by Dawn Sinclair-Shapiro MSNBC

While 3 million Americans stutter, the cause of stuttering remains unknown, and therapies and treatments surrounding the condition are often as perplexing and varied as the theories surrounding the cause.

Word By Word Resources in Your Area Researching the Cause 2500 Years of Stuttering It Didn't Stop Them Typing Speech

Early theories During the early part of this century, theories about the cause of stuttering ranged from the; Repressed Need Theory; that says stuttering originates from a repression of infantile needs, to the; Cerebral Dominance Theory; a belief that stuttering could be caused by forcing a left-handed child to become right-handed. "It is a new disorder and we're just beginning to understand it," says Beth Ansel, director of the communication disorder department at the National Institute on Deafness and Other Communication Disorders. "In the 1950's, people felt the sole source of stuttering was psychologically based, but in fact, the work that has been done since that time has taken a much more broad view of the disorder." Beth Ansel talks about some of the theories behind the cause of stuttering. Beth Ansel explains the current state of stuttering research. Freudian approaches In the 1950s, psychoanalysis of stuttering led to what one stutterer during the period described as;… "a period when psychologists and psychiatrists tended to see everything you said, dreamed, or did in terms of Freudian symbolism." In his book, Tangled Tongue: Living with a Stutter, Jock Carlisle chronicles his life as a 20th-century stutterer who served as a guinea pig for the "mind-benders" after World War II. Thus, the following transcript from his book depicting one of his encounters: At one session my serious young man pumped me full of pentothal. As I floated on a warm, comfortable, carefree cloud, he asked me a strange question. Transcript Doctor: Now just relax. (I was already paralyzed.) Can you hear me? Jock: Mmmm. Doctor: Tell me, now, which of your testicles is lower than the other? Jock: You're joking? Doctor: No, this is serious. Please tell me. Jock: (Silence) Doctor: What's wrong? Jock: I’m thinking. Wouldn’t you? Doctor: Come along now. Surely you know. Jock: I haven’t the faintest idea. Doctor: Nonsense! You must know. We all know. Jock: Do you know which of yours is lowest? Doctor: That’s beside the point. Jock: I couldn’t put it better myself. (Low chuckle) Doctor: (Long silence) Try to remember. Haven’t you ever looked? Jock: I just don't know. I guess I’ve never looked that closely. Doctor: You’ve never looked? Oh, come now! Can you tell me if you have two of them? Jock: My God! Are you implying I’ve got more than two? I demand a recount! Today's approaches The majority of modern therapies are rooted in speech pathology which began developing in the late 1960s. Today scientists are enthusiastic about new and advancing technologies and the impact it will have on understanding speech and language. But until the cause is further delineated, treatment for a disorder with no universal definition, (stuttering is commonly described as a condition in which the flow of speech is broken by abnormal stoppages, repetitions or prolongation of sounds and syllables) is primarily geared toward improving fluency and successful communication. The two main approaches are fluency shaping and stuttering modification, says Dr. Edward G. Conture, professor of Communication Sciences and Disorders at Syracuse University in Syracuse, N.Y. Fluency shaping tries to help a person speak more easily and fluently while stuttering modification helps a person to stutter more easily. The exact approach is determined by the age of the client, how long the person has stuttered and the severity of the stuttering, but measuring the success of treatment is difficult and far from an exact science. According to Dr. Conture, there are three issues to look at when assessing treatment outcome: the source, the disability and the handicap. "Most therapies deal with the disability, to help alleviate the symptoms of stuttering," Conture says. "We are just getting into treating the handicap, to alleviate the disadvantages." Conture asserts, for a stutterer, being more fluent may not be more functional. He says the professional community is moving toward approaches that treat the whole person by asking questions that address how stutterers live daily and whether they can use their speech where, when and to whom they want.

"It's getting in your head the idea, if I accept the fact that I'm going to stutter to some degree, then you can modify it so that your stuttering is more comfortable, less struggling and if you will, socially acceptable."

Therapy The therapist office is a controlled and familiar environment where techniques tend to work better and the focus is the stutterer's speech. But once outside these walls, many stutterers express frustration. "You have people who rush you, people who make you nervous, people who make you anxious," says biology researcher Jonathan Fine, 27 who began stuttering at 12. "Those things are controlled when you are in a clinical area, but you can't control all these outside things," Fine said. "Air flow and precision fluency works OK when you are in the session with the therapist, but when you go out in the world, it all changes," says George Laday during a recent meeting of Speak Easy, a support group for stutterers based in Paramus New Jersey. George Laday describes the ordeal of purchasing movie tickets. Self-help Support and self-help groups, such as Speak Easy, are aimed at filling the gap between therapy and the outside world. "Self-help groups are not meant to replace therapy sessions," says Bob Gathman, who founded Speak Easy in June 1977 and continues as the non profit organization's president. "They serve as an encounter group where people who share the same life experience come together and share stories and knowledge about the problem of stuttering," he says. Kerry Downing practices ordering theater tickets during a Speakeasy meeting. Consumer Beware Considering there is no known cure for stuttering, and the disorder itself has more than one definition, people who stutter can become easy targets for scams claiming to be a cure all. "Anything that distracts your mind from fear or anticipation of stuttering will give you temporary relief," says Jane Fraser, President of the Stuttering Foundation, a nonprofit organization that provides educational materials and referrals to speech pathologists and support groups nationwide. "Stutterers are often mislead by tricky procedures, such as having the person talk with a sing-song inflection, metronome timing, talking while tapping a finger and other odd ways of talking," she says. Therapy success and failure The average stutterer can go through numerous therapies, with little success, often resulting in feelings of failure and frustration. Jim Tsiamisioris, 24, a sociology student, has stuttered since childhood, saying it dictated his way of life as he constantly maneuvered to get around stuttering and tried to hide it. In high school, he elected not to participate in therapy, hoping his stuttering would just go away. Before entering college at 19, he tried precision fluency shaping with no success. "After going through that, I felt like I was a failure because I think the people who ran that program thought that this would help almost everybody, and I felt like I wasn't doing something right since it didn't help me," he says. Tsiamisioris eventually entered a program that taught him skills to manage his speech, and as he continues to work on maintaining and improving his communication skills, he is optimistic about overcoming future barriers to his speech. Jim Tsiamisioris on growing up with a stutter. Beating the odds In the contemporary workplace, the need for effective communication is more crucial than possibly anywhere else. Stutterers frequently choose occupations where minimal importance is placed on verbal performance, often working in areas involving the manipulation of numbers. However, an unexpected discovery in a recent study conducted by the National Center for Stuttering shows approximately 12.5 percent of 520 stuttering patients were either salespersons or lawyers, but these findings were not surprising to James Spurlock, 47, a lobbyist for AT&T. As director of government affairs for the company, he can find himself arguing before the Federal Communications Commission on any number of issues affecting his employer. "When I'm stuttering a great deal, I've had people comment to me, how can you do what you do for a living, how do you do that?" Spurlock says. "Part of what I have to explain is, I don't always sound like this, there are good days, bad days, good hours and bad hours." Spurlock' s outlook toward his stuttering came after years of what he describes as "beating myself up" and talking to numerous therapists. Dealing, coping and finally managing the disabling aspects of his stutter has brought Spurlock to his own understanding of the disorder. "It's getting in your head the idea, if I accept the fact that I'm going to stutter to some degree, then you can modify it so that your stuttering is more comfortable, less struggling and if you will, socially acceptable." Try not to finish a stutterer's sentences. Refrain from making remarks such as: "Slow down," "Take a breath," or "Relax." Such simplistic advice can be felt as demeaning and is not helpful. Maintain natural eye contact. Just wait patiently until the person is finished speaking. Use a relatively slow, relaxed rate in your own conversational speech, but not so slow as to sound unnatural. Let the person know by your manner and actions that you are listening to what he or she says, not how they say it. Be aware that those who stutter usually have more trouble controlling their speech on the telephone. Be extra patient in this situation.

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