THE INDIANS HAVE NOWORD FOR IT*

I. STUTTERING IN CHILDRENILLIAM NUTTALL, an Englishstutterer, writing in the journal

Psyche, in 1937, said, in effect, that who-ever finds a cure for stuttering will havefound a cure for all the ills of society ..We should not permit his possible exag-geration to distract us from the peculiarlyfundamental wisdom which he expressed .In a sense, what he said of stutteringmight also be said of such other perplex-ing forms of behavior as thumb-sucking,or nervousness, worry, gossiping, etc . Mr.Nuttall elaborated his point by sayingthat he seldom if ever stuttered whenalone (as is true of stutterers generally),but only when speaking to other people,so that whatever the causes of his dis-order, they must lie in those other peoplequite as much as in himself. In his ownway, Mr. Nuttall was pointing a fingerin the direction of semantic environ-mentl-the environment of attitudes andevaluations, opinions and beliefs-as asource of his difficulties .

* Reprinted by permission from Quarterlyjournal of Speech, XXX (October, 1944),pp. 330-337 .

'The use of term 'semantic environment' isto emphasize more pointedly than is usuallydone that the aspects of environment most im-portant in relation to stuttering are semantic,or evaluational, in a broad sense . To put itmore roughly, semantic environment includesthose aspects of the total environment that areleast important to a dog or an oyster .

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WENDELL JOHNSON

The significance of semantic environ-ment in relation to stuttering is furthersuggested by certain experiences that thewriter has had in attempting to investi-gate stuttering among North AmericanIndians . A few years ago one of his stu-dents, Miss Harriett Hayes, became ateacher on an Indian reservation in Ida-ho. She carried with her a set of detailedinstructions for making a study of thestutterers among the Bannock and Sho-shone Indians, with whom she was towork. At the end of the school year, how-ever, she returned with the highly inter-esting information that she had been un-able to find any stuttering Indians. More-over, the superintendent of the schooland the other teachers, many of whomhad been in close association with Indiansfor as long as 25 years, had reported toMiss Hayes that they had never seen anystuttering Indians. Since then we havereceived reports, from unknown originalsources, of one stuttering Indian in theState of Maine and two in the RockyMountain area. It has not been possible,however, to verify these reports . Over a25-year period there have come to theUniversity of Iowa Speech Clinic onehalf-breed Indian from South Dakota,who had lived almost entirely amongwhite men, and one strange case of a full-blooded Indian, also from South Dakota,who had been educated in a missionschool .

This latter case is of special interest,for the reason that he did not appearto be either a typical Indian or a typicalstutterer. When brought to the Iowaclinic he was about twenty years old . Forthe previous two years he had appar-ently been unable to speak at all, andit was for this reason that he was referredto us by the head of the mission school .There was a history of the boy's having'stuttered' for an indefinite, but limitedperiod immediately before his 'loss ofvoice.' A neurological and general physi-cal examination revealed nothing of im-portance. It took about a month to ob-tain from the boy, in written form, thehighly significant information that hehad regarded his earlier stuttering as 'asign from God,' which he had inter-preted to mean that God intended forhim not to talk at all . His 'loss of voice,'therefore, had been his way of expressinghis obedience to God's will. He was con-vinced, however, of his utter inability tospeak, that God had sealed his lips .

This presented a neat problem from aspeech-correction point of view. Withchildlike simplicity, he had come to be-lieve what he had been taught, and hehad learned his lesson so well that itseemed both impractical and dangerous,particularly in view of the short timeavailable, to attempt to undo the effectsof his previous teachings . Dr. C. EscoObermann, who was assigned to the case,finally hit upon an ingenious solution,however. He managed to convince theboy that he had misinterpreted 'God'ssign.' Dr. Obermann re-interpreted theearlier stuttering as a test of faith, andasserted that God would be pleased onlyif the Indian lad would continue to speakand so to spread the gospel in spite ofthe stuttering. A day or so later the In-

ETC. : A REVIEW OF GENERAL SEMANTICS

66

than boy came to Dr . Obermann in astate of high excitement . He could talkagain! And he stuttered only slightly .Eventually arrangements were made forhim to enter a monastery-which is prob-ably not a practical solution for moststutterers!

The point of the story is simply thatthis stuttering Indian was far from beingrepresentative either of Indians or ofstutterers-and it is the only case of afull-blooded Indian stutterer of whomthe writer has been able to obtain anyverified direct or indirect knowledge . Forall practical purposes, then, it may besaid, so far as the writer is aware, thatthere are no stutterers among NorthAmerican Indians living under condi-tions comparatively free from the whiteman's influence .

A year or so after Miss Hayes had madeher preliminary study of the Indians inIdaho, the writer arranged with anotherof his students, John Snidecor, who wasthen located in that region, to continuethe investigation. Professor Snidecor wasto make special note of two things : thelanguage of the Indians, and their poli-cies and standards concerning the careand training of their children . He madea thorough investigation, interviewingseveral hundred Indians . He was alsogranted permission to appear before thechiefs and members of the tribal councils .

He learned in the main two things .First, these Indians had no word forstuttering in their language. In fact,when he asked whether there were anystutterers in the tribes, he had to demon-strate stuttering for the chiefs and thecouncil members before they could un-derstand what he was talking about.They were intensely amused by his dem-onstrations . Second, their standards ofchild care and training appeared to be

xtraordinarily lax in comparison with)ur own. With respect to speech in par-ticular, it seemed to be the case that everyIndian child was regarded as a satisfac:ory or normal speaker, regardless of thenanner in which the child spoke . Speechdefects were simply not recognized . TheIndian children were not criticized orevaluated on the basis of their speech, no-omments were made about it, no issuewas made of it. In their semantic environ-ments there appeared to be no speechanxieties or tensions for the Indian chil-Iren to interiorize, to adopt as their own .This, together with the absence of aword for stuttering in the Indians' lan-guage, constitutes the only basis on whichthe writer can at this time suggest anexplanation for the fact that there wereno stutterers among these Indians .

II

One need not go to the North Ameri-:an Indians, however, in order to glimpse:he importance of semantic environmentin relation to stuttering. There is a verylarge group of persons belonging to thewhite race who apparently do not stut-ter: namely, very young children in ourown culture . Through George D . Stod-dard, then Director of the Iowa ChildWelfare Research Station, the writer ob-tained funds in 1935 from the Laura5peiman-Rockefeller Foundation withwhich to conduct a study of the onset ofstuttering. Up to that time it appearedto be more or less generally taken forgranted that stuttering at its onset wasessentially the same as stuttering inadults, that stuttering children were gen-erally_retarded or constitutionally defec-tive, and that stuttering ordinarily beginsas a result of illness, injury, shock, orsome other more or less serious and dra-matic event. From the research to be de-

STUTTERING IN CHILDREN

67

scribed it seemed quite impossible to sup-port any of these commonly acceptedviews . 2

In the first place, it was discovered thatwhen the attempt is made to find stutterers shortly after they have begun tostutter, so that relatively detailed andaccurate information might be secured,the cases obtained are practically allyoung children. Three out of four of thechildren investigated had begun to stut-ter at or before the age of three yearsand two months. However-and this isextremely important-all the children en-countered in this study had talked with-out stuttering for from six months toseveral years before the onset of stutter-ing.

In this research 46 stuttering childrenwere involved, and for each stutteringchild investigation was made of a non-stuttering child of like age, sex, and in-telligence level . Relatively thorough ob-servations and case-history studies weremade; two or more interviewers exam-ined independently the case of eachstuttering child, and in large measurethe investigations were carried out inthe homes of the children . On the aver-age each stuttering child was kept underobservation for a period of two and one-half years . Over a period of approxi-mately five years the writer had the assist-ance of seventeen workers trained inspeech pathology, chief among whomwere Charles Van Riper, Dorothy DavisTuthill, Hartwell Scarbrough, and SusanDwyer.

Without going into elaborate detail,it is to be reported that :

z A preliminary report of this investigationhas been published . See W. Johnson, 'A Studyof the Onset and Development of Stuttering,'Journal o f Speech Disorders, VII (1942), 251-257 .

ETC. : A REVIEW OF GENERAL SEMANTICS

1 . Practically every case o f stutteringwas originally diagnosed as such, not bya speech expert, but by a layman-usu-ally one, or both, o f the child's parents .

2 . What these laymen had diagnosedas stuttering was, by and large, indis-tinguishable from the hesitations andrepetitions known to be characteristic o fthe normal speech o f young children .Under the writer's direction investiga-tions have been made of the fluency ofchildren between the ages of two and sixyears. These studies have been done atthe Iowa Child Welfare Research Sta-tion by Dorothy Davis Tuthill, GeorgeEgland, Margaret Branscom, JeannetteHughes, and Eloise Tupper . 3 They havewell established the fact that young chil-dren speak in such a manner that from15 to 25 per cent of their words figurein some kind of repetition . The initialsound or syllable of the word is repeated,or the whole word is repeated, or theword is part of a repeated phrase . Inaddition, there are frequent hesitationsother than repetitions .

These repetitions and hesitations arenot accompanied by any apparent ten-sion or anxiety on the part of the child .They seem to occur somewhat more fre-quently when the child is 'talking overhis head,' when he lacks sufficient knowl-edge of what he is talking about, whenthe listener does not respond readily towhat the child says, or his vocabularydoes not contain the seemingly necessarywords. Such conditions appear to occuroften in the speaking experience of very'D. Davis, `The Relation of Repetitions in

the Speech of Young Children to Certain Meas-ures of Language Maturity and Situational Fac-tors," journal o f Speech Disorders, IV (1939)303-318, and V (1940), 238-246 . The studiesof Egland, Branscorn, Hughes, and Tupperhave not yet been published . -They were alldone as M .A. theses in the Iowa Child Wel-fare Research Station .

68

young children . It is what you woubexperience if asked to speak for ten minutes about Einstein's theories, or an •other subject concerning which you ladboth information and vocabulary . Afteall, it takes a child a few years to acquirthe experience, the words and the language skills necessary for the smootlhandling of ordinary conversation. Alsononfluency seems to occur more frequently when the child is talking in the facof competition, as at the family tablwhen others are talking a great deal an<are paying slight attention to the child'own attempts at expression . There istendency for more nonfluency to occuunder conditions of shame, sense of guiltetc., occasioned by parental scolding, rebuff, or disapproval, particularly whetthese serve to create negative evaluationby the child of his own speaking right;or ability . There is probably increase(nonfluency, also, during 'language spurts,as during the transition from the speaking of single words to the speaking o :short sentences, or from the speaking o .simple sentences to the use of complexsentences, or when the child is discontinuing the pronoun me in favor of 1, etc

There are doubtless other conditionthat tend to increase hesitations and repetitions in the child's speech . The poinis that these conditions are very commonand while they may occur more frequently in some environments than in othersthey occur sufficiently often for all children so that the speech of early childhoo(is in general quite nonfluent . What iimportant is that the so-called stutterin€children were found to have been apparently normal, even with respect t(speech, at the time when someone, usually the parents, first regarded them as stutterers. And, as has been mentioned, the,had all talked for considerable period:

vithout being regarded as defective be-'ore they had come to be diagnosed astutterers .3. Stuttering at its onset was found,

hen, to be remarkably different fromtuttering in the adult. Stuttering as aainical problem, as a definite disorder,vas found to occur, not before beingliagnosed, but after being diagnosed. In)rder to emphasize this finding, the writ-~r has coined the term diagnosogenic ;stuttering is a diagnosogenic disorder inhe sense that the diagnosis of stutterings one of the causes of the disorder . The,valuations made by the parents (usual-y), which they express, overtly or implic-tly, by diagnosing their child's speechis 'stuttering' or as `defective,' or 'ab-iormal,' are a very important part of thehild's semantic environment . Insofaris the child interiorizes this aspect of his;emantic environment, he, too, evaluatesits speech as `defective,' `difficult,' `notacceptable,' etc ., and his manner of;peaking is consequently made more hesi-:ant, cautious, labored and the like . In:his way normal speech hesitations andrepetitions are transformed into the ex-tggerated pausing, effort, and reluctance:o speak which are so conspicuous andfrustrating in the speech of adult stut-:erers .Thus we see certain interrelationships

among the child's semantic environment,ais own evaluations, and his overt be-':iavior. The more anxious the parents'ecome, the more they hound the child'o `go slowly,' to `stop and start over,' to'make up his mind,' to `breathe moreleeply,' etc ., the more fearful and dis-heartened the child becomes, and themore hesitantly, frantically and labori-9usly he speaks-so that the parents,teachers and others become more wor-ried, appeal more insistently to the childto `talk better,' with the result that the

STUTTERING IN CHILDREN

child's own evaluation become still moredisturbed, and his outward speech be-

havior becomes more and more disor-dered . It is a vicious spiral, and all thefactors involved in it are closely inter-related .

4. The stuttering children were foundnot to be retarded in development . Theywere compared in several ways with thenonstuttering children who were also in-vestigated . The stuttering children werenot more retarded in speech, in walking,teething and other common indexes ofdevelopment . The only child who hadsuffered a definitely serious birth injurywas a stutterer who was no longer stutter-ing at the close of the investigation . Thestutterers had not had more diseases andinjuries, and those they had had did notappear to have been related to the 'on-set of stuttering' (this term is now putin quotes because it appears to be mis-leading-it refers merely to the originaldiagnosis o f stuttering) .With respect to handedness and

changes in handedness, the two groupsof children could not be differentiated .In fact, there were 14 nonstutterers asagainst 12 stutterers who had undergonesome handedness change, and this differ-ence between 14 and 12 is not significant .Moreover, conditions of handednessseemed not to be related to the degree ofspeech improvement achieved by thestuttering children during the course ofthe investigation .

In brief, no evidence was found thatthere are stutterers, in the sense that thestutterers investigated were a differentkind of children, that they differed fromthe non-stutterers in any basic anatomicalor physiological respects .

5. In this investigation of young stut-terers it was found that practically all ofthe children, after being diagnosed, de-veloped overt speech behavior that was

69

ETC. : A REVIEW OF GENERAL SEMANTICS

in some degree unusual and of clinicalimportance. At the end of the studyabout three out of four had regainednormal speech, so far as the parents,teachers and investigators could judge .In general, this result was obtained byconveying to the parents and teachersessentially the explanation of stutteringthat is here being presented. For allpractical purposes the children wereneither talked to about their speech norwere they given any instructions as tohow they should speak . Moreover, noth-ing was done from a physiologicalpoint of view, except that general prin-ciples of physical hygiene were recom-mended, but in very few cases was thereany unusual need for such a recommenda-tion. Insofar as anything was done di-rectly about the problem in any case, itwas done entirely or mostly with refer-ence to the semantic environment .

That is to say, an attempt was madeto change the attitudes and policies-theevaluations-of the parents and teachersconcerning the child as a person and asa speaker. An attempt was made to createa semantic environment for the child inwhich there would be a minimum ofanxiety, tension and disapproval for himto interiorize . In this way, we undertookto produce in the child such evaluationsof his own speech as would permit himto speak spontaneously, with pleasure,and with confidence, not confidence inhis ability to speak perfectly but in hisability to speak acceptably. It was essen-tial, therefore, although it should bestressed that it was not possible in allcases, to get the parents and teachers toevaluate the child's speech and to reactto it-regardless o f how he spoke-inways that would convince the child thathis speech was approved . As the childappeared to sense that his speech was be-ing thoroughly approved, his reluctance

70

to speak, his exaggerated hesitancy andcaution and effort in speaking all decreased . The eventual result tended to bespeech that was free, spontaneous, asource of evident enjoyment to the child,and speech that was normally fluent-notperfectly fluent, for perfect fluency is a :'abnormal,' or unusual, as very severestuttering .

In order to enable the child to speakwith normal fluency, it was also necessaryin some instances to bring about certainchanges in the home or school . We haveremarked that children-and this holdsfor adults as well-tend to speak morefluently under some conditions than underothers. We are not now talking aboutstuttering . We are referring simply tcthe essentially effortless and apparentlyunconscious hesitations and repetitions inthe normal speech of children and adults,Whenever a home or school was foundin which there seemed to be an excess ofconditions that tended to make for non-fluency, an attempt was made to reduceor eliminate these conditions . 4

In some cases, for example, the attemptwas made to expand the child's vocabu-lary or to give him a wider range of ex-perience. In other instances, the parentswere urged to be more responsive to thechild's remarks. On the whole, however,certain other considerations were ofgreater importance. It was rather com-monly observed, for instance, that notonly the standards of speech to whichthe child was being held were too high,but that also the parents were inclined tobe perfectionists generally . For example,the child was being held to abnormallyhigh standards with regard to table man-

' For a detailed account of the treatment ofone case see Nell Will, 'The Personality De-velopment of a Stuttering Boy,' ETC ., I(Spring, 1944), pp. 165-173 .

ners, cleanliness, toilet habits and obed-ience ; or certain words, innocent to thechild but profane or vulgar to the parents,were vigorously, almost frighteningly,forbidden ; the child was being constantlyrequested to be quiet or to sit still, etc .-the full list is truly impressive . (One seeshere very vividly the difference betweenthe semantic environments of Indianchildren and those of some of our ownchildren.) Whenever such standards werediscovered, an attempt was made to getthe parents to adjust their ideals to theactual level of development and abilityof the child . The effect of this was gen-erally calming and appeared to be in somemeasure reflected in the child's speech .

Another measure that was found tobe advisable and helpful in certain caseswas that of bringing about a more affec-tionate and friendly relationship be-tween the parents and their child . Theirtendency to be critical and disapproving,as evidenced, for example, by their re-garding his normally hesitant speech asdefective, tended to make for generallystrained relations and for apparent feel-ings of insecurity on the part of thechild . Just as you might speak hesitantlyin a situation in which you feel that youare not welcome and that what you say isnot being well received, so a child tendsto be less fluent when too much criticismand too little affection raise doubts forthe child as to whether his parents likehim and will stand ready to give neededhelp and encouragement .

On one occasion in this study of youngstutterers, the writer spent several hourswith a stuttering boy's father, a conserva-tive and very busy merchant who spentalmost no time with his son. In themornings the little fellow would tag athis father's heels, trying to visit with himas he bustled about the house and out

STUTTERING IN CHILDREN

71

the door lost in a fog of business cares .The boy was nonfluent in his attempts tospeak with the father, who scarcelylistened, and seldom replied, to what theboy said. The father was not harsh to theboy ; he just paid no attention to him,with the result that the child was fre-quently under considerable strain in hisefforts to get an amount of attention andrecognition that seemed altogether rea-sonable. Finally, the writer actuallyshowed the father how to get down onhis hands and knees and play with theboy. He got him to play catch with thechild out in the yard, to take him ridingwith him, to read to him and in otherways to be companionable. This was oneof the cases in which the stuttering wasvery definitely eliminated .

In other cases it was a matter of gettingthe parents to use less severe methods ofdiscipline, to refrain from scolding thechild or making derogatory remarksabout him in the presence of his friends,to play games with' the child, or just tohold the youngster and cuddle himenough to establish some feeling ofwarmth and affection. Some parents areso doggedly set on making little ladiesand gentlemen of their youngsters thatthey seldom look on them as little chil-dren .

In general, then, and in the respectsindicated, the treatment of stuttering inyoung children is to be directed, not to-ward the child, but toward the relevantevaluations-the attitudes, assumptions,beliefs, etc .-and the resulting policiesand reactions, of the child's parents andteachers and the other persons who affecthis own evaluations and reactions . It isa matter of changing the child's speechresponses by changing the pertinent fea-tures of the conditions under which theyoccur.

II. STUTTERING IN ADULTS*

IN adults the problem is quite dif-ferent, but in both children and adults

certain general principles are funda-mental. To begin with, a clear distinc-tion must be made between non fluencyand stuttering . Most young children andmany adults speak quite nonfluently, re-peating frequently, pausing conspicu-ously, saying ah or ub, etc. They speakvery differently from stutterers, however,who may be even quite fluent by ordinarystandards but who exhibit considerablestrain, embarrassment, and apprehensive-ness with regard to such nonfluency asthey do have . It is the stutterer's anxietyand strain, the fear and the effort withwhich he pauses or says uh, repeatssounds or prolongs them, that serve todistinguish him from the so-callednormal speaker .

I

It is commonly supposed that whatails the stutterer is that he cannot speakfluently . The degree to which such mis-conceptions as this can come to be widelyaccepted is, indeed, fascinating . The facto f the matter is that the stutterer cannottalk nonfluently . He can speak fluentlyall right ; so long as his speech is fluent,as it is 80 per cent or more of the time inthe majority of cases, his speech cannotvery well be distinguished from that of anormal speaker . To say that stuttererscannot talk fluently is to commit a fan-tastic misrepresentation of the facts . Ifthey talked nonfluently as well as theytalk fluently they could only be regardedas normal speakers. Their peculiarity lies

* Reprinted by permission from QuarterlyJournal of Speech, XXX (December, 1944),pp. 456-465 .

72

in the fact that whenever they do hesi-tate or repeat they make a great show offear and effort, instead of proceeding tostumble along calmly as normal speakersdo .

In a fundamental sense, stuttering isnot a speech defect at all, although ex-cessive nonfluency might sometimes be soregarded. Stuttering is an evaluationaldisorder. It is what results when normalnonfluency is evaluated as something tobe feared and avoided ; it is, outwardly,what the stutterer does in an attempt toavoid nonfluency. On such a basis hisreluctance to speak at all, his shyness,his excessive caution in speaking, hisgreat effort to speak perfectly, whichshows up in his facial grimaces, bodilycontortions and strained vocalizations-all this, which is what we call stuttering,becomes understandable when viewed asavoidance reactions, reactions designedto avoid the nonfluency which the indi-vidual has learned to fear and dread andexpect .

In the normal speaker nonfluency issimply a response, occasioned by someexternal stimulus or, perhaps, by a lackof vocabulary or preparation . As a re-sponse, in this sense, nonfluency is, in-deed, normal . For the stutterer, on theother hand, nonfluency has become astimulus, to which he reacts with anxietyand with an effort to avoid it and its sup-posed social consequences. Nonfluencyas a response is hardly a problem ; non-fluency as a stimulus is something elseagain. The child's repetitions of sounds,words, and phrases are of no consequence,until they come to serve as a stimulus forhis parents or teachers . When that hap-pens, they tend to become for the child

STUTTERING

the same sort of stimulus they are for hisparents and teachers, who, in large meas-ure, create his semantic environment . Asthey react with worry and disapproval andwith an effort to get the child not torepeat, so the child in time adopts theirworry and disapproval of his own speech,and consequently he makes a great effortto talk without repeating . These atti-tudes and this effort are, in the main,what constitute stuttering . Simple hesi-tancy in speech is normal and harmless .But to hesitate to hesitate is relativelyserious in its consequences.

It is these attitudes of fear and embar-rassment, and this second-order hesitatingto hesitate, these anxious exertions of ef-fort to speak perfectly and without non-fluency-these are the symptoms of stut-tering that stand out in the adult . Theymay be present in rather young children,of course, since in some semantic environ-ments it does not take very long for thechild's own evaluative behavior to becomeseriously affected . The essential point isthat before the child has interiorized hissemantic environment to a very consid-erable degree, the problem can be dealtwith effectively for the most part bychanging the semantic environment it-self, without any direct attempt to changethe child's own evaluative or overt be-havior so far as his speech is concerned .Besides, a child's semantic environmenttends to be fairly largely confined to thehome and is created by very few indi-viduals, so that it can be changed effec-tively in a great many cases .

IIIn the case of older children and

adults, on the other hand, a more directattack on the problem is usually neces-sary. The individual's semantic environ-ment extends eventually beyond the homeor the school ; it becomes too big to

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IN ADULTS

be easily manipulated . Besides (and thisis more important) the individual hasinteriorized it . His nonfluency has be-come a stimulus, not only for the peoplearound him, but also for him . He reactsto it in his own right, so to speak . It ishis own evaluations that now largely de-termine his overt behavior, and so thoseevaluations must be attacked directly .All the relevant factors are interrelated,however, and it is generally more effec-tive to work on all of them than to limitattention to one only. Anything that canbe done to change the semantic environ-ment, to modify attitudes and policies inthe home, school, neighborhood or com-munity, or to educate 'public opinion'in the larger sense, helps to promotefavorable changes in the individual'sown evaluative behavior . Likewise, anychanges that can be brought about moreor less directly in the stutterer's mannerof stuttering in order to make it morebearable, may make it easier for him toevaluate it differently . Moreover, a pro-gram of physical hygiene will sometimeshelp to keep the individual 'feelinggood,' so that he will have the energyfor an enthusiastic and sustained attemptto overcome his difficulties .

From this point of view, then, theproblem of stuttering is not to be re-garded elementalistically as being either'physical' or 'mental,' either 'organic'or 'emotional .' It is neither 'all in themind' nor 'all in the tongue.' The ap-proach throughout is nonelementalisticand relativistic . Nor is it to be missedthat within this frame of reference, notwo stutterers are to be regarded as ex-actly alike . The specific procedures thatappear to be most helpful in one casemay not be helpful in another . We mustgo further and say that the specificmeasures that are advisable for a par-ticular stutterer at one time, or in one

ETC. : A REVIEW OF GENERAL SEMANTICS

situation, are not necessarily advisable atanother time and under other circum-stances. There is no single method oftreating stuttering from the point of viewhere presented . Any particular stuttereris to be examined, evaluated, and treatedextensionally with reference to the specificalterations advisable and feasible in hisown case. It is even possible that forsome stutterers the factor of physical con-stitution would be more important thanany other, although in the general run ofcases other factors would appear to be ofdefinitely greater significance .

III

On the basis of this general statement,it is possible to discuss in more specificterms the treatment of stuttering in well-developed or adult cases :

Semantic environment . As a generalrule, it is advisable to see to it that thestutterer's family, teachers, employer,friends, and associates are made ac-quainted with the nature of his prob-lem. An explanation, in simplified termsif necessary, along the lines presentedhere, will often go far to weaken thetaboo against nonfluency which the stut-terer usually feels whenever he speaksat home, in school, or elsewhere.

For example, most people are inclinedto praise a stutterer when he speaks flu-ently. The practical effect of this is tostrengthen the stutterer's conviction thathe should never speak nonfluently ; as aconsequence, he tends to become a bitmore anxious and to exhibit more ten-sion in -his attempts to avoid nonfluency .In other words, he tends to stutter moreseverely when praised for speaking flu-ently . It is better to praise the stuttererwhenever he handles his nonfluencycalmly and without undue strain . Thisnotion may sound odd to those who areunfamiliar with the problem, but there

74

are very few parents, teachers, or otherpersons who will not do what they canto help a stutterer, once they see clearlywhat there is to do. In general, whatthere is to do is to adopt the attitude-and mean it-that the stutterer is underno obligation whatever to speak fluently,that, in fact, he is to be complimented forspeaking nonfluently in an unworried,unhurried, effortless and forthright man-ner .

It is also generally advisable to createin the stutterer's semantic environmentthe attitude that he is a worthy indi-vidual. He should be able to feel sureof his parents' affection and reasonablemoral support without having to strug-gle for it. He should not be given reasonto suppose that his teachers pity him, orlook down on him as a person. His em-ployer should make clear to him the re-spects in which his speech is and is notthe basis for any criticisms of his work,and he should help him to see thoseaspects of his work in which his efficiencyis not affected by his speech difficulty. Itwill pay the employer in the long run tofollow such a policy, and it will help thestutterer considerably to achieve an ade-quate re-evaluation of himself and of hisspeech .

It is well to encourage a stutterer todevelop his talents along various lines,and to provide opportunities for him todo so. One of the marks of a healthfulsemantic environment is that it providesthe individual with stimulation for pos-sible self-development. It should not,however, stimulate him beyond the rea-sonable limits of his ability, for to do thatis to invite failure, and nothing fails likefailure . Experiences of success, on theother hand, are healthful in their ef-fects. In order to experience successes,one's goals must be reasonably specific

and recognizable, and they must be prac-tically attainable . But there must begoals ; one must be provided with some-thing at which to shoot, so to speak, andwith the opportunity to shoot at it . If astutterer has athletic ability, or can serveas school cheer-leader, or shows promiseof becoming a writer or trombone player,then he should be provided with thenecessary opportunities to experience suc-cess accordingly. It is definitely bene-ficial to have a good opinion of oneself-based on performance, properly evalu-ated . If a stutterer can have positiveevaluations of himself as a person, he iscorrespondingly more likely to evaluatehis speech nonfluency with less dread andtrepidation .

Finally, it should be said that moststutterers should be encouraged to speakas much as possible. In this respect, how-ever, parents and teachers need to berealistically alert . For a stutterer, speak-ing can be extremely gruelling and de-moralizing, and any stutterer varies con-siderably from time to time in his abilityto 'take it .' In general, it is advisablefor him to do most of his speaking, andas much speaking as he can, in such situ-ations as he can manage with the greatestpoise and satisfaction . But he should beencouraged and helped to extend therange of such situations . Most stuttererswill benefit from speaking in those situ-ations in which no premium is placed onfluency. As the stutterer loses his dreadof nonfluency he speaks with less anxiety,and with less hesitation and strain-thatis to say, with less stuttering . This gen-eral principle should guide the stutterer'sparents and teachers in providing himwith speaking experience .

So far as oral recitation in school isconcerned, it is best for the teacher todiscuss the matter frankly with the pupil,making clear to him that he may recite

STUTTERING IN ADULTS

if he wants to, and that in doing so heneed feel no obligation to talk perfectly .He may prefer to recite only when hevolunteers to do so. It may be advisableto excuse him from the wear and tear oflonger recitations, such as book reports .It may even be advisable to excuse himfrom all oral work, to arrange matters sothat he need not even answer roll call .In such a case extra written work mightwell be assigned . In other cases, nospecial consideration whatever need begiven so far as oral work is concerned .Every case must be handled on its ownmerits . There are no rules of thumb .The main thing is to see to it that thechild does not become demoralized, andthat he develops such evaluations of him-self and his speech that he will want tospeak and that he will enjoy speaking tothe greatest possible degree.

One more point : As far as possible,the stutterer himself should undertakethe task of changing his semantic en-vironment. In this way the job will bedone more thoroughly, and the stuttererwill be developing a frankness about hisown problem in talking about it to others,and he will be acquiring valuable expe-rience in dealing directly with his eldersand associates . 'I, a stranger and afraidin a world I never made,' in the wordsof the poet Housman, is not the themesong of an individual who takes uponhimself as much as he can the responsi-bility for making his own semantic en-vironment. It is of great adjustive valueto learn that the evaluations which otherpeople make of oneself, and the attitudesthey have which affect one's own living,can in a measure be determined by one'sown efforts. A stutterer, like anyone else,needs to learn that he is in large measureresponsible for the manner in whichothers regard him and for the policiestoward him which they adopt .

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IVEvaluative Behavior. Evaluative be-

havior, as the term is here used, involvesthe forming and expression of attitudes,beliefs, wishes, likes and dislikes, as-sumptions, etc . We are not born withopinions or attitudes ; rather, we are borninto a semantic environment from whichwe derive them . The notion that repeti-tious speech is socially taboo is one of thefeatures of many semantic environmentsin our culture . Whenever this taboo ishighly developed, the child is put underconsiderable strain, since repetition is oneof the prominent characteristics of speechin its early stages. The baby does notsay, Da, but, Da, da, da. This tendencyto repeat continues into early childhoodand even into the adult years to some ex-tent . It is very significant, therefore, thatsuch writers as Froeschels, Bluemel, andVan Riper have emphasized that 'primarystuttering'-'stuttering' in its early stages-consists of simple repetition . It is verysignificant, that is, that they have calledsuch repetition `primary stuttering .' Wehave seen that this sort of repetition isquite normal, especially during earlychildhood, and the fact that even speechexperts would call it `stuttering' indicatesthe extent to which, in our society, speechrepetition is tabooed, or disapproved .

Once a child has been called a stut-terer, it is this taboo against nonfluencythat is of particular importance in hissemantic environment . The very factthat he is called a stutterer serves tostrengthen the taboo . It is likely that ifyou have never been regarded as a stut-terer, you can come nowhere near ap-preciating the uncanny, crushing powerof the social disapproval of whatever isregarded as stuttering. It is probably oneof the most frightening, perplexing anddemoralizing influences to be found inour culture. In this connection, it is of

ETC.: A REVIEW OF GENERAL SEMANTICS

76

great interest that a similar condition isfound to exist among certain primitivetribes . For instance, in his book, PrimitiveBehavior, Professor W . I. Thomas says,'Almost every Bantu man and woman isa fluent and sustained speaker, and Dr .Gordon Brown, who is working amongone of the tribes, informs one that themost prevalent mental disturbance is inyouths who realize that they are unableto become finished speakers."

Stuttering, in the writer's opinion, isquite incomprehensible unless one takesthis cultural factor of taboo into account .On the other hand, the behavior of stut-terers appears to be quite understand-able when viewed as their attempts toavoid nonfluency, and thus to avoid theconsequences of the taboo against non-fluency. We have seen that what hap-pens to bring about the stutterer's diffi-culty is that his parents or teachers con-fuse or identify his normal nonfluencywith stuttering. To the child, then, non-fluency comes to be the same as stutter-ing. For him, the taboo against stutteringbecomes generalized as a taboo againstnonfluency . Out of this semantic con-fusion, he develops the fearful effort,exaggerated hesitancy, etc ., which we callwell-developed stuttering . He developsthis behavior as an attempt to avoid thenonfluency that was originally disap-proved, but this stuttering behavior isdisapproved also, and he is left in a dis-heartening quandary from which he cansee no possibility of escaping .

VNow most speech correctionists attack

this problem (without stating the prob-lem in these terms, however) by attempt-ing to build up the stutterer's confidencein his ability to speak perfectly . In order'W. I . Thomas, Primitive Behavior, an In-

troduction to the Social Sciences (1937) .

STUTTERING IN ADULTS

to do this, they try to get the stutterer tospeak while thoroughly relaxed, or tospeak very slowly with a sort of drawl,or to speak in a monotone, or in time tosome set rhythm, etc. The resultingspeech, while usually free from 'stutter-ing,' is frequently more or less grotesque .Try going to a restaurant and ordering ameal with any one of these speech pat-terns, and you will get the point . If theparents of stutterers would adopt suchspeech patterns for themselves theywould probably be less gullible in ac-cepting the recommendations of thosewho advocate them . What such methodsamount to is a powerful reinforcementof the taboo against stuttering with whichthe stutterer has been contending . Whatthe so-called speech correctionist says, ineffect, is this : 'Don't stutter. Whateveryou do, don't stutter . You can even talkin this strange manner that I am suggest-ing, but don't stutter .'

If, for some odd reason, the stuttereris actually content to speak in thegrotesque manner that is advocated, orif, by some miracle, he gains from theuse of it a kind of abnormal confidencein an ability to speak perfectly, the re-sults might be in a way satisfactory . Butthe writer has used such methods on him-self, and he has seen many other stut-terers who have used them, and it wouldseem that the results are usually tragic .It is common knowledge that, except inrare instances, these artificial speech pat-terns tend to wear out ; in time the indi-vidual stutters as much, or more, whenhe talks slowly or in a monotone, etc., ashe ever did . When that happens, he isnot back where he started from-he isfar behind that point . He is again a stut-terer, but the taboo against stuttering hasbeen intensified by the `speech correction'he has had . His fear and desperation arenow greater than before .

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Simply by making a clear differentia-tion between stuttering and the normalnonfluency which it is designed to avoid,such unfortunate methods and the mis-understandings from which they arisemight readily be eliminated . What thestutterer needs to learn is simply that heceases to stutter to the extent that hepermits nonfluency to occur . This doesnot make sense, of course, until a cleardistinction is made between the effortto avoid nonfluency (which effort consti-tutes stuttering) and non-fluency . Thestutterer suffers from a semantic con-fusion, which he has interiorized fromhis semantic environment. He identifiesnonfluency and stuttering .

It helps the stutterer greatly to observethat so-called normal speakers are non-fluent. In the absence of systematic re-search on the speech fluency of adults, thewriter can only report his scattered ob-servations of normal speakers, profes-sional lecturers for the most part. Count-ing their repeated syllables, words, andphrases, their exaggerated hesitations,conspicuous pauses, their uhs and ahs,they tend to average from five to eightnonfluencies per minute in continuous,relatively extemporaneous speaking . Forone famous lecturer, 540 nonfluencieswere tabulated in slightly less than onehour. For another, 65 ahs were countedin five minutes. So they go . This sort ofthing is normal . Stutterers generally re-gard it as very unreasonable, as tortureeven, when first instructed to speak withthis much nonfluency to be performeddeliberately . To them it is stuttering.Nevertheless, when they do speak withsuch deliberate nonfluency, wholeheart-edly, they loosen up very considerably,speak more smoothly, stutter much less.This, of course, is precisely what onewould expect if one regards their stut-tering behavior as an effort to avoid non-fluency.

ETC . : A REVIEW

So far as evaluative behavior is con-cerned, therefore, the stutterer needs tounderstand the taboo imposed by his se-mantic environment. He needs to under-stand the semantic confusion involved inthis taboo as he has interiorized it . Heneeds to differentiate stuttering from non-fluency, and to see stuttering as his at-tempts to avoid non fluency . Stated in somany words, this may sound rathersimple. In practice it involves extraordi-nary difficulties . The indicated alterationsin evaluative behavior have to be madein the face of powerful counteracting in-fluences in the stutterer's semantic en-vironment. It is usually very difficult toget the stutterer's parents, teachers andassociates to make similar changes in theirown evaluations . As a rule, they continueto praise him for speaking fluently, andto express or imply sympathy and anxietywhen he does not speak fluently. Also,having learned to regard him as a stut-terer, they quite automatically regard anynonfluency he may exhibit as stuttering-even though they give no heed to similarnonfluency in their own speech.

It must be realized, too, that for a stut-terer to speak with repetitions, hesita-tions, etc., on purpose, is to reverse dras-tically long-established habits . He hasbeen oriented for years, as a rule, to doingeverything possible to keep from doingthe very thing he is now being told to do .He is being asked to abandon evaluationswhich have come to seem natural to him .He is being asked to cultivate evaluationsthat strike him as contrary to commonsense. Like so many other principles andpractices that have been developed bymodern scientific students of behavior,these, too, may appear to be very simple,but in our culture they are not easy toput into practice . Insofar as they are ade-quately applied, however, their value be-comes evident .

OF GENERAL SEMANTICS

VI

Overt behavior. A great deal of whatmight be said under this heading hasalready been indicated and implied . Themain alterations to be made, so far as thestutterer's overt behavior is concerned,involve the deliberate performance ofnon fluency, the sloughing off of certainmannerisms, grimaces, etc ., and an in-crease in the amount of speaking and inthe number of situations in which speak-ing is done . The primary objective ofthese behavior changes is to aid the stut-terer in cultivating the evaluations thatwill lead to fearless, enjoyable, spon-taneous speech-to speech of normal(not perfect) fluency .In the usual case perhaps the steps to

be taken would be of this order : First,it is sometimes necessary, or at least ad-visable, to convince the stutterer that heis capable of normal speech . This can bedone by having him read in chorus withanother person, even another stutterer .Strangely enough, two stutterers are, withrare exceptions, able to read aloud to-gether without difficulty. It is also help-ful in some cases to have the stuttererread and talk when alone, or perhaps tohis dog, since practically all stuttererscan do this without stuttering . Such prac-tices are helpful to the extent that theycounteract any assumptions the stutterermay have as to his physical inability tospeak .

Second, practically every adult stuttererexhibits certain mannerisms, or so-called associated movements, such asclosing his eyes, turning his head, swing-ing his foot, etc ., while stuttering. Insome cases, these mannerisms are respon-sible for much of the social handicap .Moreover, they can frequently be elimi-nated ; the stutterer can rather quicklylearn from directed practice, preferablybefore a mirror, that he can stutter with-

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STUTTERING IN ADULTS

out doing some of these things. Thevalue of eliminating such mannerisms liesin the fact that the social handicap is re-duced, and the stutterer's notion that hisstuttering is fixed and unalterable isweakened . One must be careful, how-ever, not to carry this too far ; one mustsee to it that the individual understandsthat he is not being instructed not tostutter at all . Such an instruction wouldtend to strengthen the taboo with whichthe stutterer has to contend, and resultin increased tension and discouragement .

Third, insofar as possible the stutterershould deliberately imitate his own stut-tering. This should be done at first infront of a mirror with no one presentbut the teacher ; or, the stutterer can doit by himself provided he understandsclearly what he is to do . Later, he shoulddo it in speaking to other people. Havinglearned to imitate his own manner ofstuttering, he should practice faking itwithout the effort and hurry that usuallycharacterize it . He should do this at firstwhile he is alone or with his teacher,and later in other situations . In doingthis, the aim should be to make the stut-tering entirely effortless, free from grim-aces and fear-a forthright, unhurried,deliberate performance of what would)therwise be done under protest and with:ension .

VIIAfter considerable practice in this, the

stutterer is ready for the fourth step, that)f adopting a streamlined pattern ofionfluency. This is not to be confusedwith stuttering ; for the nonfluency pat-ern is adopted and used instead o f stut-ering. Probably a simple repetition, liketha-tha-tha-this,' is most preferable, part-y because it was just such behavior thatvas originally diagnosed as stuttering andseeds, therefore, to be reevaluated asiormal and acceptable . However, aimple, effortless prolongation of the first

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sounds of words will, in some cases,prove satisfactory, although considerablepractice is required in prolonging the pand t. Also, care must be exercised lestthe prolonging become a complete stop-page reaction, which would be merelyanother way of stuttering . Havingadopted, say, a simple repetition pat-tern, such as 'tha-tha-tha-this,' the stut-terer should practice it a great deal whenalone, preferably before a mirror . If adictaphone or, better, a microphone isavailable, it is helpful to record one'sspeech, using the new repetition pattern,and then listen to it over and over again,in order to become thoroughly accus-tomed to it, and to learn to do it assmoothly and effortlessly as possible .

Gradually, then, the stutterer shouldintroduce this pattern of nonfluency intohis everyday speech, trying it out first inthe easier situations and then introducingit in more and more difficult situations .He should employ it whenever he wouldotherwise stutter and he should also feignit liberally in saying certain words onwhich he would not otherwise stutter . Hewill find that the more nonfluency hefakes the less he will experience a ten-dency to stutter . This follows becausehis stuttering constitutes his attempts toavoid nonfluency, and to the extent thathe is set to perform it, he is not set toavoid it . As time goes on the amount offeigning can be gradually reduced, sincethe tendency to try to avoid nonfluency(to stutter) will have been weakened,and eventually normal speech becomespossible.

What is accomplished by this meansis that the individual ceases to be a stut-terer and becomes instead, for a time, arather nonfluent speaker . The unusualamount of repetition in his speech, pro-vided it is performed wholeheartedly andwithout apparent effort, calls far less at-

ETC : A REVIEW OF GENERAL SEMANTICS

tention to itself than one might suppose,and is for other reasons ; also, far lessserious than the stuttering. One of themain reasons why it is less serious is thatthe repetition tends to decrease in amountwith time . This is so because the volun-tary repetition is performed in order tocounteract the impulse to stutter (to avoidrepetition or other nonfluency) . But thisimpulse to stutter tends to become weakerand weaker, and to occur less and lessfrequently, as the strength of its motiva-tion, which is the desire to avoid non-fluency, is decreased . As the inclinationto stutter decreases, the need or occasionfor voluntary repetition decreases cor-respondingly. Gradually, therefore, theindividual's speech comes to be less andless nonfluent, and tends eventually tobecome quite smooth . Thus, the viciousspiral of stuttering leading to more stut-tering, as the individual develops astronger and stronger set to avoid non-fluency-this vicious spiral is reversed, sothat there is less and less stuttering as theindividual develops a greater and greatertolerance for nonfluency . And as thethreat and dread of stuttering decreases,the need for actually performing non-fluency decreases, and the individualspeaks more and more smoothly .

Finally, it should be added that as thestutterer proceeds with this program heshould be encouraged, even definitely as-signed, to speak more and more and toenlarge the range of his speaking situa-tions. As his evaluations of nonfluencychange, he will exhibit less reluctance tospeak, less of a tendency to avoid socialcontacts . This should be encouragedjudiciously, remembering at all times thatthe main objective of all these measuresis to help the individual to cultivate suchpositive evaluations of his speech as willenable him to speak without fear andtension, and with enjoyment and poise.

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VIII

Physical condition. On the basis of th,more adequate scientific studies done tcdate, there seems to be little or no reasonfor supposing that stutterers, as a classhave any greater need for physical hygienethan do other people . As a populationgenerally we are not, on the average, th<answer to a wise physician's prayerFundamental lack of good health is indicated by most of us in the condition ofour teeth, the relative ease with whirlwe catch colds, our tendency to becom<fatigued readily, and in various otherways. Stutterers, then, are not to be co mpared with an ideal population of nonstutterers who enjoy perfect health . The3compare very well, indeed, with nonstutterers as they actually are found tcexist with respect to their physical con •dition.

What might be important, however, isthe possible tendency for some individuals, at least, to lack enthusiasm and tcbecome discouraged under conditions occasioned by excessive fatigue, loss ofsleep, improper diet, lack of exercise, o~disease. In order to carry out effectivel3the sort of corrective speech program outlined above, the stutterer needs as muclenergy, enthusiasm, and' `good feeling' apossible. Once a stutterer has begun tcchange his speech behavior, the mainthing with which he has to contend is thetendency to revert to old habitual way:of behaving whenever he feels tired ancdiscouraged . From this point of viewgood health is important for a stutterer

It need only be said, in this connection, that for the most part physical bygiene involves adequate practices of eating, sleeping, exercising, working ancrelaxing. Beyond that, anyone is to b.advised to see a doctor, and to report bactsufficiently often for him to check th,effectiveness of his recommendations anc

STUTTERING

orestall any serious threats of disease .Ear as stuttering is concerned, it is to;aid simply that, although anatomicalbasic physiological matters are usual-if little importance, if they are shown)e of importance in a specific case theyuld be given proper attention .

IxA great deal more could be said about

stuttering. The impression is not to beleft that the results of scientific studiesof the problem have been fully reported .Several hundred investigations of stut-tering have been made and a large num-ber of publications on the subject areavailable. In order to summarize andespecially to evaluate this material, itwould be necessary to write a very largebook. In fact, in order to elaborate indetail the basis and the implications ofthe discussion that has been presented,it would be necessary to expand that dis-cussion to the proportions of a volumeof considerable size. The main purpose

IN ADULTS

in the writing of this article has been tosuggest one type of practical approachto the problem . 2

In the actual carrying out of this ap-proach, use is made of any specific tech-niques and of any particular manners ofexplanation and instruction that seem ad-visable in specific cases . Details of treat-ment depend upon the age and back-ground of the individual, the nature andcomplexity of his semantic environment,the severity of the stuttering, the timeavailable for conferences and instruction,etc. Not only are no two stutterers alike,but no one stutterer remains the samefrom time to time . The principles pre-sented here, insofar as they are sound,are useful only as they are judiciouslyadapted to the individual and to his ever-changing state and circumstances .

' A concise statement of the point of viewpresented here is to be found in W. John-son, 'A Semantic Theory of Stuttering,' inStuttering : Significant Theories and Therapies,by Eugene Hahn ; published by the StanfordUniversity Press, 1943 .

Perhaps, as has often been said, the trouble with people is not somuch with their ignorance as it is with their knowing so many thingsthat are not so . . . . So that it is always important to find out aboutthese fears, and if they are based upon the knowledge of somethingthat is not so, they may perhaps be corrected .

WILLIAM A. WHITE

It is often said experiments must be made without a precon-ceived idea . That is impossible. Not only would it make all ex-periment barren, but that would be attempted which could not bedone. Every one carries in his mind his own conception of theworld, of which he can not so easily rid himself . We must, forinstance, use language ; and our language is made up only of pre-conceived ideas and can not be otherwise . Only these are uncon-scious preconceived ideas, a thousand times more dangerous thanthe others .

H. POINCARE, The Foundations o f Science

81