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Peter Wolson

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Is Stuttering Biological or Psychological?

Posted: 10/16/11 11:48 AM ET

The Stuttering Foundation of America has proclaimed on its website (www.stutteringhelp.org), "There is no reason to believe that emotional trauma causes stuttering." Similarly, the National Stuttering Association (www.nsastutter.org) has stated: "We do know that stuttering is not caused by emotional problems and is not a 'nervous' disorder. We also know that stuttering is not the fault of the family or the person who stutters."

These organizations suggest that stuttering is primarily an inherited disorder unrelated to environmental upbringing. Based on case studies I, a psychoanalyst, am convinced that the exclusive emphasis on biological causes is misguided, insofar as it rules out psychoanalytic psychotherapy for those stutterers whose speech disorder derives from internal conflicts due to family influences, as was strikingly evident in last year's Academy Award-winning film, "The King's Speech." This film was based on historical fact.

From its viewpoint, Bertie, who became King George VI, was portrayed as intimidated and frightened by his oppressive father, the King of England, during childhood. The film implied that this caused him to become fearful of expressing himself verbally, especially his anger. From a psychoanalytic perspective, the expression of his own speech apparently represented transgressing against his father. Bertie's symptom of stuttering served the defensive function of blocking any provocative speech while making him look inadequate, thereby diminishing the fear of his aggression and its anxiety-inducing consequences.

Although his Australian speech therapist, Lionel Logue, treated him with various speech exercises, what appeared to help most was when he provoked Bertie's anger, first by having him say the F word, over and over again, and then by acting like a dominating authority figure while sitting on the king's royal throne. Enraged, Bertie screamed at Logue and was amazed when Logue pointed out that he wasn't stuttering. In effect, the stuttering diminished when he was able to express his anger. The speech therapist's friendship and support of Bertie's right to express his own independent feelings and thoughts, especially his anger, and especially when the therapist represented a dominating father figure, ultimately made Bertie feel safe enough to speak freely. This is what happens in psychoanalysis when the patient might experience the therapist in the transference, for example, as an oppressive parental figure. The therapist then helps the patient work through his fear of aggression toward dominating authority figures in the transference relationship.

In various interviews, the writer-producer of "The King's Speech," David Seidler, a stutterer himself, speculated that in real life, Bertie benefited most from his speech therapist's "talking cure" based on Freudian psychoanalysis, not from the mechanical speech exercises portrayed in the film. In fact, Seidler said that most of the speech therapists he consulted agreed that speech exercises didn't eliminate stuttering. He concluded that Logue must have used Freud's "talking cure" on Bertie based on the fact that Seidler's uncle, who was also a stutterer, had coincidentally been treated by Lionel Logue for years. His uncle said that Logue got him to talk about his parents and childhood, and although his uncle considered all of that rubbish, by the time his treatment ended, he no longer stuttered (www.dailymail.co.uk).

Seidler noted that he wished he had someone like Logue to listen to him attentively and help him understand his life better. Bertie, in "The King's Speech," clearly didn't grow up with a father or brother who were lovingly attuned and supportive of him. But Lionel Logue, his speech therapist, helped him to repair these experiential deficits and to resolve his internal psychological conflict over his aggression.

Similarly, Jack Welch, former CEO of General Electric, on June 11, 2011 confided to TV guest show host Piers Morgan that he was a stutterer. He said that what helped him most was his mother's belief in the value of what he had to say and her encouragement to speak his mind. He felt listened to and understood by her, and she supplied the reassuring explanation that his intelligent mind worked more rapidly than his capacity to speak his ideas. In effect, she validated his right to say what he wanted and to be his authentic self.

There is abundant research evidence for a biological predisposition for stuttering; however, environmental stressors, such as family relations, can produce internal psychological conflicts that cause stuttering, possibly in combination with this predisposition, as in the case history cited above and in the psychodynamics of George VI depicted in the film, "The King's Speech." That is why I urge stutterers and organizations devoted to the treatment of stuttering to consider psychoanalytic therapy as an often essential part of the treatment for this debilitating, humiliating psychological symptom. Proclaiming that stuttering is unrelated to emotional issues and family relationships is a misguided, potentially damaging omission for individuals whose stuttering is largely caused by psychological conflicts in childhood.

 
The Stuttering Foundation of America has proclaimed on its website (www.stutteringhelp.org), "There is no reason to believe that emotional trauma causes stuttering." Similarly, the National Stuttering...
The Stuttering Foundation of America has proclaimed on its website (www.stutteringhelp.org), "There is no reason to believe that emotional trauma causes stuttering." Similarly, the National Stuttering...
 
 
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Wmof2011
Vote,KickOutGOPs/TPs,Vote,LookUpHomeVoteDay,Vote
05:12 AM on 11/04/2011
..continuation.

Plus, the fact that King George and Welch still continued to stutter; however, they were or became mild stutterers. Not all stutterers are severe. A stutterer or speech pathologist would know that, actually many know this to be fact.

As far as the boy who stuttered because he disliked the step father... Well, he could have been a mild stutterer before hand. Anyway, I would hope the psychoanalyst would focus on why the boy hates the new step father, instead of just calling it anger.

The perception by Wolson is different from a stutterer or speech pathologist (due to lack of training and experience: and ignorance by choice). He says the anger over a bad childhood caused the stutter. However, Welch had a great childhood: What caused his stutter. Also there are many with traumatic childhoods who never developed a speech impediment.

And lastly, there has already been a -scientific- study on whether a traumatic childhood causes a stutter. The theory had proved to be false. stutterhelp.org may have this study on their site.

I think Wolson is the mad scientist, determine to prove what he already knows to be wrong. lol.
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Wmof2011
Vote,KickOutGOPs/TPs,Vote,LookUpHomeVoteDay,Vote
05:11 AM on 11/04/2011
A psychoanalyst who has real education in speech pathology should not be treating or evaluating a speech impediment. And what happens when the psychoanalyst fails at curing the stutterer after months of therapy? Will he blame the stutterer to cover his failure (or to cover his fraudulent cure)? This is damaging to the stutterer, who already has negative feelings about his/her stutter. Maybe he will tell his patients that it takes 50 years to get cured. And maybe he wants the stutterer to wait 50 years to find a career or raise a family, because a cure will make things better?

I noticed the article never mentions a psychoanalyst who has cured a stutterer: ie no empirical evidence (certainly no scientific evidence). Wolson does not claim he has done so or that any of the psychoanalyst he knows, or reads about has cured a stutterer. Still he has a responsibility to not use his psych skills to even miss-lead. Clearly, its his claim that psychoanalysis will cure stuttering.

The examples given, King George and Welch, were not alleged by Wolson to be cured by a psychoanalyst. Instead, it was King George's speech pathologist, and Welch's mother. So from that one needs the skill of a speech pathologist or mother to be of great help to a stutterer. Anyway, a scientific study with only two subjects is not very scientific, of course. So this would not be evidence of a psychological -cause- of stuttering.

Plus, the fact....
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Wmof2011
Vote,KickOutGOPs/TPs,Vote,LookUpHomeVoteDay,Vote
05:16 AM on 11/04/2011
Error...

That should be a psychoanalyst who has "no real education" (longer than a paragraph) in speech pathology should not treat or evaluate a speech impediment.
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HUFFPOST BLOGGER
Peter Wolson
04:07 PM on 10/22/2011
Frequently when a stutterer can read or sing something without stuttering, it is because it is relationally safe to do so. Reading or singing reduces the interpersonal stress of speaking spontaneously, which is more likely to evoke internal conflicts, such as the fear of disinterest, of rejection or of one's own anger or need to be loved, etc. A common dynamic is the fear of expressing repressed rage, as in the King's Speech and in the case example I cited. Speech therapists tell me that the emotional basis of stuttering is widely accepted in their profession. This does not discount the possibility of a genetic predisposition, of multiple causative factors. Since the genetic factor has only been proven in 9% of the cases, why is there such a pressing a need to prove it as the only factor and dismiss psychological causes, or claim that psychological factors are only important as responses to genetically caused stuttering. This form of "all or none" splitting and denial is extremely suspect, as indicated in my previous post. I strongly urge Jane Fraser and the Stuttering Foundation of America and the National Stuttering Association to reconsider their position on this issue.

Peter Wolson, Ph.D.
Past President and former Dean of the Los Angeles Institute and Society for Psychoanalytic Studies
05:15 PM on 10/22/2011
I care less about the reasons why people stutter, and care more about why we consider stuttering a problem. There is already a prevailing discourse around stuttering that marginalizes people who stutter (I believe in the benefit of making people with more typical ways of speaking feel more healthy/normal) and invalidates their ability to contribute. A similar marginalization/pathologizing occurs for people with mental illnesses. Essentialist etiologies (biological, genetic, mostly fixed) are ways of conceptualizing stuttering, mental illness, or other behavior/identities that counters some of the abnormalizing/shaming/blaming that happens to people who experience them. I don't think ultimately it is a great way to conceptualize, but it has its uses and I understand why people hold to it.

Again, I say debating origins of stuttering is not that interesting and ultimately damaging, and that a more effective discussion can be had about the social/economic forces that privilege some ways of communicating at the expense of others, who benefits from that process, and how can we challenge it.

And speaking of how suspect "this form of 'all or none' splitting and denial" is, your post is titled "Is Stuttering Biological or Psychological?" I don't know if you get to choose your own titles, but honestly, the title provokes an "either or" scenario you are suddenly upset that folks chose sides? You then rhetorically pathologize folks who disagree with you by labeling them "psychophobic." Who here can't handle disagreement?
05:21 PM on 10/22/2011
I just want to go on the record here and label everyone who thinks people who stutter need to treat stuttering as having a phobia of speech variation and should promptly receive treatment to resolve that phobia. If they continue to push that people who stutter are the ones who need to change, then they should offer to pay for the treatment and not expect people who stutter to do so. If you are unwilling to do either, I suggest spending your time combating the discrimination and difficulty people who stutter face and examine how you may contributed.
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HUFFPOST BLOGGER
Peter Wolson
03:36 PM on 10/22/2011
Dear Jane Fraser, these are psychoanalytic case studies in which stuttering was caused by internal conflicts and cured through psychotherapy. S.L. Ablon (1988). Psychoanalysis of a stuttering boy. International Review of Psycho-Analysis, 15:83-91; S. Klaniczay (2000). On childhood stuttering and the theory of clinging. Journal of Child Psychotherapy, 26:97-115; M. Wilkinson (2001). His mother’s tongue, from stuttering to separation: a case history. Journal of Analytical Psychology, 46:257-273, to name just a few. These are intense, scientific, empirical field studies which prove that stuttering has psychological causes. If merely one of them demonstrates this, you cannot say there is no valid evidence for psychological causes of stuttering.
I wonder if your need to absolutely deny the possibility of psychological causation is motivated by psychophobia, a fear of the stigma of having psychological problems, as if this implies one is crazy or blames one’s family, etc. Psychophobia prevents people from getting the psychological help they need. I refer you to, “A World of Psychophobia,” an op-ed piece I wrote for the LA Times, May 28, 2000.
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HUFFPOST BLOGGER
Peter Wolson
09:58 PM on 10/21/2011
You state there is no evidence for an emotional cause of stuttering. Yet the psychoanalytic literature contains case studies which prove that there is empirical evidence for this.

In one case, a five year old boy whose parents divorced when he was one, began to stutter after learning that his mother with whom he lived, had married a man whom he detested. She had promised the boy that she wouldn't marry this man. One day she announced that she had married this man, the boy felt deeply wounded and enraged. He wanted to attack his mother and stepfather. Instead, he began to stutter. He knew they wouldn't want to hear what he had to say, and he feared destroying his vital connection to his mother. Unconsciously, he turned his anger against his words. With his real father, whom he loved, his stuttering would disappear, but when he returned to his mother and stepfather, he would stutter again. The psychological basis of his stuttering was demonstrated by the fact that he didn't stutter when with his real father, but did with his mother and step-father, toward whom he felt enraged. If the cause of his stuttering was purely genetic, he would have stuttered with his real father as well. At the age of 12, he went to live with his father and after a brief period, he stopped stuttering entirely.

With empirical evidence like this, why wouldn't you consider psychological conflict as a possible causative factor.

Peter Wolson, Ph.D.
02:32 PM on 10/22/2011
Because one case study in the face of more emperically based research cannot be generalized. Psychoanalytic studies do not integrate evidence from other fields who specialize in stuttering and speech disorders. I have read recent psychoanalytic studies saying that the patient stuttered on words like mom, Margret (the analyst's name), and bottle as examples of his anger at his mother. This did not take into consideration that he probably also stuttered on similar words that are bilabial. If stuttering was caused by anger or psychological issues then more then 1% of the population would stutter!
03:47 PM on 10/22/2011
Case studies don't "prove" anything, as they don't control for any factors and can assume that change in the variable case study authors are biased towards looking for is a causative agent among the countless many that were ignored. It could simply be that kids who stutter often start stuttering by the age of 5, and many stop stuttering as they become teens. Stuttering can be intensified by tense or anxiety provoking situations (ex. difficulty with home life/parents), and it seems that is where this boy stuttered most.

Additionally, this case was resolved without analysis, so why would psychoanalysis be an indicated part of treatment for this case (or any)? Stress, anxiety, and anger can make stuttering increase, and relaxing and feeling comfortable can reduce stuttering frequency. In this case, moving from a tense situation to a calmer one seemed to make the difference, not an active treatment. Any other treatment that could also help someone who stutters relax and address stressors would be helpful if someone is looking to stutter less.
02:51 PM on 10/20/2011
How timely! Oct. 22 is International Stuttering Awareness Day. Much can be learned and shared about stuttering from groups such as the Stuttering Foundation. See here: www.facebook.com/stutteringhelp and www.StutteringHelp.org
01:59 PM on 10/20/2011
The genetic linkage is the strongest evidence for cause at the moment, which can then cause emotional issues.
abhorson
Si Si Chiquita. There's a woman worth her ransom
11:54 PM on 10/18/2011
it's also occasionally caused by edemas on the brain or some type of brain injury... in some cases, once you eliminate the edema you will automatically eliminate the stuttering
12:49 PM on 10/18/2011
Is this guy's next article n refrigerator moms causing autism? Because that's just as accurate, updated and offensive.
02:38 PM on 10/18/2011
P.S. I stutter and have no trauma in my background and any painful memories are a result of living in a society that invalidates my experience as a person who stutters. Luckily I have been able to use that in my stand up comedy
12:32 AM on 10/18/2011
Note that the author said "exclusive emphasis on biological causes is misguided." He's saying there are multiple factors at the heart of the phenomena, including physical, environmental, psychological, not exclusively physiological.

I dated a stutterer in my youth -- a charming, handsome chap, and I am quite sure there were multiple causes. However, my adoring gentle focus on him -- a tuning in rather than a tuning out or exhibition of nervousness in return -- always seemed to help him ease out of a bout when it occurred. I must admit, it gave me a fantastic opportunity to stare into his beautiful green eyes, and voila, whatever it was that he had to say, was witty when he was then able to get it out! Our own lovely little feedback loop.

R, I remember you fondly, and hope you are happy and well!
07:30 PM on 10/17/2011
Stuttering is biological (it has been linked to being genetic), psychological (overcoming negative feelings and attitudes are a huge goal in speech therapy) and physiological.

http://www.home-speech-home.com/stuttering.html

Stuttering is not caused by parents although parents can make it worse (i.e. time pressure, language demands)

I'm a Speech-Language Pathologist and have had some experience with stuttering.

Dr. Wolson is correct when he says "Proclaiming that stuttering is unrelated to emotional issues and family relationships is a misguided" because like I said a huge component of stuttering therapy (for most older children and adults) is based on negative feelings and attitudes.
05:22 PM on 10/17/2011
Dr. Wolson is way out of the mainstream on this issue. Stuttering certainly has a strong psychological component but is generally physiological in origin -- though the mix of factors may from person to person. He does make a valid point that psychological factors play a role, which is why therapy that's limited to fluency mechanics generally is unsuccessful. The experience of people who stutter shows that the most effective therapy includes counseling and is best administered by a specialized speech-language pathologist, not a psychiatrist or psychologist. Surveys show that psychology-only treatments are generally less effective than speech therapy.
05:19 PM on 10/17/2011
This is a really difficult post for a life-long stutterer to read. I am an adult, who has stuttered all my life. I have experienced all the negative social consequences that many people who stutter often do - ridicule, mockery, laughing, name -calling, people asking me stupid questions, like did I forget my name or where I work.
I have also had people presume I must be intellectually or emotionally deficient because of my stuttered speech, which is the farthest thing from the truth. Parents don't cause their child to stutter and you should not imply such!
Studies show that there is a genetic predisposition to stuttering, (as evidenced by research done and recently published by Dr. Dennis Drayna of the NIH.)
Neurological research continues. I have participated in two clinical studies, 2006 and 2009, involving brain scans so that researchers can determine if brain activity differs for people who stutter vs. those who don’t. There are differences.
I was raised in a chaotic household - oldest of six, alcoholic mother, abusive father. My five siblings never stuttered. As others have commented here, stuttering is a part of me. It does not define me, nor impede my ability to be an outstanding, expressive communicator.
You should be wary of any movie that touts "historical accuracy." Hollywood takes liberties all the time with history, in order to sell tickets. That's their business.
Thanks for the post - it keeps the dialogue about stuttering going, and the opportunity to bust myths.
05:57 PM on 10/17/2011
Oh, I also wanted to add this, but due to word count limits, had to re-structure my original post.
I agree that some people who stutter could benefit from psychotherapy, but not because their stuttering is psychological in origin, but in addition to other life issues a person may have who seeks any kind of therapy.
Any psychotherapist who works with someone who stutters better have some experience with stuttering - because it is much more complex than just what comes out (or doesn't) of our mouths.
And by the way - my profession? I have worked as a counselor with youth and young adults for over 25 years, that last four as a career counselor in a public high school. My stuttering has had no ill affects on any of the people I have helped over the years. My background is in social work!
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bnyb
sky-gazer
03:24 PM on 10/17/2011
I've had a stutter all my life (which varies from completely undetectable for weeks on end, to absolutely delibitating for days) and for me, it's a manifestation of stress/anxiety, not breathing correctly and wanting to say the million things in my head all at once. My speech therapist focuses on a mix of physical exercises with the mouth, breathing techniques and psycho-analysis, which has helped tremendously. Also regardless of how I do speech-wise from day to day (a bad day used to be soul-crushing in the midst of a high-powered job managing an international team), my personal mantra is "je ne suis pas mon begaiement" (I am not my stutter).
01:22 PM on 10/17/2011
I agree with the author. Stuttering can be and may very well be the result of both biological heredity and stress induced or by default. And of course one would make the other worse.

My sister stuttered when she was young and occassionally still does but she has mastered overcoming it in pubilc settings. Her daughter my niece stutters still and worse than my sister. My nieces's home life was considerably better than my sisters and mine so the stress issue was unrealized.