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One of the first questions asked by the stutterer or stammerer is, "What is the cause of my trouble?" In asking this question, the stammerer is getting at the very essence of the successful method of treatment of his malady, for there is no method of curing stuttering, stammering and kindred defects of speech that can bring real and permanent relief from the affliction unless it attacks the cause of the trouble and removes that cause.
Inasmuch as this book has to do almost entirely with the two defective forms of utterance known as stuttering and stammering, we will at this time drop all reference to the other forms of speech impediments and from this time forth refer only to stuttering and stammering.
These forms of defective speech are manifested by the inability to express words in the normal, natural manner--freely and fluently. In other words, there is a marked departure from the normal in the methods used by the stammerer in the production of speech. It is necessary, therefore, before taking up the discussion of the causes of stuttering and stammering, to determine the method by which voice is produced in the normal individual, so that we can compare this normal production of speech with the faulty method adopted by the stutterer or stammerer and learn where the fault is and what is the cause of it.
Let us now proceed to do this: In other words, let us ask the question: "How is speech produced in the normal person not afflicted with defective utterance?"
Voice is produced by the vocal organs much in the same manner as sounds are produced on a saxophone or clarinet, by forcing a current of air through an aperture over which is a reed which vibrates with the sounds. The low tones produced by the saxophone or clarinet result from the enlargement of the aperture, while the higher tones are produced by contracting the opening. Variations of pitch in the human voice are also effected by elongation and contraction of the vocal cords with comparative slackness or tension, as in the violin.
It would be of no value, and, in fact, would only serve to confuse the layman, to know the duties or functions of the various organs or parts entering into the production of speech. Suffice it to say that in the "manufacture" of words, there are concerned the glottis, the larynx, thorax, diaphragm, lungs, soft palate, tongue, teeth and lips. In the production of the sounds and the combination of sounds that we call words, each of these organs of speech has its own particular duty to perform and the failure of any one of these organs properly to perform that duty may result in defective utterance of some form.
BRAIN CONTROL: It must be borne in mind that for any one or all of the organs of speech to become operative or to manifest any action, they must be innervated or activated by impulses originating in the brain.
For instance, if it is necessary that the glottis be contracted to a point which we will call "half-open" for the production of a certain sound, the brain must first send a message to that organ before the necessary movement can take place. In saying the word "you," for instance, it would be necessary for the tongue to press tip against the base of the lower row of front teeth. But before the tongue can assume that position, it is necessary that the brain send to the tongue a message directing what is to be done.
When the number of different organs involved in the production of the simplest word of one syllable is considered (such as the word "you" just mentioned), and when it is further considered that separate brain messages must be sent to each of the organs, muscles or parts concerned in the production of that word, then it will be understood that the process of speaking is a most complicated one, involving not only numerous physical organs but also intricate mental processes.
When all of the organs concerned in the production of speech are working properly and when the brain sends prompt and correct brain impulses to them, the result is perfect speech, the free, fluent and easy conversation of the good talker. But when any or all of these organs fail to function properly, due to inco-ordination, the result is discord--and defective utterance.
CAUSE OF DEFECTIVE UTTERANCE: Now, let us consider the cause of defective utterance. What is it that causes the organ, muscle or parts to fail properly to function? The first and most obvious conclusion would be that there was some inherent defect in the organ, muscle or part which failed to function. But experience has proved that this is usually not the case. An examination of two thousand cases of defective utterance, including many others besides stuttering and stammering, revealed three-tenths of one per cent. with an organic defect--that is, a defect in the organs themselves. In other words, only three persons out of every thousand afflicted with defective utterance were found to have any physical shortcoming that was responsible for the affliction.
Take any of these two thousand cases--say those that stammered, for instance. What was the cause of their difficulty, if it did not lie in the organs used in the production of speech? This is the question that long puzzled investigators in the field of speech defects. Like Darwin, they said: "It must be this, for if it is not this, then what is it?" If stuttering and stammering are not caused by actual physical defects in the organs themselves, what then can be the cause?
DUE TO A LACK OF CO-ORDINATION: Cases of stammering and stuttering where no organic defect is present are due to a lack of co- ordination between the brain and the muscles of speech. In other words, the harmony between the brain and the speech organs which normally result in smooth working and perfect speech has been interrupted. The brain impulses are no longer properly transmitted to and executed by the muscles of speech.
This failure to transmit properly brain messages or this lack of co-ordination may take one of two forms: it may result in an UNDER-innervation of the organs of speech, which results in loose, uncontrolled repetitions of a word, sound or syllable, or it may take the form of an overinnervation of the vocal organ with the result that it is so intensely contracted as to be entirely closed, causing the "sticking" or inability to pronounce even a sound, so common to the stammerer.
Suppose that you try to say the word "tray." Do not articulate the sounds. Merely make the initial effort to say it. What happens? Simply this: The tip of the tongue comes in contact with the upper front teeth at their base and as you progress in your attempt to say "t," the tongue flattens itself against the roof of the mouth, moving from the tip of the tongue toward its base. If you are a stammerer, you will probably find in endeavoring to say this word, that your vocal organs fail to respond quickly and correctly to the set of brain messages which should result in the proper enunciation of the word "tray." Your tongue clings to the roof of your mouth, your mouth remains open, you suffer a rush of blood to the face, due to your powerful and unsuccessful effort to articulate, and the word refuses to be spoken.
Now, in order to dissociate "lack of co-ordination," from stammering and to get an idea of its real nature, let us imagine an experiment which can be conducted by any one, whether they stammer or not.
You see on the table before you a pencil. You want to write and consequently you want to pick up the pencil. Therefore, your brain sends a message to your thumb and forefinger, saying, "Pick up the pencil." Your brain does not, of course, express that command in words, but sends a brain impulse based upon the kinaesthetic or motor image of the muscular action necessary to accomplish that act. But for our purpose in this experiment, we can assume that the brain sends the message in terms which, if interpreted in words, would be "pick up the pencil." Suppose that when that brain message reaches your thumb and forefinger, instead of reaching for the pencil, they immediately close and clap or stick, refusing to act. Your hand is unable to pick up the pencil. That, then, is similar to stammering. The hand is doing practically what the vocal organs do when the stammerer attempts to speak and fails. But, on the other hand, if, when the message was received by your thumb and finger, it made short, successive attempts to pick up the pencil, but failed to accomplish it, then you could compare that failure to the uncontrolled repetitions of stuttering. This inability to control the action of the thumb and forefinger would be the result of a lack of co-ordination between the brain and the muscles of the hand, while stuttering or stammering is the result of a lack of co-ordination between the brain and the muscles of speech.
WHAT CAUSES LACK OF CO-ORDINATION: But even after it is known that stuttering and stammering are caused by a lack of co-ordination between the brain and the organs of speech, still, the mind of scientific and inquiring trend must ask, "What causes the lack of co-ordination?" And that question is quite in order. It is plain that the lack of co-ordination does not exist without a cause. What, then, is this cause?
An inquiry into the cause of the inco-ordination between brain and speech-organs leads us to an examination of the original or basic causes of stammering. These original or basic causes in their various ramifications are almost as numerous as the cases of speech disorders themselves, but they fall into a comparatively few well-defined classes.
These original causes in many cases do not appear to have been the direct and immediate cause of the trouble, but rather a predisposing cause or a cause which brought about a condition that later developed into stuttering or stammering.
Let us set down a list of the more common of these causes, not with the expectation of having the list complete but rather of giving facts about the representative or more common Basic Predisposing Causes of Stuttering and Stammering.
A little more than 96 per cent. of the causes of stammering which the author has examined can be traced back to one of the five causes shown below:
Let us take up these familiar causes of stuttering or stammering in the order in which we have set them down and learn something more of them.
The first and one of the most common causes is Mimicry, or, as it is probably more often called, Imitation. Mimicry or Imitation is almost wholly confined to children. After reaching the age of discretion, the adult is usually of sufficient intelligence to refrain from mimicking or imitating a person who stutters or stammers.
The average small boy, however, (or girl, for that matter) seems to find delight in mocking and imitating a playmate who stutters or stammers, and so keen is this delight that he persists in this practice day after day until (as its own punishment) the practice of mockery or mimicry brings upon the boy himself the affliction in which he found his fun.
It may be noted, however, that Imitation is not always conscious, but often unconscious. The small child begins to imitate the stuttering companion without knowing that he engages in imitation. This practice, notwithstanding the fact that it is unconscious, soon develops into stuttering, without any cause being assignable by the parent until investigation develops that unconscious and even unnoticed imitation is the basic cause of the defective utterance.
It has been definitely determined that stuttering may be communicable through contagious impressions, especially among children of tender age whose minds are subject to the slightest impressions.
For this reason, it is not advisable for parents to allow children to play with others who stutter or stammer, nor is it charitable to allow a child who stutters or stammers to play with other children who are not so afflicted.
So far-reaching are the effects of Imitation or Mimicry that in certain cases, children have been known to contract stuttering from associating with a deaf-mute whose expressions were made chiefly in the form of grunts and inarticulate sounds.
FRIGHT OR SEVERE NERVE SHOCK: Another common cause of stammering is fright or nervous shock, which may have been brought about in countless ways. One boy who came to me some time ago stated that he had swallowed a nail when about six years of age and that this was the cause of his stammering. The logical conclusion in a case like this would be that the nail had injured the vocal organs, but an examination proved that there was no organic defect and that the stammering was caused, not by injury directly to the vocal organs but by the nervous shock occasioned by swallowing the nail.
Another case was that of a stammerer who reported that he had been given carbolic acid, by mistake, when a child and that he had stammered ever since. This, like the case of the boy who swallowed the nail, might be expected to prove a case of absolute physical injury or impairment of the vocal chords, but once again, it was clear that such was not the case and that the stammering was brought about solely from the nervous shock which came as a result of taking carbolic acid.
There is still another case of a boy who felt that he was continually being followed. This was of course merely a hallucination, but the fright that this boy's state of mind brought on soon caused him to stutter and stammer in a very pronounced manner.
Fright is a prolific cause of stuttering in small children and may be traced in a great many cases to parents or nurses who persist in telling children stories of a frightful nature, or who, as a means of discipline, scare them by locking them up in the cellar, the closet or the garret. To these scare-tales told to children should be added the misguided practice of telling children that "the bogey-man will get you" or "the policeman is after you" or some such tale to enforce parental commands. An instance is recalled of a woman who created out of a morbid imagination a phantom of terrible mien, who abode in the garret and was constantly lying in wait for the small children of the household with the professed intention of "eating them alive."
Such disciplinary methods of parents savor much of the Inquisition and the Dark Ages and should, for the good of the children and the future generation they represent, be totally abolished. While these methods do not, in every case, result in stuttering or stammering, they make the child of a nervous disposition and lay him liable in later years to the afflictions which accompany nervous disorders. In some cases "tickling" a child has caused stammering or stuttering. Care should be exercised here as well, for prolonged tickling brings about intense muscular contraction especially of the diaphragmatic muscles, which contraction is accompanied by an agitated mental condition as well as extreme nervousness, all of which approaches very closely to the combination of abnormal conditions which are found to be present in stammering or stuttering.
FALL OR INJURY AS A CAUSE: Step into any gathering of average American parents for a half-hour and if the subject of the children should come up, you are sure to hear one or more dramatic recitals of the falls and injuries suffered by the junior members of the household, from the first time that Johnny fell out of bed and frightened his mother nearly to death, to the day that he was in an automobile crash at the age of 23. And these tales are always closed with the profound bit of confided information that these falls are of no consequence--"nothing ever comes of them."
While in a great measure this is true, there are many falls and injuries suffered in childhood which are responsible for the ills of later life, although it is seldom indeed that they are blamed for the results which they bring about.
Injuries and falls are a frequent cause of stuttering and stammering. Usually, however, an injury results in stuttering or stammering, not because of any change in the physical structure brought about by the injury but rather by the nervous shock attending it. In other words, cases of stammering and stuttering caused apparently by injury might, if desired, be traced still further back, showing as the initial cause an injury but as a direct cause the fright or nervous shock resulting from that injury.
A good example of this is found in a case of a young man who came to me some years ago. He said: "When I was about five years old, my brother and I were playing in the cellar and I wanted to jump off the top step. When I jumped, I hit my head on the cross-piece and it knocked me back on the steps and I slid down on my back, and ever since, for ten years, I have stammered."
Here is a case where the blow on the head, or the succession of blows on the spinal column as the boy slid down the stairs, might have been the cause of the trouble. More probably, it was the combined injury, undoubtedly resulting in a severe nervous shock from which the boy probably did not recover for many days.
Another man said, in describing his case during an examination: "At the age of 16, I was hit on the head with a ball. I lost my memory for one week and when I regained it, I was a stammerer." This is a plain case of injury resulting in immediate stammering.
Still another case is that of a boy who, at the age of three, was shot in the neck by a rifle, the bullet coming out of his chin, which resulted in his becoming an immediate stammerer. Here, as in the case of the boy who swallowed the nail, it might be expected that the cause was a defect in the organs of speech, but I found stammering was brought on by the nervous shock.
From these few cases of actual occurrences, it will be seen that practically all cases of stammering caused by injury can be traced to the NERVOUS SHOCK brought about by the injury.
HEREDITY AS A CAUSE: There is little that need be said on the subject of heredity as a cause of stuttering and stammering, save that heredity is a common cause and that children of stuttering or stammering parents usually stammer. In this, as in the case of any malady hereditarily transmitted, it is difficult to say whether the trouble is caused by inheritance or by constant and intimate association of the child with his parents during the period of early speech development.
THE RESULT OF DISEASE: Many cases of both stammering and stuttering may be traced back to disease as the basic or predisposing cause. Acute Chorea (St. Vitus Dance) is frequently the cause of stuttering of a type known as Choreatic Stuttering or "Tic Speech." Infantile Cerebral Palsy sometimes brings about a condition known as "Spastic Speech," while whooping cough, scarlet fever, measles, meningitis, infantile paralysis, scrofula and rickets are sometimes responsible for the disorder.
Disease may cause stuttering or stammering as an immediate after effect or the speech trouble may not show up for considerable time, depending altogether upon the individual. But regardless of the length of time elasping between the disease which predisposes the individual to the speech disorder and the time of the first evidence of its presence, diagnosis reveals but an insignificant percentage of organic defects in these cases resulting from disease, indicating that even here the predominant causative factor is a mental one.
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