Psycho-Social Stress and Speech Dysfluency
Bernard-thomas Hartman, Ph.D., FAAMD
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I have stuttered, while speaking, and to varying degrees, most of my adult life. Largely due to this fact, I’ve spent the bulk of my career studying speech pathology and psychology. I’m now a retired university professor, and would like to take this opportunity to pass on to you something that I’ve learned about stuttering, and articulate a particular approach to this problem which I believe addresses the root cause of the problem for most, (if not all), people who stutter.
I mentioned, previously, that I stutter when I speak. Early in my life, what used to really nag me was that I spoke fluently – when I was alone. When I started my university studies, I attended speech therapy for my problem. I experienced, first hand, the main therapy techniques and found them, as a ‘stutterer’, inadequate in that they didn’t consistently aid me in my out-of-clinic experiences. I read, extensively, about stuttering and through my own clinical experiences, found that the methods that were applied would fail to consistently improve the client’s fluency outside the clinic. Or that the effectiveness of the method would be eroded, over time, by the client’s loss of sensitivity to the application as they became too accustomed to it.
The successes achieved in the clinic were decidedly inconsistent with the experiences of the client outside of the clinic. This was due to the fact that the adversities of the psycho-social stresses of everyday life were not present in the clinic and could not be readily, or at least convincingly, simulated.
As a young man, I used to memorize phrases, tracts of Shakespeare, anything, and recite them in the mirror, thus, proving to myself that I possessed this gift of fluent speech. But I learned that it takes two to stutter. My fluency is wholly dependant on who I perceive to be listening, and the gravity of the message that I want to express.
It wasn’t until I was taking my master’s degree, and had gained enough experience with other people who stutter that I became convinced that the problem is psycho-social, and that this problem may manifest itself as any of the ‘classic’ stuttering behaviors (tonic, clonic, etc.).
I’m an unrepentant fan of masking devices and have seen them to be a considerable aid in eliciting fluent speech in my clients. But this fluency is generally short-lived. This is, perhaps, as it should be. Masking devices and other external stimuli should only be applied as one would a crutch. Get the person back on their feet and experiencing positive episodes of fluent speech.
Under varying levels of stress, everyone is predisposed to exhibit stuttering speech behaviors. In other words, very stressful situations will exceed anyone’s threshold for maintaining fluent speech. It’s simply a matter of the level of stress versus the individual’s threshold for maintaining fluent speech.
People, whom we term to be ‘stutterers’, have a lower stress threshold than most people with regards to maintaining fluent speech. The severity of a person’s stuttering behaviors is determined by the level of psycho-social stress that it takes to disrupt the person’s innate ability to speak fluently. And with each episode of disfluency that the stutter experiences, this threshold for maintaining fluent speech dips a little lower.
The reason for this, is that the stutterer begins to anticipate failure and tweaks up the psycho-social stress related to the encounter. In addition, the more time that the stutterer is allowed to prepare for the encounter, (and anticipate failure), the more this tension tends to grow. The constant conditioning of anticipation of failure, and then the fruition of these anxieties creates the basis for habitual stuttering behaviors.
So how do we break this cycle of anticipation of failure/realization of failure…?
For me, that has always been the big question. How to reduce the amount of psycho-social stress that a stutterer experiences when he or she needs to say something to somebody? How can we diffuse the tension of the moment for the stutterer?
As I mentioned previously, there are two parties involved in every stuttering episode – the stutterer and the listener. In the event that a stutterer needs to say something to someone they aren’t familiar with, (a waitress, prospective employer, policeman…) the stutterer generally doesn’t know how this listener is going to respond to the realization that stuttering behavior is occurring in the conversation, but will be anticipating any or all of the negative responses that they have experienced previously.
As for the listener, most people have a streak of goodness/understanding and are happy to do their ‘good deed for the day’ (for lack of a better term) when dealing with a handicapped person. They generally respond to handicapped people with an extra degree of patience and understanding. But what most people find awkward or uncomfortable is to be thrust into the position where they are made aware of a handicap as it manifests itself and they are not prepared for the situation. And a stutterer, engaged in speaking, is acutely aware of the listener’s discomfort which only adds to the problem.
The first thing, I believe, is to understand that a stutterer is a person whose communication skills are handicapped. Like a mute or person who is hard of hearing their communication skills are impeded, but unlike the former examples, the handicap of stuttering speech may be transitory if the psycho-stresses which cause the condition can be relieved.
When I was a young therapist, I attempted to take on this problem by ‘padding’ my clients’ social environment. I did this by taking the time to meet with spouses, employers, teachers, etc. and counsel them on how they might help relieve some of the tension that may occur in their discourses with my client as well as ways that they can encourage and empower them to communicate more frequently. The important thing is to allow a potential listener the time to prepare mentally for the role that they must assume in a conversation with a person who has a communication handicap. I found this to be a considerable aid to my therapy, but it eventually became impracticable due to my client load.
I propose that the same effect may be achieved by openly establishing with the listener, at the point of contact, that the speaker suffers from a handicap that affects their speech. This can be accomplished the same way that many people with other communication difficulties inform a listener that they have a problem – with a little card that is presented to the listener before communication begins.
What this will do is de-fuse a great deal of the psycho-social stress both for the stutterer and the listener. The stutterer can relax considerably knowing that his/her ‘cover’ is blown and that the listener knows that the stutterer may experience difficulty in communicating what they have to say. The listener has time to prepare themselves for such an event and accept assuming the role of a person attending to someone who is challenged in this way. To the stutterer’s advantage, most people are perfectly willing to display their sense of humanity if forewarned. I believe that this is the closest we can come to re-creating the dynamic available in a clinical setting and reinforce the positive experiences that the client receives from their therapist’s clinical programs and applications.
About the author:
Dr. Hartman, now retired, has served as the director of Speech and Hearing pathology for several institutions during his career and finally as professor and director of the Speech and Hearing department (23 years) at Stephen F. Austin State University in Texas. He is the author of ‘The Neuropsychology of Developmental Stuttering’ as well as other works. He now lives with his family in Norway.