Remarks From Oliver Bloodstein

Remembering Joseph Sheehan

by Oliver Bloodstein
presented at the ASHA Convention Memorial to Joseph Sheehan

Joe Sheehan and I shared many basic assumptions about stuttering. There was a good reason for that. We were both students at the University of Iowa at the same time, in the late 1940s. There we both absorbed Wendell Johnson's own special reformulation of the anticipatory struggle hypothesis. The anticipatory struggle hypothesis is an idea that has been expressed in different ways by different people from time out of mind. In its most general form it says that the decisive factor in stuttering is the stutterer's belief in the difficulty of speech. The stutterer anticipates difficulty on the word "Mississippi," struggles and strains in the mistaken belief that is the only way to say such a difficult word, and consequently stutters, because the struggle and strain is the stuttering. There is an entirely different way of expressing the same concept. It's the theory that if stutterers were to forget that they are stutterers, they would have no further difficulty with their speech. They would have no need to learn a new way of talking, or to monitor their speech, or to be concerned with transfer or maintenance; they would just go ahead and talk like anyone else.

Joe Sheehan eventually elaborated this concept to such an extent that it became in many respects a different theory. But at the core of his thinking there remained a basic idea that linked it strongly to the anticipatory struggle hypothesis. That was the assumption that the underlying cause of stuttering blocks is the individual's self-concept as a stutterer, or, as Joe Sheehan preferred to put it, the person's role as a stutterer.

Needless to say, I was influenced by the anticipatory struggle hypothesis too. My own efforts to elaborate it were far more prosaic than Joe's. But our views had much in common; we were both groping in the same dark. I don t want to discuss my own ruminations about stuttering here, but it's necessary for me to say something about them in order to tell about something significant that Joe contributed to them. In my view, an illuminating way to talk about stuttering is to say that all of the surface features of the disorder are reducible to two underlying factors, tension and fragmentation in 'speech. Tension comes to the surface in the form of all of the signs of effort and strain that are observable in stuttering. Fragmentation is evident whenever normal movement stops in speech, but it is especially apparent in the stutterer's repetitions. A stutterer repeating the first sound or syllable of a word seems to me to be uttering the initial part of the word in the belief that the whole thing is too difficult to attempt all at once, and to be doing that repeatedly until the conviction needed to say the word as a whole returns. From this point of view, stutterers do not really repeat anything; what they really do is repeatedly stop themselves from going on. This helps to explain why stutterers seem perversely to repeat sounds that they have already said perfectly several times. It also explains why stuttering virtually never occurs at the ends of words. But it remained for Joe Sheehan to provide what seems to me to be the most compelling evidence in support of this view in a very simple observation that I had overlooked in twenty-five years of listening to stuttering. In an article he published in 1974 he pointed out that stutterers' repetitions often involve progressively larger segments of the word, as in the example "th--thir--thirty-five."

This observation of Joe Sheehan's illustrates something of fundamental importance about his contribution to stuttering research. Joe was never subverted by the narrow view of science as something wholly limited to laboratory experimentation. He himself was an outstanding experimenter who knew more about research design and inferential statistics than most people in the profession. But he never allowed himself to substitute laboratory experimentation for careful clinical observation guided by intelligence. He knew that laboratory experimentation is a double-edged weapon. Used to the exclusion of everything else with a problem like that of stuttering, it can limit our perspective and distort our vision. In the first place, it limits us to those aspects of stuttering that we can investigate in the laboratory. Even worse, it may create misleading laboratory analogues of real life conditions. Let me give two examples that show how Joe Sheehan refused to be swayed by misleading results of laboratory investigations.

The first example has to do with punishment. As long as speech clinicians have worked with stutterers, they have observed that in situations in which stutterers anticipate social penalties for stuttering, their speech difficulty often tends to increase. Then, about twenty-five years ago, the first attempts to do operant conditioning experiments on stuttering seemed to show the opposite: Loud noise contingent on stuttering blocks decreased their frequency; so did electric shock, the words "no or ~~wrong," and time-out from speaking. And so the cry arose that all our previous assumptions about the effect of punishment on stuttering had been wrong. Now Joe Sheehan had been a pioneer in the application of learning theory to stuttering. But he was not beguiled by this new wisdom about punishment. He had too much faith in his clinical observations. He attributed the so-called punishment effect to distraction. And he was criticized for that. Only later did it become evident that the stimuli used in the laboratory experiments were for the most part not punishing. Reed and Lingwall (1976) showed that the response-contingent administration of loud noise and the word "wrong" frequently failed to elevate the subjects' GSR. Adams and Popelka (1971) and James and Ingham (1974) found that few subjects perceived time-out from speaking as punishment; some evaluated it as a chance to relax. Finally, Cooper, Cady and Robbins (1970) demonstrated that clearly non-punishing stimuli such as the words "tree" or "right" reduced stuttering just as effectively as the word "wrong." It is, of course, possible to regard these effects as punishment by a literal interpretation of Skinner's definition of the term. But calling them punishment does not make them valid analogues of the social penalties that stutterers receive in real situations.

No one knows what causes the "punishment" effects of the laboratory, but I would like to point out in passing that Joe Sheehan's distraction hypothesis is more plausible than many people think. When stutterers perceive loud noise or the words "no" or "right" after every block, they soon become conditioned to expect the strange stimulus each time they expect to stutter. This means that the distraction--if distraction it is--comes at the precise moment that is critical for the precipitation of the stutterering block.

The concept of distraction brings me to my second example. For decades it was generally agreed that stutterers could be distracted from stuttering. It was plausible in itself, and it seemed to explain a great many conditions under which stutterers speak fluently, including the observation that stuttering often disappears when the stutterer adopts almost any novel speech pattern. Then, with the revival of therapies that teach stutterers to speak in new ways, the concept of distraction came under a cloud. Some workers felt that their therapies were disparaged by the implication that their effects were due to mere distraction. So distraction was often branded as a false or even meaningless explanation. The effects of the fluency-inducing speech patterns were attributed to the fact that they produced vocal changes, with the rationale that they compensated for something wrong with the stutterer's phonation. This was easy to do, because the few fluency-inducing speech patterns that had been studied in the laboratory all involved changes in phonation. No attention was paid to the fact that stutterers can often talk fluently when they use a foreign accent or regional dialect, or even when they simply imitate another person's manner of speaking, because these effects have never been studied in the laboratory. No attention was paid to the fact that stutterers are often fluent when they are carried away by enthusiasm, when they are taken off guard, or when they are in emergency situations, because these conditions are very difficult to investigate in the laboratory.

Joe Sheehan was not influenced by the movement to downgrade distraction. His vision was not tied to the laboratory. It ranged over a wide array of conditions that included acting a part in a play, assuming an attitude of false confidence, or hamming in a social situation. He attributed the fluency we often observe in such situations to the fact that the stutterer is assuming a new role, different from his role as a stutterer, and he tended to view the fluency that resulted from novel speech patterns in the same light. I think Joe was right. The distraction in these cases probably does not come from the small amount of attention it takes to talk in a monotone, a high pitch, in a whisper, or in time to rhythm. It seems to come from something that might be called the masquerade effect--the distraction that comes from seeing ourselves in a bizarre role, and perhaps also from the knowledge that others are observing us in that role.

In sum, one of Joe Sheehan's outstanding contributions was the broad and rational perspective that he brought to the scientific study of stuttering. It's a perspective that can be epitomized by saying that what we urgently need in the scientific investigation of stuttering is a little less Skinner and more Darwin. As researchers and theorists, we should never forget that our speech clinics are our Galapagos Islands.

Finally, it remains to be said that Joe Sheehan brought the same rational outlook to the treatment of stuttering that he did to its scientific study. Today we all recognize that, although we can help most adult stutterers a great deal, all our therapies have limitations. In the first wave of behavior therapies fifteen and twenty years ago, these limitations were often overlooked. Joe Sheehan's vigorous warnings were almost the only counterweight to unrestrained optimism and extravagant claims. Joe's warnings have been vindicated. Experience has brought the sobering realization that many stutterers relapse and that cures in which individuals no longer need to monitor their speech carefully are relatively few.

Today one of the questions we hear frequently is "What causes relapse?" If I were to answer that question in the spirit of Joe Sheehan's writings, I think I would say that that's the wrong question. The question is not why so many stutterers relapse, but why some of them don't. When therapy is based on techniques that leave many stutterers talking in somewhat strange ways; when the techniques require stutterers to monitor their speech for indefinite periods; when the techniques have little visible or clear relationship to the cause of blocks, whatever that may be; and when the techniques seem to have the improbable effect of ridding the stutterer of a lifelong speech difficulty in a few moments; when all these things are true, it seems to me that the real question is why some stutterers gain genuine and lasting benefit. If we could answer that question, it might mean significant progress in our ability to help stutterers. I think I can guess at the kind of answer Joe Sheehan might have given. I think he would have said that virtually every therapy has some potential, however small, for helping a stutterer to accept a genuine role as a normal speaker. To put it in a slightly different way, perhaps all therapies have some potential for helping stutterers to forget that they are stutterers. If this is so, then the challenge to us for the future is to find out what it is about almost all therapies that gives them that potential, so that we can make it work for more stutterers.