UNCONSCIOUS STUTTERING: This is a misnomer because there can be no such thing as unconscious stuttering. It appears that the person afflicted is not conscious of his difficulty for he insists that he does not s-s-s-s-tut-tut-tut-ter. Unconscious Stuttering is but a name for the disorder of a stutterer who is too stubborn to admit his own difficulty.
THOUGHT STUTTERING: This is an advanced form of stuttering which is also known as Aphasia and which is caused by the inability of the sufferer to recall the mental images necessary to the formation of a word. Stuttering in its simpler forms is usually connected with the period of childhood, while aphasia is often connected with old age or injury. The aphasic person is excessively nervous as is the stutterer; he undergoes the same anxiety to get his words out and the same fear of being ridiculous. In aphasia there is, however, no excessive muscular tension or cramp of the speech muscles. In these cases, the stutterer will sometimes repeat the first syllable ten or fifteen times with pauses between, being for a time unable to recall what the second syllable is. It is, in other words, a habitual, but nevertheless temporary, inability to recall to mind the mental images necessary to produce the word or syllable desired to be spoken. This condition is more commonly known as Thought Lapse or the inability to think of what you desire to say.
One investigator shows that the diagnosis of "insanity" with later commitment to an asylum occurred in the case of a bad stutterer. When excited he would go through the most extreme contortions and the wildest gesticulations in a vain attempt to finally get all of the word out, finally pacing up and down the room like one truly insane. This tendency to believe that the stutterer is insane because of the convulsive or spasmodic effort accompanying his efforts to speak, is a mistaken one, although there can be little doubt of the tendency of this condition finally to lead to insanity if not checked.
HESITATION
Hesitation is marked by a silent, choking effort, often accompanied by a fruitless opening and closing of the mouth. Hesitation is a stage through which the sufferer usually pa.s.ses before he reaches the condition known as Elementary Stammering.
STAMMERING
Stammering is a condition in which the person afflicted is unable to begin a word or a sentence no matter how much effort may be directed toward the attempt to speak, or how well they may know what they wish to say. In stammering, there is the "sticking" as the stammerer terms it, or the inability to express a sound. The difference between stammering and stuttering lies in the fact that in stuttering, the disorder manifests itself in loose and hurried (or in some cases, slow) repet.i.tions of sounds, syllables or words, while in the case of stammering, the manifestation takes the form of an inability to express a sound, or to begin a word or a sentence.
ELEMENTARY STAMMERING: This is the simplest form of this disorder.
Here, the convulsive effort is not especially noticeable and the marked results of long-continued stammering are not apparent. Most cases pa.s.s quickly from the elementary stage unless checked in their incipiency.
SPASMODIC STAMMERING: This marks the stage of the disorder where the effort to speak brings about marked muscular contractions and p.r.o.nounced spasmodic efforts, resulting in all sorts of facial contortions, grimaces and uncontrolled jerkings of the head, body and limbs.
THOUGHT STAMMERING: This, like Thought-Stuttering, is a form of Aphasia and manifests itself in the inability of the stammerer to think of what he wishes to say. In other words, the thought-stammerer, like the thought-stutterer, is unable to recall the mental images necessary to the production of a certain word or sound--and is, therefore, unable to produce sounds correctly. The manifestations described under Thought Stuttering are present in Thought Stammering also.
COMBINED STAMMERING AND STUTTERING: This is a compound form of difficulty in which the sufferer finds himself at times not only unable to utter a sound or begin a word or a sentence but also is found to repeat a sound or syllable several times before the following syllable can be uttered. Any case of stuttering or stammering in the Simple or Elementary Stages may pa.s.s into Combined Stammering and Stuttering without warning or without the knowledge, even, of the stammerer or stutterer.
CHAPTER II
THE CAUSES OF STUTTERING AND STAMMERING
One of the first questions asked by the stutterer or stammerer is, "What is the cause of my trouble?" In asking this question, the stammerer is getting at the very essence of the successful method of treatment of his malady, for there is no method of curing stuttering, stammering and kindred defects of speech that can bring real and permanent relief from the affliction unless it attacks the cause of the trouble and removes that cause.
Inasmuch as this book has to do almost entirely with the two defective forms of utterance known as stuttering and stammering, we will at this time drop all reference to the other forms of speech impediments and from this time forth refer only to stuttering and stammering.
These forms of defective speech are manifested by the inability to express words in the normal, natural manner--freely and fluently. In other words, there is a marked departure from the normal in the methods used by the stammerer in the production of speech. It is necessary, therefore, before taking up the discussion of the causes of stuttering and stammering, to determine the method by which voice is produced in the normal individual, so that we can compare this normal production of speech with the faulty method adopted by the stutterer or stammerer and learn where the fault is and what is the cause of it.
Let us now proceed to do this: In other words, let us ask the question: "How is speech produced in the normal person not afflicted with defective utterance?"
Voice is produced by the vocal organs much in the same manner as sounds are produced on a saxophone or clarinet, by forcing a current of air through an aperture over which is a reed which vibrates with the sounds. The low tones produced by the saxophone or clarinet result from the enlargement of the aperture, while the higher tones are produced by contracting the opening. Variations of pitch in the human voice are also effected by elongation and contraction of the vocal cords with comparative slackness or tension, as in the violin.
It would be of no value, and, in fact, would only serve to confuse the layman, to know the duties or functions of the various organs or parts entering into the production of speech. Suffice it to say that in the "manufacture" of words, there are concerned the glottis, the larynx, thorax, diaphragm, lungs, soft palate, tongue, teeth and lips. In the production of the sounds and the combination of sounds that we call words, each of these organs of speech has its own particular duty to perform and the failure of any one of these organs properly to perform that duty may result in defective utterance of some form.
BRAIN CONTROL: It must be borne in mind that for any one or all of the organs of speech to become operative or to manifest any action, they must be innervated or activated by impulses originating in the brain.
For instance, if it is necessary that the glottis be contracted to a point which we will call "half-open" for the production of a certain sound, the brain must first send a message to that organ before the necessary movement can take place. In saying the word "you," for instance, it would be necessary for the tongue to press tip against the base of the lower row of front teeth. But before the tongue can a.s.sume that position, it is necessary that the brain send to the tongue a message directing what is to be done.
When the number of different organs involved in the production of the simplest word of one syllable is considered (such as the word "you"
just mentioned), and when it is further considered that separate brain messages must be sent to each of the organs, muscles or parts concerned in the production of that word, then it will be understood that the process of speaking is a most complicated one, involving not only numerous physical organs but also intricate mental processes.
When all of the organs concerned in the production of speech are working properly and when the brain sends prompt and correct brain impulses to them, the result is perfect speech, the free, fluent and easy conversation of the good talker. But when any or all of these organs fail to function properly, due to inco-ordination, the result is discord--and defective utterance.
CAUSE OF DEFECTIVE UTTERANCE: Now, let us consider the cause of defective utterance. What is it that causes the organ, muscle or parts to fail properly to function? The first and most obvious conclusion would be that there was some inherent defect in the organ, muscle or part which failed to function. But experience has proved that this is usually not the case. An examination of two thousand cases of defective utterance, including many others besides stuttering and stammering, revealed three-tenths of one per cent. with an organic defect--that is, a defect in the organs themselves. In other words, only three persons out of every thousand afflicted with defective utterance were found to have any physical shortcoming that was responsible for the affliction.
Take any of these two thousand cases--say those that stammered, for instance. What was the cause of their difficulty, if it did not lie in the organs used in the production of speech? This is the question that long puzzled investigators in the field of speech defects. Like Darwin, they said: "It must be this, for if it is not this, then what is it?"
If stuttering and stammering are not caused by actual physical defects in the organs themselves, what then can be the cause?
DUE TO A LACK OF CO-ORDINATION: Cases of stammering and stuttering where no organic defect is present are due to a lack of co-ordination between the brain and the muscles of speech. In other words, the harmony between the brain and the speech organs which normally result in smooth working and perfect speech has been interrupted. The brain impulses are no longer properly transmitted to and executed by the muscles of speech.
This failure to transmit properly brain messages or this lack of co-ordination may take one of two forms: it may result in an UNDER-innervation of the organs of speech, which results in loose, uncontrolled repet.i.tions of a word, sound or syllable, or it may take the form of an overinnervation of the vocal organ with the result that it is so intensely contracted as to be entirely closed, causing the "sticking" or inability to p.r.o.nounce even a sound, so common to the stammerer.
Suppose that you try to say the word "tray." Do not articulate the sounds. Merely make the initial effort to say it. What happens? Simply this: The tip of the tongue comes in contact with the upper front teeth at their base and as you progress in your attempt to say "t," the tongue flattens itself against the roof of the mouth, moving from the tip of the tongue toward its base. If you are a stammerer, you will probably find in endeavoring to say this word, that your vocal organs fail to respond quickly and correctly to the set of brain messages which should result in the proper enunciation of the word "tray." Your tongue clings to the roof of your mouth, your mouth remains open, you suffer a rush of blood to the face, due to your powerful and unsuccessful effort to articulate, and the word refuses to be spoken.
Now, in order to dissociate "lack of co-ordination," from stammering and to get an idea of its real nature, let us imagine an experiment which can be conducted by any one, whether they stammer or not.
You see on the table before you a pencil. You want to write and consequently you want to pick up the pencil. Therefore, your brain sends a message to your thumb and forefinger, saying, "Pick up the pencil." Your brain does not, of course, express that command in words, but sends a brain impulse based upon the kinaesthetic or motor image of the muscular action necessary to accomplish that act. But for our purpose in this experiment, we can a.s.sume that the brain sends the message in terms which, if interpreted in words, would be "pick up the pencil." Suppose that when that brain message reaches your thumb and forefinger, instead of reaching for the pencil, they immediately close and clap or stick, refusing to act. Your hand is unable to pick up the pencil. That, then, is similar to stammering. The hand is doing practically what the vocal organs do when the stammerer attempts to speak and fails. But, on the other hand, if, when the message was received by your thumb and finger, it made short, successive attempts to pick up the pencil, but failed to accomplish it, then you could compare that failure to the uncontrolled repet.i.tions of stuttering.
This inability to control the action of the thumb and forefinger would be the result of a lack of co-ordination between the brain and the muscles of the hand, while stuttering or stammering is the result of a lack of co-ordination between the brain and the muscles of speech.
WHAT CAUSES LACK OF CO-ORDINATION: But even after it is known that stuttering and stammering are caused by a lack of co-ordination between the brain and the organs of speech, still, the mind of scientific and inquiring trend must ask, "What causes the lack of co-ordination?" And that question is quite in order. It is plain that the lack of co-ordination does not exist without a cause. What, then, is this cause?
An inquiry into the cause of the inco-ordination between brain and speech-organs leads us to an examination of the original or basic causes of stammering. These original or basic causes in their various ramifications are almost as numerous as the cases of speech disorders themselves, but they fall into a comparatively few well-defined cla.s.ses.
These original causes in many cases do not appear to have been the direct and immediate cause of the trouble, but rather a predisposing cause or a cause which brought about a condition that later developed into stuttering or stammering.
Let us set down a list of the more common of these causes, not with the expectation of having the list complete but rather of giving facts about the representative or more common Basic Predisposing Causes of Stuttering and Stammering.
A little more than 96 per cent. of the causes of stammering which the author has examined can be traced back to one of the five causes shown below:
1--Mimicry or Imitation 2--Fright or severe nerve shock 3--Fall or injury of some sort 4--Heredity 5--Disease
Let us take up these familiar causes of stuttering or stammering in the order in which we have set them down and learn something more of them.
The first and one of the most common causes is Mimicry, or, as it is probably more often called, Imitation. Mimicry or Imitation is almost wholly confined to children. After reaching the age of discretion, the adult is usually of sufficient intelligence to refrain from mimicking or imitating a person who stutters or stammers.
The average small boy, however, (or girl, for that matter) seems to find delight in mocking and imitating a playmate who stutters or stammers, and so keen is this delight that he persists in this practice day after day until (as its own punishment) the practice of mockery or mimicry brings upon the boy himself the affliction in which he found his fun.
It may be noted, however, that Imitation is not always conscious, but often unconscious. The small child begins to imitate the stuttering companion without knowing that he engages in imitation. This practice, notwithstanding the fact that it is unconscious, soon develops into stuttering, without any cause being a.s.signable by the parent until investigation develops that unconscious and even unnoticed imitation is the basic cause of the defective utterance.
It has been definitely determined that stuttering may be communicable through contagious impressions, especially among children of tender age whose minds are subject to the slightest impressions.
For this reason, it is not advisable for parents to allow children to play with others who stutter or stammer, nor is it charitable to allow a child who stutters or stammers to play with other children who are not so afflicted.
So far-reaching are the effects of Imitation or Mimicry that in certain cases, children have been known to contract stuttering from a.s.sociating with a deaf-mute whose expressions were made chiefly in the form of grunts and inarticulate sounds.
FRIGHT OR SEVERE NERVE SHOCK: Another common cause of stammering is fright or nervous shock, which may have been brought about in countless ways. One boy who came to me some time ago stated that he had swallowed a nail when about six years of age and that this was the cause of his stammering. The logical conclusion in a case like this would be that the nail had injured the vocal organs, but an examination proved that there was no organic defect and that the stammering was caused, not by injury directly to the vocal organs but by the nervous shock occasioned by swallowing the nail.
Another case was that of a stammerer who reported that he had been given carbolic acid, by mistake, when a child and that he had stammered ever since. This, like the case of the boy who swallowed the nail, might be expected to prove a case of absolute physical injury or impairment of the vocal chords, but once again, it was clear that such was not the case and that the stammering was brought about solely from the nervous shock which came as a result of taking carbolic acid.
There is still another case of a boy who felt that he was continually being followed. This was of course merely a hallucination, but the fright that this boy"s state of mind brought on soon caused him to stutter and stammer in a very p.r.o.nounced manner.