Tag Archives: Medical model

The Neuroscience of Stammering

Most of us will likely agree that the brain of a person who stammers works somewhat differently to the brain of someone who is fluent. What is not so clear, is how it is different. Earlier this year Dr Soo-Eun Chang at the University of Michigan spoke to Peter Reitzes from StutterTalk about her research on the causes of stammering. We used this opportunity to discuss the neuroscience of stammering at a recent Open Space session.

Open Spaces provide a forum for people who stammer to come together and share their experiences and views on stammering. At this particular session we chose to focus the discussion on some of the scientific developments being made in the field of stammering research and what we felt this meant for us and the wider stammering community.

neuroscience2Dr Chang’s research has discovered that neural connectivity is a critical factor in producing fluent speech. In her work with children, she has found that those who stammer appear to have slower connections between the brains regions that control speech. Interestingly, this difference is also seen in kids who have ‘grown out’ of their stammers.

This could mean that stammering permanently changes the activity of the brain, or it could show us that children with this type of brain activity are more likely to start stammering. Dr Chang says more data is needed before we can be certain one way or the other.

What researchers do know is that timing is an essential component of speech production. When we speak, we string together a series of movements to produce the right sounds in the right order, and at the right time. In stammering, the timing of these movements appears to be impaired so that the flow of speech is disrupted.

A brain structure, called the basal ganglia, may play a starring role in all this. Buried in the centre of the brain, one of the many functions of the basal ganglia is to control movement. Scientists think that people who stammer could have too much of a chemical, called dopamine, which interferes with the ability of the basal ganglia to provide timing cues for speech. They have shown that when people who stammer take drugs to block the action of dopamine, their speech becomes more fluent.

Dr Chang explained that there is a link between rhythm – a product of timing – and stammering. A study carried out by a different research team has found that children who stammer have a weaker sense of internal rhythm compared to those who do not stammer. When these children are provided with an external rhythm – in the form of song lyrics, for example – they are able to produce speech more fluently. This suggests that independently finding and sticking to an internal rhythm is key to speaking fluently.

These insights into the ‘stammering brain’ were met with mixed feelings among the group. Some people said they felt comforted by having a physiological explanation for why they stammer, while others were uneasy with being labelled as different by science. For me, it was almost a vindication; it has given me something to fight back with against assumptions that I may be partly to blame for my stammer.

I’m aware that a focus on science – and the drugs and treatments that may ultimately arise from it – is helping to feed our medicalised approach to biological difference. It has been argued by some in the stammering community that, instead of fixing people who fall outside the norm of fluent speech, the onus should fall on society to change its expectations of what it means to speak normally.

In an ideal world there would be room for both approaches, with science providing us with knowledge and society offering us change. Indeed, despite the group’s contrasting views, what we all seemed to share was a huge appreciation for the progress being made in stammering research and the prospect of one day having answers to our many questions. My hope is that this will be paralleled by progress outside the laboratory, too.

Cara Steger

 

 

Stammering and the social model of disability: challenge and opportunity

Where does the real problem of stammering lie?

How does society communicate its values and norms about fluency and how does this affect people who stammer?

How does the SLT tread the delicate path between helping their client manage their stammering more effectively (and increase ease of communication) without reinforcing unhelpful ideas about stammering (and fluency)?

These are just some of the questions Katy Bailey, Sam Simpson and I posed in a joint presentation to the Oxford Dysfluency Conference on 19 July 2014.

photo 1

At the presentation’s heart was a conviction we all share that the social model of disability has much to tell us – people who stammer, speech and language therapists, and wider society – about stammering, and how by working together we can challenge and overcome some of the stigma out there and self-oppression in here which can make life so difficult for those of us who stammer.

Katy began by tracing the origins and development of the social model in the disabled people’s movement which disputed the traditional medical conception of disability as the individual’s problem requiring impairment expertise, cure, therapy and care. Instead, the social model locates the ‘problem’ of disability in society: in the physical barriers, but also in the negative stereotypes and prejudices which can push disabled people to the margins of society, whilst upholding powerful notions of ‘normality’. The physical barrier of a voicemail which does not let me finish saying my name may be familiar to people who stammer, but far more insidious and interesting for me is the stigma around stammering which operates along psychological and emotional pathways, and is there, Katy argues, in the struggle of stammering itself.

Sam then recounted her own development as a speech and language therapist and the disturbing realisation that she was training within a tradition firmly underpinned by the medical model in which she, the ‘impairment expert’ was expected to ‘fix’ and restore the client to normality (fluency), without any awareness of the social norms and stigma the therapy was reinforcing. Times have moved on since then – Sam’s book which she co-edited with Carolyn Cheasman and Rachel Everard, Stammering Therapy from the Inside is evidence enough – but there is still plenty of stammering therapy for which fluency is the overriding preoccupation, and which fails to take the client’s voice into account, and to grasp the broader factors of self-identity, society and social stigma.

Finally, I assessed some of the cultural pressures we face: the performance-driven and perfectionist zeitgeist in which we live and the haunting and destructive appeal of the ‘fluency god’ which I am happy to say more and more people who stammer are starting to renounce. That certainly seems to be the impression I get from a range of blogs, podcasts and websites: StutterTalk, Stuttering is Cool, British Stammering Association, Free Speech, Diary of a Stutterer and the latest, Did I Stutter? project. If you haven’t done so already, check them out! The internet and social media has been a wonderful way of bringing people who stammer together, to share our stories, insights and experiences, and to provide some collective resistance to the powerful social norms which tell us either to keep quiet and get it fixed, or at least to keep up the façade of fluency. This is the good news. And the other piece of good news is that speech and language therapists also have an important part to play in helping people who stammer overcome these barriers. Approaches such as mindfulness and cognitive behaviour therapy enable us to look at our thoughts around stammering differently, and foster healthier and more self-accepting thoughts and behaviours. There is much good work to build on, and more opportunity to continue this conversation between therapists, clients and self-help groups on how we can all work together to help people who stammer on our ongoing journey from oppression to liberation.

St John Harris
website: www.free-speech.org.uk

email: stjohn.harris@free-speech.org.uk
twitter: @StJohnHarris