What Is Wrong With John Wayne's Stuttering Therapy?
About the presenter: Hans-Georg Bosshardt is a professor of psychology and vice-dean of the Department of Psychology at the Ruhr-University Bochum (Germany). He is president of the International Fluency Association and has the status of an ASHA international affiliate. He has published and presented several papers on stuttering and presently investigates how speech planning and short-term memory load affect speech fluency, laryngeal activity and the timing of speech movements. He dreams of bird watching and hiking in Arizona and California.
What Is Wrong With John Wayne's Stuttering Therapy?
by Hans-Georg Bosshardt
Germany
This paper is about personal responsibility for stuttering. I will discuss whether persons who stutter are responsible for the fact that they stutter. With reference to one of the Western characters enacted by John Wayne I will show in which sense the claim for personal responsibility is wrong and even harmful. I will confront the presuppositions and subjective beliefs behind the responsibility claim with facts about stuttering.
The Story
John Wayne admirably represented the strengths of western heroes who take full responsibility for their life. In one of John Wayne's less well-known westerns he in all his self-reliant power was actually confronted with a boy who stuttered. In the film "Cowboys" (1972) John Wayne acted as Bob Anderson, a rancher, who hired a group of school boys as cowboys for his cattle track. One of these boys, Bob Wilson, stuttered. When the cattle was driven across a river Bob observed that in the mid of strong currents one of the other boys was thrown from his horse and was in greatest danger to be carried away and to get drowned. Bob Wilson wanted to report this important event to Mr. Anderson but had severe blocks and was unable to do so in time. Happily another boy came to the aid of the thrown-off and rescued him.
This event was the reason for John Wayne alias Mr. Anderson to reproach Bob Wilson with having not done enough for the prevention of his comrade's death. If Bob Wilson himself were fallen in the river he would have been able to make himself understandable and to cry for help. Because he did not try hard enough he could not speak clearly. Mr. Anderson did not accept any of Bob Wilsons protestations and assurances that he was unable to speak fluently. Mr. Anderson imperatively demanded him either to stop stuttering or to go to hell. In a mixture of fury and helplessness Bob Wilson began to insult Mr. Anderson. When Bob realized that he became fluent he repeated his insults with increasing loudness and with indications of joy. Mr. Anderson began to smile and turned away murmuring that he would not recommend that Bob continues to address him in that way.
For the remaining part of the film Bob Wilson was talking completely fluent - except when he was deliberately imitating his former way of talking. Thus, what Juergen Benecken (1996. p. 43) called "John Wayne's stuttering therapy", seemed to be quite successful! I will take this approach serious as if it were a systematic stuttering therapy because I am convinced that this way of dealing with stuttering still is very appealing for many persons. In order to make clear that I am not talking about a particular person's thoughts but about a way of thinking about stuttering I will refer to it as "JW's stuttering therapy". The stuttering awareness day is a highly welcomed opportunity for me to describe the elements of this approach and to make clear which harmful and devastating effects this way of treating persons who stutter can have.
INTERPRETATIONAL SCHEME IMPLIED IN JW'S STUTTERING THERAPY
Responsibility. The concept of personal responsibility cannot be defined without reference to a complex philosophical and cultural context. My own thoughts were heavily influenced by Stegmuellers (1975, p. 138ff.) concept of "deep intentional analysis" [intentionale Tiefenanalyse], by Diemer's (1971) process of making sense [Verstehensvorgang ] and by Mischels (1963) ideas about the explanation of human behavior. These philosophers have inspired me but my own ideas are much simpler and directly related to the belief system implied in JW's therapy.
Within the western roman-christian tradition persons are made responsible for actions (or the results of such actions) if - within the given situation - they actually have and should have seen alternative ways of acting and if, for some reason or other, they prefer one of these alternatives. In order to make someone responsible for his behavior you have to interpret his behavior as an action, i.e., you interpret the other's behavior in the light of an interpretational scheme. This scheme essentially consists of two parts, the claim that the responsible person has the ability to act in either ways and is motivated to prefer one over the other alternative(s). In the end, the results of these interpretations are somehow "projected into the other person's mind" claiming that she or he actually is (or was) acting in accordance with the principles of the interpretational scheme.
Ability to speak fluently or disfluently. Responsibility implies that the person is able to perform either of alternative actions. The first assumption implied in JW's therapy is that Bob Wilson is able to speak fluently as well as to stutter.
Fluent and disfluent speech as a matter of choice. From the first assumption follows that Bob Wilson has some reasons to prefer to stutter instead of speaking fluently. JW imputed that Bob Wilson would have been able to speak fluently if he himself were in danger of being drowned. There were also some other indications in the film suggesting that it could have been advantageous for Bob to stutter.
Interventional principle. JW's therapeutic intervention is a direct consequence of the first two interpretational assumptions. In order to change Bob Wilson's speech JW simply has to make it less attractive for him to stutter and Bob would then switch to the now comparatively more attractive form of fluent speech. JW took for granted that it was more attractive for Bob to be together with the other boys and drive the cattle than "to go to hell". In order to make Bob fluent he simply had to accept his participation in the trek only under the condition that Bob speaks fluently and that is what Bob did.
"TRY-" AND "CAN-" INTERPRETATIONS OF STUTTERING
JW and Bob Wilson are looking through completely different glasses at stuttering and fluent speaking. Bob is looking at stuttering and fluent speaking as something that depends on his abilities or disabilities while JW on the hand claims that it is a matter of "trying". Fritz Heider (1958) described how these two points of view are related to one another. Heider showed that in everyday language human actions are explained by factors localized within the person and within the environment. The try and can components are the two personal factors which work together in every human action. Even the highest levels of ability (the can component) are useless if the person is not sufficiently motivated (the try component) to use these abilities. The final effect of mobilizing personal abilities however depends on the difficulty of the situation which is seen as an environmental force.
Under this view, both JW's and Bob Wilson's positions are rather short-sighted and primitive ways of thinking about stuttering. They do not realize how their interpretations are related to one another and completely neglect the role of environmental demands. Given his present skills and abilities it is of course impossible for Bob to speak fluently in a situation with highest time pressure and under emotional excitement. But frequently inadequate consequences are derived from such can or cannot interpretations. With appropriate techniques it is possible to increase the abilities and skills for fluent speech. Thus, to acknowledge that an ability or disability component is involved in fluent speech and stuttering does not imply that it is futile to strive for fluent speech. Conversely, it seems silly to insist exclusively on a "try" interpretation of fluent speaking and to disregard completely the disabilities for fluent speech.
The variability of stuttering makes it very difficult for JW to accept that his try interpretation is inadequate. The same word or sound can be produced without any perceptible indications of tension and struggle at one occasion, and is articulated at a different occasion with severe blocks and several repetitions. What makes speech so difficult at one occasion and so smoothly at another one? JW's explanation for this fact is very straight-forward. This fact demonstrates - so would JW argue if he would argue at all - that the person is able to speak fluently or disfluently and that the choice between these alternatives depends on the attractiveness of either ways of talking. For JW and the adherents of this theory it is difficult to understand how a disability for fluent speech - if it were actually involved - would not result in disfluencies under all conditions and in all situations.
However, it can be shown that the disabilities behind disfluent speaking are inadequately construed in JW's theory. They should be seen as dispositions that result in disfluent speech only under certain conditions. A disposition is comparable to the fragility of a window. A glass window is fragile although this characteristic becomes apparent only if you throw bricks into it but not if you take light pebbles or are only looking through it into the rain. Similarly the disability for fluent speaking becomes manifest only under certain environmental conditions and not under others. The fluent speech in children and adults who stutter is very fragile and the cognitive and emotional requirements of talking may be already sufficient to make it disfluent.
In summary, stuttering can be explained with a description of personal (try and can) and environmental factors. Interventions for fluent speaking must be founded in an adequate understanding of the interrelationships between these factors. In all these respects JW's way of dealing with stuttering is clearly inadequate.
SHORTCOMINGS OF JW'S STUTTERING THERAPY
Fluent or disfluent speech is not a matter of choice. It is generally assumed that the communication process itself imposes particular demands on the speaker's cognitive, language and motor systems (Bosshardt, in press). Proper temporal coordination between these processes is a prerequisite for fluent speech (Perkins, Kent, and Curlee, 1991). Communication situations impose continuously changing demands on these abilities. The basic idea is that children who develop fluency problems are particularly vulnerable in one or several of these areas. When these children are confronted with various communicative demands, their fluency temporarily breaks down (Starkweather, 1997a,b). Some children learn to emotionally react to their own stuttering with feelings of guilt or shame and develop coping, avoidance and defensive behaviors.
All this sounds very different from the description of a stuttering child which can be derived from JW's therapy. In summary, fluent or disfluent speech cannot not be seen as instrumental behaviors which are used for the maximization of parental attention, protection and allowances (c.f. Starkweather, 1997b, p. 271). Rather, both ways of speaking result from a complex interplay between personal factors (try and can) and environmental demands.
Tactics of J.W.'s successful colleagues. The inadequacy of JW's intervention may become most clear if it is contrasted with professional intervention strategies. In spite of the many differences between therapeutic approaches (for reviews, see among others Culatta and Goldberg, 1995; Guitar, 1998) they share two assumptions which are relevant for their efficiency. a) Stuttering therapy is a process. During this process the abilities for fluent speech are increased, environmental sources of stress are removed, and the persons who stutter are encouraged to communicate. By contrast no learning is involved in JW's therapy because it is taken for granted that Bob is able to speak fluently. Environmental demands are non-existent in JW's thinking. b) At every point during therapy, speaking situations and assignments are chosen so that their difficulty matches the speaker's capacities for fluent speaking. Care is always taken to make communication enjoyable for the person who stutters. By contrast, JW's intervention puts very high demands on Bob Wilson's speech fluency without increasing his abilities. In reality these conditions almost certainly would increase tension, provoke negative emotional reactions, anticipatory struggle and avoidance behavior.
CONCLUSIONS
I have written this article because I feel that some of the beliefs implied in JW's therapy are very common - even among persons who stutter. I may be wrong. But this is my explanation for the fact that many adult persons who stutter forbid themselves to talk - unless they are talking fluently. This is my explanation for the observation that many persons who stutter invest much effort in trying to hide the obvious fact that they are not always talking fluently.
REFERENCES
Benecken, J. (1996). Wenn die Grazie misslingt - Stottern und stotternde Menschen im Spiegel der Medien [When grace does not succeed - stuttering and persons who stutter as represented in media]. Koeln: Demosthenes Verlag der Bundesvereinigung f�r Stotterer-Selbsthilfe e.V.
Bosshardt H.-G. (in press). Effects of mental calculation on stuttering, inhalation and speech timing. Journal of Fluency Disorders.
Culatta, R. & Goldberg, S.A. (1995). Stuttering therapy. An integrated approach to theory and practice. Boston: Allyn and Bacon.
Guitar, B. (1998). Stuttering. An integrated approach to its nature and treatment. Baltimore: Williams & Wilkins.
Heider, F. (1958). The psychology of interpersonal relations. New York: Wiley.
Mischel, T. (1963). Psychology and explanations of human behavior. Philosophy and Phenomenological Research, pp. 578-594.
Diemer, A. (1971). Die Trias Beschreiben, Erklaeren und Verstehen in historischem und systematischem Zusammenhang [The trias of explaining, describing and understanding in historical and systematic contexts]. In A. Diemer (Ed.), Der Methoden- und Theorienpluralismus in den Wissenschaften [The multiplicity of methods and theories in arts and sciences] (pp. 5-24). Meisenheim/Glan: A. Hain.
Perkins, W., Kent, R.D., & Curlee, R.F. (1991). A theory of neurolinguistic functioning in stuttering. Journal of Speech and Hearing Research, 34, pp. 734-752.
Stegmueller, W. (1975). Hauptstroemungen der Gegenwartsphilosophie. Band II. [Main streams in present-time philosophy, Volume II]. Stuttgart: Kroener Verlag.
Starkweather, C.W. (1997a). Learning and its role in stuttering development. In R.C. Curlee & G.M.Siegel (Eds.), Nature and treatment of stuttering. New directions (2nd.ed.) (pp. 79-96). Boston: Allyn and Bacon.
Starkweather, C.W. (1997b). Therapy for younger children. In R.C. Curlee & G.M.Siegel (Eds.), Nature and treatment of stuttering. New directions (2nd.ed.) (pp. 257- 279). Boston: Allyn and Bacon.
September 29, 1998
