India, Stuttering and Mixed-Up Speech Pathologists!

About the presenter: Ajit Harisinghani (http://www.searchpune.com/ent/speech/index.html) is a practicing speech pathologist in Pune, India, over the last 20 years. He pretends to be a therapist who helps stutterers but his work is actually more 'motivational' in nature as he tries to get his clients into a more facilitative frame of mind where the stutterer becomes ready to reduce or even drop his obsession with judging himself based only on the number of speech blocks he has. Ajit has been a prolific writer for the various newspapers and magazines with a focus on facilitating speech fluency and has produced two short films on stuttering for the Indian TV channels. He is now involved in developing a more 'real' therapy module which does not ignore the mind and mental mechanisms that operate to create stuttering in an otherwise normal, healthy human being. Ajit has travelled worldwide, been in various jobs ranging from being a public school speech therapist in the West Virginian boon-docks to washing floors, waiting in a texan restaurant, driving a cab in chicago, working the skin-of-his-hands-off in Chicago, internship at the California State University, Northridge, setting up a speech department for the Ministry of Public Health Kuwait when not travelling as a hippie (of the flower-generation) sampling delights all over the world. He says his near-death-experience in California finally set him free. Ajit is now 49 years old and thinks he'll live another 100 years!

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India, Stuttering and Mixed-Up Speech Pathologists!

by Ajit Harisinghani
from India

My therapy-plans with stutterers have turned a full circle since when I began my work as a speech pathologist in India - way back in 1977. I returned from the US with a Master's degree in speech pathology and a CCC-Speech to boot. However, I must confess that while I knew what to do with most of the other speech disorders I encountered, I found myself at sea when stuttering cases came my way. I can laugh about it now, but I took my cases through a gamut of accepted therapies and even through some not-so-recognised procedures. I'll tell you about a few of them and then take you away from these stories towards what, I believe, is a good, workable stuttering-management plan; the one I use today with many of the young adult stutterers who come to me.

QUACKERY in the Wild, Wild East :

From the well-organized environs of California State University (Northridge)'s Speech Clinic where lessons-plans were supervised, reports filed, and procedures discussed, I found myself in a wilderness of my own when I started work in India. What little I knew about stuttering-therapy was basically defeatist in nature. My young, inexperienced mind reasoned that if Charles Van Riper and Jon Eisenson could not get over their own stutter, what therapy was everybody actually talking about? Weren't the gurus telling us that stuttering cannot really be 'cured'? I remember advising my clients to avoid all kinds of quack remedies while all the time an inner voice asked me : "Aren't you a quack too? Your master's degree does not really make you any better than these other guys, only more expensive! You can't cure it either."

And what quackeries I saw!

An old man in the Kemp's Corner cemetery (in Mumbai) who said his snakes would cure stuttering. I'm not kidding. This guy was wearing a long black wollen garb (in the heat!) with many pockets, each of which had snakes of varying poison-potency. Yes, snake-bites for stutterers! He claimed the weak, non-fatal poison would affect the nervous system and relax the tense stutterer who would then be able to speak normally! Only 50 rupees a bite! (that's around 1 US dollar). I waited around for an hour and then a young guy walked to the snake-man and actually wanted a bite which a thin brown snake delivered under the guy's tongue! (That was when I started stuttering!) Don't ask me if this treatment worked but the bitten customer seemed happy enough. Snake-venom in controlled doses is known to cause a feeling of euphoria.

Road-side doctors in India offer everything from special stones to be placed under the tongue while speaking to 'powerful' potents which can contain anything from simple glucose or cinnamon powder to oil from crushed wild lizards (I saw that in a himalayan town).

Ayurvedic and homeopathic doctors offer medicinal remedies while some allopathic MDs advice tongue-tie release surgery or even tonsillectomy. There is a wide-spread belief here in India that stuttering is a disease and needs to be 'cured'. Cases are generally referred to Ear, Nose, Throat Specialists, or pediatricians who usually advice that the problem be ignored and that it would go away of its own accord.

But all this is probably no different from the days of the wild, wild, west in America when the travelling doctor with his wagon-load of remedies sold all kinds of treatments.

Has the "treatment" for stuttering in India progressed any further from what it was so many years back when placebos ruled the roost and counseling was limited to what mama said as she milked the cows?

Well, yes. It has come a long way. As an undergraduate student, I was told that there is nothing 'physically wrong', that there was no organic cause for stuttering; it was all behavioural. But today, it appears that the 'seed' of stuttering might one day be found hidden in the person's genetic (DNA) make-up - everyone here is finally saying that stuttering usually has neurological origins which are then compounded by psychological factors. There is mention of the act of speech in ancient hindu texts (from before 1000 bc) which say that speech is the most powerful of all human actions. It can move worlds!

Speech is actually a trinity of actions (i.e. three forces are involved) and this trinity comprises of three essential elements which are :

1. The birth of the thought that needs to be conveyed (spoken)
2. The emotions that accompany any such thoughts that are "born"
3. The physical neuro-muscular act of speech.

To help develop enhanced control of this trinity of elements is the focus of my therapy for stutterers. Actually, I don't like the word "control" and rather prefer that the stutterer flow with his own basic (DNA programmed) neurological and psychological nature. It is in attempting to control these innate tendencies that the stutterer finds himself entering ever increasing conflicts which arouse feelings of inability, frustration, anger (etc.) which are the very reasons he stutters in the first place. So here, I begin to agree with the ancient(!) American gurus (Van Riper et al) when they advise the stutterer to stutter openly which automatically suggests that he not try and expend any energy in hiding the problem from his listeners. Such desperate efforts to stop stammering are like trying to stop the flowing waters of a raging river - an impossible task which can only result in the waters going this way and that - causing havoc. Rather, the stutterer is advised to begin to alter the direction of these surging waters - not stop them. Since the origin of these surges are neurological, attempts are made in the direction of calming these surging (negative) energies. All neurological signals are electro-chemical in nature and originate as thoughts which are then transformed into (neuro-muscular) actions. Emotions have a direct relationship with the nature and degree of these electro-chemical neurological impulses. And like cholesterol, there are "good" emotions and "bad" emotions. Good emotions facilitate neuro-muscular acts like speech and "bad" or negative emotions work against the smooth implementation of the signal for speech and result in blocking the flow of this electro-chemical signal. Energy "knots" or blockages result and these then work havoc with the person's biology as well as his psyche. The stutterer carries this burden of knotted-up up electrical energy which needs to be given a way out of his system. Now, I realize I have become caught in a mess of words here! - but the idea is for the stutterer to ground this excessive electrical energy which can accumulate in the body and snowball into a growing "power-storage" crisis. And the simple solution is to ground this energy - earth it. And how does one do that? Simple, by walking bare-foot on earth for 20 minutes every day! Not on the flooring-tiles in the house, nor on the cement pathway, but on real, natural earth outside. It is astonishing, but many of us get very few opportunities to walk bare-foot in the park these days. It is healthy for everybody and also for those who stutter. If the ground (or lawn) that one is walking on is a bit wet with dew, so much the better because wetness increases electrical conductivity (ask all those guys who got a shock in the bath-room!)

The Birth of Thought:

With many stutterers, thoughts about what they want to say become polluted with doubts about how they are going to say them. These doubts are directly related to the importance of the situation. Often, the stutterer finds himself juggling with so many elements. Avoiding 'difficult' sounds, replacing words, keeping cool, desperately involved with not stammering. With so much jugglery going on in the stutterer's mind, his speech will convey not ease but tremendous effort whether or not he stutters. Keeping the mind cleanly focussed on the essence of what he wants to communicate can be aided through meditation.

Meditation basically aims at stopping the internal dialogue that constantly goes on in the mind. Doubts, decisions (about what to say and what not to say), such tremendous conflicts that confuse the stutterer need to be calmly and lovingly stilled and this is achieved through the process of regular meditation. So the stutterer is encouraged to learn meditation techniques and begin to spend 30 minutes each day stilling his mind and enjoying the feelings of calmness and tranquility which result from these techniques. The ancient technique of Vipassana was re-discovered by Buddha 2500 years ago. Vipassana centers exist all over the world. Beginners are enrolled in a 10-day residential course during which complete silence is observed. Meditation begins at 4:00 am and participants are guided towards becoming aware of the various sensations that move through our body. In silence, one is encouraged to focus one's attention first on the movement of breath. Become aware of the various neuro-muscular events that are happening all the time. This technique is not specifically meant for stutterers as such. Anyone can benefit - but I do encourage my adult clients to enroll and undergo this tough ten-day course. The vipassana centers charge no fee at all for any of the varying degree of courses - even accomodation and food are completely free. The are vipassana centers all over the world. More information can be obtained from their website http://www.dhamma.org/

Another ancient hindu technique which has gained world-wide recognition is the science of Yoga. Yoga has outlined specific physical exercises which encompass both the mind and the body aspects and help improve neurological-balance. This helps the stutterer to channel his nervous energy from acting in 'spurts and jerks' towards becoming smoother and more relaxed. Yogic exercises need to be learnt from an experienced instructor. The benefits are that the stutterer begins to speak in a less-strenuous manner and learns to operate 'below' the "trigger-point". By trigger point, I mean the level of neurological-tension which when crossed results in his system going haywire and out of control and evidencing various behaviours such as tremors, tics, eye-blinks, uncontrolled movements, etc. Most stutterers are desperate for speech fluency and it is this feeling of desperation that keeps them enmeshed in the problem. Some sessions are devoted to preparing a foundation for therapy and one of the pillars is drop desperation. Another is to not focus all the time on the fruits of one's efforts. Many stutterers measure their progress by counting the number of speech-blocks they have on any given day and then feel elated or depressed as the case might be. Stop being clerical about measuring success - in fact, don't measure it at all. Only in retrospect can one say that "yes, six months back I had many more speech-blocks than I have today" but too much involvement with measuring gains can be counter-productive. In fact, stuttering is such a slippery problem that the more one tries to control, measure or "catch" it, the more it escapes away from our grips. Therefore, the focus of my therapy is not to remove stuttering but to increase speech fluency. And it is this intention that counts. I cannot push out the darkness (stuttering) but I can certainly switch on the lights in the room. That the darkness goes away is incidental. It's the light I was focussing on. So we work with changing the mental focus from an involvement with stopping stuttering and move to develop good speaking habits. But as we all know, it's the attitude that finally counts, "the mind behind the mouth" as it were. So much of my therapy is intertwined with focus on attitude. In this endeavour, I take a lot of help from the Bhagwad Gita - the most ancient of all hindu scriptures which enumerates a philosophy of living life like a winner. I also use many techniques suggested by the "new-age gurus" or motivational facilitators like Anthony Thomas, Wayne Dyer, Deepak Chopra and of course Ajit Harisinghani(said he modestly!).

So my therapy for stutterers is an amalgamation of eastern and western techniques which could be itemized as:

1. Meditation
2. Yoga
3. Speaking with the mouth more open
4. Developing smoother exhalation techniques
5. Not using force to get the blocked sound out
6. The Art of Listening
7. Relaxation techniques
8. Easier body language
9. Altered Attitude towards communication.

In conclusion, if I had to summarize my approach to stuttering therapy, I'd say it's more of unlearning - a clearing up of all the psychological and neurological "debris" which has so far clouded up the stammerer's act of speech. One doesn't have to "work hard" to learn fluency. Rather, one has to begin to believe that speaking fluently is a lot more "easier" than stuttering.