adults, so are they helpful to prevent the development of indecision--and
bashfulness--in children. Parents will do well to bear this in mind. But,
as in the prevention of selfishness, jealousy, and so forth, reliance on
hygienic measures alone is not enough. It is all very well to see that
children get plenty of good food, abundant muscular exercise, and much
life in the open air. This is excellent and necessary. Also, however, they
must be given wise moral training--training that will make it habitual
for them to think and act vigourously, to keep their emotions well in
hand, to be interested in much besides themselves, and to develop the
feeling of self-confidence and the spirit of initiative.
Now, let us turn to still another preventable and serious life handicap
having its origin in the days of childhood--the handicap of stammering.
FOOTNOTES:
[Footnote 11: "Studies In Psychopathology," 1907, pp. 22-23.]
[Footnote 12: J. J. Walsh's "Psychotherapy", p. 736.]
STAMMERING
VII
STAMMERING
There lies convenient to my hand at this moment a thin, pamphlet-like
volume that tells the story of one of the strangest, among the many
singular and tragic blunders which medical science has made in its
progress to knowledge. It is a translation from the German of Doctor J.
F. Dieffenbach's "Memoir on the Radical Cure of Stuttering." Assuredly,
Dieffenbach's "cure" was radical enough, for it consisted in nothing less
than the excision of a large, wedge-shaped section from the stammerer's
tongue! In this little book, published in 1841, and embellished
with several ghastly full-page engravings, is described, with great
professional gusto, the first of these terrible operations as performed,
without the merciful aid of any anesthetic, on an unhappy boy of thirteen.
The result was a "complete success." Says Dieffenbach, writing a few weeks
after the operation:
"At the present time not the slightest trace of stuttering remains,
not the slightest vibration of the muscles of the face, not the most
inconsiderable play of the lips. His speech is, throughout, well toned,
even, and flowing."
Thus was inaugurated a period of butchery that lasted until--almost before
the year was out--it was observed that those "cured" by this sanguinary
means usually began, before long, to stammer as badly as ever, and also
that those who were not "cured" had a tendency to die. Yet Dieffenbach was
no charlatan, no "quack." He was a reputable surgeon who honestly believed
that he had discovered the true remedy for stammering. And, if the passage
of time has intensified the tragedy and absurdity of his method and has
relegated his glowing account of it to a place in the literature of
medical curiosities, there is this to be said of him--that he has had
plenty of successors who have erred almost as seriously in their attempts
to solve the problem presented by the widespread and baffling malady of
stammering.
In fact, up to within quite recent times the record of the struggle
against stammering has been one of continuous failure. There has been a
steady accumulation of methods of treatment, from surgical operations of
a less drastic type than Dieffenbach's to the use of various articulatory
and respiratory exercises and devices, without any appreciable effect
in the diminution of stammering. Even to-day the great majority of
physicians and lay specialists--to whom, by a sort of tacit agreement,
the medical profession has largely relinquished the task of dealing with
stammering--labour to next to no purpose. At this very moment there are
in the United States at least three hundred thousand persons who stammer,
fully half of whom stammer so badly that they are severely handicapped in
the gaining of a livelihood. Thousands of these have resorted to medical
advice, or have attended so-called schools for stammerers, with lastingly
beneficial results to few. Small wonder that there is, among stammerers
and their friends, a tendency to believe that stammering is one of the
hopelessly incurable maladies of mankind.
And this would undeniably appear to be true, as regards many stammerers.
On the other hand, it may confidently be said that nearly all cases of
stammering are actually susceptible of marked improvement, often amounting
to 75 or 90 per cent. of a cure; and that a number of cases can be
completely cured. Such a statement, to be sure, could not have been safely
made even a few years ago. This for the reason that only lately has there
been any really systematic effort by scientifically trained investigators
to study the phenomena of stammering, with a view to ascertaining, with
scientific exactness, its true nature and causation.
Stammering, it has long been recognised, is not a malady of uniform
symptomatology, like tuberculosis or typhoid fever. No two stammerers
stammer precisely alike. They stumble over different letters and sounds;
time, place, and circumstances have varying effects on the degree of
their stammering; and the physical spasms and contortions that so often
accompany this trouble differ in different stammerers. There is, too,
a great variation in the onset of stammering. Mostly, it is true, it
manifests itself in childhood, from the age of four to eleven. But it may
not set in until much later in life; and, when it does begin in childhood,
it begins under much diversity of conditions.
Sometimes a child stammers almost as soon as he has learned to speak,
though seldom, if ever, coincident with the learning. Often, the first
appearance of stammering follows some disease like measles or diphtheria.
Or, again, a child who has been speaking quite well, suddenly begins to
stammer, and persists in stammering, after being brought into contact with
people who are themselves stammerers.
"I was entirely free of stammering," declares a clergyman, in a typical
statement, "till I was five years old. At that time of life there was a
gentleman who occasionally came to my father's house, and stammered very
badly. I distinctly remember one afternoon trying to imitate him; when,
unfortunately, he heard me, and was very indignant. So ashamed were my
parents at my conduct that, after he had gone, I was taken to task and
punished severely for it. Ever since that night I have been afflicted with
this most distressing malady, in spite of all my efforts to overcome it."
Compare a statement by a Philadelphia physician, Doctor D. Braden Kyle:
"Several years ago I saw three interesting cases of stammering. Two of
the cases were imitation. These two lads, who were associated with a boy
several years older, the worst stammerer I ever saw, clearly imitated him.
As they were constantly together, the imitation was almost continuous.
They certainly developed into expert stammerers. In less than two years
they were confirmed stammerers, and it was impossible for them to speak
at all without stuttering and stammering."
Facts like these, I repeat, have long been observed and commented on
by specialists in the treatment of stammering; but they have, for the
most part, been dismissed as mere "oddities," while emphasis has been
laid on the single fact that, in the majority of cases, stammerers have
had parents or other relatives who themselves stammered. "Heredity,"
consequently, has been assumed to be the one and sufficient explanation
of all stammering; and it has also been assumed that what is inherited
is either an anatomical or a physiological defect. Hence, in too many
instances, the use of the surgeon's knife; and, hence, the invention of
innumerable systems designed to train the stammerer in the correct use
of his breathing and articulating organs--in a word, systems intended to
teach him how to talk.
But, as even the most enthusiastic exponents of these corrective systems
are now beginning to appreciate, whatever else the stammerer may need, he
does not need to be taught how to talk. For he can talk well enough on
occasion. Nothing is more significant, from the standpoint of assisting
to a clear understanding of the nature of stammering, than the fact that
there are uncommonly few stammerers who have any difficulty in speaking
when nobody is with them. On this point, every stammerer with whom I
have been in touch is in remarkable agreement, and others who have had a
far wider acquaintance with stammerers testify to the same effect. For
example, Mr. Charles L. Rowan, of Milwaukee, a gentleman who has stammered
for years and has made a close study of the subject, informs me:
"When I am alone--and the same is true of other stammerers--I have no
speech difficulty whatever, and can talk or read aloud for hours with
ease. It is only when I am with others that I halt and stammer in my
speech. Sometimes I talk in my sleep, and the folks tell me I do not
stammer then. But, if I am dreaming, and in the dream imagine myself
talking, it is always in a stammer.
"I have also noticed that most stammerers talk better when the subject
is light and frivolous than when it is something serious. And they talk
better when conversing with people whom they regard as inferiors. I know a
man who is a section foreman, and he says he can give orders to his negro
and Mexican labourers perfectly, but if the roadmaster comes along he
cannot talk to him at all."
And a stammerer from Spokane, Washington, informs me:
"I would like to say that there are periods when I can talk much better
than for corresponding periods. Indeed, there are times, generally a few
days at a time, when it is most difficult for me to talk with even a
slight degree of correctness; and, then, there are periods of as long, or
longer, duration when speech seems to flow with more ease, though never
perfect, except for a few words in succession."
More than this, according to one diligent investigator, the majority of
stammerers fail to stammer if addressed in such a way that their replies
are made without their realising that they are talking. Says this
observer:
"Suppose a stammerer is engaged in a deep study and unaware of your
presence. You speak to him softly. He answers readily, without hesitation,
in an absent manner. Again, you ask a careless question, implying by your
manner that you do not expect or desire an answer; to this he quickly and
easily replies also. Now, look straight at him and pointedly interrogate
him. See, when it becomes necessary for him to speak, how he is thrown
into confusion."
It has further been found that most stammerers are at their worst when in
the presence of strangers. Some stammer scarcely at all when at home with
their relatives and intimate friends. On the opposite, there are some who
stammer worse than usual when with relatives. Not so long ago I learned of
one stammerer--a young lady who had stammered from early childhood--whose
trouble was most in evidence when she was talking with her mother. Almost
all stammerers, too, enjoy temporary relief from their speech defect when
greatly startled, angry, or otherwise excited.
Decidedly, then, it is not from anatomical or physiological inability
to speak that a stammerer suffers. It is, rather, from a psychological
inability. That is to say, the facts just mentioned indicate strongly that
stammering is primarily a mental malady--that it is due to the presence,
in the mind of the stammerer, of some idea or ideas that inhibit the
normal functioning of the organs of speech. This conclusion is confirmed
by the additional circumstance that nearly every stammerer who has been
questioned on the subject admits that he is perpetually tormented by a
haunting dread of not being able to express himself clearly to others, and
so of exposing himself to their ridicule, contempt, or pity. Many, indeed,
affirm their conviction that if they could only overcome this dread they
would be free from their affliction. "I believe," is a characteristic
utterance of stammerers, "that if I were to wake up some morning with
total forgetfulness that I had ever stammered, I should never stammer
again."
Still more significant is the fact that, of the many methods which have
been invented for the treatment of stammering--and which include such
curious devices as beating time with every word, and wearing artificial
supports under the tongue--all have had to their credit a certain--however
small--proportion of genuine cures. This would suggest, not that they
have been intrinsically valuable, but that, in the cases cured, they so
impressed the mind of the stammerer with their therapeutic virtue as to
banish his long-entertained belief that he could not talk like other
people. For that matter, recent experiments go to bear out the view that
almost any method, no matter how fantastic, will cure some stammerers, if
only they have a lively faith in its efficacy.
For example, there was once brought to the Boston City Hospital a woman
of thirty-five, who, though formerly speaking without any difficulty, had
begun to stammer in a frightful manner, following a violent quarrel with
her husband. She could utter scarcely a sound, except weirdly inarticulate
noises, and these only by a great effort. The physician to whom her
case was entrusted soon became satisfied that she was suffering mainly
from a profound belief that she would never be able to talk again; and
he therefore endeavoured to reason her out of this, but to no purpose.
Finally, he abandoned the attempt, and, after leaving her pretty much to
her own devices for several days, impressively said to her one morning, in
a tone of great authority:
"Well, Mrs. Blank, I have been looking carefully into your case, and I
find there is one way certain to cure you. It may be a little painful, but
I know you will not mind that, as long as it is going to make you entirely
well."
So saying, and with an air of the utmost confidence, he began to apply
to her an electric current, just strong enough to make her wince. Only a
few treatments of this sort were found necessary to enable the hospital
authorities to discharge her as cured--and she stayed cured.
Of late, consequently, with growing recognition of the dominant psychic
factor in stammering, there has been an increasing tendency--though as
yet it is far from universal--to employ psychological methods in treating
stammerers. The effort is made to instil confidence in the sufferer--to
convince him that he need only exercise his will power to bring about
his own cure. In a good many cases, and frequently with gratifying
results, resort is had to hypnotism, the "suggestion" being reiterated
to the patient, while in the hypnotic state, that in the future he will
experience none of his overwhelming sensations of dread and anxiety and
will speak as fluently as persons who have never stammered. Or he may
be treated by psychic re-education, which consists essentially in the
development of volitional control by suggestions tactfully imparted in
the ordinary waking state. All of which unquestionably marks a tremendous
advance over the theories and practices based on the alleged anatomical
or physiological defects of stammerers.
There is this to be added, though, that, sanely beneficial as is the
psychological treatment of stammering, it often happens that the
confidence-inspiring suggestions given to stammerers do not "take."
The stammerer, albeit he may perhaps show improvement for a time,
remains without clear articulatory power. When this occurs, the natural
tendency among those treating him--in view of the demonstrated truth
that stammering is the effect of a peculiar state of mind--is to throw
the blame on the patient instead of on the method. Yet, actually, it is
the method that is at fault--or, to be exact, it is the failure to apply
the method, which itself is thoroughly sound--in such a way as to remove
from the stammerer's mind not only the fear that haunts him and helps to
perpetuate his stammering, _but also the ideas in which his stammering
originated_.
Here we come to the central fact in the whole problem of stammering--a
fact which, when it is widely enough known and appreciated, is certain to
exert a far-reaching influence on the prevention of stammering, as well
as its cure. Until very recently, few have been aware of this fact except
a small group of foreign investigators, physicians with a psychological
training, whose special business it has been to determine scientifically
the possibilities, the limitations, and the exact procedures to be
followed in supplementing, by wholly mental treatment, the ordinary
medical and surgical treatment of disease. Impressed by the predominance
of the mental factor in stammering, these investigators were particularly
impressed by some of the peculiarities mentioned above--as, the ability
of almost every stammerer to speak well when alone or when in a state of
abstraction. Such peculiarities, they knew from long experience, bore a
strong resemblance to oddities in the behaviour of victims of hysteria,
psychasthenia, or other psychoneurosis, in all of which disorders there
is a tendency for symptoms to disappear when the sufferer's attention
is momentarily withdrawn from them. Accordingly, it seemed to the
investigators quite possible that, in the last analysis, stammering was
not so much a disease in itself as a psychoneurotic symptom.
They were well aware, for reasons already set forth in these pages, that
psychoneurotic disorders have their origin in emotional disturbances of
one sort or another, which, occurring to a person of nervous temperament
or rendered neurally unstable by a faulty upbringing, react adversely
on the entire organism. Exactly what happens is that the emotional
disturbance--whether it be a fright, a grief, a worry, or what not--while
perhaps completely forgotten by the victim, so far as conscious
recollection is concerned, remains subconsciously alive in his memory,
is ever seeking to emerge again into conscious remembrance, and, failing
to do this, takes its revenge, so to speak, by the production of disease
symptoms ranging from mere eccentricities of thought and behaviour to
symptoms mimicking those of true organic disease.
Also, the investigators knew that the particular form these mentally
caused symptoms take depends chiefly on the kind of suggestions received
from the sufferer's environment. If he chances, for instance, to have
a relative or a friend who is a paralytic, he may, in time, develop
pseudosymptoms of paralysis himself. Or, if his nervous equilibrium
be sufficiently upset, he may develop them from merely hearing or
reading about them. Whatever the symptoms he manifests, his malady is
curable--precisely as it was produced--by mental means alone. Often, a
counter-suggestion, to the effect that henceforth the psychoneurotic
person will be perfectly well, is enough to work his cure. Or, permanently
curative effects may be had only when, by special techniques devised
for the express purpose of rummaging through the subconsciousness, the
forgotten memory, or memories, responsible for the psychoneurosis are
brought to light, and the specific suggestion directly or indirectly made
that from that time they will do no harm. Sometimes, experience has shown,
the mere recalling of them to conscious remembrance is enough to put an
end to the disease symptoms they have caused.
On the view that stammering is similarly a psychoneurotic symptom, and
that, when it fails to yield to treatment by general suggestion, it is
because the subconscious memories underlying it are too intense to be
thus subdued, this group of investigators undertook to treat it as they
would any stubborn psychoneurosis. The outcome of their experiments has
been such that I feel justified in declaring that science has at last
penetrated to the true inwardness of stammering. These psychologically
trained physicians have taken stammerers who had well-nigh exhausted their
hopes and their resources in a futile quest for normal speech, and, after
subjecting them to the searching methods of psychological analysis, have
sent them on their way rejoicing, either in a perfect cure or in a lasting
improvement far beyond their expectation.
Citing a few instances of actual occurrence, a German member of the
group, Doctor B. Dattner, was once consulted by a stammerer of thirty-six,
who had been burdened by his speech defect from boyhood. He had first
stammered, he told Doctor Dattner, after an attack of diphtheria, at the
age of nine; and he had for some time been treated on the supposition that
the diphtheria had caused a peculiar kind of throat paralysis.[13] This
treatment failing, he had sought relief by other means, always without
more than temporary benefit. Like many another stammerer, he spoke of the
abnormal dread that harassed him, especially when with strangers, and
expressed the belief that if he could conquer this he would be free from
his stammer.
"Ah, but," Doctor Dattner pointed out, "do you not realise that, after
all, your dread is caused by--not the cause of--your stammer? It has
helped, doubtless, to keep it alive and to aggravate it. But it has
not been the thing that originally made you stammer. That we must seek
elsewhere."
"You mean in the attack of diphtheria?"
"Not at all. I mean in something that happened to you before you had
diphtheria--something which so exceedingly distressed you that it was
continually uppermost in your thoughts, and which finally worked on you so
much that when your nervous system was weakened by the diphtheria it gave
rise to your stammering. Now, we are going to try to discover what that
something was, and, when we have done so, it will be possible really to
cure you. Can you recall any particularly disagreeable incident of your
childhood occurring at any time before you were ill of diphtheria?"
"No," said the other, after a little reflection, "I think that I was
perfectly happy as a child, and certainly I was treated kindly."
"Just the same, something must have happened at that period to disturb
you very much. Let us find out, if we can, what it was."
To this end, Doctor Dattner now made use of the "free association
method of mental analysis," which consists in requesting the patient to
concentrate his attention on his symptoms, and state without reserve the
thoughts coming to him in connection with them--the theory being that, if
there is any exceptionally distressing idea underlying them, the current
of his spoken thoughts will, soon or late, reveal it. In the present
instance, this method at first brought forth only trivial and commonplace
memory associations. But, after a time, a reminiscence of intense
emotional colouring suddenly emerged.
It related to an episode of the stammerer's eighth year, shortly before
his attack of diphtheria, when he was pounced upon and frightened almost
into convulsions by a huge black dog. This had virtually faded from his
conscious memory; but now, as he sat in the quiescent mood enjoined on
all patients undergoing psychoanalytic treatment, it welled up into full
recollection, every detail of it being vividly recalled--the sight of
the dog, the emotions of fear and horror, the hysterical shrieking that
followed his escape, the difficulty his parents had in convincing him that
he was unharmed. He used to lie awake, he remembered, thinking of the dog;
he used to dream of it; the thought of it was always with him.
"Precisely," said Doctor Dattner, drily. "And, you see, the thought of it
is still with you, for look how graphically you have described it all. The
trouble is that it has been leading an independent existence, as it were,
in the depths of your mind, with all its original emotional intensity.
Your stammering, I can assure you, has been nothing more than the external
manifestation, the symbol, of its continuing presence, and of the deadly
power it has had over you--sensitive, impressionable child that you must
have been. But I can also assure you that your stammering will now come
to an end; for we have not only found its cause in the subconsciously
remembered shock of your boyhood, but we have actually removed that cause
by the very fact of recalling it to your conscious recollection and,
consequently, finding a normal outlet for the repressed emotions."
Altogether, it had required just six hours of psychoanalysis, at the rate
of about an hour a day, to recover this horror-encrusted memory of the
stammerer's childhood. But, with its recall, and strikingly validating
Doctor Dattner's confident prediction, he once more began to enjoy the
blessing of a facile, flowing speech.