Delat 11

 

WHAT GOES

RESEARCH INTO?

 

Del 11

Who is doing the research and what does it say?             
In recent years research has been done to some degree in the world. Most of the literature is written in English, which in turn gives the opportunity  to take part of the knowledge more difficult but with the help of others everything goes. In addition  some research has been reported in the book "Atmosphere, psyche, the environment,” which is written by Wendell Johnson. In Sweden, research is sparse. The reason it is so little research may be that we are a relatively small group. It may also be that there is an unusually difficult task in that we as a group are unusually well-behaved so the problems are literally below the surface.

                       
Stutter Research                     
1920 – 1958            
The result of Wendell Johnson's extensive research shows that people who are stuttering are NORMAL. Moreover, he came up to that "The stutter is fear of stutter" or "Stutter is what the ordinary stutterer makes for not falter again.”                     

Below is a statement of research under Wendell Johnson's leadership:    

No physical defects of stutterers: Travis, L, Ed-vard: Iowa, 1920.         
The speech mechanism is normal: Strothern, Charles and Louis Kriegman: Iowa, around 1938.
Calcium and blood sugar is normal: Genevie Stearns, Iowa, 1933       
Calcium and blood sugar is normal: I.W. Karlin and A.E. Sobel, Brooklyn, 1940.                      
Cardiac activity, blood pressure and metabolism - are normal: Carl Ritzman, student, Iowa, 1943.
Biochemistry and physiology is normal: Harris Hill, Journal of Speech Disorders, Dr. Hill´s final conclusion of the possibility of a natural cause of stutter was: "One factor in the form of a single state . . is still as far from detection as 4 000 years ago.” 150 physiological and biological studies, 1944.       
Right-handed or left-handed or brain dominance - not detectable: 100 surveys, not detectable, 1940.           
Right-handed or left-handed or brain dominance - not detectable: Harry Heltman, Syracuse, and EJ Spadino, Columbia, and Wendell, in cooperation with King Arthur, 1940.              
Differences in personality - not detectable: Wen-part Johnson: "The difficulties and humiliations that the stutterer is subjected to influence his social use of standby and self-esteem, but some essentials of personality I could not find.” 1929-1921.
Differences in personality - not detectable: Leo-nard Good Joseph Stein and Sheehan, the same position as, in 1958.     
Birth Injury and stutter - no relation.      
Stuttering children's development is normal.
Heredity: Despite extensive scientific studies

no such link was found.       

ADJUSTMENT IMPACT (Adaption effect)
During the 1930-1940 inquiries were made of this adaptation effect by Steer, who was the first. Then followed Wendell and John R Knott came with the results publication. A stutterer is speaking better and better the more he "repeats the speech task" in 1937          

MORE STUTTER             
More stutter at the long words: Spencer Brown, in the 1930´s.             
Meaningful text meant more stutter: Spencer Brown, in the 1930´s.     
More stutter when the sentence begins with a consonant: Spencer Brown, in the 1930´s.          
More stutter in the first three words in a sentence. Spencer Brown, in the 1930´s.                     
More stutter where the words provide meaningful content sources. Spencer Brown, in the 1930´s.
More stutter when reading meaningful text. Spencer Brown, in the 1930´s.                      
More stutter when reading meaningful text. Jon Eisenson and Miss Esther Horowitz, in 1945.
More listeners - more stutter: Wedell and Mrs. Harriet von Krais Porter, 1939.                      
A stutterer´s doubt and tension for a person depends on what his feelings are for her or him. Wendell and Mrs. Naomi Berwick.         

LESS STUTTER               
Sing - not stutter: Wendell and Leonard Rosen, in 1937.
Speak slowly and whisper – the stuttering varies: Wendell and Leonard Rosen, 1937             
Speak in pace with the metronome or monotonous rhythm - not stutter: Wendell and Leonard Rosen, 1937    
Change of the rhythm of the speech: Very loud, very low, shrill voice, whispering or very slow, even to talk faster. Wendell and Leonard Rosen, 1937.      
Some form of support: For example, two stutterers are reading a text in unison, in chorus etc. Wendell and Leonard Rosen, 1937.                
Distraction. One of Wendell´s colleagues Virginia Barber Simmons heard less stutter through reading loud at a walking pace, friendly claps on the shoulder, with flashing lights (one word for each clap, pace, tap or blink). They could even read really good at strong noise.  
Talk in loneliness: stutterers often speak excellent when they are completely alone. (p 61).           
Reading with loud sound in the headphone): Wendell and Mary Lou Sternberg, 1946.            
Reading with loud sound in the headphone: Colin Cherry, England, 1956.                     
The experiments show, according to Wendell, that the stutterers have a basic ability to speak normally.

To stammer "on purpose"  
 In 1928, the psychologist Knight Dunlap expressed the idea that one way to get rid of a habit is to practice it on purpose. He tested the idea in Los Angeles, California, on some stutterers and found that the results were promising.                 

The idea was almost immediately taken up by  Bryngelson, Minnesota, who developed it further. He instructed the stutterer to freely and voluntarily repeat the first sound of the first letter in some  words a number of times before he started to say a word. Sometimes he asked the stutterer to read aloud a few moments with each word spoken in this way. On other occasions the voluntary stutter was carried out only occasionally in speeches or reading aloud.          

Encouraged by the initial results Bryngelson brought the idea with him to Iowa when he arrived for taking his doctor´s degree in 1931.With him   he had a young man, Charles Van Riper, who was a severe stutterer. For one year he worked intensively with this stutterer. Dr. Bryngelson insisted on that Van Riper would stutter voluntarily for some time each day. The results were really encouraging. Charles Van Riper continued to take doctoral degree in speech pathology and became one of the leading specialists in the United States on stutter and other speech disturbances.            

Accept yourself - Van Riper´s last two pieces of advice.                      
Devote much more of your attention to your normal speech than the one you think is your stutter. Show more interest for the feelings, attitudes and thoughts that are associated with the normal speech. Accept without reservation your speech and yourself as a human being.  

Work to become a normal speaker, says Van Riper.

 

 

 

Feelings and personality 
As a basis for this book, I have gone through all the literature that is written in the literature list. I think I find support in the research on stutter that it is also about feelings. Van Riper´s recommendations are that you should show more interest for the feelings, attitudes and thoughts associated with the normal speech. It can also refer to his research on the fact that "The stutterer´s doubt and tension for a person depends on how he feels about her / him." (Ref above) Likewise Frederick P Murray, Ph.D., has given the advice: "Remember that our speech reflects how we feel at a given moment.”        

Animal experiments have shown that if a small monkey kid cannot be near his mother and get her or other´s love he will not survive. This can surely be implanted in human beings. I would suggest that the most important thing on this earth is just feelings and contact with other people. All our efforts lead to just that both in the family and at  work. I think the emotions give life a meaning after reproduction. It is probably just what is the ultimate meaning of life to bring up the next generation.                     

After writing these words, I read the evening newspaper and there Thomas Zengotita from New York expresses himself:”One of the greatest human needs is to get confirmation and today all have access to the technology required to appear.                     
Happiness, however, is an equally difficult-defined word but I suspect it has to do with feelings. According to Bengt Brülde who is a person doing research in happiness money has nothing to do with it after a certain "limit.” He means however that it is important with good relations, a job that you enjoy and meaningful recreation.         

An experiment                   
According to stutter researcher Wendell Johnson a stutterer diminishes his stutter when he reads a paragraph several times in a row on average the decrease amounts  to around 50 after reading through five times. After the fifth reading through  Mrs. Berwick  put a photo of the person  the stutterer had said to be difficult to talk to in front of him. She asked him to read the paragraph again - to the photo. The decrease trend ceased and was reversed - now the stutter increased instead with an average of 20 percent. What is in a picture? Whatever influenced Mrs. Berwick´s stutterers must have been put in by the stutterers. It is the most important conclusion to be drawn from her data. This study shows in a simple but dramatic way how the stutterer´s hesitation and tension when he speaks to a person - even a photo of him - depends on how he feels about the person.

Wendell Johnson affirms that the stutter's feelings for a person can increase stutter frequency by 20 percent, which I interpret as a difference of 70 percent.

Swedish research                  
In Sweden there are a few theses on the stutter.

Abstracts of lectures on heredity and environment by  Martin Ingvar, Marie Åberg.

 

                     
Sensational research on  Heredity and Environment

"Heart or brain, so you become mentally ill?" Lectures on November 6, 2006 in The Culture House  in Stockholm .The most interesting point program for my part was Heredity or Environment. Research shows that when you are growing up you are not affected by the genes during the first period of your life. We believe that environmental factors are added to the factors of heredity then there are  the vicious circles which consolidate the problems so that they become chronic. The environment, however, shapes the individual. Everyone is hurt by various forms of abuse or to stay in a bad environment. This and several other circumstantial evidence makes that I would not have become a stutterer if I had had other, more harmonious parents. And parents we cannot choose who you know.       

Martin Ingvar and Marie Åberg spoke about an Australian study showing how important it is to be loved and looked after by your mother. It was done in rats: How secure the rat is depends on how much love it gets by the mother that shows that by licking her kids differently. Those who got licked the most were those who dared to go out farther than the others and dared to be in the unprotected area.                     

Stress like in war                    
In the CS- group in 1966 with Bengt Edgren, Rolf Leanderson, and Lennart Levi at the Laboratory of clinical stress research in Stockholm, where I participated in one of two groups, one group received  medication and the other group placebo pills. Fortunately I ended up in the placebo group. For another participant from the association club it was much worse when he ended up in a pill addiction. One of the most sensational discoveries was that the stutter caused abnormally high levels of stress. The noradrenalin was as high as measured by the belligerent soldiers.                     

In 1972 Steen Fibiger was researching on external stutter symptoms such as mouth movements, EMG  research of the lip movements of stutterers at the University of Technology in Frescati, Stockholm.           

The two brain halves           
Per Alm: "Heick´s hypothesis is that those who stutter have developed Broca area in the two brain halves, which leads to problems. The situation can be likened to having two captains on the same ship - they can not agree on who should give orders and the result is chaos.”                  

Elisabeth Sederholm gave a lecture in Härskogen in which she referred to a study where attention is specifically drawn to the fluent speech among stutterers. ”We have compared this with non-stutterers speech and found differences.” she says. Thus, you can often find overflow movements in the vocal cords before the start of a fluent word. In the EEC (brain) film-studies desynchronization has been found between the two brain-halves that could indicate errors in the interaction between the halves.     

Joachim Trettin explains in Plus: "Most of us have surely heard that our brain has two halves and the halves perform different tasks. The left half is considered by many to answer for "intellectual" functions while the right half handles the emotions. The two halves do their job, however, not completely independent of each other. There is a vivid signal traffic between them - through the so-called gate. But generally considered is that each brain half has its own sphere of influence even if the overlap between the spheres is common.”       

 

 

 

Brain halves and memory

Per Alm: "To understand how stutter may arise and develop, it is important to know something about how the brain works. Much of today's stutter research suggests that the key to the stutter conundrum can be found in the brain's functioning. Stutter may be in the first instance regarded as a problem with the control of the speech. We still do not have much knowledge but we are on track. A major problem for the stutter research, however, is that the stutter is so incredibly complicated and influenced by so many factors. But it makes it an exciting challenge to try to understand how stutter works.”

 

The memory of fear               
Memories of emotional events engrave themselves and have been important for human survival in prehistory. It is important to remember that a particular animal is dangerous. If you have been chased once by a dangerous animal the scent and image of the animal has become strongly associated with danger. It is precisely the fear that makes the memory stuck so strongly. Next time you feel the smell of the animal fear awakes directly and you run away.                

Research has shown that there is a small almond-shaped part of my brain, the amygdala, which specifically has the ability to connect memories with fear and danger. When the amygdala has been removed from a rat it doesn´t show fear of anything - it can without hesitating go up to a sleeping cat biting the ear ...The amygdala communicates with the rest of the brain and seems to have the ability to add an emotional colouring in our memories and thoughts. In addition, it has the signal lines to all the nerve centres that trigger the usual symptoms of fear - from heart rate to diarrhoea.         

Baring: "It is amygdala that is haunting you when you as a stutterer almost can feel mortal dread  before making a phone call. You have previously had a strong negative experience when you called, and any thought of calling the person, or just to use the phone arouses strong anxiety. Fortunately the  amygdala can also forget - if it repeatedly discovers that there really was not anything dangerous, the fear can disappear. "   

The amygdala has been highlighted in the TV- program Kobra. They showed pictures of where it is in the brain.             

Per Alm: "The brain has thus moving memories, reflexes, stored for all the sounds and words we should say. These patterns of movement are learned when the child learns to talk.”                     

"The more we stutter the more amplified is the stutter reflex and the easier it is therefore to falter again - it's hard to accept.”                   

If you repeatedly expose yourself to situations you are afraid of and nothing dangerous happens the fear is reduced. It is the effect that therapists use in the treatment of fears and phobia.                    

 

Per Alm´s thesis for a doctor´s dissertation –

What causes a stutter        
A press release 2005-12-04 published in Medicine, Care and Health. Per Alm Ph.D. thesis with the title: On the causal mechanisms of Stuttering.

"Stutter is one of the most common problems of speech and occurs throughout the world. Various theories have located the cause of stutter either to the reactions of those closest to the stutterer or to stutter and the psyche and to wrong relations in his or her brain. Per Alm at Lund University has now written a thesis in the neuropsychology of stutter.  
According to Per Alm the stutter seems to be about a problem with starting signals of the speech. Every syllable needs a signal that tells exactly when to start - if it becomes a problem here you get caught up in the speech. It may be difficult to get started or repeat what has been said.          

One known fact is that a stutterer often temporary gets rid of his stutter when he sings or is imitating a dialect, is speaking in a choir or otherwise alters his voice. Per Alm explains that it is because of  the brain's "second system of speech,” which is  then connected. According to his model there are two parallel systems of speech that cause problems for the stutterers. Singing, speaking in choir and otherwise altered speech seem to go through the other system and usually run well even in those who stutter.                

Per Alm´s model could also explain why many stutterers may have better fluency if you distort  how they hear their own voice on their headphones - the changed sound leads to a shift of control for the speech. Research is going on, particularly in the U.S., if the possibilities to use the changed sound of a hearing aid can be used as an aid of the  speech by the stutterers.” 

                                    / / Björck              

From DN´s series of stutter 2007

                     
When the signal system gets out of order the speech is stuttering             
Per Alm has written a thesis on stutter, published two years ago.            

He argues that the human brain has two systems for the start of the speech: "The middle system” located at the centre line of the brain and dominates in spontaneous speech. "The side system" which includes parts of the cerebral cortex and is dominating when it comes to, for instance, singing and drama. When usual speech changes in song or poem-reading the brain rapidly switches between the systems. It is probably the middle system that ordinary stutterers have problems with, according to Alm. They have difficulty in getting ahead in the speech sequence.                     

-They know what they want to say, but cannot go on, said Per Alm.       

The side system, however, that we use when we sing and play the theatre, can make use of external assistance for start-up signals - a guitar chords, a rhythm or a rejoinder. Exactly what the cause of the disturbance in the brain would depend on we do not know. But there are parallels with Parkinson's disease, some researchers say, among them Per Alm. A person who suffers from the Parkinson´s disease has a lack of neurotransmitter dopamine in the middle of the brain. Dopamine is a substance that can be put in motion the body's movements.                    

Stutterers who on trial received medication for Parkinson's disease have been either better or worse in their stuttering. It suggests that the medication has effect and that it might be possible to stabilize the system.                      

But it does not, of course, mean that we have the Parkinson´s disease only for the reason that we stutter, says Per Alm. And there is no medicine that can be recommended for stutter today.

Research focused on the effect of the dopamine for stutter is going on mainly in the United States, but research facility is still in its infancy. The disagreement within the scientific sphere is great. A solid clear explanation for the stutter is not yet available.

In The United States there are aids of speech for stuttering people who delay or alter their own voice. With the help of "headphones" the brain gets help to switch system. But there are few people who have access to them because they are so expensive. A model the size of a hearing aid costs almost 50 000 SEK.                      / / Alm / / Lofors

 

                                                   

Discussion
It is fantastic that Sweden has two persons who have taken a doctor´s degree in stutter. Ferenc Albert was the first, and now it's Per Alm, who also continues to do research. There are rumours that my friend Steen Fibiger in Denmark has a doctorate in the subject "The history of stutter."

Åke Byström in The Academy of Speech is probably happy about Per Alm´s research. His work is   confirmed and he knows that he is talking about the right things. I who have been in his company a few times know how forcefully and intensively he tries to get stuttering people to do their utmost to get started in a stutter-free speech. Per Alm´s theories about words starting signals make sense given that it must be the brain which by one of the two systems of speech is sending out signals that control the speech. The feedback of the speech goes through the auditory meatus which I guess works as the steering control of the speech.          

Having changed the sound by a hearing aid, I assume that this is a DAF device that provides a delay of the speech. My experience from these devices is that stutterers speak better. The question is whether it is persistent or if it is for a short time. The strange thing with this is that normal speakers who have tried these devices have got difficulties in speaking.  

The Swedish DAF sets are affordable. Negative is that some experience them as inconvenient, it is trying with the cables, the big headphones.  I myself have not used it for a year, says NN. "It shows that we have a problem.” "We want to be free of means.”

Two different nervous systems                
What Per Alm means by talking about two different systems of speech I do not know. But for me it reminds me of the two different nervous systems we have - the ordinary and the other which automatically controls the various organs. In everyday speech it is expressed with words like: "It is deep-rooted in the spinal marrow.”                      

One nervous system disturbs the other    
For me it feels natural if it were the case that one nervous system disturbs the other. The usual nervous system sends out signals that are impeccably fair. The other that has stored historically inaccurate information retorts. This conflict results in stutter.

 

 

Summary of Ferenc Albert's book

                     
Stutter from the psychoanalyst´s point of view                      

"Ferenc Albert's lecture" An empirical study of stutter,” an attempt to interpret the origin of the stuttering and treatment according to psychoanalytic theory. The matter was taken from the lecturer´s  recently published dissertation. Empiricism means knowledge gained through experience. Ferenc Albert has systematically gathered an extensive experience for about ten years and presents findings in his book.            

Initially Ferenc said that he has no solution to stutter problem, but some thoughts on the subject. Since the whole study is organized according to a psychoanalytic model, the thoughts are of course  coloured by psychoanalysis.              

The stutterer is, according to Ferenc, not more neurotic than other people, but the stutterer resolves his internal anxiety by stuttering. Internal anxiety is something that (according to psychoanalysis) all people have in specific situations and it is not specific for stutterers.          

The normal development of speech goes from l) prattle over 2) imitation with deficiencies 3) to a stage where you speak automatically, without thinking about what to do. The development of speech for a stutterer on other hand goes from prattle to imitation and stutter which is a disturbance of the automatic fluent speech. . . you make the stuttering to a part of your "normal speech,” by overlearning.                     

Is there any clear cause of the stuttering? Psycho analysts believe that there is no single circumstance, but it is probably a number of components that together contribute to stutter emergence. For example, stuttering varies widely among different cultures, which could indicate that socioeconomic factors play a role. Similarly, the scaring experiences during childhood could provide a trigger for the stutter.           

In psychoanalysis, one speaks of various psychosexual phases: the oral stage (depending phase), anal phase (independence aspirations) the phallus phase (the child becomes aware of his sexuality), etc. According to Ferenc "may, but need not be" an unresolved conflict over any of these stages express themselves as stutter.                     

Ferenc Albert also presented a model of how stutter might affect personality. He stressed the primary profit as an important part of the stuttering problem. "Stuttering binds emotional tension and reduces anxiety. The internal anguish (which all people are carrying on) is in itself a threat to the ego, that is personality. By stuttering the individual contributes to consciously/ unconsciously reduce the anxiety and protects in that way himself."  
The basic identity of the stutterer is important. Is the "I-identity" strong the ”stuttering identity” will not be so strong, but you realize that you are a person, a whole. The stuttering is just one part.

The expectations play a large role. The stutterer has negative expectations for the listener: "You don´t have time to listen when I stutter" and at the same time he believes that all normal speaking people are eloquent. The expectations can become self-fulfilling if we do not do anything about it.                
Some stutterers feel hypersensitive in the environment. They think everyone is listening (critically) when they speak and stutterers are very attentive to the
listener´s reactions. Therefore the telephone creates much anxiety among some stutterers as you cannot control the reactions of the surroundings  when talking on the phone.     

The treatment: Ferenc has no panacea, and stresses the importance of individualized diagnosis and treatment. The treatment should include different methods depending on the patient's stutter and back-ground. It is important to have a thoughtful treatment plan. The stutterers are very different to each other in many respects. It should therefore be planned so that not a component of treatment counteracts the effect of another.”              

One more abstract of Ferenc Albert´s book:                    

 
Psychological theories and treatment - excerpt                      
"The subjective experience of blockings of stutter usually is that the organs of speech are locked:" The tongue is stuck in the palate, the throat is constricted” or “the lips are convulsively held together" Stutterers also experience tensions in other parts of the body and a general malaise usually accompanies major blockages varying from mild discomfort among some to the extreme panic amongst others. There are stutterers who report that they more or less lost contact with the outside world under certain hung ups. At least the stutterer is much more concentrated on how he / she is speaking than in the rest of what´s happening at the moment. The case is also true that for most stutterers it is actually the above mentioned expectation of the coming hung ups which are the worst. There are theorists who have taken on this fear to the extent that they speculate in if not this anticipation is the true cause of the stutter to actually occur. By fighting against an expected blocking the stutterer strains himself so that stutter occurs.

                       
The idea is that if a stutterer, for example, has an open and vigorous stutter, which is a direct impediment to effective communications, he is best served by a treatment which modifies the fluency of speech, while another individual, who suffers more from the social effects of stuttering, is likely to have more use of a psychotherapeutic treatment.”   . . . .          
"Most stutterers end up in humiliating situations, which possibly for a few serves as a masochistic satisfaction."  
. . . .              
"Stutter should not be considered as an isolated disturbance of the mechanisms of speech but as an external expression of a more fundamental character disorder. An effective treatment must focus on helping individuals to understand their specific neurotic difficulties, with associated neurotic solutions and to come to a solution of the underlying fundamental conflicts.”       

"The aim of psychotherapy for stutterers must focus on the primary benefits of stutter in an indirect manner. The therapist should not focus on the stutter symptom itself - not even in the group of stutterers. . ."                   

                       
"The early development"   
The literature I been through about stutter and my clinical experience has convinced me that the original conditions of stutter in the psychological sense are unique to each stutterer.

 
The conditions under which stutterers are growing up seem to span across a widely field. There are found early insecure environments in the form of threatening adults and generally unstable upbringing conditions but also relatively conflict free youth environments. Sometimes it has been found disturbances in the relationship between family members such as lack of contact, fear between the family members themselves and other threats to disrupt a full and continuous relationship. Something that is often described are high demands from the parents' side, which is likely associated with the fact that stutter is more usually found in "career families.” Furthermore, mothers of stutterers are often described in the literature as controlling (Snyder 1962) and overprotective.” / / Johnson in 1966         
. . . .              
"Here we see examples of how the requirement to" hold back "unacceptable impulses and the need to articulate what you feel will result in a conflict, which in this case might be projected on the organs of the speech with a conflict between talking and to be silent as a result. This conflict is manifested itself as a stutter.”                      
. . . .              
"It may sound as if people who somatisize internal psychological conflicts more than others are living in the body, but the trend is rather the opposite. They are often heavily intellectualizing also regarding emotions and bodily sensations. They imagine that, so to speak, they can conduct both thoughts and feelings as bodily sensations with the intellect, which leads them to a mutual contradiction instead of complement of each other.”
. . . .              
"One can easily conclude that speech is one of the most complex co-ordinations of muscles´ activities that human beings can devote themselves to. Such activity requires harmony.”              
. . . .              
"The speech is used to exchange thoughts and feelings with other people.”                     
. . . .              
"Stutter  in the adult life situation"         
"Regarding secondary benefits it  appears that to adulthood their importance have been modified in the sense that, although some benefit from their stutter, one has come to realize that just limited changes would come about in one's life if stutter ceased. At one point - in terms of their careers -probably most stutterers agreed that stutter has been and is a clear obstacle. Indeed there are various professions and positions represented among stutterers, but it is realistic to assume that the labour market in today's society does not always make room for a free choice for someone who has a disturbance of speech.”             

International researchm Here I only mention some researchers' results, which I think are especially interesting.                   

 

Sheehan:
No measurable deviationsmm Sheehan insists that it is based on scientific evidence that no systematic deviations can be discovered among stutterers in comparison with the normal speaker.             

Sheehan sees stutter as a dual approach-avoidance conflict. The stutterer wants both to speak and be quiet. Both options have a positive and a negative effect.                     

The therapy should not seek to teach fluent speech – it is already there in some situations - but to reduce fear of the stutter. To accept the stutter must not be a sign of resignation, but a means to reduce this fear and also reduce avoidance tendency.                                            
Stutter is something that is very dependent on strong attempt to avoid it. An illustration is the following parable: It is more difficult to walk the tightrope on a narrow plank high above the ground than on a board situated directly on the ground. The challenge is the same, but the fear of falling down is added and makes it more difficult in the previous case.         

The emphasis in therapy is thus on non-avoidance of stutter and to examine how you stutter, not in what situations you stutter more or less.

 

 

 

Frederick P. Murray, Ph.D.

Toward freer speech            
"Your ultimate goal, no matter how you reach it, is to convince yourself that you are capable of speaking in oral communication situations.”                    

  Before starting work on improving your speech, I would suggest that you begin working with some constructive and positive thinking. If you want to achieve good results in terms of fluency, it is vital that you are motivated to work towards the goal of better speech. In this regard, I wish to recommend you to use all possible resources you have within you, and the resources that religion, friends or books may be able to contribute with. It is also very important to believe in yourself and to cooperate with others.      

Don´t expect rapid changes in prolonged confirmed stutter. Many stutterers have made the mistake of believing that if only the cause of the stutter was found this would result in a rapid cure. Would a fire in a house be extinguished by itself, if you  found the match which started the fire in the yard? Stutter in an advanced stage, maintains itself, much like a fire. Fear of words and speech situations serves as fuel to intensify it. It is quite clear that YOU have to stand up and confront your problems. From your point of view active efforts are required, because "conditioned motor responses" are amended by action, not by thoughts.

Many of you have heard about the miracles that hypnosis can achieve, and perhaps some have hopes for a quick profit with this technology. Progress with this method, however, is almost always only temporary. The method does not build up any resistance to the many dangers that now threaten you in terms of your oral communication. A change can come about only gradually, as you change your behaviour of speech, your personal attitudes and as you adjust yourself to the new role itself as an improved speech forces with you.            
The situation is similar to when a very overweight person should lose weight of 100 kg. In order to do it in a safe manner, he must do so at a pace that his heart and body can tolerate. If he is on diet too fast, he can at worst collapse because of the rapid change his body undergoes. The body needs a chance to gradually adapting itself to every level of weight improvement. In the same way the stutterer must gradually adapt to better fluency. So I would urge you to have patience as you make progress. Do not demand the impossible first! There is no law that says you have to lift the heavy end of the stock each time.             

Commented so far, it may be appropriate to say something about the likelihood of overcoming the stutter. Judging from my personal acquaintance with several dozen stutterers, who have achieved good results, I can say that none of them claim that they always are quite fluent. Each of them has moments of non-fluent speech or remaining stutter. On the other hand, there are stutterers that have made so much progress that their ability when it comes to talk is greater than the average speaker. So keep your head high!      

Your ultimate goal, no matter how you reach it, is to convince yourself that you are capable of speaking in oral communication situations. This is the statement to say to yourself, you can not stand these situations because you can not speak. It is important that your belief is so strong that it is automatically reflected in your feelings. Remember that our speech reflects how we feel at a given occasion.                      

Here is some advice that may help you in your work towards your goal: 

The first concrete step you might take is to get acquainted with your stutter behaviour. This may seem extraneous, but few stutterers know what they are doing that disrupts the normal fluency of speech.

To do this effectively, you must first learn to keep in touch with yourself during the moment of stutter. This is the opposite of that run away from yourself and do everything you can to try to avoid stutter.

Different kind of feedback helps you with this self-study job. For example, you can look at yourself in a mirror and try to get an idea of what you do when you use the phone, a situation that is likely to appeal to the stutter. Is it possible to record your voice on tape in a stressful situation, and then play the tape for careful analysis?                     

This may be tough, but it is a good way to get a grip on your problem. If you can arrange sufficient number of these behavioural experiences, you discover that your stutter is not a constant or fixated behaviour, it rather show wide variations. You discover that parts of your stutter are not disabling.

No matter how serious the long deadlocks are, each stutterer also have easier stutter in his speech. These lighter stutters represent an end in itself. If you can get down the harder stutters to the same proportions as the easier ones a lot of your problems have disappeared. This also leads to the realization that there are countless ways to falter on. Even if you do not have a choice when it comes to stutter or not, you have a choice in how you do it.                 
It is also necessary to develop awareness about the feelings you have in relation to stutter. Often your problems of speech are so great that you cannot in an objective way effectively assess them. Usually there is a connection between anxiety, shame, guilt and severe blockages in the speech and it is necessary to some degree be able to distinguish these forces from each other.

Your basic task is twofold: change your behaviour of speech and try to bring about a positive change r in terms of your-image and your emotions. There is a psychological principle that means that one way to affect emotions is to work directly with the external behaviours that these feelings are associated with. If you can modify the more serious interruptions of speech by replacing them with a more relaxed, forward-liquid movement of speech, you will translate this psychological principle of reality.              

One way to achieve this is to carefully make plans for some experiments of speech. Your first goal is to allow yourself to stutter openly, without tensions or struggle. Don´t try to speak as fluently as possible!  

By deliberately allow yourself to extend the first sound of a number of words you will go on the psychological offensive. This allows your fear to disappear, instead of gradually be building up inside you. Moreover you give your neurological system an opportunity to work in better harmony. You are confronted with, rather than avoiding your problem. Your habitual avoidance of situations of speech and dreaded words will lead you nowhere in the long run. The sooner you give up your "hold-back" behaviour, the better.              

The following advice can help you on your way from the stutter:

                       
1. Stutter handicap consists mainly of learned behaviours.

2. Stutter behaviours can be changed. Remember, you can choose the way you stutter on, even if you can not choose not to falter.

3. A person may stutter in many ways

 

4. Moods can be changed by modifying symptoms that are associated with them.

                     
5. Fear and avoidance procedures decrease as you confront your stutter.

                     
6. Sustained improvement is not likely to occur in a scientific laboratory environment. Create your own portable laboratory, and use it in real life.

7. Progress towards your stutter will likely occur during a long and gradual process. Have patience and respect for yourself.

                       
This sums up what I have found to be efficient in achieving improvements in the behaviour of speech as well as to maximize the chance to reach a solution to your problem.

From“To the Stutterer. Speech Foundation of America. 1988: Toward Freer Speech.” Translation: Lars Åfeldt.             

Bloodstein, 1975                  
To choose method of treatment
The method must be effective on a large number of stutterers.

Improvements must be demonstrated by objective and subjective measurements. The stutter needs to reduce in frequency and the speech has been improved.

Reports of good results for a method must be based on repeated evaluations.

The stutterer's speech must be natural.

The stutterer must not only speak better, but also change his attitude to the stuttering.

The method must be shown to be effective by more than one qualified therapist.

Reports of good results for a method must be followed up.

We must show that the improvements are greater with treatment than without treatment after the same time.

The method must provide a durable result even after “the charm of novelty.”

 

 

.

Scientists disagree               
WHO's definition of stutter reads: "Stutter is a disorder of the rhythm of speech, where the individual knows exactly what he should say, but at the moment is unable to say it because of involuntary repeating, extension or disruption of an entire sound.”

The only fact that scientists have agreed on is that  "stutter is a disorder of the rhythm of stutter.” Otherwise they are much disunited. The reason for their disunion can be the basis of their training and approaching the problems from different angles.                  

What is the cause of the stutter?              
Someone claims that it is genetically caused. Another person that it is mentally reasons. A third that it is a learned behaviour. The popular cognitive therapy has been around problems similar to those by ignoring them.

                     

The solution is:                  
To take note of what is happening by carrying out the practice. I am afraid I am looking for gently what makes me afraid.

 

 

 

 

 

 

 

 

 

 

 

 

 

REFERENCE LIST:

 

 

 

 

 

Albert, Ferenc: Stamning ur psykoanalytikerns synvinkel, s 20, 61, 63-64, 76, 78, 81, 82, 85, 98. (Stuttering from the phsychoanalyst´s point of view)

Albert, Ferenc: Stamning ur psykoanalytikerns synvinkel, Strang, P, Plus 4, s 9-11, 1981

American Journal of Cardiology: Meditation förlänger livet. (Meditation prolongs your life)

Alm, Per: doktorerade med avhandlingen: On the causal mechanisms of stuttering.:  DN 18 april, Emma Lofors: När signalsystemet är i olag hackar talet, s 22-23, 2007  (When the signal system is out of order you stutter)  

Alm, Per: Stamning, s 15, 20, 23, 38, 41, 62, 65, 97, 155-156, 1995 (Stutter)

Alm, Per: Föredrag 28 november 92, Linköping. VHS band producerat av Stig Lindh (Lecture 28 Nov 1992)

Baringa: M: How scary things get that way, Scence, 1992, Alm, 1995

Bahar, Akbar, TALAkademin och McGuire, Erfarenheter av olika talträningsmetoder, Stockholms stamningsförening, okt, 2006 (The Academy of Speech and McGuire)

Bloch, Viktor: Om behandling av stamning på en talklinik i Kanada, Plus, 3, s 25, 1992 (About treatment of stutter in a clinic in Canada, Plus 3)

Brülde, Bengt: Han kan ge dig lycka. City Stockholm, Nicklas Tollesson 25 okt 2007 (He can give you luck)

Bloch, Viktor: Om behandling av stamning på en talklinik i Kanada, 1958, Plus, 3, s 25, 1992

Bloodstein, Oliver: A Handbook on Stuttering, 2nd Ed, National Easter Seal Society for Crippled Children and adults, 1975

Byström, Åke: Litet intresse i Ö-vik, Plus, 1, s 15, 1965 (Not much interest in Ö-vik)

Casriel, David: Det förlösande skriket, 1979 (A Scream Away From Happiness)

Crona, Mikael: McGuire-programmet. Erfarenheter av olika talträningsmetoder, Stockholms stamningsförening, okt, 2006

Dagens Nyheter, Lofors

Danielsson, Hans: Landet bortom bergen - En underlig trygghet, SRF tal & punkt AB 1987 (The Land beyond the Mountains- a peculiar safety)

Danielsson, Hans: Stackars mig, av och om Hans Danielsson, Stig Lindh, 2007 (Poor me)

Danielsson, Hans: Tack Dan Mogren – en hälsning från fagra Östergyllen, Plus 2, s 2, 1983

Edenby, Anders: P-club och terapierna, Plus 3, s 8-10, 1979

Edman, Gunnar: Vårt behov av tröst, Expressen, 8 december, 1974 (Our need of comfort)

Fast, Julius: Kroppsspråket  (The body language)

Gunnar Edman: Vårt behov av tröst, Expressen 8 dec 1974

 (Our need of comfort)

Engdahl, Erland: Att bortarbeta sin stamning, Plus s 23, juni, 1969 (To get rid of your stutter)

Fibiger, Sten: EMG undersökning av läppmuskulaturen, Plus, s 46, december, 1972 (EMG investigation of the muscles of the lips)

Fraenkel, Britt-Marie: Plus 1, s 3, 1999       

Genýukai stamningsförening i Tokio: Stammares programförklaring från Plus, 1, s 5-6, 1979 (The manifest of stutterers)

Gimstedt, Lars: Föredrag om Neurolingvistisk programmering, Brunnsvik, 19 oktober, 2007. (Lecture on Neurolinguistic programming)

Grönholm, Ann-Marie: Terapirapport från USA, Plus, 2, s18,1979  (Report on therapy from the U.S.)

Gunnar Wiklund: - SR P1 Livskraft sept -06 (Power of life)

Hauschild, Karen-Marie: Stamning som handikapp, Nordiska stamningsseminariet, Plus, 4 s 4-5, Kerstin E. Andersson, 1981 (Stutter as a handicap)

Heick, A: Balbutio: 1985-1989

Henriksson, Ulla: Sparka ut terapeuterna - och väx! Plus 2, s 25-29, 1976 (Kick out the therapists – and grow up!)

Henriksson, Ulla: Nå - är det någon terapeut utsparkad? Plus,

4, s 10-11, 1976 (Well-Is there any therapist kicked out?)

Hjelm, Kenneth: McGuire-berättelse, Erfarenheter av olika talträningsmetoder, Stockholms stamningsförening, okt, 2006 (Experiences of different methods of speech training)

Ingvar, Martin o Åsberg, Marie: Hjärta eller hjärna, varför blir man psykiskt sjuk? Kulturhuset, Stockholm 6/11 -06

    (Heart or brain, why are you getting mentally ill?)

Jarric: TV-program, sept, 2006

Johnson, Wendell: Stamning, psyke, miljö, s 16, 49, 55-61, 155, 163, Norstedt & Söner Stockholm, 1966 (Stutter, mentality, environment)

Jägerfeld, Jenny: Hål i huvudet, Natur och Kultur (A hole in my head)

Larsson, Lennart: När ditt barn stammar s 33, 1984 (When your child is stuttering)

Larsson, Lennart: Stamning IC: Hur utvecklas stamning, Plus 2, s 3 1977 (How is stuttering developed?)

Larsson, Lennart: Till mina klasskompisar, KommUNIKation, 4 s20, 2006 (To my class-mates)

Lindh, Stig: Artikelserie om stamning, Plus 3, s 27-28, 1985 ( Articles on stutter)

-  ” - ,  Stamningens orsaker och uppkomst, Plus 1, s 17-18,       1986 ( The reasons and origin of stutter)

-  ” - , Ungdomsåren, Plus 2, s 19-21, 1986( Youth)

-  ” - , Vuxenstamning, Plus 3, s.19-22, 1986 (Adult stutter)

-  ” - , Släpp loss känslorna! Plus 1, s 31-35, 1987(Let the feelings out )

-  ” - , Probleminventering, Plus 2 s 34-36, 1987 (Inventory of problems)

-  ” - , Slutet gott, allting gott, Plus 3, s 31-32, 1987 (All is well that ends well)

-  ” - , Informationsmöten på 23 platser, Plus, 3, s 7-9, 1977

-  ” - , Det blev succé för informationskampanjen, Plus 3, s 1-8, 1978

-  ” - , Stutter Free Spech, Film, 1999

-  ” - , Trancendental meditation någonting för stammare? Plus, 2, s 12-17, 1975 (Is Trancendental meditation anything for stutterers?)

-  ” - , Vad skall P-club syssla med? Plus 1, s 18, 21, 1979

          (What is P-club planning to do?)

-  ” - , Är stamning något att haka upp sig på? Film, 1989 (Stuttering –is that anything to get stuck on?)

Lewis, C S: Anteckningar under dagar av sorg, Bokförlaget Libris, Örebro, 1994 ( Notes during days of sorrow)

Lofors, Emma: Så lär sig Adam att sluta stamma, DN 21 april, s 28, 2007 (This is how Adam learns how to stop stuttering)

Lundgren, Marie-Louise: McGuire-metoden, ett seriöst och stödjande program, Plus 1, s 7, 1999

Lutteman, Markus, David McGuire: Vägen till frihet, Plus, 4, s10-11, 1995 (Way to freedom)

Michaelsen, Sara: The Starfish Project – en öjenvidne beretning, Dansk Videncenter for Stammen, Nyhedsbrev 56 september 2007

Mullingstorp: Kursprogram, s 12, 14, 2006

Murray, Frederick, Ph.D.: Mot ett friare tal, Ur To the Stutterer, Speech Foundation of America, 1988: Toward Freer Speech. Plus nr 1, mars, s 1-2, 1994: Lars Åfeldt

Nordiska Stammarkongressen: Att stamma är nödvändigt, Kisa, 1970 (To stutter is necessary)

Olausson, Ingrid: "Meditation - magi eller terapi?.”

 Pinker, Steven: Ett oskrivet blad, av Martin Ingvar o Marie Åsberg, 2006 (An unwritten page)

Plus, Wolgers: Beppe, Mina memoarer del 3, Bonniers, 1972

 (My memoirs part 3)

Plus, 1, s 17: Stamning på Wienkongressen, 1965 (Stutter at the Congress in Vienna)

Plus, s 3, 1/64: John Björkhem, 1964

Pressmeddelande: Vad orsakar stamning, 2005-02-14 publicerat i Medicin, vård och hälsa //Ingela. (What causes stutter?)

Rydå, Marita: berättar om sin SpeechEasy som hon rekommederar, KommUNIKation, 1, s 11, 2006

Sahlgrenska Universitetssjukhuset: Projektutvärdering, Plus, 3, s 8-9, Arbetsgruppen för Intensiv stamningsterapi, Göteborg, 1998 (Evaluation of Project)

Sederholm, Elisabeth: Föredrag Härskogen Plus,1986

    ( Lecture Härskogen)

Sheehan J G: Jämförelse av stammare och normaltalare, Plus, december, 1971 (A comparison of stutterers and normal speakers)

Sheehan, J G: Stuttering: Research and Therapy, Anteckningar från föredrag I Nyborg 2-4 april 1971

SSR: Hemsida, Behandling, 1977 (Home Page)

Strang, P: Plus 4, s 9-11, 1981Stromsta, 1986

Trettin, Joakim: De båda halvorna, Plus 4 s 9, 1987 (The two halves)

Tidskriften Leva! 4 2006

Tudor-Sandahl, Patricia: Tid att vara ensam, W&W, 2003

   (Time for being alone)

Wilks, Frances: Intelligenta känslor, Depression 146, 152, Ilska, 101, 102, Ångest, 114, 123-124, Egon Richter, Malmö 1999 (Intelligent feelings)

Perkins, William: What is stuttering and whys? 376, 1990

Wolf, Tore: DAF-apparaten, Erfarenheter av olika talträningsmetoder, Stockholms stamningsförening, okt, 2006

Wolgers, Beppe: Plus, orig, Mina memoarer del 3, Bonniers, 1972

World Health Organization: Manual of the international statistical classification of diseases, injuries and causes of death. (Vol 1), s 202, 1977, Per Alm, 1995

Åström, Christer: Stamning och yrkesliv, Plus s 3, nr 3, sept 1994 (Stutter and working life)

Åfeldt, Lars: Redaktörens spalt, Plus, 3, okt, s 24, 1995 (The column of the editor)

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Åström, Christer, Stamning och yrkesliv, Plus, Elsa-mötet i Amsterdam. (Stutter and working life)