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1. Stuttering’s history is as long as human’s history

Historical and Learned Beliefs about Stuttering a.k.a. The Sordid Tale of Stuttering’s Checkered Past. 1. Stuttering’s history is as long as human’s history. a. Some early references Chinese writings from 4000 B.C.E. Clay tablets in Mesopotamia ~2500 B.C.E. Early Biblical references

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1. Stuttering’s history is as long as human’s history

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  1. Historical and Learned Beliefs about Stutteringa.k.a.The Sordid Tale of Stuttering’s Checkered Past The Sordid Tale of Stuttering

  2. 1. Stuttering’s history is as long as human’s history a. Some early references • Chinese writings from 4000 B.C.E. • Clay tablets in Mesopotamia ~2500 B.C.E. • Early Biblical references • Egyptian Hieroglyphic The Sordid Tale of Stuttering

  3. Ancient Egyptian Hieroglyphic depicting stuttering From Frank Silverman, 2003 The Sordid Tale of Stuttering

  4. b. History repeats and builds on itself • Everything we know and believe today grew out of rich history • Even the bad ideas have helped us c. Parallels to medical practice and knowledge • Our predecessors were physicians and medical healers • Changes in who practiced medicine and the methods of practice influenced beliefs and treatments of stuttering The Sordid Tale of Stuttering

  5. Prior to the Greek Classical Age a. Early physicians were priests and priestesses • Strong mind, body, spirit connection • Tx involved rituals to heal the body, psyche, and spirit • Herbs, fasting, bathing rituals, and offerings to gods and goddesses The Sordid Tale of Stuttering

  6. ~400 B.C.E. Hippocrates moved healing professions away from religion and mysticism (spirit connection) but retained the body-psyche connection: The Four Humors Model. The Sordid Tale of Stuttering

  7. Ancient Greece & Rome (400 B.C.E. – 500 A.D.): A Problem with the Tongue a. The Four Humors Model – linking of body and psyche; spirit removed from the equation. • Diseases of the body happen because emotions and temperament are out of balance • Re Stuttering: the actual disorder wasn’t the speech defect but an imbalance in the humors that caused the tongue to malfunction The Sordid Tale of Stuttering

  8. The Four Humors (Cont’d) The Sordid Tale of Stuttering

  9. b. Hippocrates (460 – 377 B.C.E. – tongue too dry and engorged with black bile • c.Cornelius Celsus (~100 A.D.) – too much humidity in the brain causes a lingual paralysis; dry out tongue, person, and brain The Sordid Tale of Stuttering

  10. The Middle Ages & Renaissance: Four Humors Catches On a. Background of the times • In Europe, medical knowledge and practice under the control of the Catholic Church • Common treatments based on Four Humors: tongue too wet – dry it out by rubbing with salt, honey, and sage • Deep breathing to quell spasms of the glottis • Cut the lingual frenulum. The Sordid Tale of Stuttering

  11. b. Expansion of knowledge about stuttering • By 900 – stuttering tends to occur on initial sounds; more common in males. • By 1300 Bernard Gordon: all children go through phase of being non-fluent c. 1500s – beginning of scientific revolution • State of medical knowledge The Sordid Tale of Stuttering

  12. d. 1500s & Scientific Revolution (Cont’d) • Heronymus Mercurialis and the Treatise on the Diseases of Children (1583). • Don’t treat stuttering until age 7 • Caused by deep thought, lack of sleep, and too much sex • Tx for adults: spicy foods; abstain from sex • Tx for children: surgery; diuretics to dry out and dehumidify brain The Sordid Tale of Stuttering

  13. 5. 17 century: Age of Enlightenment and Scientific Revolution a. Deepening split between religion and science b. Most observable aspects of stuttering documented • Onset in childhood • High recovery rate • All core behaviors • 1st sound of 1st word • Singing and alcohol make it better • Anxiety makes it worse • Sex ratio • Temperament The Sordid Tale of Stuttering

  14. c.Scientific beliefs at the time • Problem with hyoid bone (Morgagni) • Imitation (Robert Boyle) d. Religious beliefs • Cotton Mather (1680 – 1728)punishment for sin of anger and pride The Sordid Tale of Stuttering

  15. 18th Century – Enlightenment & Empirical Observation Continue a. Mind, body, spirit connection completely severed • Illness or ailment must be caused by something observable in the body • Attention shifts to physiology behind speech and voice production • Air flow, vocal fold movement, articulation, and timing • Phoneticians worked with people who had defective pronunciation, including stuttering The Sordid Tale of Stuttering

  16. b. Associationists revisit the mind and body connection • Moses Mendelssohn (1729-1786)“A collision between many ideas flowing simultaneously from the brain.” • Erasmus Darwin (1731-1802)Conflict between wanting to speak well and fear of failure (approach-avoidance) • Darwin’s self Tx: repeat stuttered word(cancellation); use extra air and “h” (easyonset); light & soft initial Cs (light contacts);Keep talking (desensitization) The Sordid Tale of Stuttering

  17. 7. Early 19th Century – Pre-Industrial Revolution a. Quite a body of literature on stuttering; Neurophysiology appeared as a new science. b. Thoughts floating around France • Impairment in the nerves enervating tongue and larynx; Tx = gymnastics for tongue (motor speech exercises) • Tongue too short or frenulum too tight • Nervous affliction resembling chorea; Tx – brisk pronunciation and vigorous shaking of arms The Sordid Tale of Stuttering

  18. c. Thoughts floating around England • Joseph Frank, M.D. – depraved habit; Tx = regular beatings • Speaking when lungs are empty; Tx = breathe deeply and speak as air is exhaled (airflow) • Vocal folds paralyzed by extreme contraction (blocks); Tx = keep vfs moving, join words together & voice all Cs (continuous phonation) The Sordid Tale of Stuttering

  19. d. Thoughts floating around the U.S. • Edward Warren, M.D. (1931) cause=neurological disorder aggravated by circumstances; • Begins as weakness in nervous system; then fear of stuttering causes person to stutter; then organs of speech develop habit (neurological predisposition; trigger incident for precipitating factor; habit for perpetuating factor.) • Tx = stretch words (Vs); link words together (continuous phonation and slow easy speech) The Sordid Tale of Stuttering

  20. d. Thoughts floating around U.S. (Cont’d) • Elocutionists did most treating of speech disorders, including stutteringSpecial, intense classes at speech schools; promises of cure; lots of gimmicks: rhythmic activities; keep tongue in constant contact with alveolar ridge; clench jaw while talking • Homeopathic remedies: bleed lips with leaches; eat Finnish insect repellant used on cows; eat goat feces The Sordid Tale of Stuttering

  21. Surgery Craze of 1841 a. Interest in the tongue as chief culprit; interest shifted to looking at the neurological organization of the tongue and other articulators. b. Johann Friedrich Dieffenbach (1792-1847) The Sordid Tale of Stuttering

  22. c. Dieffenbach’s Theory • Stuttering is caused by spasm in the glottis that migrates up to the tongue and causes a lingual cramp. • Solution – interrupt the neurological impulse from the glottis so that it can’t get through to the tongue • Surgery technique: make horizontal cut across root of tongue; cut out a triangular wedge • First patient: 13 yr. old boy with severe stuttering; Jan. 7, 1841 The Sordid Tale of Stuttering

  23. d. The aftermath • Popular press picked up story; many PWS appeared at physician’s offices demanding surgery • Surgeons instituted their own variations • May 1841, a patient died; then another; and another • Editor of Lancet steps in • Nobody cured; some experienced temporary fluency The Sordid Tale of Stuttering

  24. Late 19th and Early 20th Centuries a. By the 1850s, France, England, and U.S. looking for a physical cause; Germany, a psychological cause. • 1842 Markel: a failure of confidence in the ability to communicate • 1890 Reinhold: approach-avoidance conflict • 1915 Freud: a conflict of excremental functions – verbal constipation • 1930 Bluemel: a form of transient auditory amnesia The Sordid Tale of Stuttering

  25. 1930s American Midwestern universities charting new ground with stuttering • Samuel Orton: PWS are naturally left handed • Lee Travis: lack of hemisphere dominance • Robert West : Breakdown hypothesis – moment of stuttering is like a miniature seizure of speech muscles The Sordid Tale of Stuttering

  26. 10. Conclusion a. Kernels of the past still alive today - Cause • Re: cause: physical problem; something with the brain; familial inheritance • Re: misconceptions: punishment for sin, thinking faster than one can talk; bad habits that can be broken; nervousness The Sordid Tale of Stuttering

  27. b. Kernels of past - Treatment • Tx methods: speak slowly by stretching words; easy onset; control of airflow; cancellation; desensitization • Misconceptions: just slow down; relax; compose thought before speaking The Sordid Tale of Stuttering

  28. c. Where we are today: revisiting some old ideas with new knowledge, understanding, and tools of inquiry. • Familial Inheritance • Something with the brain • Treatments The Sordid Tale of Stuttering

  29. d. Missing some critical elements in understanding and treating stuttering. • Mind: thinking, feeling, self-talk, attitudes, emotional triggers, and emotional responses • Spirit: stuttering affects the soul and the soul affects stuttering The Sordid Tale of Stuttering

  30. e. Where we’re going • Work in genetics, neurology, behavioral psychology, physiology, psychosocial development, and emotional health will help us understand stuttering. • Understanding the mind-body-spirit connection will help us understand the wounding that happens as a person lives with stuttering. The Sordid Tale of Stuttering

  31. e. Where we’re going (Cont’d) • Therapy for stuttering may require the hands of medical, and mental/spiritual health workers. • Someone to treat the root cause • Someone to treat the speech behaviors • Someone to treat the wounding of the psyche and soul • The best therapy methods of today may be quack treatments tomorrow. The Sordid Tale of Stuttering

  32. References Bloodstein, O. (1993). Stuttering: The search for cause and cure. Boston: Allyn & Bacon. Bobrick, B. (1995). Knotted tongues: Stuttering in history & the quest for a cure. NY: Kodansha International. Buhner, S.H. (1998). Sacred and herbal healing beers. Boulder, CO: Brewers Publications. Readers Digest (1986). The magic and medicine of plants. Pleasantville, NY: The Readers Digest Association. The Sordid Tale of Stuttering

  33. Rieber, R.W. and Wollock, J. (1977). The historical roots of the theory and therapy of stuttering. JCD 10(1), pp. 3-24. Silverman, F.H. (2004). Stuttering and other fluency disorders. Long Grove, IL: Waveland Press. Sternberg, E.M. (2001). The balance within: The science connecting health and emotions. NY: W.H. Freeman & Co. The Sordid Tale of Stuttering

  34. Warren, E. (1837). Remarks on stammering. Amer. J. of Medical Science, 21, pp. 75-99. Reprinted in JCD 10(1), (1977), pp. 159-179. Wollock, J. (1977). Hieronymus Mercurialis. JCD 10(1), pp. 127-140. The Sordid Tale of Stuttering

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