reprinted from Journal of AMA, May 8, 1909, p. 1480-1481
The case to be reported shows a condition that I believe has never before been observed or described.
History -- Mr. A., aged 38, had written shorthand exclusively from 14 to 18 years of age, and then shorthand and typewriting with very little longhand until 22. After three years illness he took up shorthand again for one year. He then obtained employment as a teller in a bank where he had to fill out names on deposit slips. He was told that his writing was bad and was urged to improve it. He tried to do so by taking courses in penmanship, by imitating the penmanship of other persons, etc. This resulted in the ability to write well when he could do so slowly and coolly but in a worse result whenever he did his work at the bank. On entering the bank in the morning he is seized with a nervous fear and a dread of writing poorly. The first few slips will be written fairly well but the anxiety soon brings on a condition in which the writing grows worse with each word. The specimens reproduced in Figure 1 show that even in my office where he is not particularly worried, the writing grows steadily more cramped and tremulous as he approaches the end of a word. He explained that he had suffered so much on account of his writing--he had been passed over in promotions and had even thought of changing his occupation--that a nervous fear seized him the moment he took up a pen. Before beginning to write he would make a number of nervous strokes with the pen without touching the paper. There was not trouble whatever in his speech.
The patient was sent to me by Dr. W. S. Thomas of New York City with the suggestion that it might be a case of stuttering in penmanship and that the methods used for correcting the speech stuttering might perhaps be applicable. The diagnosis was undoubtedly correct. There were cramps of the muscles of action resulting from a compulsive nervous fear that was aroused whenever the action was contemplated.
The therapy was based on the theory of stuttering that had substantiated itself for speech. The stutterer speaks in a peculiar voice that betrays him to the practiced ear even when he does not stutter. This voice is connected with his compulsive idea, namely, with the thought that he is going to stutter (Fig. 2). He does not stutter when he sings because the compulsive idea is not connected with singing; and he does not stutter when he speaks a dialect, for the same reason. To cure the trouble he is taught to use a form of speech this is utterly new to him, namely, the speech of normal persons. As soon as he understands how normal person inflect their voices with rising and falling melody, and can imitate them, he can speak without stuttering. His voice is changed from a harsh cramped one to a melodious easy one.
Applying this principle to the penmanship stutterer, I sought a method of imparting thought by written characters that would involve graceful and easy move-ments of the right arm and hand. This method had to be entirely different from penmanship and yet capable of gradual change to it. Chinese writing brushes were bought. These made it possible to use free and grace-ful movements of the arm. A new alphabet had to be devised in order to have no connection with the pen alphabet.
For the letter A it was explained that the Egyptians had used an inverted bullock's head; for B they had used an outline of a two-story house; C was the symbol of the crescent moon, and so on (Fig. 3). All the letters were thus regarded as hieroglyphs and felt to be new things. In this way a new means of com-municating thought was built up which was quite dis-connected from the compulsive fear. The patient was trained to write the letters with the brush until he could make them gracefully and quickly. Then he passed to words, using specially the names that he had to write in his business.
When he could write gracefully with the brush he passed to a pen and drew the letters in a similar fashion. Gradually the speed was increased and greater fluency obtained.
It was constantly impressed on the patient that he was writing in an entirely new way. He learned to know that he could write perfectly and fluently in this way. Any new form of writing might have been used, but this particular form was chosen so that the final result would not differ from the usual style of penmanship.
It is essential that the stuttering patient shall always feel that he is writing or speaking in a new way: so long as he has this feeling he will be free from the compulsive idea. The mere supposition that he is speaking in a new way is often sufficient to instantly stop stuttering in speech. One patient could not dic-tate to his secretary. To avoid discovery by his superiors he would write his letters in long hand and pass them to be typewritten. I told him to sing various letters to me. He could do so per-fectly without hesitation. But he was unable to dis-tinguish one note from another, and instead of singing--as he supposed--he really only spoke the words in a kind of monotone. I sent him hack to his secretary with the instruction to always sing his correspondence, knowing that he really would not sing them but that so long as he believed himself to be doing so he would have no trouble.
This principle of training a patient to use an entirely new set of thoughts and movements in accomplishing an act that has become disturbed through nervous troubles may be applicable in still other diseases pos-sibly in the various phobias. It is certainly closely related to the Fraenkel treatment for locomotoataxia.
reprinted from the Journal of the American Medical Association, with permission
December 27, 2007