Foundations to theories and perspectives on stuttering from a historical perspective of societal influences (Part 1)

About the authors:

hudockDaniel Hudock, Ph.D., Certificate
of Clinical Competence of Speech-Language Pathology (CCC-SLP), is an Assistant Professor at Idaho State
University in Pocatello, Idaho, USA. As a person who stutters himself, he is very passionate about fluency disorders and helping those with fluency disorders. He currently serves on the International Cluttering Association and International Stuttering Association website committees, is the Northwestern Regional Chapter Coordinator for the National Stuttering Association in the United States, and is a Chapter Leader for the NSA’s Southeastern Idaho Chapters. He is a regular presenter at conferences and has several
publications. His research interests are exploring: the communicative process during the observation of normal and disordered speech using eye-tracking,
biobehavioral and neurophysiological measures; stuttering inhibition during the perception of second speech signals; EEG temporal and spectral components for sensory and motor integration and involvement during speech perception and production; and forming effective collaborations between Speech-Language Pathologists and Mental Health Counselors for the treatment of people who stutter.
altieriDr. Altieri, PhD, is an Assistant Professor at Idaho State University. His research investigates speech and language perception, including the extent to which listeners benefit from visual speech under different listening conditions. He has worked to develop and apply capacity measures to investigate efficient information processing, integration, and brain functioning in normal-hearing and hearing-impaired listeners.

Author Note

Daniel Hudock and Nicholas Altieri; Department of Communication Sciences and Disorders, Division of Health Sciences, Idaho State University

Correspondence concerning this presentation should be addressed to Daniel Hudock, Ph.D., Department of Communication Sciences and Disorders, Division of Health Sciences, Idaho State University, 921 South 8th Ave, Mail Stop 8116, Pocatello, ID 83209-8116, USA. Phone: (011) 208-282-4403; Fax: (011) 208-282-4571; E-mail: Hudock@isu.edu

Introduction

The central purpose of the manuscript was to provide an easy to understand entertaining historical framework of how society influences paradigms and paradigm shifts in the field of stuttering and to lay the foundation for more current frameworks. Since the time of Ancient Greece philosophers there have been numerous proposals about the causes, cures, and features of stuttering (Bloodstein & Bernstein-Ratner, 2007; Van Riper, 1973). The proposal of “popular” theories still occurs via novice individuals offering unwarranted advice of what they believe is helpful advice to an individual who stutters (Silverman, 1996). An explanation for the frequency of these perspectives by a plethora of well-known historical figures is likely, at least in part, due to the observable overt characteristics represented by stuttering. Additionally, stuttering has relatively little influence on individual longevity as a whole, but exhibits major emotional impact on both the person who stutters (PWS) and their communication partners (Kalinowski & Saltuklaroglu, 2005). Being a PWS, the first author, has on several occasions been reminded by wait-staff, servers, employees and various others that upon meeting they have previously met, even if it was more than two years prior, some of these individuals have remembered the authors name.

Classical Era: Early Historical Accounts

Over the past 14 centuries there have been thousands of theories and therapeutic ideas for stuttering (Bloodstein & Bernstein-Ratner, 2007; Van Riper, 1973). A large majority of which are influenced or developed by niche philosophic, psychological, or technological innovations of the time period. Throughout the manuscript the authors will attempt to relate changes in social psychology, philosophy, science, technology, and the societal culture to altered beliefs and theories regarding stuttering and how components of those perspectives have persisted through the centuries and into recent times. We will attempt to sequence this discussion in chronological order in hopes of providing adequate support for our argument. Additionally, by constructing the flow in this manner, we hope to build on preceding theoretical and empirical foundations to support our notion that more recent stuttering theories and perspectives have been built from historical perspectives. Moreover, we hope to illuminate the fact that interpretations about stuttering are heavily influenced by societal perspectives and technological advancements, however are based on unchanging general anatomical, psychological, or environmental factors. In other words, as the society advances, in technological or scientific terms, definitions, descriptions, theories, and therapies related to stuttering may change, but these changes have a basis on previous interpretations of associated factors. The interpretation may change but the phenomena remains.        

China and the Middle East

Stuttering has been documented in Chinese writings from earlier than 4,000 BCE, on clay tablets in Mesopotamia (i.e., 2,500 BCE), in Egyptian hieroglyphics, and throughout biblical references (Bloodstein & Bernstein-Ratner, 2007; Faulkner, 1991). However, due to translation issues researchers can only offer interpretations for some of the texts. Yet, the more recent of these historical documents— the biblical references provide insight into views of stuttering from that time. Goldberg, (1989) relays the following account of baby Moses:

According to a Talmudic scripture the pharaoh knew of a prophecy that a first-born would rise up against him to lead the Israelites. The pharaoh offered a baby named Moses a plate of gold and a plate of hot coals, intending to kill the prophesied child if the plate of gold was chosen. As any child would, baby Moses reached for the shiny gold. Before the pharaoh acted an angel appeared and put a hot coal in Moses’ mouth. Being made slow of tongue the pharaoh saw no need to harm Moses. It is reported in the scriptures that the angel then told Moses:

“the heart also of the rash shall understand knowledge, and the tongue of the stammerer shall be ready to speak plainly (Isaiah 32:4)”

Another documented case referring to Moses’ stuttering is in Exodus (4:10-12):

“Then Moses said to the LORD, “Does though not wish to send my brother Aaron, Please, Lord, I have never been eloquent, neither recently nor in time past, nor since You have spoken to Your servant; for I am slow of speech and slow of tongue.” The LORD said to him, “Who has made man’s mouth? Or who makes him mute or deaf, or seeing or blind? Is it not I, the LORD? “Now then go, and I, even I, will be with your mouth, and teach you what you are to say.”

These passages reveal some clues as to how people of that time viewed stuttering. The idea that stuttering could be caused by placing a hot coal on the tongue of an infant suggests that people of that time believed stuttering was caused by an anatomical malformation of the tongue. God promising that he would later cure Moses of his disorder indicates that people believed a cure for stuttering relied on divine intervention.

During the second passage, Moses asked the Lord to send his brother in his place to give the message to the pharaoh. This event implies that Moses had doubts along with negative emotions related to his stuttering. Finally, the phrase “I will be with your mouth and teach you what to say” supports the interpretation that stuttering can be cured if the PWS is taught how to properly speak. The mentality that PWS can relearn how to speak properly maintains today in some circles, and throughout naïve stereotypes.

Although there were likely folk remedies for stuttering at the time in many areas of the world, from the remaining texts of the provided locations, one is left to interpret that the biblical Mediterranean, or at least Christian religiously influenced areas, believed that stuttering was caused by some organic malformation to the tongue and could only be cured by divine intervention. As will be shown, the state of the society influences the perception of stuttering.

Greek and Roman Era

The tale of Battos (son of Pylos) a Greek Sheppard of Neleus in 484 BCE is another one suggesting belief of divine intervention (Hunt, 1861). “It is said that the god Apollo made Battos stutter after angering the god. Battos angered the god by withholding the identity of the person who stole Apollo’s cattle. Battos had previously made a deal with Hermes to not tell Apollo that Hermes stole the cattle. Battos did not tell Apollo because he feared Hermes’s reprisal for betraying promise. To cure his stuttering Battos sought guidance from Oracle of Delphi. Knowing that he stuttered more when he was around people, she recommended that he banish himself to placate the gods and in doing so would cause them to be merciful (Herodotus, 1821)” as referenced in (Silverman, 1996, pg. 10).

These representations suggest a fear of deity reprisal and a societal necessity for obedience to religious statues. As democracy increased and religious control over philosophy waned, philosophers began theorizing about the processes of the human body. One philosopher who sought separating religion from science and medicine during this time was Hippocrates, known for the Hippocratic Oath. He developed the theory of the four humors and equated these (fluids) to four temperaments: blood to hopefulness, black bile to sadness, yellow bile to irascibleness, and phlegm to apathy. It was believed that pathologies were caused by an imbalance of the humors. Stuttering was no exception; Hippocrates believed that a symptom of stutter was caused by a dry malformed tongue and that wetting the tongue with wine would aide in rebalancing the humors (Bloodstein, 1992). This notion of a more distal cause with proximal symptoms is the first record of stuttering being viewed from a medical model that saw speech disruptions as a symptom, not a cause.

Around the same time Aristotle and Demosthenes were treating stuttering with approaches focused on improving the functioning of the tongue and speech mechanism (Van Riper, 1973). While relatively little is known about the therapies prescribed by Aristotle, this is not true about the self-prescribed therapy of the great Greek Orator Demosthenes. In an effort to strengthen his tongue and improve his elocution, he would walk up and down the beach speaking with pebbles in his mouth (Van Riper, 1992).

Similarly, Aurelius Cornelius Celsus (42 BCE – 37 ADE) another physician cited in Hunt (1861):

When the tongue is paralyzed, either from a vice of the organ, or in consequence of another disease, and when the patient cannot articulate, gargles should be administered, of a decoction of thyme, hyssop, or penny royal; he should drink water and the head, the neck, the mouth and the part below the chin should be well rubbed. The tongue should be rubbed with lazerwort, and he should chew pungent substances, such as mustard, garlic, onions, and make every effort to articulate. He must exercise himself to retain his breath, wash the head with cold water, eat horse-radish, and then vomit. Celsus also describes the operation of dividing the fraenum in tongue-tied subjects.” (pg. 22)

Regardless of the specific treatment, or belief that the tongue needed moistened or dried, this time period still maintained the view that the “malformed” tongue was just a symptom of another deficit area and that the symptoms of the disorders should be treated. Clinicians maintained treatment of the tongue for more than a millennia and still treat symptoms of the underlying disorder, albeit with different strategies that generally focus on language and cognition.

Middle Ages

The demise of the Roman Empire in 476 ADE brought about inactivity in science and philosophy from the 5th century to the 16th century. The church regained their lost grip over science and medicine and consequently little time or energy was devoted to scientific topics (Heather, 2007). Therefore the “sluggish tongue” remained a symptom of another underlying physiological deficit until the start of the Renaissance (Onslow, 1995). Aetius of Amida in the sixth century maintained that the frenulum attachment of the tongue should be cut to alleviate spasms. During the Middle Ages, it was common knowledge that stuttering occurred more often in males and that the moment of stuttering occurred more frequently during initiation. In 1300 AD Bernard Gordon reported that all children appeared to go through disfluent periods (Hunt, 1861). However, one of the only other accounts of stuttering from this era was Notker the Stammerer, a Roman Catholic saint of music, literature, and poetry (Hunt, 1861). It was reported that he was “delicate of body but not of mind, stuttering of tongue but not of intellect, pushing forward in things Divine, a vessel of the Holy Spirit without equal in his time” (Hunt, 1861, p. 22). This account of his intellect as being sound of mind is the first report of the intellectual capacities of PWS. The secular description along with lack of scientific inquiry indicates that the society maintained previous perspectives on stuttering.

Part I of this paper provided a brief discussion on early societal influences on perspectives about stuttering that build on historical interpretations. As we shall see, especially in Part II, many of these historical perspectives guide and influence current theories and therapies of stuttering.

Click here to go directly to part 2 of this paper.

References

Bloodstein, O. (1992). Stuttering: The Search for a Cause and Cure. Boston: Allyn & Bacon.

Bloodstein, O. & Ratner, N. B. (2007). A Handbook on Stuttering (6 ed.). Delmar Cengage Learning.

Bible, K. J. (1993). The Book of Psalms (Dover Thrift Editions). Dover Publications.

Faulkner, R. (1970). Concise Dictionary of Middle Egyptian (Egyptology: Griffith Institute). Griffith Institute.

Goldberg, B. (1989). Historic treatments for stuttering: From pebbles to psychoanalysis

Hunt, J. (1861). Stammering and Stuttering; Their Nature and Treatment. General Books LLC.

Kalinowski, J., & Saltuklaroglu, T. (2005). Stuttering. San Diego: Plural Publishing.

Onslow, M. (1995). Behavioral Management Of Stuttering. San Diego: Singular.

Silverman, F. (1996). Stuttering & Other Fluency Disorders 2nd EDITION. Alyn & Bacon.

Van Riper, C. (1992). The Nature of Stuttering. USA: Waveland Press.

Van Riper, C. G. (1973). The Treatment of Stuttering. Englewood Cliffs, NJ: Prentice Hall.

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