9 Mar, 11 | by BMJ Group
The film “The King’s Speech” which portrays King George VI of England’s life long struggle with a stammer and his relationship with Lionel Logue, his speech therapist, has raised the profile of stammering and possibly dispelled some myths on the nature of this enigmatic condition. The problem of stammering can seem straightforward to the fluent and it is clear that George VI was not short of either well intentioned advice on the management of his stammer or of offers of treatments that would “cure” the problem.
The experience of speaking with a stammer has been likened to the challenge of getting in a good first serve in tennis. While no analogy is perfect and there is enormous variation in patterns of dysfluency among people who stammer (akin to fingerprints, to use another analogy), the tennis analogy works reasonably well for me. It captures the variation in my underlying fluency in different settings and situations (including the extremes of easy victories and comprehensive defeats), and the sense that even under ideal speaking conditions, a reasonably smooth flow of language can never be taken for granted. Of course in tennis the player on the other side of the net is pleased and relieved if you miss a shot. This is where the analogy with stammering breaks down. In speech we generally create a bond with our listeners and there is a real sense in which our listeners have a stake in us getting the words out and share with us the embarrassment of repetitions, blocks, and associated head or body movements. This is well captured in Philip French’s recent Observer article on King George VI’s stammer in which he describes “a special unease all over the country, indeed all over the Commonwealth and Empire” associated with the King’s Christmas broadcasts, where “Listeners wondered if the king would make it to the end, as if he were precariously carrying words like a drunken waiter crossing a polished floor bearing a tray laden with wine glasses.” One of the consequences of this embarrassment about stammering, completely inordinate from my current perspective, is that the subject becomes taboo with family, friends, and work colleagues. I occasionally discuss stammering with our medical students and I advise them that patients with a stammer, as with any disability, often welcome an opportunity to discuss it.
In tennis if you hit the net or put in a poor serve the game does not stop and you must continue playing. One of the many lessons or challenges of stammering is to stay as much as possible in the present moment, without looking back on stumbles and errors or looking forward in anticipation of dreaded words. This sounds reasonable and it chimes with eastern concepts of mindfulness that are growing in popularity in the west. However it is not easy. It is more an aspiration than a fluency technique. It takes practice, time, maturity, and a certain amount of doggedness to stay fully engaged and aware in moments of pain, frustration, embarrassment, and shame. Why the embarrassment and shame of stammering? In speech we project a version of the self. Most of us operate on the assumption of the self as a fixed and stable entity, and we hold an image of the self that we wish to protect and promote. Stammering sabotages our efforts to project a stable and polished version of the self as our fluency and sense of control over the flow of communication varies markedly in different situations and in conversations with different people. This can lead to a sense of loss and brokenness.
However, the experience of stammering is not entirely negative. I suspect that stammering sensitises one to the tone of conversations and to non verbal cues. The experience of dysfluency in private and public and settings (provided one is not demoralised and defeated by the experience) can help cultivate humility, resilience and possibly a sense of humour. I currently work with an experienced speech and language therapist, with a life long stammer, who has an extensive and colourful repertoire of stammering jokes and the capacity to reduce friends and clients alike to helpless laughter. The relentless demolition of our fabrications of self has the potential to promote an understanding of the self that is more fluid and open and less rigid, precarious, and fragile.
According to Winston Churchill, an outstanding orator despite a stammer, history is written by the victors. In essays and other reflections on stammering there is a tendency to accentuate the positive, to celebrate the achievements of historic figures, such as King George VI, Winston Churchill, and Nye Bevan, all of whom triumphed over adversity despite a stammer. However it is salutary to reflect that the estimated prevalence of stammering in the population (including covert stammering where feared words and difficult speaking situations are avoided) is approximately 0.7%, i.e. over 400,000 people in the UK. There is clearly another history to be written of those silenced in the struggle for words and the attendant fear and shame. We are not doing enough for this silent majority.
Ivan Perry is a professor of public health at University College Cork