I STUTTERING SMILEY BLANTON T was while working with Professor James Albert Winans at Cornell University that I first undertook investigations of the causes and treatment of stuttering. Both as head of the Department of Public Speaking, and personally, Professor Winans encouraged and helped me in my study of stuttering and of other speech difficulties. This work was begun in 1907. At that time the general opinion among physicians in the country was that stuttering was caused by some weakness of the tongue or some abnormality of the nervous system. I soon became convinced that stuttering was caused primarily by psychological factors; and subsequent studies by myself and others have strengthened this theory. Stuttering is now regarded by the medical profession as a neuropsychiatric problem, to be treated primarily by psychotherapeutic means. For a long time past, the prevailing treatment of stuttering was by phonetic exercises and vocal drill. Stutterers were given such exercises as "Peter Piper picked a peck of pickled peppers," and other tongue-twisters. The stutterer was considered more or less fair game. Neglected by the medical profession, he turned to the quack stuttering school whose alluring advertisements in the magazines urged the stutterer to come with the hope of being permanently cured. Stuttering, under which term we include stammering, may be defined from a descriptive standpoint as a break in the rhythm of speech due to a blocking or inhibiting of the coördinating nerve impulses resulting in an incoördination and tension. Stuttering is a symptom just as fever is a symptom and must not be considered as a disease in itself. The cause of stuttering must be sought through a study of the emotional life, conscious and subconscious. To treat the symptom successfully the various causes back of the symptom must be understood. Stuttering is common enough to constitute a very serious problem. A personal survey of six thousand school children of Madison, Wisconsin, revealed that eight out of one thousand stuttered. Dr. Wallin found, in a survey of the school children of St. Louis, that seven out of one thousand stuttered. Surveys generally, in this country and abroad, show that about nine children out of every thousand stutter. Not infrequently we hear it claimed that children who stutter will overcome the defect in time. In order to determine the number of boys and girls who reach the age of eighteen and still stutter, a personal survey was made of fourteen hundred members of the freshman class at the University of Wisconsin. It was found that one per cent of the students had a marked stutter and one per cent had a mild stutter. It will be seen from these figures that stuttering cannot be left to time for remedy. Even though the defect itself disappears in some cases, the cause may remain—an undue sensitiveness, a feeling of inferiority which interferes with the development and progress of the individual. There is apparently very little relationship between the severity of the symptoms and the severity of the emotional difficulty which gives rise to them. Many people have a very slight stutter, so slight that it is not easily noticed, but they feel severely handicapped; as one boy expressed it, he never knew when he was going to have trouble with a word, and, even though he stuttered very rarely, meeting people and adjusting himself to groups was a terrible strain. The distribution of stuttering between boys and girls is very disproportionate. There is from four to six times as much stuttering among boys as among girls. Just why, is not known. When a girl does stutter, however, it is just as difficult to overcome the defect as it is in the case of a boy. We do not find any explanation of the cause of stuttering through the examination of the bodily organs. Of course, such conditions as malnutrition, diseased tonsils, carious teeth, and nasal obstructions, may cause an increase in the natural irritability of the nervous system, but these conditions are not the cause of stuttering. Moreover, stuttering is not inherited. A sensitive nervous system may be inherited, it is true, and on the basis of it stuttering is likely to develop unless there is proper discipline and training. Speech is one of the chief ways by which we adjust ourselves to the group. Stuttering is caused by fear, partly conscious and partly subconscious, of meeting the group. The child fears to meet the group, but he also has a desire to do so. He would like to flee from the situation altogether, but also he would like, if possible, to meet the situation. These tendencies to flee from and to meet the situation come into conflict and there is a compromise in which there is neither good speech nor absence of speech, but broken, inhibited, stuttering speech. A search into the emotional life of stuttering children always reveals some of these emotional attitudes and conflicts-timidity, strong feeling of inferiority, overdependence on the parents, and a feeling of general inadequacy. In some cases we notice a marked rigidity towards life, an unwillingness to change food and sleep habits; or an oversuggestibility, a chronic fear of meeting certain groups of people or situations, a marked sensitiveness. Some have claimed that these emotional conditions are the result of stuttering and have nothing to do with its cause. A study of the personality of stutterers, however, shows that their emotional attitudes are primary and are the cause of the speech defect. Stuttering may accentuate the emotional condition, but it does not cause it. The essential characteristic of the temperament of the stuttering child is a marked sensitiveness to social situations. This sensitiveness is really a great virtue if properly trained and controlled. In my own experience with stutterers I have come to feel that they have the most pleasing and delightful personalities of any group with which I have come in contact. Their quick responses to social situations, their marked sensitiveness, and their keenness of perception of social relationships give them an insight and develop a type of personality that is pleasing and appealing. Stuttering should not be thought of as something that is wholly bad. It should be thought of more as a danger signal which indicates that the child requires very careful training in order that he may properly utilize a sensitive, overreacting nervous system. A study of the temperaments of two hundred unselected stuttering children revealed the following facts: fourteen per cent seemed 1 to have normal temperaments; forty-eight per cent had marked feelings of inferiority; fourteen per cent overcompensated for this inferiority by being bumptious and forward; fifteen per cent showed marked swings of mood beyond the average-happy and excitable one day, moody and depressed the next; and nine per cent were overexcitable and overactive. A psychological study of stutterers enables us to divide them into several clearly marked groups: 1. The Hysterical Type a. Conversion hysteria b. Fixation hysteria 2. The Anxiety Type 4. The Organic or Motor Type Case 1. Illustrating conversion hysteria. Mary, age eleven, was born on a farm. She was in good physical condition, with good intelligence, and no abnormalities of the articulatory organs. She walked about four or five months later than the average child; she did not begin to talk until about the age of twenty-two to twentyfour months, which is almost a year late. This slowness in walking and talking probably indicated an innate inability to coördinate the muscles easily. (A predisposition to speech disorders seems to run in the family: an uncle and an aunt, whom the child never saw, stuttered.) Under emotional strain we should expect this child to show some speech symptom. When the girl started to school she began to stutter. Speech is an adaptive mechanism and very often children are unable to make the adaptations required at school. After about a year the stuttering tended to disappear, so that it was scarcely noticeable except at times of stress. Her mother died when the child was five years old. After that time, her two aunts and three grown brothers looked after her. She was very happy on the farm, and her speech defect seemed to be entirely eliminated. Then the father, who had been living in town, married again, and brought the little daughter in to live at his new home. The child heartily disliked this change, although her stepmother made a good mother. Mary yearned to be back on the farm where she was petted by her brothers and humored by her aunts. When she started to school in town it was found that she could not talk. For several weeks she was mute. Later, she began to talk in a whisper. She was given training and after some weeks was able to speak in a tone loud enough to be heard. This mutism was of an hysterical nature. She reëntered school in the autumn and was able to talk very well. She had practically no speech difficulty until the spring, when the desire to go on the farm probably grew more intense; and the emotional struggle gave rise to severe symptoms of stuttering. The treatment consisted primarily in training the child to meet the situations of life adequately, in training her to understand that the attempt to gain her ends by hysteria was not wise. The speech training consisted of a few simple exercises in tone production, without mention of breathing. Often the symptom of stuttering is an hysterical mechanism. The physical symptom is caused by a mental conflict. In one form there is direct conversion of a mental conflict into a physical symptom. It was so in the case of this girl. There was a conflict in her mind between her desire to stay in town with her father, and the desire to go back to the farm with her brothers and her aunts. This conflict was carried over into a physical symptom which attacked the speech mechanism because there was some inherent disability there. It should be noted that when this girl was allowed to go back to the farm she had no trouble whatsoever with her speech. Case 2. Illustrating fixation hysteria. Ella, age eleven, was asked to recite a poem at the Commencement exercises in her school. She was expected to have a flower in her hand to illustrate one of the passages of the poem. Her mother, however, was too poor to buy her the flower. The little girl, not realizing her mother's poverty, felt very much aggrieved; an emotional conflict was set up. She felt that she was neglected, that no one loved her. The day came when she was to recite, and she forgot her piece and stuttered. This stuttering was a transitory symptom of the disturbance caused by the forgetting. Curiously enough, however, the stuttering continued; the next day the child was unable to recite in class without stuttering, and she began to stutter at home. This was a case of fixation hysteria. The symptom was fixed |