INTRODUCTION:
When Judy Kuster asked me to write a paper for the international stuttering awareness on-line conference, the search for a subject seemed rather difficult. After four years of participating in the on-line discussing groups and reading almost everything about stuttering on the Internet, I wondered if I could add something new to the subject. Not being a scientist, nor having had any special course in speech pathology, I decided to make a personal approach by exploring what in my life has been the greatest obstacle to fully integrating my stuttering. Compared to others I have a rather mild stutter, but trying to hide it was the greatest mistake I could make. This hiding is the basic notion in the "covert stuttering syndrome." By bringing this subject to the forum it is my deepest wish that other "covert stutterers" come in the open and will learn to accept and integrate, and by thus doing, avoid unnecessary pain and difficulties.
Come and follow the path of a covert stutterer
A burning sunshine accompanies our family-van on its annual course to southern France: it is holiday-time. My relaxation increases by the number of kilometers on the odometer. After a while the car is out of fuel. On highways, there are self-service gas stations. You have to pay on exit after shouting the number of your fuel pump into a microphone. So my heart is beating in apprehension, and when I arrive at the ticket-window, I make the number with my ten fingers. My youngest son is astonished to see his father struggling with a simple number, and this is still the beginning of the trip. This is how the holidays start for a 49 year old PWS, who happens to be a doctor, general practitioner, eagerly hoping to find some rest.
I received thirty-five patients yesterday: thirty-five conversations without any obvious dysfluency. Maybe twenty telephone-calls were done, with more difficulty, but it worked. The most difficult one was a call to the garage (yes, cars are very emotional for me!). I always wonder why the technician who sees my childish stuttering behavior in his garage still wants to trust me as his physician.
Tomorrow morning I will go to the baker to buy those delicious French baguettes, although I already know this will be hard. Yesterday I had no problem in discussing the best cancer-treatment; tomorrow I will be gesticulating trying to express the desired number of sandwiches! I already anticipate her pitiful face.
These recent experiences are an illustration of the situational aspect of stuttering which seems to confuse our listeners most and which made me choose "The stuttering Paradox" as title of the paper. Many PWS (people who stutter) are able to speak as fluent as anyone in certain comfortable situations. Listeners of those lucky hours are confused to hear you fail in other circumstances. What is confusing for others surely is confusing for the young PWS himself. How does he deal with that unpredictable failing? Most of us will struggle to overcome the block. Other discussions will certainly clarify aspects of this apparent behavior. Another escape out of the embarrassment of the stuttering moments could be denial. Perhaps it is the easiest way to escape. Denial can take many forms. Classically this is done by avoiding situations or sentences. An extreme form of denial is pretending there is no stuttering at all.
Woody Starkweather writes: "Extreme are the people with 'covert' stuttering: People who have become so adept at word substitutions that they never stutter overtly at all. It is not uncommon for such an individual to carry the secret of his or her stuttering alone, with no one among friends or family aware that an inner struggle to speak in a normal-sounding way is always present. This person is an extreme example of avoidance, illustrating, as only an extreme example can, something about the nature of the disorder. Sheehan described stuttering as an iceberg, with most of the disorder hidden from view. In the person with covert stuttering, ALL of the disorder is hidden from view. This suggests that the important aspects of the disorder are the parts that are unobservable, as Sheehan noted." (From Stuttering. 1997.)
Like every human behavior, denial is the result of a conditioned learning process. Avoiding the shame and humiliation of stuttering is the reward of that behavior. Everything is good except stuttering.
On the contrary, a person with a permanent (not situational) stutter is less prone to such denial behavior, because he simply cannot avoid reality. In his case stuttering occurs almost in every sentence or every situation. He has to confront his stuttering identity one way or another. This acceptance work will not be the subject of my paper.
Earlier studies make a difference between internalized (covert) versus externalized stutterers, where the later are generally more relaxed and adapted to their situation. My thoughts are directed towards covert stutterers, where there are inherent typical psychological problems. Their specific coping with stuttering dominates life more than the speech impediment self.
A covert stutterer resembles in a certain way a child abuse victim. There is great resemblance between both in their behavior towards life's unwanted aspects: there is a perpetual effort to hide the bad self, or what is perceived as the bad part of ourselves. In no way may others find out about that horrible secret.
For this purpose, the covert stutterer has achieved great strategies: he continually scans situations, subjects, feelings, sentences, and words, to eliminate the traps. His brain tends to be filled with synonyms to be prepared for everything. When there is no synonym, there is still always a possibility of flight. Regularly sentences are broken by long questioning pauses, hoping for some help from the listener. Sometimes there is no other escape than to express totally distorted ideas, weird and sometimes false. Better saying something stupid than stuttering on a true idea. What was true for Marty Jezer: "The world was a minefield through which I had to maneuver" (Stuttering: a life bound up in words), applies surely to the covert stutterer.
The condition involves a continuous basic tension, muscular and psychological, responsible for very specific secondary symptoms. The muscular tension has been documented in many places, and especially at the level of the vocal folds and has in itself the power to lower the threshold for stuttering, thus realizing what was to be avoided.
This exaggerated muscular tension will dominate the whole body and its functioning. Energy is derived from the proper goals to maintain the secret, leading to bad school results, non-adaptive professional choices, workplace difficulties, social isolation, and misunderstanding. This energetic drift can really exhaust the subject, predisposing him to chronic fatigue and nervous depression.
"Why am I so tired after what should be a routine work? Why this yearning for the next holidays on the first work day after holidays? It becomes evident that there is some wasting of energy!"
Covert stutterers are more prone to function below their capacities, compared to the general population. The same project puts higher demands on a covert stutterer compared to a non-stutterer or a fully adapted mild stutterer, although I do not want to make comparisons in terms of severity between the different types of stuttering.
Instead of directing energy towards realistic strategies to deal with the stuttered speech by one of the available methods, everything is done to simply avoid problems. I remember myself simply denying that I resembled my neighbor who is an externalized stutterer, very mild. That funny speech, that made some people laugh, made me shiver. I never wanted to be identified by it. In my opinion, I did not have a speech impediment, but something very special, never seen in others until much later -- I persevered in denying.
One day or another a brutal confrontation with reality will result in crisis.
Thank God, I've had many written exams in high-school and college. However, at the end of my medical curriculum, there was an oral test assisted by a large number of other students. At that moment, I had build up a rather fluent small-talk pattern in the presence of friends, therefore, they were astonished to hear a long silence when simple questions where addressed to me. I blocked totally. The Professor reacted to my distorted face with the suggestion to call the emergency team of the hospital, so augmenting the hilarity of the moment. A short letter to this person or to the ombudsman at the beginning of the year would have been sufficient to avoid this horrible scene!
This is the great trap: to continue to live as if there were no problems at all. The amount of energy necessary to obtain this denial is not measurable. All this energy is lost for real personal growth. Social interactions are dominated by these false premises and not by our deepest wishes or by realistic demands. Isolation can be the consequence.
How does this works in reality?
The last patient today was the mayor. I felt a certain tension to help him well to a degree I felt uncomfortable with. What is the difference between this man and the old woman before? Something in me wanted to make a good impression on him. Suddenly the telephone rang: it was my sister with a rather embarrassing family question, and I blocked and stuttered worse than ever. The whole day I had fluent conversations with strangers and patients, and now with the mayor in my consultation room, my speech collapsed! There goes the good impression.
The speech system can switch from the non-stuttering to the stuttering state and vice versa as illustrated above. Generally, we will know very well where the threshold is. Some covert stutterers will be able to maintain permanent control to a point where others do not recognize them as people suffering from a speech impediment. For others, alas, the key is not in their hands anymore. Breaking points are unpredictable and this brings their mind in a permanent alert situation. Not recognizing this will result in a life full of disillusion and unnecessary troubles. In hiding behind their fluent self, they are making irrealistic or even false approaches to reality, which is the worst obstruction to real acceptance.
A psychodynamic approach to this denial behavior will certainly reveal individually different accessory motivations, which I consider to be beyond the limits of the presentation. The purpose of my essay is to encourage all PWS and especially the covert ones to fully accept their stuttering part, to let go, to avoid denial. Let us face the devil in our life even if he seems very little.
"Often it's easier to muddle in confusion and to let negative feelings and distorted perceptions control my life. But I have the power and the knowledge to cut through that garbage. I can't will myself to be totally fluent, but I can will myself to see the difficulties that stuttering causes, and I do have the power to do something about it." (M. Jezer: Stuttering: a life bound up in words.)
Parents, doctors (family doctors and pediatricians), teachers, child psychologists, and counselors must be educated to recognize those hidden stutterers. They carefully can advise the stuttering youngster to contact a "stutter-team" where psychological counseling goes hand in hand with speech-reeducation or logopedics. The latter must be aware of the prevalence of the condition.
Progress in etiological research certainly will lead to an effective treatment next century. Nevertheless, to prescribe a cure the patient must accept his illness and ask for help. Information to the public about the condition will make asking for help easier.
Contact with other PWS can facilitate acceptance. Recognizing the syndrome in other persons and communicating with them makes us feel comfortable. Knowing that so many other people share the same secret relieves the violation of our pride. We are no longer isolated. Others have gone the same path, suffered the same shame and humiliation. The actual self-help movement in its many forms (local circles, gatherings, Internet) is of the greatest value in establishing the actual forums to make contact.
I want to end with a quote from the book Stutter no more by Dr Schwartz that expresses beautifully what a total cure would mean to a covert stutterer. It says in little words where it is all about. At first glimpse, a total cure seems not very realistic, but my personal feeling denies the impossibility of it.
"If you stutter openly and you stop, it is a gift to the world because the world is no longer required to see and hear you stutter -- and a gift to yourself because you know you are free of the affliction. But when you are a covert stutterer, it is a gift just to yourself, you can't expect society to know or care or be interested in your hidden problem. The gift, of course, is this incredible sense of freedom to be able to say whatever you want to say, wherever you want to say it, whenever you want to say it without fear."
EPILOGUE
On this southern terrace I look at a bright evening sky. This is our last holiday evening. My wife, my youngest son and myself, we had a wonderful time wandering, hiking, swimming, enjoying life in the Haute Provence Mountains, making life happy for each other. I had books to read in my wallet about stuttering. I had lots of paper and pencils but I did not write anything. Ideas grew in the background while I was walking. Everything became clear. I wondered what my life would have been now if I had never stuttered at all. Surely, it would have been different, easier. But after the experiences with family and friends who fully accepted me in real life, after the shared pain and mutual comprehension in the self-help community and on the internet, after getting deep insights about human nature through others testimonies, I guess life would not have had the same intensity. I paraphrase with Edith Piaf "Non, je ne regrette rien." No, I don't regret anything.
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