THERE lies convenient to my hand at this moment a thin, pamphlet-like volume that tells the story of one of the strangest, among the many singular and tragic blunders which medical science has made in its progress to knowledge. It is a translation from the German of Doctor J. F. Dieffenbach's "Memoir on the Radical Cure of Stuttering." Assuredly, Dieffenbach's "cure" was radical enough, for it consisted in nothing less than the excision of a large, wedge-shaped section from the stammerer's tongue! In this little book, published in 1841, and embellished with several ghastly full-page engravings, is described, with great professional gusto, the first of these terrible operations[208] as performed, without the merciful aid of any anesthetic, on an unhappy boy of thirteen. The result was a "complete success." Says Dieffenbach, writing a few weeks after the operation: "At the present time not the slightest trace of stuttering remains, not the slightest vibration of the muscles of the face, not the most inconsiderable play of the lips. His speech is, throughout, well toned, even, and flowing."
Thus was inaugurated a period of butchery that lasted until—almost before the year was out—it was observed that those "cured" by this sanguinary means usually began, before long, to stammer as badly as ever, and also that those who were not "cured" had a tendency to die. Yet Dieffenbach was no charlatan, no "quack." He was a reputable surgeon who honestly believed that he had discovered the true remedy for stammering. And, if the passage of time has intensified the tragedy and absurdity of his method and has relegated his glowing account of it to a place in the literature of medical curiosities,[209] there is this to be said of him—that he has had plenty of successors who have erred almost as seriously in their attempts to solve the problem presented by the widespread and baffling malady of stammering.
In fact, up to within quite recent times the record of the struggle against stammering has been one of continuous failure. There has been a steady accumulation of methods of treatment, from surgical operations of a less drastic type than Dieffenbach's to the use of various articulatory and respiratory exercises and devices, without any appreciable effect in the diminution of stammering. Even to-day the great majority of physicians and lay specialists—to whom, by a sort of tacit agreement, the medical profession has largely relinquished the task of dealing with stammering—labour to next to no purpose. At this very moment there are in the United States at least three hundred thousand persons who stammer, fully half of whom stammer so badly that they are severely handicapped in the gaining of a livelihood.[210] Thousands of these have resorted to medical advice, or have attended so-called schools for stammerers, with lastingly beneficial results to few. Small wonder that there is, among stammerers and their friends, a tendency to believe that stammering is one of the hopelessly incurable maladies of mankind.
And this would undeniably appear to be true, as regards many stammerers. On the other hand, it may confidently be said that nearly all cases of stammering are actually susceptible of marked improvement, often amounting to 75 or 90 per cent. of a cure; and that a number of cases can be completely cured. Such a statement, to be sure, could not have been safely made even a few years ago. This for the reason that only lately has there been any really systematic effort by scientifically trained investigators to study the phenomena of stammering, with a view to ascertaining, with scientific exactness, its true nature and causation.
Stammering, it has long been recognised, is not a malady of uniform symptomatology, like tuberculosis[211] or typhoid fever. No two stammerers stammer precisely alike. They stumble over different letters and sounds; time, place, and circumstances have varying effects on the degree of their stammering; and the physical spasms and contortions that so often accompany this trouble differ in different stammerers. There is, too, a great variation in the onset of stammering. Mostly, it is true, it manifests itself in childhood, from the age of four to eleven. But it may not set in until much later in life; and, when it does begin in childhood, it begins under much diversity of conditions.
Sometimes a child stammers almost as soon as he has learned to speak, though seldom, if ever, coincident with the learning. Often, the first appearance of stammering follows some disease like measles or diphtheria. Or, again, a child who has been speaking quite well, suddenly begins to stammer, and persists in stammering, after being brought into contact with people who are themselves stammerers.
"I was entirely free of stammering," declares a[212] clergyman, in a typical statement, "till I was five years old. At that time of life there was a gentleman who occasionally came to my father's house, and stammered very badly. I distinctly remember one afternoon trying to imitate him; when, unfortunately, he heard me, and was very indignant. So ashamed were my parents at my conduct that, after he had gone, I was taken to task and punished severely for it. Ever since that night I have been afflicted with this most distressing malady, in spite of all my efforts to overcome it."
Compare a statement by a Philadelphia physician, Doctor D. Braden Kyle:
"Several years ago I saw three interesting cases of stammering. Two of the cases were imitation. These two lads, who were associated with a boy several years older, the worst stammerer I ever saw, clearly imitated him. As they were constantly together, the imitation was almost continuous. They certainly developed into expert stammerers. In less than two years they were confirmed stammerers, and[213] it was impossible for them to speak at all without stuttering and stammering."
Facts like these, I repeat, have long been observed and commented on by specialists in the treatment of stammering; but they have, for the most part, been dismissed as mere "oddities," while emphasis has been laid on the single fact that, in the majority of cases, stammerers have had parents or other relatives who themselves stammered. "Heredity," consequently, has been assumed to be the one and sufficient explanation of all stammering; and it has also been assumed that what is inherited is either an anatomical or a physiological defect. Hence, in too many instances, the use of the surgeon's knife; and, hence, the invention of innumerable systems designed to train the stammerer in the correct use of his breathing and articulating organs—in a word, systems intended to teach him how to talk.
But, as even the most enthusiastic exponents of these corrective systems are now beginning to appreciate, whatever else the stammerer may need, he does[214] not need to be taught how to talk. For he can talk well enough on occasion. Nothing is more significant, from the standpoint of assisting to a clear understanding of the nature of stammering, than the fact that there are uncommonly few stammerers who have any difficulty in speaking when nobody is with them. On this point, every stammerer with whom I have been in touch is in remarkable agreement, and others who have had a far wider acquaintance with stammerers testify to the same effect. For example, Mr. Charles L. Rowan, of Milwaukee, a gentleman who has stammered for years and has made a close study of the subject, informs me:
"When I am alone—and the same is true of other stammerers—I have no speech difficulty whatever, and can talk or read aloud for hours with ease. It is only when I am with others that I halt and stammer in my speech. Sometimes I talk in my sleep, and the folks tell me I do not stammer then. But, if I am dreaming, and in the dream imagine myself talking, it is always in a stammer.
[215]
"I have also noticed that most stammerers talk better when the subject is light and frivolous than when it is something serious. And they talk better when conversing with people whom they regard as inferiors. I know a man who is a section foreman, and he says he can give orders to his negro and Mexican labourers perfectly, but if the roadmaster comes along he cannot talk to him at all."
And a stammerer from Spokane, Washington, informs me:
"I would like to say that there are periods when I can talk much better than for corresponding periods. Indeed, there are times, generally a few days at a time, when it is most difficult for me to talk with even a slight degree of correctness; and, then, there are periods of as long, or longer, duration when speech seems to flow with more ease, though never perfect, except for a few words in succession."
More than this, according to one diligent investigator, the majority of stammerers fail to stammer if addressed in such a way that their replies are[216] made without their realising that they are talking. Says this observer:
"Suppose a stammerer is engaged in a deep study and unaware of your presence. You speak to him softly. He answers readily, without hesitation, in an absent manner. Again, you ask a careless question, implying by your manner that you do not expect or desire an answer; to this he quickly and easily replies also. Now, look straight at him and pointedly interrogate him. See, when it becomes necessary for him to speak, how he is thrown into confusion."
It has further been found that most stammerers are at their worst when in the presence of strangers. Some stammer scarcely at all when at home with their relatives and intimate friends. On the opposite, there are some who stammer worse than usual when with relatives. Not so long ago I learned of one stammerer—a young lady who had stammered from early childhood—whose trouble was most in evidence when she was talking with her mother. Almost all[217] stammerers, too, enjoy temporary relief from their speech defect when greatly startled, angry, or otherwise excited.
Decidedly, then, it is not from anatomical or physiological inability to speak that a stammerer suffers. It is, rather, from a psychological inability. That is to say, the facts just mentioned indicate strongly that stammering is primarily a mental malady—that it is due to the presence, in the mind of the stammerer, of some idea or ideas that inhibit the normal functioning of the organs of speech. This conclusion is confirmed by the additional circumstance that nearly every stammerer who has been questioned on the subject admits that he is perpetually tormented by a haunting dread of not being able to express himself clearly to others, and so of exposing himself to their ridicule, contempt, or pity. Many, indeed, affirm their conviction that if they could only overcome this dread they would be free from their affliction. "I believe," is a characteristic utterance of stammerers, "that if I were to wake up[218] some morning with total forgetfulness that I had ever stammered, I should never stammer again."
Still more significant is the fact that, of the many methods which have been invented for the treatment of stammering—and which include such curious devices as beating time with every word, and wearing artificial supports under the tongue—all have had to their credit a certain—however small—proportion of genuine cures. This would suggest, not that they have been intrinsically valuable, but that, in the cases cured, they so impressed the mind of the stammerer with their therapeutic virtue as to banish his long-entertained belief that he could not talk like other people. For that matter, recent experiments go to bear out the view that almost any method, no matter how fantastic, will cure some stammerers, if only they have a lively faith in its efficacy.
For example, there was once brought to the Boston City Hospital a woman of thirty-five, who, though formerly speaking without any difficulty, had begun to stammer in a frightful manner, following[219] a violent quarrel with her husband. She could utter scarcely a sound, except weirdly inarticulate noises, and these only by a great effort. The physician to whom her case was entrusted soon became satisfied that she was suffering mainly from a profound belief that she would never be able to talk again; and he therefore endeavoured to reason her out of this, but to no purpose. Finally, he abandoned the attempt, and, after leaving her pretty much to her own devices for several days, impressively said to her one morning, in a tone of great authority:
"Well, Mrs. Blank, I have been looking carefully into your case, and I find there is one way certain to cure you. It may be a little painful, but I know you will not mind that, as long as it is going to make you entirely well."
So saying, and with an air of the utmost confidence, he began to apply to her an electric current, just strong enough to make her wince. Only a few treatments of this sort were found necessary to enable[220] the hospital authorities to discharge her as cured—and she stayed cured.
Of late, consequently, with growing recognition of the dominant psychic factor in stammering, there has been an increasing tendency—though as yet it is far from universal—to employ psychological methods in treating stammerers. The effort is made to instil confidence in the sufferer—to convince him that he need only exercise his will power to bring about his own cure. In a good many cases, and frequently with gratifying results, resort is had to hypnotism, the "suggestion" being reiterated to the patient, while in the hypnotic state, that in the future he will experience none of his overwhelming sensations of dread and anxiety and will speak as fluently as persons who have never stammered. Or he may be treated by psychic re-education, which consists essentially in the development of volitional control by suggestions tactfully imparted in the ordinary waking state. All of which unquestionably marks a tremendous advance over the theories and[221] practices based on the alleged anatomical or physiological defects of stammerers.
There is this to be added, though, that, sanely beneficial as is the psychological treatment of stammering, it often happens that the confidence-inspiring suggestions given to stammerers do not "take." The stammerer, albeit he may perhaps show improvement for a time, remains without clear articulatory power. When this occurs, the natural tendency among those treating him—in view of the demonstrated truth that stammering is the effect of a peculiar state of mind—is to throw the blame on the patient instead of on the method. Yet, actually, it is the method that is at fault—or, to be exact, it is the failure to apply the method, which itself is thoroughly sound—in such a way as to remove from the stammerer's mind not only the fear that haunts him and helps to perpetuate his stammering, but also the ideas in which his stammering originated.
Here we come to the central fact in the whole problem of stammering—a fact which, when it is widely[222] enough known and appreciated, is certain to exert a far-reaching influence on the prevention of stammering, as well as its cure. Until very recently, few have been aware of this fact except a small group of foreign investigators, physicians with a psychological training, whose special business it has been to determine scientifically the possibilities, the limitations, and the exact procedures to be followed in supplementing, by wholly mental treatment, the ordinary medical and surgical treatment of disease. Impressed by the predominance of the mental factor in stammering, these investigators were particularly impressed by some of the peculiarities mentioned above—as, the ability of almost every stammerer to speak well when alone or when in a state of abstraction. Such peculiarities, they knew from long experience, bore a strong resemblance to oddities in the behaviour of victims of hysteria, psychasthenia, or other psychoneurosis, in all of which disorders there is a tendency for symptoms to disappear when the sufferer's attention is momentarily withdrawn from[223] them. Accordingly, it seemed to the investigators quite possible that, in the last analysis, stammering was not so much a disease in itself as a psychoneurotic symptom.
They were well aware, for reasons already set forth in these pages, that psychoneurotic disorders have their origin in emotional disturbances of one sort or another, which, occurring to a person of nervous temperament or rendered neurally unstable by a faulty upbringing, react adversely on the entire organism. Exactly what happens is that the emotional disturbance—whether it be a fright, a grief, a worry, or what not—while perhaps completely forgotten by the victim, so far as conscious recollection is............