A Tour around Stammering
(Date of publication 04 June 2004)

If you have Quicktime installed on your computer, just click here and listen. Does it seem possible that Winston Churchill, considered the best orator in Parliament, was a stammerer? Many famous people have stammered (or stuttered), including Isaac Newton, Lewis Carroll, Aneurin Bevan, John Updike and Bruce Willis. Marilyn Monroe's exaggerated mouth movements and breathy speaking style (to re-acquaint yourself click here) seem to have been taught by a speech coach to control her stammering, while Churchill wrote his speeches well in advance and then memorised them both forwards and backwards so that he could practice them assiduously before delivery.

A good description of the condition can be found on this speech therapy site. Stammerers know what they wish to say but cannot articulate it because of involuntary repetition, prolongation or cessation of speech sounds. Many more males than females (80% to 20%) are affected, and a significant majority of sufferers (65%) have a family history. Stammering usually starts before the age of 5 and, if left untreated, peaks during the teenage years before stabilising or diminishing with age. All stammerers have periods of fluency when they are emotionally relaxed, but revert to dysfluent speech when under stress. Also, problems do not arise when the words to be uttered and their timing are known; actors who stammer become fluent when performing, and even those most severely affected can sing without speech blocks. In ordinary conversation, however, difficulty is experienced in maintaining a smooth forward flow of words. As these episodes recur, the sufferer experiences tremendous frustration, anxiety, shame and embarrassment, exacerbating the problem.

Stammering is unlike any other disorder of communication, for a number of reasons. Its presence and severity vary, and while instances are sometimes predictable, sometimes they are not. Also, no two people stammer in the same way and during childhood the condition can fluctuate, disappearing and later returning.

Whilst most authorities agree that there is no cure for stammering and that it can only be controlled, a whole host of different causes has been postulated. Some of the old wives tales are so positively weird - go to the bottom of this page - that one can only speculate upon their origin. How could allowing an infant to look in the mirror, cutting its hair before it learns to speak, or tickling the soles of its feet possibly affect its powers of speech?

Turning to more scientifically plausible theories, two researchers in Utrecht have put forward the Vicious Circle Hypothesis. We all constantly monitor our own speech and stop, correct errors, backtrack and start again whenever necessary, creating minor dysfluencies such as hesitations, reformulations and repetitions. This hypothesis suggests that stammerers monitor their own speech too closely, identifying trivial irregularities. The detection itself creates an error, which is detected, creates an error, and so on, making the problem worse. Evidence supporting this view is that sufferers who perform an additional task while speaking, thereby distracting their attention, stammer significantly less.

At another page on the same site, Professor Webster of Brock University, Ontario, elucidates his theory, citing the research that underpins it. He believes that the speech centre of stammerers is located in the left cerebral hemisphere - as in fluent speakers - but that it is inefficient and unusually susceptible to interference from both hemispheres. Also, there is a lack of 'left hemisphere activation bias'; in fluent speakers the left hemisphere is in a greater state of readiness than the right, but in stammerers the balance is more equal, and it is known that activity in the frontal portion of the right hemisphere is associated with negative emotions such as fear and anxiety. Thus the fundamental cause is biological but the condition is reinforced psychologically. Recent research from Germany, involving sophisticated magnetic resonance imaging, appears to corroborate this to some extent, indicating that stuttering is associated with a structural abnormality in the left side of the brain.

A widely disseminated but scientifically unproven theory is that forwarded by William Parry, who attributes stammering to the Valsalva Manoeuvre, a natural mechanism which increases air pressure in the lungs in order to help exert physical effort or expel things from the body. One example is a weightlifter 'holding his breath' as he raises a barbell above his head. Muscles throughout the body are involved, but the relevant activity is that the larynx closes tightly around the upper airway to prevent air escaping from the lungs. This theory argues that when a stammerer anticipates a difficult word is needed, the need for extra effort is registered, triggering the Valsalva Manoeuvre and causing a stuttering block.

Professor Maguire of California University takes a different view, believing that the cause is a chemical imbalance in the brain, namely an excess of dopamine in the corpus striatum. This implies that drug treatment might provide the answer; haloperidol has been shown to reduce symptoms and Professor Maguire suggests that olanzapine, which he has used successfully, could prove effective.

Information about the best currently available therapies can be found at Stammering.net. These fall into four basic categories: self-therapy, electronic devices, speech language pathologists and speech clinics. It is emphasised that stammering is not only a speech disorder, but also a communication and behavioural disorder, and it cannot be eliminated overnight. Click here for a detailed review of electronic devices, which work by manipulating the stammerer's voice and relaying it back, and the neurological mechanisms involved.

Should you be really interested in this field, and its future development, there is a new quarterly online journal, Stammering Research, which was launched in April. The goal is to provide a forum for open exchange on relevant topics and to provoke strong debate from proponents of different theoretical positions.

Finally, here is a paradox from the UK. According the Disability Discrimination Act 1995, speech therapy which encourages stammerers not to avoid difficult words or to use substitution, thereby helping them to overcome their problem, could actually make them more likely to qualify as disabled and entitled to protection under its terms. Bizarre!

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