10.4 Stuttering
There is reason to assume that early traumatic experience (ignoring of baby-signals, family fights, parental divorce) is one of the sources of chronic stuttering. However that applies to a small proportion of all stutterers. The reverse course is equally noteworthy: even in the presence of a hereditary disposition for stuttering, a supportive and encouraging upbringing will usually prevent stuttering from becoming chronic.
It is elucidating to compare some features of two bizarre communication dysfunctions that are still causing controversy between the specialists in the field: spastic dysphonia (also called voice stuttering) and stuttering, which has the official name dysphemia.
Most cases of stuttering take years to develop, during which time the symptoms escalate and de-escalate. Thus there is plenty of time for secondary prevention, time which should not be passed in idleness. It has in many cases shown to be a reversible disorder, but once fully developed it usually takes years to become manageable. Some children need intensive treatment, others recover without treatment. Because life is unpredictable, we cannot know who will benefit from favourable life-events and who will be defeated by strains he cannot cope with. In the late stages of the developing disorder the principal features are: tense attempts to avoid or overcome interruptions in the speech flow.
The most striking fact however about stuttering is that all stutterers can speak fluently. This is the paradox of stuttering. In fact the fluently spoken utterances are more numerous than the stuttered ones. It means that the speech/language apparatus is intact and at least most of the timef unctioning properly. Stuttering is a conditional disorder. It is not a neurological speech disorder such as a dysarthria, since the symptoms in that case would be more constant. There are neurological patients whose speech is repetitious, halting or spastic, but that is not the kind of dysfluency that is here discussed. When a person who stutters is free from such emotional pressures or negative anticipations as usually elicit speech inhibitions, he is capable of speaking fluently. In one stutterer that occurs when he is talking to himself, to a small child or to a dog, in another when he whispers or sings or acts in a play, in a third when he is deeply relaxed or under hypnosis. Stuttering has therefore to be defined as a conditional speech disorder. Many stutterers have given evidence that the condition which elicits stuttering behaviour is time-pressure, and that it becomes worse when they feel they have lost control of their speech.
Another common feature of stuttered speech is that it sounds monotonous and dull. It lacks the appropriate intonation of normal speech. Because strong feelings disrupt the fluency of speech, it is possible that any expression of feeling is inhibited in order to prevent the disruption. During therapy for stuttering the clinician may ask the participants to concentrate on the sound of the voice and to express the intended feelings by intonation, but that is only in the final stages of therapy.