Stuttering Therapy in 2050 A.D.
Van Riper, C., "Stuttering Therapy in 2050 A.D.," in Emerick, L.L., and Hamre, C.I. (ed.) An Analysis of Stuttering , Danville, Ill., 1972, pp. 808-812.
This volume began with a review of stuttering theories and therapies of the last one hundred years. It is perhaps fitting that it should end with some prophetic speculation concerning the next century's contribution to the solution of the problem of stuttering. We prefer prophecy to prediction because people do not have the same strong urge to kick a prophet that they have to kick a weatherman whose predictions go awry. With our fingers, toes and frames of reference crossed for good luck, we lay before you our clouded crystal ball.
By the year 2050, some real advance had been made in the area of stuttering by the application of information theory to the disorder. The tremendous interest and growth in automation and automatic control devices had led to a large series of investigations of speech as a servosystem. Among these were the early finding that certain stutterers had differential bone and air-conduction times; also that when measured in terms of the arrival of the auditory impulses in the termporal lobes, the bilateral delay was sufficient to produce the interruptions in fluency characteristic to those produced in the delayed feedback experiments of the middle 1900's. It was also shown that certain conditions of stress could delay or facilitate the arrival of these impulses in the cortex. Side tone experiments had demonstrated that stuttering could be increased or decreased at will by the experimenter by the use of differential intermittent masking of either bone or air-conducted side tone. Experiments such as these led to therapeutic procedures. Young stutterers were given daily baths of masking to re-establish the normal patterns of fluency, the few more chronic and older stutterers submitted themselves to doses of masking several times each day, and portable stimulators were available for self-treatment before stress situations.
Other experiments had shown that heightened kinesthetic and tactual feedback as compared with auditory feedback was most useful in monitoring the stutterer's speech. New drugs, first synthesized from mushrooms, were able to render the tactual and kinesthetic end-organs highly sensitive, so much so that increases in pressure or tension of the lips or tongue, for example, would produce extreme discomfort. As a result, when the stutterers were given these drugs, they soon learned to speak without the localized tensions and pressure postures which triggered the stuttering tremors. What is more, the heightened awareness of kinesthetic and tactual experiences produced by the drugs enabled the stutterer to know immediately when abnormal postures and contacts were assumed. This information enabled him to correct immediately and thus to monitor his speech in a more fluent fashion. Unfortunately, there were several bad side effects from these drugs. Many cases experienced hallucinatory distortions of time and space which relegated the use of the drugs to the clinical training centers. Nevertheless, they formed an excellent first experience in therapy and were widely used.
Many other monitoring devices and techniques were used. Stutterers read passages previously spoken by themselves and taped when fluent and when nonfluent. The nonfluent passages were piped into one ear and the fluent passages into the other. The stutterer attempted to speak in unison, resisting the influence of the non-fluent tape. By altering the sound levels of each the therapist could train the stutterer to resist the tendency to stutter and to remain highly aware of the normal standards of fluency. Another ingenious device was the artificial mouth. This electronic device was so designed that it would not speak or relay any message spoken into it if any repetition or prolongation of a sound or silence exceeded the normal amount. The stutterer spoke to his listener only through the artificial mouth. With the proper setting the device could be timed to speak at an interval, thus providing opportunity for correction and revision of utterance. Training centers used these artificial mouths routinely on their severe cases to prevent the constant reinforcement in terms of communication completion which normally occurs as a consequence of the stuttering behavior. When using the artificial mouth the stutterer had to speak correctly or not at all.
Other devices carried by the stutterer were so set that when triggered by silent tremor or abnormal vocalization they provided a variety of vivid signals to the stutterer which he could not ignore. Some of these were audible or visible; others were vibratory against the skin or body openings. But there were certain signalling devices which broadcast to a tiny receiver button, surgically implanted in the brain, which could be automatically set to decrease tremor proneness and increase relaxation. These latter were still experimental, however, and not in general practice, though all speech therapists were highly excited over their possibilities.
In general, it was obvious in the year 2050 that the stutterer's normal monitory controls were defective and that he would require accessory aids and training if he were to be able to scan the information returning from his mouth sufficiently to bring the output into resonance with the standards of fluency demanded by the listener. There was no premium placed on being willing to stutter or to stretch the standards of fluency so that the stutterer could consider himself merely a "nonfluent normal speaker." Such a phrase would have been thought an absurd contradiction in terms of an age where automatic controls were king.
Much research with tranquilizing drugs had also been performed but with disappointing results for stuttering, though they had practically eliminated most neuroses and psychoses as social problems. Very promising, however, were the new cerebellar suppressant preparations. These reduced the severity of stuttering markedly because few tremors could be sustained. Cases under the influence of the cerebellar suppressant drugs stuttered very mildly at most, and many of them were quite willing to bear the tendency to lalling and slurred articulation which resulted from the decrease in muscle tonus. Certain stutterers who were highly tremor-prone learned to live with their difficulty through the use of these drugs. It had also been found that another variety of stutterer, who had proved resistant to feedback control and to the cerebellar suppressants, could be treated by the new antiparoxysmal drugs. These stutterers, whose electroencephalograms showed occasional epileptiform spikes, and whose histories included migraine, allergies and eneuresis, were viewed as possessing a very low frustration and stimulation tolerance due to genetic factors. The antiparoxysmal drugs acted as chemical buffers in ways not thoroughly understood, but they did wonders in preventing the spasmodic discharge behavior. With a fairly well controlled environment and these drugs, these stutterers were able to live fairly normal communicative and useful lives.
Great efforts had been made in the attempt to prevent the onset of stuttering in the child, but the incidence was still one in every three hundred children of preschool age. The resources of the Agency of Public Welfare and Education had been mobilized to brief all prospective parents concerning the approved methods for teaching a child to talk, and it was obvious that these campaigns were beginning to have an effect. Still there were individual parents who were stupidly making exorbitant demands upon their children for display speech, and who refused to provide simple fluency models suitable to the age and development of the child. When such children were located by the agency workers, the parents were required to submit to treatment at the local parent clinic, but often the disorder had already reached its autonomous and self-reinforcing stage.
There was also another group of children whose thalamograms showed high affectivity and low frustration tolerance, but who often were not discovered until after the stuttering had become the characteristic drainage mechanism. The Agency had not yet been able to have sufficient funds to require all children under five to have their thalamograms checked every three months. As a result approximately 50,000 children contracted the disorder each year due to trauma or emotional conflict. The speech therapists still had plenty of work to do.
In addition to these young children who began to stutter because they were genetically paroxysmal or tremor prone (some 150,000) there were also those whose difficulty could be traced to brain damage or anomaly, the congenital aphasias, the retarded myelinization cases, the severe dysarthrias, and to children with delayed speech. It had been found that these children required special and careful training by experts to prevent the scanning and motor interferences which so often resulted in stuttering. These children and their mothers spent most of their days in the training centers under constant supervision until the fluency skills were mastered. Intensive training in verbal scanning, free association, verbal commentary and symbolization was stressed, but geared to the level of the child's capacity. Again, the biggest problem was in discovering these children in time.
We should say something here about the treatment of all of these stuttering children. The therapist for stutterers was a specialist, having had intensive training at the area centers before being assigned locally. He was quite competent to make a differential diagnosis of the different varieties of stuttering, to administer the appropriate drugs, to fit feedback control devices, and to carry out the appropriate therapy. As the dominant member of a team of specialists including the neurosurgeon, child psychologist, pediatrician and social scientist, his was the responsibility for seeing to it that no child became an adult stutterer.
Indeed, each therapist was rated in terms of his percentage of failure, and paid accordingly. In the year 2050 most of the ills that formerly plagued the human race had been fairly well conquered, and stuttering alone, of all these human ills, still continued to be a major health problem. As the typically human problem--even communicative speech is the typically human difference--stuttering presented to the culture a challenge which caused it to mobilize all of its resources.
Once the stutterer had been discovered he was immediately placed under the care and supervision of the therapist. As soon as the team of specialists had surveyed the problem and worked out the appropriate therapy plan, desensitization therapy was instituted for all stuttering children. It was felt that these children were far too vulnerable to communicative stress and had to be toughened to withstand it. Accordingly they were trained in speaking under disrupting conditions of every sort, but these disruptors were carefully and gradually fed into the situation so that the child could withstand them. Among the devices used to accomplish this was a fluency trainer, an electronic apparatus which randomly interrupted the speaking circuits, inserted noise, stimulated with stuttering and phased in subliminal suggestions of incorrect word choices and word fears. The stutterer was trained to resist these influences as he read to his listener on the televiewer. There also were training films in which the stutterer spoke directly to the listener on the screen, answering his questions while the listener showed by his expressions and speech all the unfavorable audience reactions to which the stutterer was vulnerable. Most of the stuttering children showed immediate and profound gains in fluency as the result of this desensitization.
Another important part of the therapy for child stutterers was the teaching of basic fluency. By this time, sentence dictionaries had been compiled for every age and cultural level and the probability of a sentence occurrence had been computed. Beginning with those sentences which were spoken most frequently, the child was required to say them prior to stimulation, during stimulation and following stimulation with these sentences until he was able to duplicate them exactly. Flashing lights or warning bells signalled any deviation from the exact duplication, and correction had to be made immediately. Not only the tempo but the tones and inflections had to be exact. The child acquired an extreme awareness of the standard patterns of normal speech, an awareness which research had shown was seldom found in the stutterer.
In addition to this training in basic fluency, each child constantly carried his own utterance recorder. This device, when attached to the speech decoder, was able to provide a complete printed transcript of the day's performance along with a running count of all nonfluencies and other abnormalities. Using these transcripts, the therapist was able to collect enough samples of normal speech to be used in basic fluency training of the sort mentioned earlier. No child went to bed until he had reviewed the day's speech output and had replaced the defective speech with its fluent cognate.
Since it had long been known that stuttering varied with the victim's morale and ego-status, intensive training in this area was also instituted. The children were systematically trained not only to acquire new social assets and skills which would make them desirable to their fellows; they were also subjected to various experiences which heightened the attractiveness of their own body image. The new drugs, previously mentioned, which made very vivid the kinesthetic and tactual feedbacks were administered along with companion drugs which induced exhilaration. This combination not only made stuttering intolerably painful when it did occur because of the increased sensitivity, but it also facilitated the voluntary monitoring of utterance. It enabled the stutterer to summon and or- ganize his energies to cope with the moments of communicative stress.
For thousands of years the problem of relapse in stuttering had plagued the human race. This problem had finally been surmounted in the terminal stages of therapy by using other drugs to induce temporary states of generalized anxiety coupled with hypnotic suggestion of phonetic fears. These conditions produced the desired recurrence of stuttering which was then attacked and extinguished, using all of the methods we have outlined. Again the basic principle of desensitization governed the therapy. The first provoked relapses were mild and easily reduced until adequate fluency levels were experienced; then more and more severe relapses were provoked to be followed by successful extinction of stuttering. Few stutterers required more than three extinction experiences to insure permanent relief.
At the present writing (Sirius, 2b, 3000 A.D.) we can report that stuttering, at least as a public health problem, has been conquered. Only on the planet Earth is the incidence one in every hundred, and this high ratio is due to the peculiarly stubborn temperaments of the earthlings who never seem to be able to use their intelligence to solve their emotional problems. Fortunately, the galactic council has designated this planet as the place to which refractory adult stutterers can be sent. They live fairly happily there, torturing their speech therapists and in turn being tortured by them.
added with permission of , August 14, 1997
