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 "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, 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. 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 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 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 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 "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. "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 "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 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 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 "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 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 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 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 concerned, remains subconsciously alive in his memory, is ever seeking to emerge again into conscious remembrance, and, failing to do this, takes its revenge, so to speak, by the production of disease symptoms ranging from mere eccentricities of thought and behaviour to symptoms mimicking those of true organic disease. Also, the investigators knew that the particular form these mentally caused symptoms take depends chiefly on the kind of suggestions received from the sufferer's environment. If he chances, for instance, to have a relative or a friend who is a paralytic, he may, in time, develop pseudosymptoms of paralysis himself. Or, if his nervous equilibrium be sufficiently upset, he may develop them from merely hearing or reading about them. Whatever the symptoms he manifests, his malady is curable—precisely as it was produced—by mental means alone. Often, a counter-suggestion, to the effect that henceforth the psychoneurotic person will be perfectly well, is enough to work his cure. Or, permanently curative effects may be had only when, by special techniques devised for the express purpose of rummaging through the subconsciousness, the forgotten memory, or memories, responsible for the psychoneurosis are brought to light, and the specific suggestion directly or indirectly made that from that time they will do no harm. Sometimes, experience has shown, the mere On the view that stammering is similarly a psychoneurotic symptom, and that, when it fails to yield to treatment by general suggestion, it is because the subconscious memories underlying it are too intense to be thus subdued, this group of investigators undertook to treat it as they would any stubborn psychoneurosis. The outcome of their experiments has been such that I feel justified in declaring that science has at last penetrated to the true inwardness of stammering. These psychologically trained physicians have taken stammerers who had well-nigh exhausted their hopes and their resources in a futile quest for normal speech, and, after subjecting them to the searching methods of psychological analysis, have sent them on their way rejoicing, either in a perfect cure or in a lasting improvement far beyond their expectation. Citing a few instances of actual occurrence, a "Ah, but," Doctor Dattner pointed out, "do you not realise that, after all, your dread is caused by—not "You mean in the attack of diphtheria?" "Not at all. I mean in something that happened to you before you had diphtheria—something which so exceedingly distressed you that it was continually uppermost in your thoughts, and which finally worked on you so much that when your nervous system was weakened by the diphtheria it gave rise to your stammering. Now, we are going to try to discover what that something was, and, when we have done so, it will be possible really to cure you. Can you recall any particularly disagreeable incident of your childhood occurring at any time before you were ill of diphtheria?" "No," said the other, after a little reflection, "I think that I was perfectly happy as a child, and certainly I was treated kindly." "Just the same, something must have happened To this end, Doctor Dattner now made use of the "free association method of mental analysis," which consists in requesting the patient to concentrate his attention on his symptoms, and state without reserve the thoughts coming to him in connection with them—the theory being that, if there is any exceptionally distressing idea underlying them, the current of his spoken thoughts will, soon or late, reveal it. In the present instance, this method at first brought forth only trivial and commonplace memory associations. But, after a time, a reminiscence of intense emotional colouring suddenly emerged. It related to an episode of the stammerer's eighth year, shortly before his attack of diphtheria, when he was pounced upon and frightened almost into convulsions by a huge black dog. This had virtually faded from his conscious memory; but now, as he sat in the quiescent mood enjoined on all patients undergoing psychoanalytic treatment, it welled up "Precisely," said Doctor Dattner, drily. "And, you see, the thought of it is still with you, for look how graphically you have described it all. The trouble is that it has been leading an independent existence, as it were, in the depths of your mind, with all its original emotional intensity. Your stammering, I can assure you, has been nothing more than the external manifestation, the symbol, of its continuing presence, and of the deadly power it has had over you—sensitive, impressionable child that you must have been. But I can also assure you that your stammering will now come to an end; for we have not only found its cause in the subconsciously remembered shock of your boyhood, but we have Altogether, it had required just six hours of psychoanalysis, at the rate of about an hour a day, to recover this horror-encrusted memory of the stammerer's childhood. But, with its recall, and strikingly validating Doctor Dattner's confident prediction, he once more began to enjoy the blessing of a facile, flowing speech. In another case—treated by the American neurologist, Doctor Coriat, who has made extensive use of psychoanalytic methods—the patient was a man of middle age, who stammered not only when he spoke, but even when he wrote, repeating letters and syllables in anything he tried to put on paper. He had been to two stammering schools and had been discharged from both as cured, but each time had speedily relapsed. As in the case of Doctor Dattner's patient, psychoanalysis "These," he recalled, "took complete possession of my mind. I became convinced that the end of the world could not be long delayed, and I was in an agony of terror. Constantly I kept asking myself what I should do to escape destruction. I knew I was a bad boy—very bad. Nothing could atone for the sins I fancied I had committed. But I kept my fears to myself; I did not dare confide them to others. Night and day I worried about them, picturing to myself the terrible happenings of the approaching time of doom." Until psychoanalysis brought them up to the surface Another of Doctor Coriat's patients—a young woman—impressed him, from the day of her first visit, with her extreme timidity and self-consciousness. Both were so pronounced as to be abnormal, and he immediately suspected that they, in common with her stammering, would be found linked with subconscious memories of occurrences that had tended to deprive her of proper appreciation of her abilities and rights. She proved a good hypnotic subject, and, knowing that in hypnosis long-forgotten events "Can you remember," he asked her, "just when it was that you began to stammer?" "It was when I was a very little girl." "Had any one or anything greatly frightened you before then?" "Yes." "What was it?" "It was my father." Then followed, in answer to further questions, a long series of reminiscences of the severe discipline imposed on her in earliest childhood by her father, a stern, hard man. As she related them, she seemed to feel again all the emotions that they had provoked—the shame, grief, fear, doubt, longing for sympathy. Literally, she lived through them anew, and to the trained understanding of the physician it was evident that she had never really forgotten them—although, in the waking state, she was able to recall her childhood only vaguely—but had subconsciously dwelt Similarly, it has been found that emotional disturbances are at the bottom of stammering when it develops, not in childhood, but in adult life. A particularly instructive case, because of the insight it affords into the ingenuity with which the expert psychoanalyst gets at the truth in even the most complicated cases of functional nervous or mental disorder, is one that was successfully handled by Doctor A. A. Brill, already mentioned in these pages, a pupil of the pioneer Austrian psychoanalyst, Doctor Sigmund Freud. Doctor Brill's patient was a man who, after an early life untroubled by speech defect, had begun to stammer from no discernible cause, and had been stammering for a number of years before he consulted the New York specialist. Several weeks of psychoanalysis elicited nothing that However, after psychoanalysis had proceeded further, Doctor Brill learned that there had been an event in the patient's life, though occurring some little time before the development of the stammering, that had made a most painful, even agonising, impression on him. He had been engaged to a young woman who had eloped with his closest friend; and this had so wrought on him that he had vowed never to utter her name again. "And what was her name?" asked Doctor Brill. The stammerer stared at him and burst into a violent tirade. "Haven't I just told you," he cried, "that I have taken an oath never to speak it? What business "Only this bearing—that it may be the means of curing you. Come, now, I am sorry you have taken an oath, because you will have to break it and tell me the name." "I'll die first." With this he seized his hat and dashed out of the doctor's office in a frenzy of indignation. Doctor Brill did not see him again for a month. Then he returned, repentant. He would tell the name, he said, on condition that Doctor Brill did not write it down in the detailed record which, as is customary, he was making of the case. To this a prompt assent was given, and the troublesome name was as promptly made known. As Doctor Brill had expected, it began with K. He then said, leaning forward and showing his sheet of notes: "See, I have kept my promise. I have called her Miss W. And, now, we'll soon have you quite well." But on his next visit the patient was in despair. "At last," said Doctor Brill, "we know for a certainty what has made you stammer. It was the foolish oath you took, which served to sustain in your mind the memory of the terrible experience you went through on account of your faithless sweetheart. Vowing never to utter her name, yet thinking constantly of her, you have unconsciously made it difficult for you to utter even words in which the most prominent letter of that name—its initial—occurs. And, now, since she has become Miss W. to you, as well as Miss K., you are stammering on words with "w," as well as words with "k." We must free you from the torment of that vow and of the pent-up emotions that go with the forbidden name, and then you will never stammer more." To this mode of dealing with stammerers could Stammering, to recapitulate, is not at bottom an anatomical or physiological trouble. Its individual peculiarities, varied as they are, all tend to prove that it is a mental malady, symptomatic of a psychoneurosis having its origin in subconscious emotional states. The rÔle that heredity plays in it is merely to provide the soil in which it can flourish. Of wholly mental causation, it is curable by mental Lest, however, I raise hope unduly, I would at once add that not even the most expert practitioners in psychoanalysis, or in any other psychological mode of treating stammering, are justified in guaranteeing an absolute or an "approximate" cure in every case. Experience is showing that the "emotional complexes" responsible for stammering are, in many cases, so deep-seated—and often so entangled in later complexes—that it is virtually impossible to get at them by any present-known method of mind tunnelling. And, in many other cases, the process of psychoanalysis is so slow and tedious that the stammerer is all too likely to lose heart and abandon the effort at cure. Consequently, in respect to stammering, prevention becomes of more than usual importance. And |