no one should be allowed to dominate the session (Ramig, 2003). Because of the interactive nature of shaping groups, small ones generally work better than those larger.
RECOVERY AND THERAPY
V
49
PROGRESS IN THERAPY Regardless of whether therapy is in a group or one-on-one, progress is based, in large measure, on meeting goals. It is important, however, not to lose sight of the fact that clients can feel satisfied with their treatment even when formally stated goals have not been realized. For this reason, less formal indicators of therapeutic progress are also important to track. Signs that a client is becoming a more effective and independent communicator include the use of longer speech utterances, a willingness to talk in previously feared situations, and increased participation in classes, work settings, or social activities. Some clients perform tasks associated with even greater communicative stress, such as auditioning for plays or leading discussion groups.
COMPLETION OF THERAPY With progress, of course, comes the eventual completion of therapy. Although this sounds like an obvious point, it is not always so easy to determine when a client is ready to be dismissed. Because of the high relapse with stuttering (St. Louis & Westbrook, 1987), dismissal from therapy need not occur the moment speech goals are met. A better strategy is to end gradually, reducing the frequency of visits while monitoring progress. Increasing the time between sessions will assure both client and clinician that performance can be maintained without regular therapy. The course of action could be to ask a twice-a-week client to start attending therapy once a week. Then, frequency can be reduced to once every two weeks, then once a month. Should gains be maintained and the client discharged, follow-up telephone calls are recommended as a way to help monitor the client’s skills. Also, it should be understood that the therapist can be contacted in the event of any form of relapse (e.g., more avoidance or a reversion to previous disfluency level) that the client is unable to manage successfully. One means of controlling relapse from stuttering modification treatment is voluntary stuttering. Deliberate use of the easy stutters helps clients maintain their therapeutic gains. That is, should hard stutters or, worse, secondary behaviors, become more prevalent, voluntary stuttering can return the client to a mindset favorable to the production of open, manageable stutters. For this reason, some consider it to be the most im-
50
V
CHAPTER 5
portant tool obtained in therapy (Lewis, 2001; Starke, 1999; Tereva et al., 2004). Similarly, fluency shaping clients can help themselves by practicing (and putting into practice) the speech skills learned in therapy. Of course, time constraints and other restrictions can make it difficult to complete the requisite practice. Moreover, it is not always easy to maintain the awareness of speech needed to regularly employ fluency enhancing techniques. For reasons such as these, clients should be encouraged to not only maintain contact with their SLP, but also to attend follow-up/refresher visits as needed (Schwartz, 1999). Regardless of the techniques with which clients leave therapy, they should possess skills conducive to more effective communication. This means that they can say what they mean rather than some ineffectual version of it that the stuttering permits. Hopefully, it is now evident that proper therapy can significantly aid in the achievement of this goal if all aspects of stuttering are addressed.
SELECTING A THERAPY I suppose the next question, then, is how can a potential client know that the entirety of his or her stuttering will be managed appropriately? Or maybe a better one is this: How can one reasonably determine whether a treatment under consideration is likely to meet his or her objectives? As previously noted, there are published reports indicating client satisfaction with different treatment outcomes (Conture, 1996; Davidow, Crowe, & Bothe, 2004; McClure & Yaruss, 2003; St. Louis & Westbrook, 1987; Yaruss et al., 2002). And although these reports may be helpful, there are cautions that need to accompany their mention. For one, it is possible that a therapy approach that is effective for many will be unsuitable for one (Yaruss & Quesal, 2002). To make a simplistic example, a client with who is afraid to speak to anyone but family would likely benefit more from a treatment that includes desensitization than one stressing only fluency enhancement techniques, regardless of the success rates associated with the latter. It should also be pointed out that published analyses of effectiveness reflect the goals of the treatments in question, which may or may not coincide with the client’s goals. Evidence of reduced stuttering (to continue with the same example) tells us nothing about how natural the resulting speech sounds or whether clients successfully confront feared situations. Given the variability across both clients and treatments, it is sometimes difficult, though always important, to get a good client–therapy match. And while there are no guarantees of achieving this match, clients en-
RECOVERY AND THERAPY
V
51
rolled in therapy should feel free to discuss the issue with their speechlanguage pathologists. Those still looking for an SLP, however, may not be sure what to ask potential therapists. Here are some possible suggestions (in no particular order). What is your treatment philosophy? How will you decide which goals are right for me? Will I learn about stuttering? Will I learn about my stuttering? If so, how? How will my speech change? How will we get those changes from the treatment room to real life?
SYNOPSIS Treatment for stuttering can significantly aid the recovery process. While the specific goals of treatment should be individualized to each client, they will likely revolve around learning and talking about stuttering, modifying existing behaviors (speech and non-speech), and stretching the client’s comfort zone. Guidance from an SLP, support from friends and family, and hard work on the part of the client are all helpful toward accomplishing these objectives.
Chapter
6
The Depo
U
When I got the telephone call, I was in my office. “Hello,” I said. “This is Dr. Dale Williams.” “Mr. Williams?” asked a female voice. “Close enough.” For some reason, people never seem to think I should have the title of doctor. “I’m just surprised you answer your own phone,” the caller explained. The sudden change in respect level caught me off guard. I wasn’t certain how to respond. Yes I’m busy, but you just happened to call as I was forwarding the last e-mail joke of the day? The voice returned. “Please hold for Mr. Jones.” Seconds later came a male voice. “Dr. Williams,” it said. “This is Sean Jones, attorney with Dale, Christel, Christel, and Leach.” “Oh.” When that answer didn’t produce a response, I added, “Hi.” “How’re you doing? We’re interested in having you be an expert witness for a case involving stuttering.” “I’m fine, thank you.” “What? Oh . . . right. Glad to hear it. Anyway, we’re interested in having you be an expert witness for a case involving stuttering.” My mind was racing with questions. Me, an expert? Should I be flattered? Suspicious? What sort of case? Which side would I be on? Was someone mistreating someone else? Because of stuttering? And most important: How was I going to get out of this?
52
THE DEPO
V
53
I did not want to appear unsympathetic, but I had things to do. Let’s face it: e-mail jokes don’t forward themselves. And once that task was completed, I had to organize my schedule and come up with new ways to avoid projects with real deadlines. Was any of that the real reason I was hesitating? In all honesty, no. I was worried about being cross-examined and looking stupid. “Dr. Williams?” How was I going to excuse myself without appearing uncaring? I had to think fast. “Dr. Williams, are you there?” “I’ll do it,” I said. Thinking fast has never been my specialty. “Great,” said Mr. Jones. “And what is your usual fee for these services?” Usual? Here is my out, I thought excitedly. I can price myself right out of this job. I gave him an hourly rate that I thought was ridiculous. “Fine,” he said. Clearly, I wasn’t very good at this. The case involved a man who claimed to be disfluent as a result of a recent accident. After a thorough evaluation, I found him to be disfluent, a condition likely resulting from a recent accident. I wrote a report, which for some reason led to the scheduling of a perfectly awful activity known as a deposition. Jones informed me of this over the telephone. Actually, what he said was that we needed to do a depo, which seemed at the time to be a pathetic attempt to make a gathering of lawyers sound hip. He told me that he and opposing counsel would meet me in my office, on a day and time of my choosing. I chose a day and a time. He told me the day wouldn’t work. I chose another. That didn’t work either, but this time Jones gave me an alternate day and time. I said fine. “Do you and I meet first?” I asked. “I’ll come a little early so we can talk,” he said. This did nothing to reassure me. I called my sister, who is a trial attorney. “Sue,” I began. (Yes, a lawyer named Sue.) “Don’t witnesses get prepared before a deposi—a depo?” “Mine certainly do.” “How?” “Well, at the very least, they learn how to keep their answers brief, preferably ‘yes,’ ‘no,’ and ‘I don’t recall.’ ” That wouldn’t be easy with stuttering. As a topic, it doesn’t lend itself well to short answers and sound bites. “So why isn’t Jones preparing me?” I asked.
54
V
CHAPTER 6
“Well, some lawyers are . . .” Her voice trailed off. “Are what?” I asked. “Confident in their witnesses? Busy with multiple cases?” “No,” she said. “The word I was looking for was stupid.” Well, that was reassuring. “Make sure his check clears,” were her final words of advice. Jones was late for the preparation meeting, so his coaching consisted of the statement, “Just answer the questions and you’ll be fine.” “I’ll do that. Thanks,” I replied. The first 30 minutes of the deposition were actually quite easy, as Jones lobbed softball after softball right down the middle of the plate. Yes, I’m licensed. Yes, I’m certified. As a matter of fact, I do teach a class in stuttering. And so on. While I spoke, the opposing attorney, who looked to be about 12 years old, sat silently, save for the occasional nod. The only other person in the room was a court reporter, who was somehow typing every word on what appeared to be foot pedals from a church organ. Jones finished his questioning by asking whether I recommended therapy for the plaintiff, a recommendation that was already in the evaluation report he had supposedly read. I nodded. “Dr. Williams, please answer verbally,” he instructed. “The court reporter can’t record nods.” “Yes,” I said. Smith turned to Twelve. “Your witness.” Twelve looked at me, paused, then asked a lengthy question that was basically confirming the date I evaluated the plaintiff. I decided to try the yes-no-I don’t recall thing. “Yes.” And do you remember what time the evaluation took place? “Yes.” A long pause followed this confirmation. For the first time, the court reporter stopped typing. “And what time was it?” continued Twelve. “Ten a.m.” “I see.” Twelve shuffled some notes for several minutes, then launched into a string of questions about the tests I gave—what they’re for, how they’re given, and anything else he could think of. I think at one point he even asked me the test authors’ political affiliations. Jones objected a couple of times, although I never understood why. He always threw in Latin phrases, so his objections sounded like, “Basis for witness testimony E pluribus Unum.” After the endless questions about the testing, Twelve finally moved on.
THE DEPO
V
55
“It says here in your recommendations that the plaintiff suffers from disfluency. Could you define this for me?” “Yes.” This was getting fun. Twelve sighed. “Please do so.” “Disfluency is disordered fluency.” “I see. Is stuttering disordered fluency?” I nodded. “Dr. Williams, answer verbally so the court reporter can record your answer.” “Oh, right. And yes.” “So what you are telling me is that the plaintiff stutters. Is that correct?” “No.” At this, Twelve looked over the top of his glasses, the way older people do when they give meaningful advice such as “Sometimes it’s not what you do, but what you don’t do.” With Twelve, it had the desired effect of making him look more mature. At that moment, he could have passed for sixteen. “Please explain,” he instructed. I looked at Jones. Please explain is not something that can be answered with yes, no, or I don’t recall. I was thinking my attorney would jump up and say something brilliant, like, “Post mortem non grata!” Instead, Jones sat still, looking half asleep. “In my opinion, there’s a difference between disfluency as a result of a head injury and what we typically refer to as stuttering,” I said. “And what is this difference?” asked Twelve. “Different symptoms, different causes, and different responses to therapy.” “I see. Let’s start with symptoms. Please explain the difference.” I had to think hard about this one. I began to sputter about secondary behaviors, variability, and awareness. “I see,” was Twelve’s response to my explanation. “What causes stuttering?” It was my turn to sigh. Clearly, Twelve didn’t see anything. “I don’t know,” I said. “No one does.” “Surely there are some theories.” “Yes.” “Do some people feel it is psychological?” “That depends on what you mean by psychological.” He flashed me a condescending smile. “All right,” he said. “You define it for me.” As I really didn’t know how to define the word psychological, I said, “Let’s call it learned.”
56
V
CHAPTER 6
“OK, define that.” I launched into a lengthy explanation of how different combinations of various components likely lead some people to stutter, a different disorder, by the way, than the one suffered by the plaintiff. Sue would have slapped me, as I had by then ventured quite far from the yes-no-I don’t recall strategy. Twelve studied me closely during my lecture. He even allowed an extra pause after I finished, in case I wanted to talk more. “Dr. Williams,” he finally began, although it sounded like a statement in and of itself, a sort of confirmation that I still existed. I nodded. This time, there was no correction. “You recommended therapy as a result of your evaluation. May I ask why?” “Sure.” This answer seemed to irritate him. “All right, why?” he asked, his inflection more pronounced. “Because I thought that, you know, the client could benefit from therapy.” “And what would be the nature of this therapy?” “I don’t understand the question,” I said. “Which word didn’t you understand?” he asked derisively. “The individual words were OK. It was the way you sequenced them that was dopey.” OK, I didn’t really say that. I didn’t have to say anything, in fact, because Jones was already objecting. Something about ad nauseum de facto parte. Twelve responded by tearing his glasses off his face and vehemently citing “The Newark Five versus the Ford Freeway Commission!” or some such thing. This seemed to settle the matter, as Jones resumed his nap. As I watched the court reporter pedal away, I was glad she couldn’t record my thoughts. Twelve continued his questioning. “Allow me to rephrase the question,” he said patiently. “What types of things would you be doing in therapy?” He stressed the word things so everyone would know he was talking to an idiot. “Well, there’s desensitization, for one th—, uh . . . there’s desensitization.” “And what is desensitization?” “Activities designed to reduce negative emotion. In this case, negative emotion associated with speech.” “I see. And what sorts of activities accomplish this?” “Well, typically, we do uh, well we do things like expand the number of listeners, expand the types of speaking situations, and role play.”
THE DEPO
V
57
“Let me get this straight,” Twelve said. He attempted to peer over the tops of his glasses again, until he realized he hadn’t put them back on. I have to admit, though, he recovered quite nicely. “Let me get this straight,” he repeated. “You cure stuttering by having people talk to different listeners?” “Again, we’re talking about a neurogenic disfluency here, not stuttering. And no, desensitization is not designed to cure stuttering.” “Would it be safe to say that you can’t cure stuttering?” “I guess.” “So you try to reduce negative emotion instead?” “Among other things.” “We’ll save the other things for later.” Twelve smiled at me, although I found nothing even remotely amusing about his statement. “Tell me,” he continued, “is there any proof that desensitization works?” “If you mean absolute proof that it will work with each and every case, the answer is no.” “I see. Dr. Williams, do you watch Health On Wheels?” This stopped me. He was referring to a local television show about medical and allied health-related issues. It consisted of interviews conducted on a cheap set (two office chairs and a paneled backdrop), interspersed with wiggly video clips apparently shot by a monkey on espresso. “Not regularly,” I answered. Twelve turned his head toward me, making eye contact. “You’re a rehabilitation expert and you don’t watch Health On Wheels?” “I see it sometimes when I’m flipping around,” I said, trying to be helpful. “I see. Dr. Williams, are you familiar with ASHAM?” No, it didn’t actually happen that opposing counsel referenced a treatment program that I made up two chapters ago. But the one he actually mentioned was similar in scope. And purpose. And, unfortunately, credibility. I told Twelve that I knew of the program to which he referred. “It was recently featured on Health On Wheels,” he informed me. “Oh.” “Are you familiar with the success rate of this treatment?” “You mean their claims of success?” Twelve turned dramatically. “Please explain the difference,” he said. I sighed. I thought of Sue and decided I wouldn’t babble. “I’m familiar with their claims, yes.” Twelve let it go. “Is there a reason why you didn’t recommend such a highly successful treatment?” he asked.
58
V
CHAPTER 6
I nodded. “Please don’t nod. The court reporter can’t record nods.” “Uh huh,” I answered. “Please do explain,” said Twelve with a smile. “Tell us why you would advise a stuttering client against a likely stuttering cure.” I sighed. “Once again, we’re not talking about stuttering here, but a neurogenic disfluency. Second, we don’t necessarily make decisions on group data, but on what’s, in our professional opinions, best for the individual client.” “I see. So, in your opinion, he wasn’t one of the overwhelming majority who would benefit?” “Yes, in my opinion, he is not like those reported to be successful.” “What’s the difference between the plaintiff and those who experience success?” “Well, for one thing, the plaintiff exists.” Here again is something I didn’t actually say. Instead, I rambled on more about how success rates can be misleading and don’t necessarily apply to a given client, particularly when said client is suffering from a different disorder. When I finished, Twelve asked, “Is desensitization part of your usual stuttering therapy?” “Yes.” “This technique is part of stuttering modification, is it not?” As the questioning was again going toward developmental stuttering, and away from neurogenic disfluency, I tried to coax Jones into objecting. I looked straight at him as I replied to the question. “When you say stuttering modification, are you referring to the therapy approach designed for stuttering?” Jones sat still. “Are there other stuttering modifications?” asked Twelve. “No, I was just surprised that you would ask about a stuttering treatment.” I was still looking at Jones. My attorney, however, was busy drawing storm clouds in the margins of his notes. “I asked whether desensitization is part of stuttering modification,” Twelve reminded me. I nodded. “Please answer verbal—” “Yes.” “What else makes up stuttering modification?” “Identification, modification, and stabilization.” “Let’s start with identification. What is that?” “In essence, the client learns about his stuttering and, in doing so, loses some fear of it.”
THE DEPO
V
59
This clearly did not interest him. “And modification?” “Learning to modify the stutter.” He smiled. This was clearly what he was looking for. “And how does one modify a stutter?” he asked, although he clearly had a good idea. “Basically, you learn to stutter with less tension.” “I see. So, essentially, what you’re saying is, you teach stutterers how to stutter.” “I teach them to more easily manage their stuttering.” “What’s the difference? On second thought, here’s a better question: Why teach people how to stutter when they already know how? Why not teach a cure?” “Well, for one thing, there isn’t a cure.” Twelve smiled again. “OK, why teach people how to stutter when there are other approaches with high success rates?” Jones suddenly returned to life, speaking for the first time in twenty minutes. “We’ve covered success rates,” he said impatiently. “In a general sense, yes,” Twelve responded. Turning toward me, he continued. “But I can’t help but wonder what the success rate is for teaching people how to stutter. Excuse me—how to stutter in front of new listeners.” I looked at Jones to see whether I had to answer. He appeared ready to resume his artwork. “We don’t know,” I admitted. “I see. But presumably it does work sometimes.” “Yes.” “Why?” “Some clients meet the goals and become more effective communicators.” “No, I mean why does it work with some and not with others?” “Many factors.” I was all set to list them but, to my surprise, Twelve didn’t ask. “I see,” he said. “To sum up your testimony, then: You don’t know the cause of stuttering, you don’t have a cure, you don’t know if your therapy is going to work, and, when it does, you don’t know why.” “It’s not an exact science.” “I guess not,” he said. “No further questions.” Jones’ response to this was, “I guess we’re done then.” As he stood up to leave, I noticed that he avoided eye contact with me. Apparently, the parts of my testimony he didn’t sleep through hadn’t gone as well as he’d hoped. “Don’t talk about the case.” This instruction was directed at me, but spoken to a blank wall.
60
V
CHAPTER 6
I think my response was something like, “What do you think I’m going to do—write a book chapter about it?” The case was settled before going to court. At least I assume it was. The truth is, I never heard from Jones again. I did, however, recently see a picture of Twelve in the paper. He was at some benefit, laughing it up with other donors to Save the Rich or whatever the cause was. I noticed he had mixed some gray coloring into his hair, a pathetic attempt to add some years to his looks. The effect was to make him look like that one kid in every high school who goes prematurely gray. In any case, because of the presumed settlement, I was spared from having to answer more questions about stuttering for a case that wasn’t about stuttering. In a way, that’s too bad. After the depo was over, I thought up some new responses for Twelve: “Take it from me dude, the more you know the less you know.” “My professional opinions put food on the table. Remember that,
punk, the next time you get the urge to say ‘I see.’ ” “With humans, sometimes two and two doesn’t equal four, you know?” “You want guarantees? Go to Wal-Mart.” And, when all else fails: “Oh yeah?!”
I even ran these responses by Sue. She recommended against them.
Chapter
7
Support Groups
U
I know that I’ve some things to share, Things I wish I’d heard said. Like we’re not here on earth that long. We lead lives, then we’re dead. —Mete Schubert A Stuttering Poem
In Chapter 5 it was noted that support systems can be an important adjunct to therapy and, more importantly, to the recovery process itself. This raises an important question. What are support systems? In the earlier chapter, they were seen to be assemblages of family, friends, and/or people who stutter, all of them accepting of disfluent speech and willing to discuss it. Such a definition differentiates support systems from another commonly used term in this realm, support groups. The term support groups, as generally defined, refers to a specific type of support system (Ramig, 1993a). Richardson and Goodman (1983), for example, stated that such groups are made up of “people who have a common problem and have joined together to do something about it.” This simple and straightforward definition captures the essence of the typical stuttering support group. They tend be small (fewer than 12) collections of adults between the ages of 25 and 40 years (Hunt, 1987) who meet regularly in the same setting to discuss issues related to stuttering.
61
62
V
CHAPTER 7
Of course, the Richardson and Goodman definition is general enough to also encompass group therapy. This chapter, however, does not as that particular topic was already discussed in Chapter 5. Here I deal with groups that meet for the purposes of mutual aid and emotional support. In Chapter 5, support groups were said to provide an important adjunct to therapy and, more importantly, to the recovery process itself. Specifically, they were noted to serve two therapeutic functions: Open discussion about stuttering (Hunt, 1987; Krauss-Lehrman &
Reeves, 1989), including its patterns, variability, evolution, and whatever else is on participants’ minds. A setting in which to practice therapy targets with new listeners (Gathman, 1983; Manning, 2001; Ramig, 1993a; St. Louis, 2001). The former function can aid the desensitization process and the latter transfer. That is, participants can come to better understand stuttering and to speak openly. And once a client feels comfortable performing speaking tasks with sympathetic listeners, transferring skills to other settings may well become easier. Interestingly, when support group participants were surveyed, accessorizing therapy was seen to be the least important function of such groups (Krauss-Lehrman & Reeves, 1989). Benefits associated with mutual aid were considered paramount. In light of the development sequence outlined in Chapter 1—the cabal of silence within families, the embarrassment among friends, and so forth—this makes perfect sense. For someone who stutters, feeling alone is feeling different. Luckily, the converse (the old bit about strength in numbers) is also true. As one local support group member said, “I felt like there was nothing wrong with me when I saw there were lots of us out there.” This statement touches on three overlapping benefits of support groups—acceptance, socialization, and empowerment (Gathman, 1983; Manning, 2001; Ramig, 1993a). Prior to group participation, many feel as if their fight against stuttering is unaided. For these individuals, support meetings offer the earliest glimpse that it need not be faced alone, that there are others who share the experience (Hunt, 1987; Manning, 2001). For the first time, they have the opportunity to talk about issues such as teasing, embarrassment, shame, and other difficulties related to stuttering. They can express suppressed emotions with listeners who are interested, who understand, and who might even offer some insight regarding how to handle such difficulties (Gathman, 1986). This sort of reciprocity among group members—get help, help others—not only allows them to socialize and make new friends (Hess, as cited in Gathman, 1986), but can also lead to improved selfconcept, greater self-acceptance, and decreased anxiety (Ramig, 1993a).
SUPPORT GROUPS
V
63
Additional reasons that people join stuttering support groups include learning about stuttering (Gathman, 1983; Hunt, 1987) and about treatment, both good and bad (Conture, 2001; Hunt, 1987). Groups often link participants with stuttering organizations and therapists (Hunt, 1987). For others, the group is their therapy (Manning, 2001). That is, people without the time or resources for traditional therapy use support groups as their sole source of help. Finally, some people are attracted to support groups for their advocacy efforts (Hunt, 1987; Manning, 2001). Although media advocacy has been a function of large organizations such as the National Stuttering Association (Zimmerman, 1993), people tend to use local meetings for less public concerns. For example, those who feel they have been discriminated against may be looking for information about what their rights are, if and when to take action, and any helpful contacts the group members can offer. As there are so many reasons that people become involved with support groups, it should not be surprising that meeting agendas vary from group to group and meeting to meeting (Hunt, 1987). Often, in fact, groups convene with no planned agenda. People come to discuss speaking concerns and accomplishments, as well as seemingly unrelated matters (weddings, babies, promotions, you name it). Indeed, even having an agenda is no guarantee that it will be addressed. Nor does it need to be. It is important not to lose sight of functions such as acceptance and socialization simply for the sake of staying on schedule. “Forest for the trees” should mean something in a support group setting. It can ostensibly be argued that support groups offer something for everyone. It is strange, then, that so few take part. Given the standard prevalence rate for stuttering of around 1% (Shapiro, 1999), that means that there are well over two million people who stutter in the United States alone. America’s largest support organization, the National Stuttering Association, has approximately 3,500 members (Lowman, 2003, personal correspondence). There are additional organizations (such as Speak Easy International and Passing Twice) with smaller memberships. But even if the total membership for all support groups is estimated at 5,000 (a generous total, considering that many hold memberships in multiple organizations) and even if it is assumed that there are 5,000 more who attend meetings without joining the parent organizations (another liberal estimate), that still means that far less than 1% of people who stutter are involved with support groups. Taking into account the total possible pool from which members could be drawn (people who stutter, family members, interested professionals, etc.), the percentage of those who take part in the support movement is miniscule. So where is everybody?
64
V
CHAPTER 7
They’re elsewhere, of course, and for a variety of reasons. The most obvious one is that many do not know that support organizations even exist. These are small groups without marketing budgets. As such, they rely on flyers, free public service announcements, and word of mouth. Obviously, such low profile advertising does not reach everyone in the targeted audience. It is also the case that some individuals who stutter are simply not in dire need of support. This is not to say that they disregard support groups or that such groups could not help them in some way. It’s just that everyone has to prioritize their lives and, for some, this is not a top concern. There are scheduling clashes or babysitting issues or other conflicts that must be placed before support. Of course, some do discount support groups and not all who do so are being truthful. As noted in Chapter 1, shame often accompanies the development of stuttering. Attending a stuttering support group meeting might involve answering questions such as “Where are you going?” or “Where were you last night?” or “What is/was the meeting about?” The easiest way to avoid such questions is to skip the meetings. Perhaps related to shame is denial. Many people who stutter are unwilling to admit that their speech is abnormal or to associate with others who stutter (Hunt, 1987). They do not wish to be viewed as people who need help, but, rather, as “strong” enough to take care of their own problems. When invited to a meeting, they respond with, “I don’t need it.” The idea that support groups are made up of relatively fragile souls is one of many common misperceptions. Another is the notion that meetings are emotional events (Gathman, 1983), full of tears and expressive outbursts. “Not my thing” is a common response when the subject of support groups is raised. I can honestly state that I have never experienced a support group gathering that degenerated into a weeping festival. On the contrary, the close camaraderie that develops among members is more akin to a gathering of old friends than it is to a Barbara Walters interview. This is as it should be. No one feels empowered, accepted, or helped when they leave depressed. Another reason some might avoid support groups is the advice of their speech-language pathologists. I have been told, for example, of SLPs who discourage participation because they believe that professionals in attendance will attempt to steal their clients. A more common concern is that involvement will be counterproductive. Because it is not uncommon for meetings to include individuals who are critical of therapy (Hunt, 1987; Manning, 2001), support groups have developed something of a reputation for being anti-treatment (Gathman, 1986). In most cases, this reputation is erroneous. Still, groups should take great pains to avoid even the perception of this sort of enmity. As previously noted, support groups can
SUPPORT GROUPS
V
65
work effectively in conjunction with therapy. Furthermore, professional involvement should be welcomed, not discouraged, as this can aid the group functions of skill transfer and serving as an information resource, among others. Although groups should not be anti-therapy, they shouldn’t attempt to be therapy either (Gathman, 1986). Yes, participants should feel free to practice therapy targets in this setting. But the purpose of the meeting is not to give or receive feedback on speaking skills. Not only does this shift the meeting focus away from what is being said (to how it is being said), it ignores the reality that the majority of participants are not qualified to administer treatment. A final reason for low membership is that local groups often dissolve. One study found that only a few last longer than 2 years (Hunt, 1987). The causes for this instability are not difficult to discern. For instance, one of the reasons why people don’t join in the first place—their SLPs discourage it—also affects retention of members. To use one common example, if the prevailing philosophical approach within the group greatly contrasts that of the therapy being administered, the SLP may feel that the client’s continued participation is detrimental to recovery. Philosophical differences can also arise among members (Ramig, 1993a), which might cause people to drop out. For example, some may be seeking fluency whereas others view this as a fruitless quest. Not only will disagreements develop, but the former group—those searching for a cure—is unlikely to be helped much by group attendance, given that there is little that can be done to improve fluency in a support group setting (Hunt, 1987). Thus, it is doubtful that those fixated on this goal will attend regularly. Another previously cited reason for missing meetings, scheduling conflicts, also results in the departure of members. People of young adult age may start families, enroll in college courses, or change work shifts, to name just three examples of factors that can either limit available time or directly conflict with meetings. In some cases, such factors result in relocation, which obviously furthers group withdrawal. Despite the reality that even the best chapters lose members, there are steps that support groups can take to remain viable. One is establishing and maintaining stable leadership (Ramig, 1993a). Those who guide the meetings need to be dedicated, as they are looked upon to organize the meetings and lead the discussions. Equally important, they need to be available to both regular attendees and those considering their first meeting. Chapter leaders will be called upon to answer questions ranging from directions to the meeting site to how to prepare for a public speaking engagement. (And, by the way, if you are thinking of starting a chapter but feel you cannot answer such questions, “I don’t know, but I’ll help you find out” is a perfectly valid response.)
66
V
CHAPTER 7
Stability of meeting place and time is also helpful to group maintenance. As noted, most groups engage in some sort of low cost advertising, usually members posting flyers wherever allowed. Once this task is completed, the basic meeting information (days, times, setting, and contact people) is public and difficult to change. Furthermore, consistent meetings are easy to remember. If they are always, say, the first Wednesday of the month at 7 p.m. in the Dale Williams room of the Community Center, those who haven’t attended in awhile can easily rejoin the group. It is also important that the site be conducive to disciplined discussion (Hunt, 1987). Meeting in a restaurant or pub might sound like fun, but quickly leads to loss of discipline, and, in time, group identity. That is, the entire purpose of the group—to meet about a common interest—becomes lost in the consumption (and discussion) of food and drink. Support of speech-language pathologists (Hunt, 1987) can also aid in a group’s survival. SLPs cannot only refer their clients to the meetings, but their own attendance may well attract other attendees. Considering that people come for education about stuttering, there is an obvious appeal to the availability of educated opinions. Because some groups meet just once a month (Hunt, 1987), reminding people via telephone or e-mail can be helpful toward keeping the meeting on their personal schedules. Special activities (social or educational) can also help attendance, but, as with all of the other aforementioned ideas, their effectiveness is both limited and variable. Perhaps future market research will enable support groups to advertise effectively to both people who stutter and speech-language professionals. Specifically, examination of what people are looking for in the way of support could be coupled with effective description of how groups offer such services. This would not only heighten the appeal of support groups, but also help to combat the misconceptions about them. Such research is important because support groups are important, enough so that both people who stutter and speech-language pathologists should get involved (Conture, 2001). The former group receives self-help and mutual aid while SLPs hear first-hand what their stuttering clients experience, as well as observe how therapy goals are implemented with new listeners. Getting involved with support groups is not only advisable, it is easy. Despite the transience of local groups, many geographic areas include strong chapters. These can generally be found through practicing SLPs or the closest university communication disorders program. Another convenient source is the National Stuttering Association (
[email protected] or 1-800-364-1677), which helps individuals find or even start local chapters. There are also various Internet sources available for support. They are
SUPPORT GROUPS
V
67
listed on the Stuttering Home Page at http://www.mankato.msus.edu/ depts/comdis/kuster/stutter.html.
SYNOPSIS Support groups add more to the recovery process than serving as therapy adjuncts. If assembled and maintained with care, they can provide a place for people to learn, socialize, feel empowered, and be with those who understand the experience of stuttering. These features benefit not only people who stutter, but speech-language pathologists as well.
Chapter
8
The Meeting
U
I recently asked a colleague, a prominent researcher of neurological systems, why my brain goes to autopilot whenever I am asked about support group meetings. She thought for a moment, and then replied, “Because you’re an idiot.” Whatever the veracity of this analysis, my rote response about support groups is very real and always includes the phrases “informal meetings,” “no agenda,” “young adults,” “shared experiences,” and “free HBO.” Those who show up in spite of my idle ramblings and outright falsehoods discover that the actual common denominator across meetings is exactly what they expected in the first place. In a nutshell, we talk about stuttering. As my six-year-old would say, “Well, duh!” What I mean is we discuss it, wrestle with it, argue about it, joke about it, and try in vain to figure it out. Often, we also lose sight of it and find ourselves debating such pressing matters as the designated hitter rule and who would win a debate between your average radio talk show host and a Tickle-Me Elmo. But the tangents always make it back around to the main topic eventually, proving that stuttering has a large impact on even those with the attention span of plankton. Despite my own stutter, my initial enthusiasm about participation in such a group was roughly equivalent to that of the average teen forced to spend Friday night watching C-SPAN with Great-Aunt Blanche. It began when someone named Marlon contacted me about attending a meeting.
68
THE MEETING
V
69
He was apparently calling from 1969, as he stated a desire to get some “cats” to “rap” at his “pad.” I told him that while the idea was not without its grooviness, I couldn’t help but wonder how he had gotten my name. “From everyone, man,” was his reply. Apparently, my stutter was a common topic of conversation in his circles. In any event, I agreed to come because I saw an opportunity to help others and, in turn, be helped myself. That and Marlon promised free food. From this passionate beginning, I began getting more and more involved in the group. This involvement had little to do with concern for others and a lot to do with the meetings themselves. Always poorly prepared, loosely constructed, and imprecisely executed, they were totally without structure or even agenda. In other words, I felt at home from the get go. Marlon had assumed the leadership position within the group. In totality, this involved 1) welcoming everyone at the start of the evening and 2) closing the meeting, usually with an observation like, “Your bogus rap is starting to bum my high. Why don’t you all book?” In between these responsibilities, he mostly sat back in his beanbag and studied the antique flip-flops that hung loosely from his sullied feet. Introductions, Marlon’s idea for a “primo tradition” that lasted exactly one meeting, marked my initial exposure to the regular participants. We were in Marlon’s basement, an apparent storage space for broken lava lamps and faded Peter Max posters. Marlon presented himself first that evening, saying his name while anxiously stroking his graying ponytail. He told us that he worked as a sales rep for a local radio station “to pay the man.” But his real passion was a book he was writing about stuttering. It was a novel involving a string of murders culminating in a bloody battle scene in which stuttering modification advocates and fluency shapers end up killing each other. The sole survivor unfortunately develops amnesia as a result of his battle fatigue. He thus returns to his commune to create stuttering therapy without his previous biases. Marlon was sure this story would one day be a top seller. After recounting his proposed fiction, Marlon pointed to his right. At the end of his finger was a man who appeared to be the anti-Marlon, closely cropped and wearing a Heroes of NASCAR novelty necktie. He said that his name was Paul and that he was a speech-language pathologist who 1) did not stutter and 2) had no literary aspirations. Next was my turn. Taking my cue from Paul, I was similarly brief, struggling through my name and the words “between jobs.” The second I finished, a guy to my right jumped to his feet, spread his arms, and said, “Stan Fey. Drama student.” A pause followed this declaration, albeit a quick one. Apparently, Stan was not one to let silence linger.
70
V
CHAPTER 8
“Now, you may be thinking, ‘A stuttering actor?’ ” he continued, although, I, for one, was experiencing no such thought. “Think about it!” Stan ordered demonstratively. “When I’m on stage, no one else is talking. No one is interrupting. I don’t stutter because I can talk any bloody way I please!” “Bloody,” Marlon repeated. “The English rock, man.” Stan bowed in the direction of a young man of slight build and calm demeanor. Knowing better than to compete with Stan’s vibrant introduction, the man said only that he was Tim, a college freshman who stuttered. When pressed for something personal, he added that he liked to collect “quiet things,” whatever that meant. At that point, the rotation had arrived at the sole woman of the group. I watched closely as she began to speak. One does not often have an opportunity to observe adult females who stutter, so, from an academic perspective, this was a rare chance to learn. OK, she was pretty. My awe changed to disappointment when Ciara, as she introduced herself, actually spoke. I still would have dated her, mind you, but her frequent prolonged sounds and inaudible gasps of silent tension distracted me. All I remember of her introduction was that she was a recent business school graduate with a lengthy job title that included a lot of terms like assistant, associate, vice, and one or two forms of the word control. Next to Ciara was the oldest and largest individual in the room. With droning yet flowing speech, he told us that his name was Charley. He was a retired police officer who still appeared powerful enough to subdue even the most crazed of criminals. Charley explained that he originally joined the group to tell others about his success in therapy. I thought that the monotonous nature of Charley’s speech could have been used as an argument against the treatment he received. Given that his wrists were roughly the size of my head, however, I kept this thought to myself. Charley’s introduction brought us to a subject that would prove to be recurring, that of treatment. Everyone always had therapy war stories to share. Except for Charley, the stories were all happy tales of short-term success and angry accounts of long-standing defeat. “It’s not easy to get a tailored fit in the off-the-rack world of stuttering therapy,” said Paul. “Tailored fit don’t feed the bulldog!” yelled Stan, for no apparent reason. Charley restated his satisfaction with speech that was uninterrupted. His slow and controlled speaking manner, however, was not for everyone. Stan, for example, said he would rather have his lips stapled shut than talk like that. Like the rest of us, however, he too longed to discover his treatment match.
THE MEETING
V
71
“Hit and miss,” was Marlon’s solution. “Talk about not feeding the bulldog,” said Charley. “Really,” I said. I made it a point to agree with Charley whenever possible. What followed was a discussion of other solutions to stuttering. Stan began by reciting the litany of advice so familiar to us all. Slow down. Think about what you’re going to say. Take a breath and try it again. Just say it. Spit it out. “L-like any of that’s going to help,” he added. “Like none of it ever occurred to us,” intoned Charley. “Exactly,” I said. “Aaaanother . . . thing I hear all the . . . time,” said Ciara, “is, ‘What causes that?’ ” “Usually followed by question number two,” added Charley. “Why doesn’t Mel Tillis stutter when he sings? I don’t know and I don’t care.” “People are stupid,” Stan informed us. As if to confirm this, Ciara related that she had once been coached to replace talking with singing. Charley mentioned that he had been told by his parents to stop stuttering “or else.” As luck would have it, however, neither Mary Poppins impersonations nor vague threats turned out to be much help in the long run, the same result as when Marlon was hypnotized. I mentioned that a therapist had once advised me to substitute easy words for those I could not say. This tip amused some of the others. I did not mention that I eventually took this idiotic advice, a decision that eventually led to more complications than a truth-in-lending document. “Why do we put up with this?” asked Stan. “Because wwwwe get . . . desperate enough to believe anything,” answered Ciara. “Believe me, the way mmmmy in-laws looked at me the fffirst . . . time I met them, I’d have . . . gotten hypnotized if ssssomeone had offered.” “You’re married?” I asked. “I once convinced a girl to d-dump me because I stutter,” said Stan. “Why?” Ciara asked, apparently oblivious to my question. “B-because I wanted to date her roommate.” “And . . . ?” “Just adding to your p-point about how stuttering can affect people socially.” There was a pause that allowed me to catch up to the present conversation. I looked at Stan, who was grinning like a toddler by an unguarded cabinet. “I’m afraid of wwwwomen,” Tim suddenly announced. “Those are tough for me too,” said Marlon. “Those?” asked Ciara.
72
V
CHAPTER 8
“Aaaand phones stink like anything,” Tim added. “There’s a sentence you don’t hear every day,” I said. “Drive-throughs stink like anything too,” Stan remarked. “Also . . . tape recorders,” said Ciara. As she said this, she placed her hands on the table and I noticed the ring. Small stone. I would have done better. Had I been working, that is. “Nonstutterers have speech issues too,” said Paul. “I get more stressed when I’m being recorded or talking on the phone or at a drive-through.” “Yeah, but you don’t sound more stressed,” replied Stan. “Good point, man,” said Marlon. “People hear us and assume we’re social misfit flakes.” “And n-not real bright,” added Stan. “Are we sssocial misfit flakes?” asked Tim. “Don’t forget not bright,” I corrected. “Not a chance,” said Paul. “The only thing experts know to be true about all people who stutter is that they all stutter.” “We’ve come a long way,” I observed. Paul ignored me. “I remember reading once that listeners react to the anxiety intrinsic to any disfluency in such a way that the anxiety impacts their opinions of you.” “Sure wish you came with subtitles,” said Stan. “Try it again,” added Charley. “Some of us aren’t fluent in academese.” “I’m not fluent in any language,” I joked. I was disappointed when no one laughed. “What he means,” said Marlon, “is the listener picks up anxiety vibes that he ties to the speaker.” He turned to Paul, “That right, Mr. Big Word Meat?” Paul nodded with a slight grimace, evidently not altogether comfortable with his new nickname. “It p-p-p-probably doesn’t help th-that all of the stuttering . . . p-ppeople on . . . TV are misfits,” said Tim. Stan agreed. “In a mystery,” he said, “b-b-bet the house that the stuttering character did it.” “I’ve seen plenty of sympathetic portrayals of people who stutter,” Paul argued. “. . . Did they ssstutter l-l-like me?” asked Tim. Stan laughed. “No way. If the character is likable, they not only make the st-stuttering mild enough to be cute, but they cure it in an hour. The guy falls in love or stands up to the authority figure or the mother-in-law moves out and—voila!—the stuttering is gone.” “OK, some writers are idiots,” said Paul. “I thought we already established that about people in general. But, hey—what can you do?”
THE MEETING
V
73
“We . . . can get involved and make them ssstop it, Meat” answered Tim. “Whoa there, Mr. Ed,” said Marlon, moving forward in the beanbag. “What about freedom of speech? Censorship gives me the winnie.” Charley laughed, an apparent sign that he understood what Marlon was saying. “I love that argument,” he said. “How about Tim’s freedom to speak out? Isn’t freedom of speech a two-way street?” “Uh huh,” I agreed. “. . . Don’t you th-th-think ignorance of stuttering is a factor in how we get . . . treated?” Tim asked, looking directly at Marlon. “Yo,” our leader admitted. “Sssso shouldn’t we fight it?” “If Twisted Sister stuttered, that’s what they would do,” Stan informed us. He commenced humming We’re Not Gonna Take It. “If people think we’re wimps, they’ll treat us like wimps,” said Charley. “I’m guessing that’s never actually been a concern for you,” I answered. “Well . . .” Charley smiled. “There was this one guy I arrested. First he mimicked me, then told me ‘Speak or forever hold your peace.’ ” Stan stopped humming. “What did you do?” “First I asked him, ‘Do you stutter too or do you just have a death wish?’ Then I handcuffed him and tossed him in the squad car.” Stan’s story was better. His family moved when he was twelve. As the new kid, he was paid a visit by Gene, the neighborhood tough guy. Stan was in the family garage, pretending to grease the chain on his bicycle, but actually hiding some magazines of which his mother did not approve. “Gene shows up to say how he ran the neighborhood and that crossing him could ‘get you killed.’ Those were his words: ‘Get you killed.’ ” Stan laughed easily at the memory. “Hhhhow’d you handle it?” asked Ciara. “I t-told him I wasn’t scared of anyone with a girl’s name. The thing of it is, I st-stuttered when I said it. He grabbed the front of my shirt, made a fist, and said, ‘Suh, suh, say it again, freak.’ ” “Did you?” asked Paul. “N-no I didn’t, Meat. I grabbed a handful of grease off my bike chain and smeared it in his face. Most of it went into his mouth. He doubled over and started r-r-ralphing big time. Then he ran home. I got in trouble, but Gene n-never bothered me again.” “That’s awful,” said Ciara. I was not so sure. There had been times in my life when some nearby bicycle grease might have come in handy. “I want everyone to stop calling me Meat,” announced Paul.
74
V
CHAPTER 8
“Sure thing, Mr. Big Word,” said Stan. “I’m not wild about that one either.” “Too bad,” answered Stan. “Mr. B the SLP has kind of a nice ring to it.” A few people laughed, but not me. I was still annoyed that my fluentin-any-language joke had fallen flat. “Good note to book on,” said Marlon, which apparently signified closure, as he added, “Catch you cats next month.” Despite Marlon’s occasional lack of focus, not to mention his questionable intelligibility, I usually came away from meetings understanding stuttering in ways unseen in textbooks. Yes, our support group was mostly “young adults” who “shared experiences” in “informal meetings” with “no agenda.” And, yes, on the most basic of levels we talked about stuttering. But there’s more to it than that, and the additional part is what’s important. Unfortunately, it is also difficult for me to explain. Maybe I am an idiot.
Chapter
9
The Stereotyping of People Who Stutter Dale F. Williams, Ph.D., CCC-SLP & Carlos F. Diaz, Ed.D.
U Some people are so “open-minded,” they can’t listen to anyone who isn’t. Deb Dart
Note: Carlos F. Diaz, Ed.D. is a professor in the College of Education at Florida Atlantic University. In addition, he is a member of the Board of Examiners for the National Council for the Accreditation of Colleges of Teacher Education. A native of Cuba, Dr. Diaz has published two books and numerous articles and book chapters on multicultural education. His next book, Touch the Future: Teach, is due to be published in the spring of 2005. Specific areas of interest include prejudice and stereotype reduction. Let’s begin with a gross oversimplification. We exist in a diverse world, one swirling with intricacy and multiple shades of gray. Unfortunately, the only weapon we are given to combat the complexities we face is a brain no larger than a fist, housing a finite number of cells responsible for a multitude of functions. So how do we make sense of a world we’re ill equipped to understand? In essence, we classify. We develop categorization schemes to impose structure onto a complex environment. It is a natural process that begins in the earliest stages of language development. A child learns a word, for example dog, and every animal is, for a while, called dog. In time, the child learns other animal names and, thus, small animals may all be classified as mouse, water animals fish, and so on, until the child has developed a com-
75
76
V
CHAPTER 9
plex categorization scheme for animals that includes numerous species and means of classification.
STEREOTYPES BASED ON SPEECH Viewed against this background, stereotyping can be seen as misclassification schemes applied to people. We group our fellow humans according to such characteristics as race, weight, age, attractiveness, and a multitude of other traits, including speech. Literature from the field of linguistics, for example, links differing stereotypes to various accents and languages (de Klerk & Bosch, 1995). Among American listeners, facility in Standard English is associated with relatively high mental capacity, whereas regional American and foreign accents are not generally viewed as positively (Gollnick & Chinn, 2002). In addition to articulatory differences, voice and resonance characteristics have also been allied with specific personality traits, with disorders in these areas often being perceived negatively (Blood, Mahan, & Hyman, 1979; Gilmore, 1974).
STEREOTYPING OF PEOPLE WHO STUTTER Not surprisingly, people who stutter also fall victim to stereotyping. In 1970, Yairi and Williams determined that speech-language therapists identified children who stutter as anxious, nervous, shy, quiet, and withdrawn, among other comparable traits. Subsequent studies of speech and language professionals have yielded similar results (Cooper & Cooper, 1985; Woods & Williams, 1976). Moreover, people who stutter also have been stereotyped in this manner by the general public (Craig, Tran, & Craig, 2003; Silverman & Paynter, 1990), employers (Hurst & Cooper, 1983a), vocational rehabilitation counselors (Hurst & Cooper, 1983b), teachers (Yeakle & Cooper, 1986), school administrators (Lass et al. 1994; Kiser et al. 1994), college professors (Dorsey & Guenther, 2000), nurses (Silverman & Bongey, 1997), and pediatricians (Yairi & Carrico, 1992). Different researchers have speculated on the existence of this “stutterer stereotype” (White & Collins, 1984). That is, why are those who stutter viewed as wallflowers as opposed to something louder or more assertive? The most obvious explanation is that they really are natural introverts, a speculation put forth by Woods and Williams (1976), then quickly dismissed by the same authors as overly simplistic. There is, after all, no evidence to support such a characterization. Woods and Williams (1976) also hypothesized that listeners react to the high anxiety of the stuttering moment, then generalize that the speaker is
STEREOTYPING
V
77
always anxious. A different explanation for the stereotype was offered by Thatchell and associates (1983), who concluded that the perception of stuttering speakers is a function of their poor eye contact, though the authors offered no evidence to back the contention that eye contact is abnormally low. Finally, White and Collins (1984) suggested that all people experience anxiety and tend to withdraw when they are disfluent. Thus, people overtly and abnormally disfluent are often seen as perpetually anxious and withdrawn. Perhaps the most sensible speculation for the stutterer stereotype emerges from the research on attitudes toward speech. From an early age (somewhere around seven), people who stutter present increased speechassociated anxiety in comparison to non-stutterers (DeNil & Brutten, 1987). Given their negative experience histories with speech, it makes sense that stuttering individuals are, overall, less likely to be verbally outspoken or serve as the storytellers within their peer groups. From this, it is an easy overgeneralization to assume that similar traits exist in nonspeech situations. Based on current knowledge, it is also incorrect. The lawyer who stutters will not negotiate less aggressively than fluent opposing counsel. A teacher may well be a strict disciplinarian, even if he or she stutters. Stuttering athletes are as apt to battle to the finish as their nonstuttering opponents. This notion of overgeneralization, basing conclusions on limited or no evidence, is common to all of the possible stereotype derivations cited. Similar mental shortcutting serves to maintain stereotypes once they are set. We tend to assimilate observations into our pre-existing schemes. In other words, we interpret data in ways that make us comfortable (i.e., see what we want to see). Observations that support our view of the world are cited, those that do not are ignored or viewed as exceptions to our rules. With people who stutter, as with any group, it is possible to find individuals who fit the stereotype to varying degrees. Those are the examples we remember. The result of this selective classification is a view of life that is orderly and easy to grasp. Communication becomes more compact as well, if one assumes that terms such as feminist, doctor’s kid, or stutterer convey an abundance of valid information in just a few syllables. Our behaviors influence our classifications and vice versa, a cycle that serves to further maintain the stereotypes we develop. White and Collins (1984) wrote of a self-fulfilling prophecy whereby stuttering clients are induced to behave in a manner consistent with the speech-language pathologist’s beliefs about them. For example, a clinician who believes a new stuttering client is likely to be shy might conduct a session filled with lengthy instructions and closed-ended questions. This plan may alleviate some worries about the perceived shyness, but it also limits the client’s speaking opportunities. Thus, after the session is completed, the percep-
78
V
CHAPTER 9
tion of the shy stutterer has been reinforced. Of course, such a process is not limited to therapists. Anyone holding the aforementioned stereotype might talk more than usual around someone who stutters, reasoning that it is necessary to do so with those who are naturally quiet. The stereotype is thus supported when the person who stutters is forced into the passive conversational role. Media portrayals of those who stutter are also worth mentioning. Although the merits of specific portrayals have been debated without conclusion (e.g., Benson, 1988; Zimmerman, 1988), evidence does exist that, in general, media depictions influence beliefs about groups. In fact, Mackie and associates (1996) wrote that, along with friends and family, the media are the “most powerful transmitters of cultural stereotypes” in Western societies. Shapiro (1999) argues that the pervasiveness of the stutterer stereotype in arts and literature (e.g., Benecken, 1995) indicates that people who stutter are widely typecast (although it is unclear which is the chicken and which the egg in this argument: Do media depictions influence society’s beliefs or merely reflect them?). Finally, there is the frequently cited matter of the self-esteem of the person who engages in stereotyping. Although the relationship between selfesteem and stereotyping has been debated (Stangor & Schaller, 1996), there does seem to be a link between individuals’ feelings about themselves and the groups (e.g., cultural, gender, fluency) to which they belong. Denigrating other groups can be used to enhance one’s view of self. Thus, it may follow that the stereotype associated with stuttering is particularly susceptible to maintenance in cultures where passivity, nervousness, and the like are socially unacceptable traits. People will look for a reason to attach such characteristics to others. When a speaker points out that someone is bland, the primary purpose of the remark may actually be to show that he or she (i.e., the speaker) is not. The United States serves as a good example of a culture in which the stuttering stereotype is undoubtedly a negative one. Americans value boldness and confidence, reserving far less admiration for reticence. In this respect, we are far from unique. Although other cultures may be more forgiving of the kind of traits associated with people who stutter, it is doubtful that anyone anywhere wishes to stutter for the resulting increase in esteem.
EFFECTS OF THE STEREOTYPE One question raised by this discussion is “So what?” More specifically, of what real importance is the stuttering stereotype? After all, there are certainly other groups presented in far more negative ways.
STEREOTYPING
V
79
So what? is a difficult question to answer, as published research has focused more on the makeup of the stereotype than its effects. Speculation is possible; firm conclusions are not. Despite the lack of empirical evidence, however, it would be ingenuous to believe that the effects are none. This is simply never the case with negative stereotypes. Social interactions, for example, are changed when one has to work past others’ misperceptions. Inaccurate media portrayals may lead to embarrassment or even ridicule. More disconcerting than the inconveniences of a negative stereotype, however, are the professional opportunities potentially lost. Many people who stutter feel that their speech negatively impacts performance evaluations and judgments of their capabilities, some reporting that they were told that it was the reason they were not hired (Rice & Kroll, 1994). In addition, employers agree that job opportunities are decreased for those who stutter (Hurst & Cooper, 1983a). It is also worth mentioning that initial research on role entrapment (Gabel et al. 2004), defined as “when the group in power defines those roles that the minority group can fulfill,” indicates that adults tend to view people who stutter as less suited for certain careers. While it is unclear from this research whether the lost chances are related to stereotyping or the actual presence of stuttered speech, there is logic to the notion that potential advancement could be adversely affected on the basis of perceived personality traits. A middle manager viewed as nervous and passive would have difficulty being promoted to vicepresident, particularly if the president (or whoever is deciding the promotion) considered himself or herself to be fearless and aggressive. We do, after all, tend to think of ourselves in socially appropriate ways, and devalue characteristics that are inconsistent with our self-perceptions (Rosenbaum, 1986). It is also a fair question to ask whether academic advancement is affected by the stereotype in question. To the extent that children who stutter are not placed in leadership positions within the classroom, are not allowed to speak as often as their peers, or are perceived negatively by teachers, academic progress is adversely impacted. Unfortunately, more research is needed to determine whether these scenarios are commonplace. Compounding the potential lost opportunities is the speculation that individuals will, over time, modify their own self-concepts to match the perceptions held by others (McCrosky, Daly, Richmond, & Falcione, 1977). Although it is unknown how often this occurs with people who stutter, at least one study (Jones, 2004) offers evidence that stuttering negatively impacts self-perceptions. For speech-language pathologists, holding a stereotype of their stuttering clients has its own set of dangers. Lacking a true understanding of
80
V
CHAPTER 9
those you treat may well decrease effectiveness. Also, there is the issue of credibility. Many people who stutter are knowledgeable about their disorder. It is doubtful that these individuals will be impressed with trained professionals who present a limited understanding.
CONTROLLING THE STUTTERER STEREOTYPE Given that stereotyping has invaded the area of stuttering with at least some negative effects, the next question is: What can be done? Stereotypes are, after all, extraordinarily resistant to change (Nachbar & Lause, 1992; Pettigrew, 1979). It seems that once a categorization scheme is set, it quickly becomes ingrained. Probably the best place to start looking for solutions is to study what has been done to combat other stereotypes. Past attempts to broaden individuals’ classification schemes have included both education about the groups being stereotyped and exposure to those from such groups. The first of these means, education, has been effective in changing dimensions of stereotyping alluded to above (i.e., organizing and simplifying the social environment; justifying actions toward those who are different; creating distinctiveness across groups) (Worchel & Rothgerber, 1997). For some people, learning about different groups can expand their classification schemes and even change existing stereotypes to more positive ones. For others, unfortunately, education will have little effect. It is important to note that the outcomes of educational efforts are not solely dependent on the individual being educated. They are also functions of the information conveyed. If, for example, a news story reported that 90% of people who stutter tally perfect scores on their SATs, the change in the existing stereotype would likely be quick and widespread. Unfortunately, no such information exists. Informing people that stuttering individuals have been successful in all walks of life, including those necessitating courage and outspokenness (which, unlike the SAT example, is true) will have a more gradual and limited effect. Another positive corrective to stereotyping is exposure to those from the groups in question. Indeed, Klassen (2001) found that friends and colleagues of people who stutter tended to have less stereotypical attitudes associated with the disorder. To be maximally effective, however, the exposure must occur in situations of status similarity (Mannheim, 1960). A wealthy student is less likely to change his stereotype of people who stutter if his family’s maid suffers from the disorder than he is if assigned a disfluent roommate in medical school.
STEREOTYPING
V
81
Assuming status similarity, it can be said that the more exposure to individuals of the stereotyped group, the more variability one sees. Narrow classification schemes thus become more difficult to justify and keep. But although the variability across people who stutter is enormous, such exposure is nevertheless difficult because of the low prevalence of the disorder. Whether the battle against the stutterer stereotype takes the form of exposure, education, or some combination of the two, creative strategies are needed. Individuals who stutter, members of their support systems, researchers, speech-language pathologists, and others can all aid the effort. Information can be conveyed via conversations, workshops, written materials, videos, formal presentations, and numerous means not yet considered. The following goals, while not an exhaustive list, may help in the development of an initial strategy. Demonstrate that stereotyping is tied to the normal classification
schemes used by all people. Intellectually, broader schemes take some effort, but they also afford greater understanding. Allow people to arrive at their own conclusions. Research on stereotyping and prejudice indicates that people cannot be forced into changing their attitudes about stereotyped groups (Pate, 1992). Provide an understanding of how stereotyping denies people their individuality. No one wants to be judged solely on his or her group identity. Focus on the numerous abilities of people who stutter, that is, their accomplishments in varying contexts. This allows for the possibility of expanded classification schemes. Expose others to how people who stutter feel—be it embarrassment, frustration, anger, or other emotions—when patronized or pushed into the background of a conversation. Such information may sensitize some people to their own unrealized but inappropriate behaviors. Listen to people and observe how they respond to these educational efforts. Through constructive feedback, more specific and effective goals can be developed to replace those already listed.
Finally, people who stutter can help their own cause by simply presenting themselves positively (see How do people who stutter get listeners to behave properly? in Chap. 11). Although those who stutter do not necessarily need to change their behavior to suit others, it is also true that the more they present themselves confidently and competently, the harder it will be for others to hold onto the existing stereotype.
82
V
CHAPTER 9
SYNOPSIS As is the case with those presenting other speech differences, people who stutter are often stereotyped. Specifically, they are seen to be shy, withdrawn, nervous, and anxious, among other similar traits. Such a stereotype is potentially damaging for a number of reasons, the foremost being lost opportunities educationally and professionally. Given that recovery is likely to include continued stuttering in some manner, it is important that people who stutter are aware of how they may be perceived, the potential costs of these perceptions, and what they can do about it.
Chapter
10
A Visit From St. Notker
U
Attendance at support group meetings had been lower than my undergraduate GPA. To rectify this situation, I covered the town with flyers, newspaper announcements, and public access TV spots promoting the group. For the next meeting all of three people showed. And one of those was Marlon, the host. He and I were joined by Stan, a college senior majoring in drama. The three of us were in Marlon’s basement, seated in vinyl beanbags flanking an oval area rug with the words Keep on Truckin’ imprinted in faded brown letters. “Where is everyone?” I asked. Marlon shrugged. “Usual story,” he said. “Cats call and say they’ll come. But when it’s time to boogie, they’re nowhere men.” “Guess no one needs us.” “Maybe someone cured stuttering and no one bothered to tell us,” suggested Stan. “Maybe everyone lost their hearing,” said Marlon. “That’s supposed to stop stuttering.” “What?” yelled Stan. “Maybe they’re all singing everything they say. That would work for me,” I said. “If it didn’t make me feel like an idiot, that is.” “Maybe everyone is rapping at once,” said Marlon. “Or whispering.” “Or acting,” said Stan. “I’ve noticed that when I t-t-take a role, I don’t stutter.”
83
84
V
CHAPTER 10
“What if you take the role of someone who stutters?” I asked. “D-d-don’t think it would matter.” Marlon appeared to think deeply about this. “Let’s see,” he said. That sounded like fun. Of course, I’m defining fun here as something better than sitting around Marlon’s basement doing nothing. “OK,” I said. “I’ll go first. I’m—” “Don’t tell us!” said Stan. “Fine. I’ll be the guy who p-pl-played John Gage—” “It won’t work unless you are that person. Talk like he would.” “All right. Let’s see . . . Here goes: ‘Gee, it sure was fun playing John Gage on Emergency! . . . d-d-during the seventies.’ It didn’t work. I’m still stuttering.” “Hey Randolph Mantooth,” said Stan. “You stink at this game.” “OK, you try it if you think you can do better.” Stan smiled. “Ready any time.” “So start.” “Ask me who I am,” he said. “Who are you?” “I won’t say. But here are some hints. I was a noted musician, teacher and poet . . .” “Was?” “Jim Morrison?” guessed Marlon. Stan shook his head. “I probably wrote Gesta Caroli.” “You’re not sure?” I asked. “Notker Balbulus,” said Marlon. “The patron saint of stuttering.” “In the flesh.” I looked at Marlon. “How in the world did you know he was—” “What’s happening, St. Notker?” asked Marlon. “You tell me. Maybe there’s a reason I’m here today.” “St. Notker or Stan?” I asked. “Play along,” instructed Marlon. “OK,” I said, “Hey St. Notker—why aren’t you stuttering?” “I’m dead, you idiot.” “Oh,” I said. “You know, you’re not very nice for a saint.” He smiled. “Just making sure I have your attention.” I took a moment to reflect on the meaning of his previous statement. “So there’s no stuttering in the afterlife?” “Depends on where you go.” Just in case Stan knew something, I made a mental to note to listen closely to next Sunday’s sermon without thinking about where I can get discount tacos on the way home. I looked at Stan. The smile had not faded, but there was a strange intensity to his expression. I noticed that his eyes were a piercing brown and tried to remember if they had always looked that way.
VISIT FROM ST. NOTKER
V
85
“So St. Notker,” I said, unsure how to continue, “how you doing these days? How’s, you know, death and stuff?” He rolled his eyes, then asked, “Why did you ask me about stuttering?” “Well, for one thing, this is a stuttering support group meeting,” I pointed out. “. . . B-b-besides, it’s what you’re known for. According to Marlon here, you’re the patron saint of stuttering.” “Notker Balbulus. That means Notker the stammerer,” added Marlon. “I know what it means!” Our pseudosaint grimaced. “Why couldn’t I be remembered as a great composer? Or as the Shakespeare of my time?” “Shakespeare lived after you,” I reminded him. “So?” “So technically, you wouldn’t know about him.” “You came after me too,” he said. “Yet here I am.” “Good point.” “It’s strange,” he began as he sat forward in his beanbag. “They called me Balbulus when I was alive and it never really bothered me.” “That’s what’s strange?” I asked. “Not the fact that you’re sitting here pretending to be a thousand something-year old saint?” “I suppose today a lot of people would find it humiliating to be called ‘the stammerer,’ ” he added. “Whatever,” I said. “You guys ready to do something else now?” “On the other hand, you have Stuttering John.” This brought me back to the activity. “Saints follow pop culture?” “Not really,” he said. “We just know things.” “How?” “It’s complicated.” For some reason, Marlon nodded in understanding. “Listen,” I said to Stan, “it’s just like you were whining about a few minutes ago. People don’t want to be identified by their stuttering. “First of all,” he began as he leaned back in the beanbag, “what I said was that I wanted to be remembered for my accomplishments. Secondly, if people recognize that stammering was one part of me, I have no problem with them noticing it. Third, I wasn’t whining.” I sighed. “Well, maybe it wasn’t a problem in ye olden days,” I said. “But in today’s world people get touchy about being recognized by their problems.” “So I gather.” “Dudes want folks to realize there’s more to them than the bogus stuff,” Marlon explained. “. . . Th-they don’t want people to think they’re imperfect,” I added. “Not to mention shy, introverted, nervous, and everything else that goes along with stuttering,” said St. Stan. “I guess.”
86
V
CHAPTER 10
“In my day—during which, by the way, we never said ye olden—being introverted was like being right-handed. It was just a trait with no value attached.” I yawned. “The good old days, eh?” “Never talk down to a saint,” he warned, like it was some new sin he just invented. “I wasn’t. I just wish people today were as calm.” “Which people do you mean? The ones being labeled or the ones doing the labeling?” “Both.” He paused and, for a moment, I thought we were finished. I was glad too. The transformation from Stan to Notker Balbulus was starting to weird me out. As luck would have it, however, he was just resting up for another monologue. “I agree that things are better when humans are judged according to whom they are than by traits they can’t control,” he began. “But since stereotyping occurs, those on the wrong end of it have a right to point it out. Otherwise, how will they ever escape the process?” “Here’s an idea,” I said, straightening my back and moving forward in the beanbag. “They could prove their detractors wrong.” “How?” “B-b-by not being passive, shy, and nervous.” Our visiting saint dismissed the idea with a wave of his hand. “Wouldn’t work,” he said. “Once a stereotype is set, it’s hard to remove.” “How do you know?” He looked at me for a full second. “Oh, right. The saint thing.” “Give me an example of a stereotype,” he commanded. “People who stutter are passive, shy, and nervous.” “A different one. One you’re not as close to.” This was quite a trial for my lethargic mind. Besides, I needed to save what few working brain cells I had for work tomorrow. Not to mention the morning drive through the never-ending Boca road construction. That’s it! Boca! Of course! “Here’s a stereotype,” I said. “The Boca mom.” “Ah yes,” St. Notker replied. “The parent supposedly too busy with the social registry to actually raise her children, yet nevertheless brags about their brilliance to the plastic surgeon, tennis instructor, and everyone else she regularly comes into contact with. Meanwhile, the nanny does the real work, freeing Mom for important duties, such as gossiping about who used the wrong salad fork at the club luncheon. Is that about right?” I nodded. “Basically.”
VISIT FROM ST. NOTKER
V
87
“Now give me an example of a stressful situation,” St. Notker instructed. “Hmm, let’s see . . . a job interview.” “A spork lodged in your tongue,” offered Marlon. “Let’s go with the interview,” said Notker. “Imagine yourself in that situation, and all you know about the interviewer is that she’s a Boca mom. What are your thoughts?” “Well, you can’t judge people based on such a small amount of information—” “Oh spare me the insincere tripe! Your thoughts are that you’ll fly through this interview because you’re talking to someone shallow and barely able to function in the working world.” “So what’s the point?” I asked. “Stay with me. Now let’s say the interview doesn’t go as expected. Say that this interviewer made points you couldn’t refute and asked questions you couldn’t answer.” “If I do, can we do something else?” “You leave the interview feeling crushed.” “D-d-does this story have a point?” “Now, let’s say that 3 weeks later you have another interview. All you know about the interviewer is that she’s another Boca mom. What are your thoughts? “I’ll tell you what they are,” he continued, without giving me a chance to answer. “You’re thinking that you’ll fly through this interview because you’re talking to someone shallow and barely able to function in the working world.” I yawned. “So I didn’t learn anything?” “Oh, you might remember the first interview and readjust your thinking. But the point is that your initial reaction will be right back to the original stereotype.” “My default position.” “I hate how computers are influencing the language.” “You’re pretty good at this,” I had to admit. “Of course I am,” said the attending saint. “I mean, I may well have a better chance in the second interview. Think about it: What are the odds of finding two sharp Boca moms in a 3 week span?” He sighed. “Then again, you might not learn anything from your experience.” I pretended to consider this before responding. “Well, thanks for the visit,” I said. “But you’re beginning to get tiresome.” “You know,” he continued, “in some ways being called a stutterer is worse than being labeled a Boca mom. Why, you ask?”
88
V
CHAPTER 10
“I didn’t ask anyth—” “Because people are so embarrassed about it. Thus, they are not only stereotyped, but, when they are, they don’t speak up.” “You haven’t been paying attention to my century,” I said, somewhat ridiculously. “They are speaking up. Loudly. Some are even carrying protest signs, for crying out loud.” “I’m paying plenty of attention. Tell me, what are they protesting?” “Bad meat?” guessed Marlon. “Negative media portrayals, mostly,” I said. “And who’s doing the protesting?” asked St. Notker. “A dozen of the 60 million people who stutter? That leaves a fair number who are staying quiet. Not only are they embarrassed, they’re scared that if they speak up, they’ll be accused of whining.” “They are whining,” I mumbled. “So what if they are?” he asked. “What’s wrong with a little whining? People today don’t stand up for themselves because they’re so afraid of being labeled whiners.” “Not 10 minutes ago you yourself objected to being labeled a whiner,” I pointed out. He glared at me in a way that, for a moment, made me think sainthood was not in my future. “All I’m saying,” he continued evenly, “is that people need to gripe now and then.” “Even if I buy that, wouldn’t you agree that griping can be carried to an extreme? Ever hear of political correctness?” His maddening smugness returned. “Ah yes,” he said. “You contemporary people and your PC arguments.” “Not in your day, huh?” “I lived in a monastery. Of course we were expected to think a certain way.” “Monastery sounds scary,” declared Marlon. “Like monster.” “Then you understand the problem,” I said to Notker. “Problem?” “Yes, problem. People are actually politicizing a speech difference like they’re an ethnic minority or other group who experiences real discrimination. I mean, what is that all about?” “You’re saying they’re going too far?” “I’m saying that and more. In trying so hard to be victims, they’re being divisive. Us against them. The downtrodden versus the empowered.” “Are you not sensitive to the plight of people who stutter?” “Oh give me a break, saint-boy. I’m as sensitive as anyone else. That doesn’t mean I have to buy everyone’s claims of victimization.” St. Notker reflected on this. “Let me ask you something else,” he said. “Is it possible to be empathetic toward people who stutter while still dismissing the issue of their sensitivity to how they’re portrayed?”
VISIT FROM ST. NOTKER
V
89
“Stop talking like a saint.” “Fine. Can you feel for people, yet disregard their feelings of victimization?” I had to think about that one. “It should be possible,” I concluded. “But you get labeled as one of the victimizers if you don’t buy their political rhetoric hook, line, and sinker.” “You keep using the term political.” “What would you call it?” “Well, I’d call it people attempting to educate others about themselves. I’d call it people trying to gain control over how they are portrayed.” “You say boloney, I say bologna,” I said. “Hmm.” St. Notker scratched his head. “In all my centuries, I never heard that one. But anyway, explain to me how this is political. No one is getting elected. No one is asking for a handout.” “Not yet.” “So you admit it’s not actually a political issue. So am I to conclude that you’re trying to force politics-of-victimization rhetoric into the matter without first seeing if it fits?” “Oh please. Can you honestly say they’re not playing the victim?” “Some are,” he admitted. “But, you know, even the most pathetic ones are trying to educate their opponents.” “You sure about that? Keep in mind they have media advocates now.” “I’m aware of that. Quite astounding really.” “I’m not sure that’s the word I’d use.” “Think about it: A group who grows up learning to be ashamed of their disorder now not only telling the world they stutter, but standing up to those who shame them. This certainly couldn’t have happened in my day.” “I should have lived your life.” “Yeah, you’d do great in a monastery.” “Are saints supposed to be sarcastic?” I asked. “There’s some license with that. Anyway, getting back to media advocates, let me point out that they have been around since roughly 4 minutes after media were invented.” “Mildew has been around a long time too. That doesn’t make it good.” “What’s your problem with media advocates?” “They’re unrealistic. People aren’t perfect. Why should any group be portrayed without faults?” “Do you really think media advocates are trying to limit portrayals to only heroic ones?” “No?” “Of course not. Their role has always been to point out even the smallest affront to a group’s sensitivities. It’s to remind people that someone is
90
V
CHAPTER 10
watching, thus assuring that, if nothing else, portrayals will not be exclusively negative.” “You’re giving them a lot of credit. Personally, I don’t think they put that much thought into it. It’s just more hypersensitive PC garbage that isn’t going to change anyone’s mind.” St. Notker allowed himself another moment of reflection. “Are you sure you’re putting a lot of thought into it?” he asked. “Because here, in a nutshell, is your argument. You are sensitive. Therefore, anything that does not offend you is not insensitive. And anyone who is offended is, by definition, hypersensitive. And finally, anyone that hypersensitive is undeserving of sympathy and, instead, worthy of ridicule.” “It sounds kind of illogical when you say it,” I admitted. “Not to mention arrogant. Worst of all, though, is that it’s superficial. You’re ignoring the real issue here. A far more pertinent and interesting question than who’s right is why some individuals are so touchy. What is it about their experiences, the impact of stuttering on their lives that make them sensitive to negative portrayals?” “Hypersensitive,” I corrected. “Again, that’s true of some,” St. Notker admitted. “And guess what. Many of them are indifferent to whatever issues that flare your temper.” “Like how people shouldn’t whistle in the workplace when others are trying to concentrate?” “Um, I guess. My point is that we all have issues we care about more than others. Issues that don’t have right or wrong answers.” “So I’m free to disagree. That’s what I’ve been saying all along.” “You can disagree, but do so respectfully. Listen, I didn’t live at a time when Porky Pig was popular. No one in the Abbey used that to mock me.” “Abbey,” repeated Marlon. “Hey saint dude—did you ever meet the Beatles?” “Others experienced this sort of teasing and didn’t like it one bit,” continued Notker. “Who am I to tell them that their feelings aren’t real and that their concerns are trivial? It’s not my call.” “You’re getting kind of preachy,” I observed. “I’m a monk, you discourteous scalawag!” “Scalawag? In what century did you pick that one up?” “Furthermore,” he continued, “even preaching beats putting your head in the sand and ignoring everything you can label as PC. It’s what you people today call a cop-out. When someone doesn’t want to deal with an issue, he calls it politically correct, like nothing more needs to be said. Then he doesn’t have to address it.” “He or she,” I corrected. “Don’t bait me. What I’m saying is that some discussions need to move past this level of debate.”
VISIT FROM ST. NOTKER
V
91
“Fine. I’ll put some more thought into it.” “That’s all I ask.” At this point the saint and I both looked at Marlon. I guess we were both unsure how to proceed. “Monster is a cool word,” Marlon told us. After a short pause to digest this information, Stan said, “I guess we’re done. What’s next?” It was kind of creepy how quickly he reverted back to his old self. “I’ll be Gary Lovetro,” said Marlon. “Who’s Gary Lovetro?” Stan and I asked in unison. “Duh. The original bassist for the Strawberry Alarm Clock? Hello?” “Time for me to go,” I said. I started to look at Stan, but he was already out the door, taking St. Notker with him.
Chapter
11
Listeners
U
How did you know it would give me a spool of faith? You liked my poem about the blue sky and asked me to recite it in a tape recorder for parents’ night. That afternoon after school you handed me a small mic and I read the poem. I read it: each word whole I read it: each line complete I read it and did not stutter once my words sailing into the bull’s-eye of myself and then I saw your hands unclench themselves from your mouth— your whole face radiant like an open sky William Palmer A Spool of Faith —letter to my fourth grade teacher
92
LISTENERS
V
93
Reactions to stuttering range from derisive to pandering, with proper listening falling somewhere in between. This assortment raises a number of questions. Let’s begin with the most obvious. 1. Why do listeners react in so many ways? Stuttering is different, a speech pattern people are not accustomed to hearing. As such, it catches them by surprise. It is perhaps this reason that stuttering often elicits reactions of confusion. Listeners are unprepared for it and many are confounded as to how to proceed. Although such a reaction seems unsophisticated, it is actually quite normal. People are programmed to react to unfamiliar, unexpected, and/ or unsettling differences as they would to known danger (Miller & Sammons, 1999). Anyone who says he or she does not see such differences is lying, a small child, or missing a basic survival mechanism. Of course, after the initial split-second neurological reflex come responses that are learned and voluntary (Miller & Sammons, 1999). This is where we see the listener’s sophistication with respect to differences. Or don’t see it, given how often it is missing. One common, albeit rather unrefined, response to stuttering is best termed flight. The reactor does not actually flee the setting as if confronted with genuine danger; he or she will, however, look for an opening to exit. They might do so out of disdain (feeling that the speaker is responsible for the stuttering) or, more likely, guilt (Liveneh, 1982). With the latter cases, the source of the guilt may be the listener’s own ability to speak normally (Liveneh, 1982). In such an instance, a listener is likely to be uncomfortable in much the same way one feels when approached by someone holding a Will Work For Food sign. We can’t do all that we feel is necessary to help and the quickest way to appease the sense of culpability is to move on and stop thinking about it. It is also possible that listeners worry about “guilt by association” if they befriend someone with a known disability (Livneh, 1982). That is, they are concerned about being perceived negatively if they are seen with someone different. Thus, they flee the scene before this can occur. Of course, not all listeners flee from stuttering. Many try to help (Makas, 1990). Unfortunately, their attempts may be viewed as condescending. For example, comments such as “Slow down” or “Take your time,” although intended to be supportive, may be received as patronizing. Helping someone requires placing him or her in a needy position (Makas, 1990). In order to be aided, the individual who stutters must be relegated to a subordinate role in the interaction, conversing not as an equal, but as someone in need of rescue. This is the source of the resentment that frequently ensues in these types of interactions.
94
V
CHAPTER 11
It is also worth noting that sometimes listeners intend to respond in a simplistic manner. If they believe, for example, that stuttering is symptomatic of a more widespread problem (e.g., see Livneh, 1982), they may well converse in a rudimentary manner, as if the speaker is slow to understand. Whether one tries to help, flees, or responds more appropriately is largely based on factors that stem back to early childhood. Some children are taught to be tolerant and doing so is quite natural for them. Although this conditioning does not exclude reactions of flight or condescension, it is likely that some measure of compassion will remain into adulthood. On the other hand, if childhood influences emphasized health and normalcy above all else, there may well be an aversion to those without them (Livneh, 1982). Our life experiences further shape our reactions. For example, listeners who do not speak normally, or who present other differences, are likely to have compassion for the struggles of stuttering (Miller & Sammons, 1999). This is particularly true if they were teased about their own distinctive traits. Similarly, those with close relatives or good friends who stutter may well have an understanding of how to respond. Related to this point are media images, which we can assume affect responses to some degree (Livneh, 1982; Miller & Sammons, 1999). Sympathetic images can lead to like reactions. Conversely, negative portrayals serve to legitimize reactions about which listeners might otherwise have felt guilty. One final point should be made with respect to how listeners respond, that being the reactions of children. Remember from Chapter 9 that classification schemes generally expand as people get older. One offshoot of this is that the reactions of children are unpredictable. Stuttering is not necessarily viewed as a difference if a child has not been conditioned to think of non-stuttering as normal. Thus, the reaction might be slight or even non-existent. However, if it is seen as a outside of normal, the resulting reaction might be strong, given that children have less understanding of why some people present differences. In other words, after the initial reflex, there is no rational thought to utilize. They might fear that stuttering is contagious or wonder why it has not been fixed (Miller & Sammons, 1999). Whatever their thoughts, they are often quick to mention them and to ask questions adults would not dream of asking. But they have an excuse. They’re kids. By the time one reaches adulthood, there should be better strategies available for responding to differences such as stuttering. This brings up the next question. 2. How should listeners behave?
LISTENERS
V
95
Obviously, each speaker has his or her own idea of what proper listener conduct entails. For people who stutter, these ideas generally include such behaviors as responding to the content of speech (without commenting on its delivery) and demonstrating acceptance and patience (Whaley & Golden, 2000). That is, good listeners don’t smirk or fidget or add time pressure by finishing sentences, asking multiple questions, or interrupting. They respond with a relaxed speech rate (not slow motion, just relaxed) without offering demeaning and unhelpful advice such as “Slow down” or “Relax” (“How to react,” 2003; Whaley & Golden, 2000). Some people who stutter are more comfortable when listeners acknowledge their difference (Starkweather & Givens-Ackerman, 1997; Whaley & Golden, 2000). Of course, there are appropriate and inappropriate ways of doing this. In general, when the listener lets the speaker know that he or she does not mind the stuttering, the speaker feels more comfortable (Starkweather & Givens-Ackerman, 1997). However, if it is not relevant to the conversation, acknowledgment can be not only insensitive, but can send a message that the listener is interested in how speech is being produced, not what is said (Miller & Sammons, 1999). Another common listener suggestion—maintaining normal eye contact (“How to react,” 2003; Whaley & Golden, 2000)—also requires clarification. While clearly one should not avoid eye contact just because a speaker stutters, the listener must also understand what normal eye contact is. It is not an unwavering stare. It is occasional, enough to regard, to let the speaker know that he or she is being acknowledged (Miller & Sammons, 1999). Of course, one person’s acknowledgment is another’s discourtesy, and thus it is not always easy for the listener to know that he or she is doing the right thing. Furthermore, it has been noted that the listener’s accommodations could be interpreted as condescension by the speaker. This leads to a third listener issue. 3. Do speakers perceive reactions that aren’t there? Each year, I give my graduate students pseudostuttering assignments, whereby they engage in voluntary stuttering in a variety of settings. When they report their experiences, many of them read like this: I walked up to a salesperson in the mall and stuttered as I asked him where the tennis shoes were. He showed me, but I could tell he was put out. He didn’t smile or engage me in conversation (other than saying “Follow me”). I couldn’t tell if it was because he didn’t want to hear more stuttering or because he thought I was “slow.” Either way, I felt really embarrassed . . .
96
V
CHAPTER 11
A quick review of this account informs us that 1) the student stuttered and 2) asked for tennis shoes, which led to 3) the salesperson directing the student to the tennis shoes. In terms of facts, that’s pretty much it. Everything else reported is perception. Was the store employee really “put out?” And if so, was it because of the stuttering? Was his lack of effusiveness due to annoyance? Are people normally verbose when directing someone to a specific location? And finally, is it possible that he was not as concerned with the student’s stuttering or intelligence level as he was with showing her where the shoes were? Before anyone thinks of this example as representative of the entire pseudostuttering experience, it should also be pointed out that students have reported reactions of outright mockery, as well as people walking away and other clearly negative listener reactions. Moreover, people who stutter have reported responses as extreme as demands to speak correctly or not at all. Clearly, stuttering sometimes evokes responses that are negative. But stuttering also stirs up reactions within the speaker—nervousness, embarrassment, anxiety, and the like—which can alter perceptions. Thus, the demeaned speakers should ask how much of their emotion is due to the reality of the situation, and how much to their own perception. Given that some portion of negative reactions are very real, however, we have to ask ourselves another question. 4. How do people who stutter get listeners to behave properly? Starkweather and Givens-Ackerman (1997) offer suggestions for teaching familiar listeners how to conduct themselves. In short, they can be told about stuttering in general and about the speaker’s specific stuttering patterns (what’s helpful and what’s not). Fortunately, this sort of teaching can be done in everyday conversation. A lot of education occurs with simple statements such as, “Please don’t finish my sentences,” or “Just so you know, telling me to ‘slow down’ doesn’t help.” Given how the stutterer stereotype affects listener perceptions (see Chap. 9), it makes sense that anything that reduces the stereotype—in this case, education—would also reduce negative reactions. And because we know that stereotypes are resisted via exposure as well, it follows that people who stutter help their cause by simply going about their daily lives. That is, talking to people familiarizes them with stuttering which, in turn, increases habituation, a term used by Miller and Sammons (1999) to indicate when differences are so familiar that they become part of the listener’s comfort zone. The way in which speakers present themselves can reinforce or challenge the existing stereotype and, by extension, the reactions they receive (Lew, 1998). Those who display vulnerability or timidity are likely to be
LISTENERS
V
97
treated differently than those who do not. Interestingly, as individuals become more desensitized and less concerned with how they are perceived, they often report more positive reactions (and/or fewer negative ones). Perhaps listeners become more wary as they perceive less vulnerability. Similarly, those who present a sense of humor about their own stuttering are likely to put the listener at ease and reduce any potential anxiety (Lyttle, 2002; Orben, 2001). With children, it is often best to discuss the stuttering. Their questions might be direct, but they are also innocent. They have no agenda beyond wanting to know why the person is speaking differently. Because they want to learn, it follows that they can be taught. Additionally, they can be reassured that stuttering is not something about which they need to be concerned. In the video Voices to Remember (Suncoast Media, 1992), a pediatric dentist relates an occurrence during which a young boy told him, “You know, you talk with an echo,” and responding with, “Hey, that’s very good! That’s exactly what’s going on!” With this simple agreement, the stuttering individual served to lower the child’s anxiety and answer his concern. 5. What about listeners who are idiots? Of course, education, habituation, exposure, humor, and reassurance won’t work with everyone. Sometimes, reactions are at the extreme end of negative. Four of five stuttering children, for example, have to deal with teasing or bullying at some times in their lives, as opposed to about half of school aged children in general (Langevin, 2001; Mooney & Smith, 1995). This is not particularly surprising, given that stuttering is associated with perceptions of insecurity, nervousness, and passivity, traits bullies often target in their victims (Blood & Blood, 2004). Who better to pick on than someone who is unlikely to retaliate? Bullying is, of course, not always limited to childhood. And even when it is, the effects can nevertheless be long-term. It can lead to loneliness, depression, social isolation, loss of self-confidence and self-esteem, and even health problems such as weight loss (Dake, Price, & Telljohann, 2003; Murphy & Quesal, 2002; Roth & Beal, 1999; Starkweather & GivensAckerman, 1997). It is also not, as some might argue, a necessary part of growing up (or of life as an adult). In fact, widespread anti-bullying programs (e.g., Colorado’s No-Bully program; Success Unlimited) exist on the basis that it can and must be stopped. Such programs stress empowerment for those being bullied, coordination among the involved individuals (e.g., the parents, teachers, and children within a given school system), and proactive and reactive advice for diminishing instances of bullying.
98
V
CHAPTER 11
Similar focal points are present in resources designed for people who are bullied on the basis of their stuttering. For example, empowerment is often addressed early, by educating stuttering individuals that 1) the stuttering is not their fault, 2) they don’t deserve to be mocked for it (Murphy & Quesal, 2002), regardless of whatever shame they have experienced or are experiencing as a result of their disorder, and 3) they are not isolated individuals; many people are teased and bullied about a variety of differences (Lew, 2000). In addition, it helps the stuttering individuals to understand that bullies do what they do for reasons of insecurity (that is, they need self-validation or attention) and ignorance (Lew, 2000). This information helps in the formulation of a solution. When confronted with bullying, there are a number of options. An alltoo-common one is avoiding. That is, the individual hides from the tormentor or stays in crowds, given that bullies rarely pick on groups. Of course, the latter technique is difficult to employ for someone who is socially isolated. Groups will be hard to form, mostly because others fear being teased themselves if they socialize with an outcast. Also, avoiding a persistent bully may require costly sacrifices (Roth & Beal, 1999). Missing school or work, for example, is a high price to pay to hide from teasing. One can also ignore it (Lew, 2000; Murphy, 2000) in the hopes that the bully will stop because he or she is not getting the desired attention or selfvalidating reaction. While this may work, it will undoubtedly take awhile. Furthermore, the severity of the teasing is likely to increase before it does (Roth & Beal, 1999). In the meantime, the self-esteem of the people being teased is negatively affected. They wonder about their own courage then and long after the bully has gone. One oft-mentioned solution is to confront the bully (Dugan, 1998; Lew, 2000; Murphy, 2000; Roth & Beal, 1999). Confrontation can take many forms. Successfully challenging the bully verbally or physically is probably everyone’s dream scenario, but this is not recommended. After all, the bully has likely chosen the stuttering individual on the bases of an inability to talk back quickly and/or a comparatively small stature. Perhaps because of these reasons, children who stutter rarely defend themselves (Roth & Beal, 1999). Of course, confrontation need not be quite so direct. A reply can be forceful without challenging the bully to any sort of battle (Dugan, 1998; Lew, 2000; Roth & Beal, 1999). “Yeah, I stutter. Big deal.” is an example, as is asking the bully to stop teasing. This technique fits with the aforementioned advice that people who stutter present themselves with assurance and confidence. Remember too, however, that in Chapter 5 it was pointed out that this often requires a lengthy process of desensitization. Those who are not desensitized will obviously have a tough time projecting the
LISTENERS
V
99
necessary assurance and confidence to successfully discourage a bully (Roth & Beal, 1999). Using humor against a bully is advocated by some (Lew, 2000; Manning, 2001; Starkweather & Givens-Ackerman, 1997). However, responding with “OK, so I stutter. You’re ugly. At least my problem can be managed,” or something milder such as “That’s not how you stutter. Let me show you again,” is fraught with potential problems. For one, the speaker is relying on verbal skills, which is the source of the bullying problem to begin with. Second, it was discussed in this chapter how unanticipated events cause people to freeze as they would to danger. Consider that, with a bully, the person who stutters is confronting an actual danger. When the same reflex takes over, expecting the child to have the presence of mind to create and implement a witticism may be outside the bounds of reality. Another means of confrontation, education, can combat the ignorance on which much of teasing is based. This can involve explaining stuttering, either in general terms or those traits specific to the individual (Lew, 2000; Murphy, 2000). Again, a level of confidence is needed that might not be present. Moreover, if the bully’s goals are self-validation and attention, he or she is not likely to be interested in learning about stuttering. With children, it can be helpful to educate the entire class about stuttering. This can be done by the child’s speech-language pathologist (Murphy & Quesal, 2002), adults who stutter (Manning, 2001), or the classroom teacher (Silverman, 1996). Possible topics to be covered include famous people who stutter, why stuttering is no one’s fault, and the fact that no universal cure exists. Bullies and others can learn how unfair teasing about stuttering is. It is important to note that, as with confrontation, the stuttering child needs to achieve a high level of desensitization before he or she is comfortable with such a presentation (Williams & Dugan, 2002). Education about teasing itself is also instructive (Lew, 2000; Murphy, 2000). The information related in this sort of presentation is general. For example, everyone has something about which they are sensitive (and, therefore, anyone could be teased). The damage done by teasing can be spelled out as well. Bullies can get some idea of how it feels to be on the other side. Unlike education about stuttering, relating information on teasing can help people who stutter without drawing undue attention to them (they may, remember, be quite self-conscious). The idea is to not only end the teasing, but also to create an atmosphere in which stuttering is accepted. As with other strategies, it will be more effective with some bullies than with others. An accepting atmosphere is also the goal of the final strategy: Getting help. The person being teased can tell someone what is happening (Lew, 2000; Murphy, 2000; Roth & Beal, 1999; Starkweather & Givens-Acker-
100
V
CHAPTER 11
man, 1997), thereby decreasing his or her social isolation by forming a helpful alliance. Of course, the danger is that the alliance might turn out to be anything but helpful. That is, those in supervisory positions may not understand the potential danger of bullying and take inappropriate (or no) action. For example, Roth and Beal (1999) point out that, although parents are willing to help children bullied at school, teachers are often not able to do so effectively. In these instances, it is difficult to persuade people to report bullying. Even when the punishment for bullying is severe, it may go unreported. Victims understand the value of doing so, often stating that they will report it, but then do not. They may feel that getting help shows weakness, an admission that they cannot solve their own problems (although we all ask for help with other problems all the time). There is also a fear of retaliation, that the bullying will become more severe if trouble is caused for the perpetrator (Lee, 2003). Reporting can be increased if there is a formal anti-bullying program put in place. Such a program would make help readily available, allowing not only for easy reporting but also instilling in bullies the knowledge that they will be punished. Ideally, such programs would also involve education about bullying. This would undoubtedly decrease the frequency of its occurrence and help those in authority learn to deal with it effectively. Obviously, however, many settings do not have these types of programs. Furthermore, they would take time to create. Thus, informing may be neither a perfect nor a quick solution. Just as obviously, the same can be said for all the other solutions to the problem of bullying. On the plus side, however, enough information exists that, in general, speech-language pathologists and people who stutter can effectively address the problem together.
SYNOPSIS People react in many ways to stuttering. A listener might flee, try to help, or tease, to name just a few possible responses. Because recovery is so closely tied to effective communication, it helps for people who stutter to be proactive with respect to listeners. They need to distance themselves from their own perceptions, decide how they want listeners to act, and let the listeners know. In some cases, such as dealing with bullies, people who stutter may be better served by seeking help.
Chapter
12
Stories of Listeners
U
STORY 1 In nearly all respects, it was an average day in junior high. The hallways were crowded with overly aggressive boys and overly decorated girls, both, in their own ways, thinking they appeared grown up. Talk was sparse, the heaviness of peer pressure keeping all but a few mouths shut. The teachers were alternately stern and silly, seemingly deriving great pleasure from both controlling and amusing us. Just another day, it seemed, as I walked toward my next class. It was then that I discovered my path blocked by Clete VanBraagt. Clete was roughly twice my size and sported a three day growth of beard, a feature few other seventh grade boys could match. As I moved to bypass him, he repositioned himself to barricade my new route. “Where you goin’ Fool?” he asked. I laughed to indicate that I received this snarled insult as good-natured ribbing. “To class,” I said, still walking. He grabbed my arm, which suddenly felt like it had become wedged in a giant tree branch. “T-t-to class,” he repeated, mimicking the stuttering he was evidently hoping to hear. “I g-gotta go,” I said, as if I were apologizing for having to excuse myself from a discussion.
101
102
V
CHAPTER 12
“Where? To learn how to talk? With the other fools?” He tightened his grip on my arm, something that, until that moment, I did not think was possible. “You ain’t goin’ nowhere,” he sneered. I was silent, terrified of Clete and of stuttering if I spoke, which would have exacerbated the situation. I stared at my tormentor, confused by my panic. “What are you lookin’ at? You getting’ ready to try something?” he asked, his voice sufficiently loud to draw the attention of passing students. “You think you want to fight me?” With that, he slammed me into a nearby locker. I quickly processed my predicament. A giant bully had me pinned to a hard metal surface. Peers were awaiting my response. My choices were humiliation or pain. Common sense dictated the former, but before I could act on this decision, I heard a voice. “Boys, boys.” It was our History Teacher, Mr. Van Horn, acting as though we were small children roughhousing too close to a pool. “Don’t you boys need to be in class and not out here fighting?” Clete released me. As I walked away, I heard him say, “Boy, are you gonna get killed after school. Van Horn don’t protect fools outside.” My sense of initial relief quickly changed to fear. I spent the remainder of the day watching the hands on the clock move slowly toward the final bell, my brain contaminated with images of Clete, his knees holding my arms to the ground as his fists pounded my face bloody. I was unable to concentrate on classes or hallway conversations. When the last class was finally over, my nerves were whittled raw and my stomach knotted. I hurried to my locker, but soon lost whatever time I had gained by doing so. My hands were shaking so violently that I took twice the usual time to remove the books and folders I needed. Once that task was finally completed, I ran to the bus, sat down, and looked out the windows, scanning the crowd of students, hoping not to see a large one. After several minutes of viewing, I decided that Clete must be waiting by a different exit. I relaxed slightly, hoping the bus would leave soon. Maybe tonight I would think of a means to avoid him tomorrow. Perhaps I would figure out a way to fight him. I looked out the window again. There he was. He was easy to spot as he stood in a group of the popular kids, his head seemingly a full foot above the others. I could see him laughing. He was not even thinking about me, I thought as the bus began to pull away. Although it upset me that I had spent the past five hours worrying for apparently no reason, I was also relieved that Clete cared so little that he could forget about me.
STORIES OF LISTENERS
V
103
I maintained this mistaken assumption for about two weeks. Then, one day in the cafeteria, Clete addressed me again. “Hey Fool,” he said. “You got any money?” “No.” “Give me 15 cents or I’ll kill you.” I gave him 15 cents. “You ever lie to me again I’ll kill you.” Over the next 6 months, he took my money, books, pencils, and whatever other supplies he wanted. When I did not present the desired items, he amused himself with such activities as spitting on the front of my shirt and knocking books and folders from my hands. I spent much of that school year in a state of anger. I was mad at Clete for regularly humiliating me. I was annoyed at every peer who told me to stand up to him, then languished out of sight whenever Clete appeared. Most of all, I was angry with myself. How, I wondered, could I be letting this happen to me? I was a strong kid. My fists could do some damage. I had never punched anyone, but I had been in fights before. Yet here was this beast daring me to battle him, giving me every reason to do so. In response, I did not lift a hand. I was certain that I was history’s only victim of a bully. This was junior high, a time when many young men are initiated into manhood via fist fights. I had witnessed such battles, entranced by the taunting, the bone cracking punches, the invigorated combatants, the inevitable blood. Why did the thought of such an encounter seem to frighten only me? Life outside my little world appeared to be equally violent. TV and movie stars, human versions of comic book superheroes, were physically threatened unremittingly. In response, they mostly smirked and cracked wise, displaying no fears of harm or abasement. It was always the bad guy, the worthless scumbag, who backed down. Why? Because that is what worthless scumbags do. Just another reason to abhor that character. Other entertainment industries cultivated their own versions of ruggedness. Rock stars, many appearing pale and sickly thin, were described in reviews and album liner notes as “manly,” “tough,” “extremely macho,” and “all man.” Every song on the radio seemed to be about either putting people in their places or physically punishing the uncool. I had never done either. I was clearly one of the uncool. Sports, my favorite diversion of all, offered the least comfort. Athletes interviewed on TV, be they boxers, catchers, offensive linemen, or goalies, handled the subject in pretty much the same manner. “I never ran from a fight in my life,” the answer usually went. “And I ain’t gonna start now.” Sometimes brawls erupted during televised sporting events. Fueled by rage, the principals struck each other furiously. Other players grabbed
104
V
CHAPTER 12
and pushed opponents, apparently establishing some sort of positional advantage. Even coaches, presumably older and wiser, joined the fray. My father would do his part to help the players on the home team. “Get in there!” he would instruct the images on the television screen. “You back down from a fight and they know they gotcha!” One time he turned to me and said, “Respect doesn’t come gift wrapped. It has to be earned!” I began to question whether I was rugged enough for adulthood. “Once a guy kicked me in the shins while playing soccer,” added my older brother David. “I told him to watch it and he threatened me. I got him back. He took a swing at me. We duked it out. Had to do it.” My dad nodded throughout this story. I wondered if I was tough enough for high school. “How’d you know how to handle a b-b-bully?” I asked. David and my father looked at each other. “Is somebody picking on you, son?” “Someone said some things awhile back,” I lied casually. “I ignored it.” “Well, if it ever happens again,” said David, “don’t back down. You got to stand up to guys like that.” My dad agreed. “You see son, bullies are cowards. When they see you won’t take it, they slither away to go torment someone else.” To my disappointment, my brother was nodding. I expected this sort of stupid advice from a parent. But David? I thought he would be of more help. After this conversation, I decided there were now two topics about which I could not confide in family: stuttering and Clete. I was nowhere near ready to challenge Clete. I also did not wish to face the resulting disappointment that would surely radiate from my father and brother. After the school year ended, I spent the summer thinking about revenge. One day I went to a Tai Kwan Do studio and approached the instructor. “I want t-to learn k-k-karate,” I told him. “We don’t teach karate,” he snapped. “I want to learn what you do.” “Why?” He eyed me suspiciously. “There’s this g-guy in school and I, uh, well, I really want to, you know—beat him to a pulp.” The instructor denied my request. He did, however, allow me to observe his class. I watched as the students, mostly average looking adults, fought with their feet as well as their hands. They turned their fists and shouted with each punch. Some could break boards with their hands. One woman did so with her head. The sounds of fractured wood and limbs
STORIES OF LISTENERS
V
105
striking protective pads became familiar to me, as I returned to watch subsequent classes. I spent hours that summer practicing the kicks and punches I had witnessed, violently punishing imaginary attackers in my bedroom. As these illusory foes enlarged in both size and number, I did pushups to build up my arms. T
