Self Help: Indian Experience

satyendraAbout the author:  Dr Satyendra Srivastava is a community health consultant working with voluntary sector in Indian Himalayas. He is the founder and present coordinator of The Indian Stammering Association (TISA).satksri@gmail.com

Philosophical origins

This Self is to be achieved through self-effort.  (Gita; Ch 6, Verse 5)

This Self is not to be attained by the weak…  (Mundak Upanishad. III. ii. 4)

As a paper originating from India, it might be forgiven to begin on a philosophical note! In my early forties, I was suffering from “Loss of self”: Who am I? My stammering self? Or my fluent self?[1] And of course, there was a deeper question, inspired by Raman Maharishi: Who am I, beyond my speech?[2]

About this time I had a breakthrough, helped by the above thoughts from scriptures and other events – and a self-help movement began. Communicating with others on the same path became a “need” as well as a practical application of the above ideas: The stammerer must take responsibility and initiative for his own healing – and the “wholeness” he is searching for is all within; it is not something to be added from outside. He just needs to stop “interfering”. This initiative had to be put in our context, in line with our evolution over the last five millennia – selfless service to others puts us in touch with our larger Self[3], which is the basis of true and enduring healing and wholeness.

Practical Implications

..Anything you accept fully will get you there, will take you into peace. This is the miracle of surrender..”  (Eckhart Tolle, The Power of Now: A Guide to Spiritual Enlightenment)

As this self help movement began, we emphasized the role of accepting the reality of this stuttering moment and from here, initiating a change, based on self-effort and self-responsibility. Acceptance sets one free from the inner loathing, resistance and struggle, and makes it possible to consider other alternatives and move forward. Instead of running away in abject fear, instead of outsourcing the whole task to an “expert” (and complain later!) we said: only I can change myself on a sustainable basis. No one else can do it for me.

We felt that search for and promise of fluency & cure, which plagues main stream therapy, in India at least, had totally eclipsed the central role of communication in the entire discourse. The sheer purpose of opening one’s mouth is to communicate something with someone. Ignoring this, many of us have gone on a meaningless trip of “clinical cure”. Fluency in isolation.

Beginning 2008, we tested and perfected a model of three day Communication workshop, based on centrality of the stammerer, his experiences and needs, principles of adult learning and de-medicalization of stammering – all, under an overall framework of self-help[4]. Participants of these workshops are encouraged to later attend (or initiate) Self-help group (SHG) meetings in their own town or workplace – and get back for a couple of more workshops, to clarify doubts and for some more practice. We stopped counting these workshops after twenty or so in 2012!

To help this process, we promoted a community blog and developed a self help manual, Apna Hath Jagannath[5]. The title is a Hindi proverb in praise of self-effort. We can not claim uniform success or large turnover. The reason is: India is a vast and complex country and the idea that stammering is a disease and some wise therapist can cure it, still survives. But whatever success we have had, has been significant and has helped to sustain TISA, a voluntary movement over the last seven years.

Challenges

We have had our fair share of challenges and criticism!  Some quarters have misunderstood our reluctance to promote this or that therapist, program or gadget on our blog and in our SHGs. We have steered clear of technical devices such as Speecheasy[6] and programs like McGuire[7]. Both cost over a lakh of Indian rupees (~1640 USD) – a huge amount for most of us! Whether these work in long term or don’t, is a separate issue, but the pricing itself shows deep insensitivity to local realities. Secondly, we felt that as a self help movement, we must not stray from our core theme: However little gain I make on my own, will be mine for ever and will add to my self-worth and confidence. If I relapse, I simply have to go back and repeat those steps.

Another genuine question has been: why is TISA not like the National Stuttering Association of America and other associations?! We think that every association is a manifestation of their national ideals and their particular way of conducting business. We continue to be totally staffed by volunteers with no brick and mortar office (other than our homes) and no balance sheets to worry about. We raise funds for specific activity internally and share the details on our website. We put necessary documentation on our public blog and website. None of us gets “compensated” for our time, for counseling, for conducting communication workshops, running self help groups, organizing conferences, managing blog and website or for bringing out a newsletter[8] etc. But yes, we must and we do learn from others – like Vipassana, Brahmavidya, Brahmakumaris, Toastmasters, StutterTalk etc., without losing our essence.

Voluntarism

Give till it hurts.  (Mother Teresa of Calcutta)

We think that the spirit of voluntarism is important enough to be kept alive, in a nation which gave the gift of Buddha’s message to half the globe, two millennia ago, without military conquest and without an army of salaried preachers. In fact, voluntarism itself has played a huge role in recovery for many of us: we stopped “daily one hour slow reading practice” and stepped out of our comfort zones, managed some crazy national “events”, connected with others over phone and internet, spoke in public for our beliefs, traveled around, conducted stuttering interviews in trains and shopping malls etc. All the soft skills which a Business school perhaps would have taught us for a suitable fee! But we try and discount these spin-off benefits in our discourse, because true voluntarism must be self-less, not constantly calculating the cost and benefit ratio.

Core content

If you don’t run your own life, somebody else will.  (John Atkinson)

Over the years, some research and some trial helped us to fine tune our core content. We promote, share, practice following core techniques or ideas:

  1. Bouncing
  2. Prolongation
  3. Pausing
  4. Voluntary stammering[9]
  5. Good eye contact
  6. Belly breathing (self/breath awareness)
  7. Block corrections (as a way to practice above techniques during moments of difficulty – a simulation)
  8. Gentle onsets (bringing awareness to speech organs)
  9. Vocalization exercises (exploring pitch, volume etc.)
  10. Expressive writing (diary or blog) & other creative expressions

All this, in an overarching framework of acceptance and communication. By acceptance we mean: I should be able to say “I am a doctor” or “I am a stammerer”, both with the same equanimity and ease. And communication skills- because, that is the REAL goal of speech and needs to be formally learned by everyone. No point in becoming fluent but unable to hold a meaningful conversation or make an effective presentation.

Then in addition, we encourage people to explore and benefit by those practices, which stand to common sense and are easily available in public domain for free or for a very small fee: Affirmations (EFT), Vipassana, Brahmavidya, Meditation, Pranayam, Kriya Yog, Art of Living, other religio-spiritual traditions or practices in India (plenty to suit everyone!), classical vocal music, acting, Toastmasters, Conversational English classes, Martial arts, Hath yoga etc.

Beyond all this and above all, we try to make TISA a home for those who have gone “beyond techniques”; who don’t want to practice any technique any more; who just want to be at peace with themselves. THIS is the most important function of TISA: offering genuine friendship to those who have had enough of therapy, and who want to focus now on other dimensions of life.

Steering between dogma and gullibility

An issue we have often faced: members join (it is open, there is no fee), without reading the core documents of TISA and then, want to promote X therapist, Y therapy or Z technique on our platform, just because they are convinced that this is what benefited them or someone they know, without discussing the question objectively.

Let me give an example. Some of us in TISA are over fifty (I am 56!).  For us, the challenges that we faced 20-30 years ago are no longer there. We are not giving high pressure interviews week after week to get a job; we are not struggling in an entry level job; nor are we trying to date that fair girl, who used to be so enamored of that other smooth talking, smart aleck in the neighborhood! I am not facing ANY of those challenges which caused and sustained my stammering in youth. Now suppose, I am practicing some technique too.

I have made my place in society at 56; my audience too accepts me, because I have been around so long. I have matured emotionally, above all. So, even if I stumble, neither myself nor my listeners make much of it, which is only right. But as a result, I get convinced that only using technique X has “cured” me. Should I go ahead and insist on teaching it to others? Will it help others, caught in different psycho-social context? Different life stages?

This has been a difficult question. In 2008, a young man wanted to write about “blowing conch-shell” on our blog, because he benefited by it. I am willing to believe that it may have worked for him. Stammering by nature is a variable phenomena: there are long spontaneous remissions. Why? No-one knows for sure, but correlation does not imply causation[10].

At the same time, we don’t want to pour cold water on people’s enthusiasm, who are trying to help themselves under difficult circumstances. Therefore, we have a policy: Do practice whatever benefits you and let TISA promote the core content, which has been well researched and documented for general public.

Neither do we prevent stammerers from seeking formal help. We have a general guideline on seeking therapy[11]. We give preference to Speech and Language Pathologists (SLPs) working in Government hospitals because the fee structure is fair, affordable and transparent[12].

But does self-help work?

We have often been asked: Does self-help work for everyone? We counter: Has therapy worked for everyone?! Gandhi said: “Change, like a tree, must grow ground up (not top down!)”. If the present quandary faced by all of us has to be resolved, stammerers should be at the heart of the change, not a therapist, however wise or well meaning. Yes, they may have a role at some point: they can educate teachers[13] and society to remove the stigma, as many health professionals have done for HIV/AIDS.

Let me explain: Therapy outcomes in stammering have been uniformly poor- both in adults and children. If we compare it with mis-articulation, we can see that treating stammering is like fighting your diversity, your biology, yourself: in brief- very frustrating. Dr. William H. Perkins, after fifty years of stuttering research, had the following to say:

“..Thus the blame lay in the professional failure to recognize that fluency is not the proper objective of therapy. Voluntarily controlled fluency could be helpful if it ever became automatic, BUT IT NEVER DID…” (Declaring War on Fluency)[14]

NSA’s May 2009 survey found that 84% of those who had speech therapy experienced a relapse after improving. Do stammerers seek therapy for short term benefit?

“Relapse” is almost the rule rather than the exception and indicates that therapy did not work in the first place[15]. If some children show improvement in some studies, how do you rule out natural recovery, in absence of control group?[16]  Psychotherapy similarly offers minor improvements – only in 8% of cases in a 1977 study[17]. Some of the best intensive programs have mixed outcomes, measured on the last day (not after 6 months)[18]. Let us face the facts: an average person who stutters (PWS) is looking for cure, and cure can not be offered by any program or therapy today. There are many scammers offering “the cure”[19]!

Paradigm Change

Insanity: doing the same thing over and over again and expecting different results.  (Albert Einstein)

As a medical professional, I am aware of the big changes that have come over medical science, because as a profession, we were willing to learn from emerging evidence and give up cherished positions. In the 70s in India, breast feeding was considered messy and risky. Infant formula (bottle) was highly and regularly recommended to new mothers! There was a powerful “infant formula” industry sustaining this trend[20]. Then, accumulating evidence led to reveal the vast benefits of breast-feeding[21]. After this, doctors began insisting: Breast is best.

Some time ago, a young PWS- Kamal (not his real name), who has been looking for a job, confided about his last interview. He was, naturally nervous and stumbled a couple of times. One of the panelists looked at him “carefully”. Kamal decided to set things at rest and talked about his stammering upfront. The panelist responded: Don’t educate us. Go to a speech therapist and get it fixed and then return! Kamal had had three attempts already! This is a sordid state of affairs for a world which produces and consumes information at a phenomenal rate- and still misses the point.

Medicalization may serve some purpose at times but, according to us, it also stigmatizes the behavior, disempowers the victim and passes on all the controls in to the hands of the powerful: technology groups and industry. In the case of stammering, we are not sure what the benefits are of “encouraging” a stammerer into therapy and how these benefits outweigh the cost: money, time, effort and the loss of faith in oneself and guilt[22] when the therapy or gadget fails.

I am aware of the deep problems faced by both stammerers and their therapists in India. Both parties do their best and still end up blaming each other and themselves! I think it is time to view the whole issue afresh. The effort therapists have put into changing a certain behavior and sustaining the change over the years could have given better results, had it been put into changing the social perception and attitudes; into making human diversity a valid object of study and respect. I will not make a similar appeal for those conditions where the cause is well understood and treatment has reasonably good consistent outcome – like misarticulation or cleft lip. But stammering is one area where the PWS is the only person who can help himself on a sustainable basis, by changing his and society’s perspective, by thinking of it as a diversity, rather than as a disorder to be cured or endured. Rather, we may celebrate our diversity and put it to best possible use: to take a closer look at ourselves, our potential and connect with others.

I must thank Cristobal Loriente for his groundbreaking paper (Towards a notion of Transfluency[23]) in this forum in 2009, which got me thinking in an entirely new direction. My heartfelt gratitude to my colleagues and friends in TISA too, co-travelers on an interesting journey!

Let me conclude with a thought from an American Buddhist nun:

“As human beings, not only do we seek resolution, but we also feel that we deserve resolution. However, not only do we not deserve resolution, we suffer from resolution. We don’t deserve resolution; we deserve something better than that. We deserve our birthright, which is the middle way, an open state of mind that can relax with paradox and ambiguity. To the degree that we’ve been avoiding uncertainty, we’re naturally going to have withdrawal symptoms; withdrawal from always thinking that there’s a problem and that someone, somewhere, needs to fix it.”

(Pema Chodron, “When Things Fall Apart”)

The end.

References

[1]  http://www.mnsu.edu/comdis/isad11/papers/srivastava11.html

[2]  http://www.sriramanamaharshi.org/teachings/instructions/

[3]  Selfless service is a limb of Yoga (Gita chapter 17, verse 20)

[4]  This is a report of the first (ten day!) communication workshop:
http://www.scribd.com/doc/26113740/Communication-Workshop
And here is the second one (5 days):
http://www.scribd.com/doc/29746286/Kolkata-Workshop
Now, we have reorganized the same content in a three day module, which needs to be repeated at least 2-3 times over an year.

[5]  This self help manual is offered as a free pdf file at:
http://stammer.in/publications/NewSHManual.pdf

[6]  http://www.casafuturatech.com/speecheasy/

[7]  http://t-tisa.blogspot.in/2010/12/genesis-of-scam.html

[8]  http://stammer.in/newsletter.html

[9]  These first four techniques have been adapted from Peter Reitzes excellent book: Fifty Great activities for children who stutter (link). We often preface these by saying: This is exactly what you normally do – you repeat a sound, stretch it, or just fall silent or go in a block and stammer. That is what these techniques are asking you to do- BUT with more awareness, grace, control, good eye contact, relaxed tummy and COURAGE in heart. Etc.

[10]  http://en.wikipedia.org/wiki/Correlation_does_not_imply_causation#Examples_of_illogically_inferring_causation_from_correlation

[11]  www.stammer.in/which-therapist-.html

[12]  http://t-tisa.blogspot.in/2010/10/wide-angle-view-of-therapy.html

[13]  Only three (out of 58) teachers reported having any formal training on stuttering (in a Mumbai study).   http://www.netques.eu/wp-content/uploads/2013/11/2011-IJDDE-beliefs-attitudes-indian-teachers-stuttering.pdf

[14]  https://www.ecu.edu/cs-dhs/csd/stutt.cfm

[15]  http://www.mnsu.edu/comdis/isad/papers/starkweather.html

[16]  http://thestutteringbrain.blogspot.in/2008/07/follow-up-study-to-lidcombe-outcome.html

[17]  http://www.veilsofstuttering.com/psychoth.html

[18]  http://www.casafuturatech.com/hollins-communications-research-institute/  (read to the bottom)

[19]  http://thestutteringbrain.blogspot.in/2010/08/name-and-shame-marketers-for.html

[20]  http://en.wikipedia.org/wiki/Nestl%C3%A9_boycott

[21]  http://babyreference.com/formula-feeding-doubles-infant-deaths-in-america/
http://pediatrics.aappublications.org/content/113/5/e435.full.pdf+html

[22] “..Some degree of therapy-induced guilt is built in to the whole venture of therapy..”  Therapy Induced Guilt : http://www.stutteringhelp.org/content/principles-counseling-people-who-stutter

[23]  http://www.mnsu.edu/comdis/isad12/papers/loriente12.html

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Comments

Self Help: Indian Experience — 29 Comments

  1. Dr. Srivastava, I really enjoyed your article regarding the importance of self-help when managing the individual’s stammer. I feel that many of the points covered in this article, as well as the core of TISA, can relate to not only people who stammer/stutter, but also to every individual. No matter what difficulties in life a person must face, they must be willing to take on the responsibility of resolution themselves, rather than look to others.
    I do have an overall question after reading this article, regarding the culture in India. In my Fluency class, we have discussed the presence of awareness and education of stutter/stammering across nations. My question is, do you find that the awareness and education in India or other countries that you may be familiar with, have more or less exposure to these types of things (awareness and education of stammering)?

    • Thanks Arielle. Like many Asian countries, in India, stammering is seen as a stigma, result of bad “karma” from the past births, carelessness while talking, evidence of guilt or fear etc. Awarenss and education is very low. Few organizations or SLPs are working on this front. To make things bad, there are websites which promote these very stereotypes. If you do a google for “stammering cure India” , you will find many such websites which attribute vause of stammering to childish imitation, parental fights, head injury, “if one is grightened of every little thing” etc! Pseudoscience is rampant here. Most SLPs are preoccupied with making the client fluent, rarely educating the family, the schools, the employers or the society at large.

      • Sorry. Was using a tiny tablet. Hence couple of spelling mistakes above- which are quite evident.

  2. Dear Sachin sir,
    Great paper similar to your teaching, totally scientific.
    Concept of self help and act of kindness truly help in developing a good human kind.
    Overcoming stammering is nothing in front of that.

    • Thanks Vikas. Science may discover new things in future.. Till then this is what I think and feel..

  3. Much needed article indeed. Initially, I was also looking for the expert advice from outside without realizing that it is “me” and only “me” who knows my stammering very well.So,I asked myself to help “me” and it is working.And as Arielle Pask has also mentioned in the earlier comment that this same principle applies to problems in our daily life.We should counter our problems ourselves instead of waiting to get help from others.
    As author has mentioned that one of the main challenge with stammering is the faster relapse rate and I believe this happens because after some period of time we loose motivation.So,here self-help group comes to rescue.It plays a major role as it constantly boosts us to improve constantly.
    I have also read the author’s self help manual “Apna Hath Jagannath” which is a complete book for all the stammering related queries and various useful techniques.After interacting with the author and reading the book,my basic mindset towards stammering had changed.
    I want to congratulate and thank the author for writing such great articles to spread the awareness about stammering .

    • Thanks Ankit. That is the whole idea – instead of feeling like a victim and waiting for “expert” help, why not try and help ourselves, as best as we can – and with each others’ help. Thanks again…

  4. Respected Sachin Sir
    I had always felt that Stammering is a disease and only speech therapy is a way out. I was actually not fully correct. After joining TISA a year ago I try to accept myself, more precisely I try to accept situation. Acceptance lead me to SELF HELP and it really did help. The reason being SELF HELP gave me the reason WHO Am I?? that was always unanswerable for me. It provided me the TRUE realisation of myself. Again I want to quote the same “This Self is to be achieved through self-effort”.
    Thank You

    • Thanks Ravi!
      Truth is often simple. But we, educated humans, tend to complicate it..!! Meeting you at NC was great joy..

  5. I really enjoyed reading your article and learning about how stuttering is viewed in your culture! I liked your point about how society should celebrate diversity. I was wondering how your participants in your three-day communication workshop feel about voluntary stuttering? Are they usually reluctant to partake in this activity or is it something they find helpful? Thank you!

    • Vol stut (vs) is a tough beast – therefore we take it up after covering other issues, by the time when good rapport has developed and participants are ready to laugh at themselves… I always begin with myself. Then, we introduce it in humorous and creative ways: longest stutter competition or weirdest stutter challenge.!. While concluding we take feedback: how did you feel? Most participants feel lighter.. Then, we also link it up with block correction techniques – In order to practice these you must know how to go in a block at will..etc. Finally, a lot depends on the atmosphere you create: we create an atmosphere of acceptance, adventure and a little fun.. Hope this answers. Thanks..

  6. Hi Dr. Srivastava,

    Thank you for sharing your stories about self-help movement and the surroundings for people who stutter/stammer (PWS) in India. It is always interesting to take into account cultural contingencies and you have given great examples to explain why the TISA and SHGs are dissimilar from those in U.S. (and perhaps from other countries).

    In addition, I would like to know more about the public perceptions toward PWS in India. Are they similar to those in U.S., if not, can you elaborate more on the differences? Appreciate it a bunch.

    -Ella

    • I have spent a short time as a tourist in Canada, so please excuse my generalisations. I think while in west (like USA?), due to pervasive role of technology and reductionism, stammering, its cause and recovery is often seen in medical terms and paradigm; in Asian countries, we tend to view stammering only as a manifestation of a deeper and more elusive causes. While for many pws, (speech?) therapist may be the first point of call for help in USA, in India, many of us try out all kind of faith healing solutions – which sometime work too, at least in short term: offering silver tongues to a goddess, reciting certain scriptural verses early in the morning, a particular hath yoga posture (simhasana), visiting shrines, using herbal remedies, getting special rituals done by a priest or exorcist etc. Some of us would even try “past life regression” in the hope of dealing with the original cause. Some, would try yoga, not for union with universal spirit, but largely to gain fluency.
      Public perception – is mixed and often based on: disbelief, surprise, pity, revulsion. But yes, many older people accept it for what it is – just a different manner of speaking. These differences in perception are based on education, social background, residence (urban/ rural) and other persoanlity traits. Sorry, I think I have wandered a bit..

      • Thank you for your reply. It’s very interesting to see so many diff. perspectives toward stuttering. The public perception and the feedbacks from the speaker as well as the listeners are definitely influential for one’s stutter. Once again, thank you for your article and taking time to reply my question. I’ve been learned a lot!

        – Ella

  7. Hello Dr. Srivastava,

    I enjoyed reading about the self-help movement and stuttering within your Indian culture! Like Ella posted above, it is always wonderful to get a perspective of cultures outside of my own to facilitate a better understanding of how I might help any one of my clients in the future given the cultural difference or views. I was wondering what brought about this movement for you personally and why you felt that a clinician could not help you as a person who stutters? I know you talked about societies understanding of the “therapy for a cure” but have you gone through therapy? What was not successful about your sessions or therapist?

    Lastly, you mentioned the testing and perfection of a model of three day Communication workshop. What has helped in perfecting this model and how have the workshops helped the people who stutter that attend them? Has it helped most or all of the participants involved? Does this model only target adults or are younger children involved as well?

    I also appreciate all the quotes added to your paper, they tied in nicely and inspired me as a reader to take initiation of myself even if I am not a PWS. We are our best advocates and if we are not doing so, who will?

    Thank you for your time,
    Stephanie

    • Dear Stephanie
      I did have a session with a proper Fluency specialist in 2003. We talked for about two hours. Essentially he told me: As a covert stutterer you keep scanning speech ahead, changing words etc. – and that is why you feel tired by evening. Second thing he told me: prognosis is not very good at your age (I was about 44). Then, he asked for his fee (a “handsome” one by our standards) and invited me for more sessions. For the first time, I had spoken to someone about stammering. It was a big relief. I thanked and paid. But few months later, I began to view the meeting more objectively. I did not go back. For two reasons: fee was steep and I was not sure if it was going to help the heaviness in my heart, which weighed down all my attempts to communicate, to relate, to aspire…

      Months later, I met a man, a seeker, who had been in silence for many years. I told him about my dilemma, the horrible feeling when you have hidden something for years. He kept looking at me with complete acceptance and a gentle smile. With a gesture he communicated “Never mind; just carry on.”. He asked me to stay on for lunch.. During this little interaction, I felt: He totally accepts me, as I am. If he can do that, why should I not accept myself? Later, this meeting with the silent saint slowly and steadily began to change my understanding of my self, my speech, my difficulties and my inner strength. Another big change: I lost all my reluctance to meet other stammerers!

      Beginning 2004, I began researching stammering, current therapies, associated stigma and social models of disability (as opposed to medical model). As a social worker, I was studying about gender / feminist issues too. I discovered, as you conclude aptly: We are our best advocates and if we are not doing so, who will?
      A few years later, Indian stammering association began.

      In a therapeutic relationship, money changes hands; client thinks that he has paid and therefore therapist will do something to him to make him feel better or become cured. Therapist too is under a pressure: I must deliver some tangible good to my client. Since both have expectations and are under pressure, the “alchemy” of inner lasting change rarely begins. Therapist can not give up controls. Client can not develop true self-reliance and initiative in this model. It is like expecting true Love to spring up, in a relationship, where money has exchanged hands. May be here, I could be guilty of “reductionism”. May be, in USA, charging professional fee has a justification and a logic. But then, I am sure, some of you in USA have discovered ways of maintaining a professional relationship and bringing in the beneficial effects of self help. Please read my reply to Rylie below.

      Communication workshops, as the name suggests, are geared to develop communication skills and moving forward in speech, in spite of dis-fluencies (not cure or fluency per se). We state upfront these objectives. A few young participants come with other assumptions: I will learn some technique that will cure my stammering once for all. Barring these exceptions, most participants benefit to varying extents. Bottom line is- they become part of a supportive community for the rest of their lives – for no fee. We have worked with children too, using same principles but adapted to that age group: turning activities into fun games, using indirect approaches etc.

      Having said this, let me emphasize, I do not see self-help or TISA as a panacea for everything, everyone. We encourage people to get help from SLPs in government hospitals, in-lieu or in addition to self-help, depending on their specific circumstances and needs. Sorry for this lengthy answer. I suppose stuttering impacts our “literary style” too, in the long run!
      Best wishes and thanks!

  8. Dr. Srivastava,

    I am currently a graduate student in the US studying speech language pathology and although I am learning to practice the traditional therapy techniques for stuttering/stammering, I find your research and experience very intriguing.

    I am a firm believer that we as people are in charge of what we choose to change and acceptance of our true selves is the first step towards resolving anything we perceive as a problem.

    Your beliefs are very inspiring. I will carry them forward with me as I progress through my education and I will definitely use them in my practice along with the traditional techniques I am currently learning in school.

    Thank you very much for sharing your ideas.

    Rylie

    • Thanks Rylie!
      You have NSA, Stuttering foundation, Friends- and I guess many more self help initiatives in USA! I am aware that society and clinical practice is quite different in USA, compared to Asian countries. So, do try different approaches or combinations when you begin. Here is a relevant write up by Lee Reeves:
      http://www.mnsu.edu/comdis/isad/papers/reeves.html

      End of the day- you must have satisfaction of having truly helped a human being; what does it matter, who gets the credit.. Right?

      Beyond this, sometime stop and think about the bigger questions: why should a teenager must look like so and so? why should a restless child attract ADHD label? Could it be that we as a society are turning normal human behaviour/ appearance/ diversity into medical problems, just because a technology is available to “fix” it?

      Best wishes and thanks!

  9. This was such an interesting article and I thoroughly enjoyed reading it. In my senior year of my undergrad, I completed some research on communication disorders in India and several other countries. I focused on services that were provided in rural areas. I was not able to find much research on what type of services for fluency are provided in rural areas. Are most of the people who attend the workshops from urban areas? Is there any raising awareness in these areas to reduce the stigmatization that follows one who stutters? If not, do you know how to best raise awareness and reach out to those in the rural areas?

    I really would appreciate your feedback on these questions! Thank you so much for your time and this article you wrote!

    • Reaching out to 1% of population scattered across India was difficult: Internet was the most efficient way of doing so. Therefore, most of us in TISA today, represent educated, urban, middle class- with access to Internet. We are trying to reach out to others. But, in my limited experience, stammering is less of an issue in rural India. Why? Let me quote a good paper from ASHA:
      “…the rural population of India has a greater tolerance for stuttering than do urban people. The reasons could be that demands on communication in those social settings are less as most people are known to each other and livelihood is mostly through manual labor. In the light of many other pressing health and economic problems, stuttering is not considered a disability and there is a philosophical acceptance of any disabling condition..” (from: http://www.asha.org/Publications/leader/2005/051018/f051018a2.htm)
      But there is no denying that rural population deserves more awareness and services- based on THEIR needs, not our perceptions. A study shows that unmet need for contraception for example, among married women is high in India: (53.1 %). It was highest (86.4%) among women in the age group 15-19 years. It could be even higher in rural areas. (from http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/506/html_9 ).
      It would be safe to assume that unmet need for cleft lip/ palate surgery and many other services for children with special needs, would be similarly high. One reason is skilled man-power does not want to live and serve in rural areas. Second- traditional support systems have been eroded without bringing in suitable replacements. A child with a lisp or stammer would have received support from family, teacher and friends earlier. Now, he will simply be “referred” to the special needs teacher or counsellor or therapist, who in any case are not there!
      In present circumstances in India, it might be better to train and equip the school teacher, so that s/he can counsel the child, make special accommodations, give more chance to practice and educate other children to prevent stigmatization. As a growing child, I did have some teachers who could intuit what was going on in my head and tried to help. Another way to increase awareness in rural areas could be the use of folk media. See : http://t-tisa.blogspot.in/2009/08/dehradun-shg-meet-held-on-23-august.html
      Hope this answers, Amy. Thanks!

  10. Dr. Srivastava,

    Thank you for your enlightening paper. The approach you describe is the exact one that has worked for me over the last 4 years, and which changed my life from one of despair to one of increasing positiveness.

    An especially big thank you for the TSA self-help guide, which was handed out with so much generosity at the last NSA conference. I enjoy speaking to many Indian PWS each week on Stutter Social, and hope to get the chance to meet you all in person one day.

    Thanks again,
    Hanan

    • Thanks Hanan!
      Sure, whenever you are this side of the world, do let us know and be our guest. We had Ruben, Jacqueline from USA, Mamdo from Nizeria – and it felt so good to listen to their experiences. Meeting, sharing, talking – this can be such an organic and spontaneous “therapy” that I wish these get togethers could last for ever!
      Thanks for your feedback!

  11. Seva: selfless service. It warms my soul to read a piece so rooted in this core component of a meaningful lifetime from you Dr. Satyendra Srivastava. Thank you so much for sharing the wisdom that comes from your particular part of the world. The reluctance of your program to promote a specific therapist/gadget/program is extremely valuable I believe, not only because money is truly an issue for many people with whom you work- but as it also places the responsibility of stuttering onto another person/object or whatever it may be. As you spoke to, it is important to take note of these different ideas and learn from them, but as I see it- it is of at least equal important to come to progress through a more organic, internally driven process. Though these technical devices and therapies often show promise- how long do the results last when the motivation and promise of hope is from an external source (everything we need, at our heart of hearts, is already within each of us)… and how do these results generalize throughout this lifetime? I loved how you noted the “demedicalization” of stuttering, and spoke of the importance of taking responsibility and initiative. Have you used mantras as a technique? I saw that you mentioned belly breathing; have you found one type of pranayama to be most effective in sustaining long-term results? What I love about these “techniques” is that they incorporate the mind, body and soul- and therefore incorporate things that people can practice (and therefore feel like they are “doing something”) as well as creating a deeper and more meaningful change on many of the different koshas. We are all so much more than our outward manifestations, yet these overt presentations are meaningful to us and affect the quality of our lives. Perhaps, if we learn to work from the bottom up (as a tree grows like you noted), starting with the deep-rooted subtle levels of ourselves… perhaps we will be able to change the presentation of our soul manifestations and create better lives while we are here on this Earth. I absolutely LOVED your article and thank you so VERY MUCH for promoting thinking on this subject on a deeper, more “real” level.
    Smiles and love,
    Erica Campbell

    • Thanks a lot, Erica, for reading and responding! To answer your questions specifically about mantras and pranayam – let me say at the outset: we try and play safe because it is so easy to go overboard with the “esoteric” stuff in any culture!! Same here. I dont doubt that some people may have genuinely been helped by these but I personally dont promote them. Sacred chants and Pranayam originally were there, in my understanding, for a deeper and greater purpose – not to cure my headache or my stammering! But if someone finds some benefit or solace- why not? Some of our members are deeply into it. For example, check this post- http://t-tisa.blogspot.in/2013/07/by-specific-breathing-techniques-can.html#more
      Having said this, let me add- reciting mantras may improve diction and articulation, because you pay attention and pronounce difficult words exactly the way they are supposed to be. Pranayam and other meditative techniques based on watching the breath (like Vipassana), I think, improves awareness of breath and awareness of inner thoughts. Whenever we discuss belly breathing in Communication workshop, it is more to sensitise people about unconscious valsalva reflex during block and how to counter that tendency. Finally, I have learned that we, the people who stammer, must find our own different paths to be at peace with ourselves- and communication is a small outward manifestation of that.

      • Thank you so much for your honest answers to my questions! I absolutely understand what you are saying and they are valid points to keep in mind (: Also, thank you for the link to the TISA website, it is intriguing and I can’t wait to further explore everything that is on there!

  12. I believe that speech therapy is beneficial in the process of becoming more fluent. However as you suggested, people who stutter must come to accept their stutter as something that cannot be changed. In doing so, they come to use the tools they are given in therapy in a more beneficial and practical way. I think more than anything people need to be educated about the goal of stuttering therapy. I understand that therapy and the commercially sold instruments can be expensive, but that is a reality that won’t easily be changed. With that being said, your article gave me an important point of view to stuttering treatment in another part of the world. It made me aware of the costs of therapy and instruments and made me reflect on the true gravity of the costs to other people.

    • Dear Lynn
      I too believe that speech therapy is beneficial but I also believe that there exist other approaches which may be equally (or even more) beneficial and a lot cheaper as far as stammering is concerned – at least in my Asian context. But there is a bigger question: should stammering be treated at all using any approach?
      Till a few decades ago, homosexuality was “treated” with psychotherapy. It has stopped now, I think. The APA guideline (number 2) states clearly: Psychologists (should) understand that lesbian, gay, and bisexual orientations are not mental illnesses (vide link below). The LGBT community is encouraged to accept their orientation, instead of trying to change it, educate society and reduce the stigma. It is accepted that embracing and affirming gay identity can be a key component to recovery from other mental illnesses or substance abuse. Have either party- psychotherapists or the LGBT community, suffered due to this changed stance? I think not. Only better, I suspect.

      (Link: http://www.apa.org/pi/lgbt/resources/guidelines.aspx)

      In giving this example, I imply nothing more than the similarities in issues faced by therapists in “treating” the two “conditions” and the positive role of community action in dealing with stigma of shame, guilt and fear on their own.
      Thanks for reading the paper and your comments.
      Best regards!

  13. Thank you so much for your insightful paper! I think your view on stuttering as a whole is very realistic and refreshing to read about. I completely agree with your statement about regarding stuttering as diversity rather than a disorder and that there should be more of a focus on the individual’s true identity. I am currently a graduate student in speech language pathology in North Carolina and I hope that your message will guide me as I begin my journey. Thank you again for the wise words!

    • Thanks Jocelyn! I am happy that you are joining the “caring” profession and that you have liked this paper. In USA, I think, Insurance companies pay for therapy. So, I think, after couple of sessions, discussing with the client- expectations and possible outcomes, you may consider putting him/her in touch with a local NSA chapter. If you can instill the faith in themselves, that they can deal with whatever life throws at them – I would say, you have done the best a therapist can hope to do! If you fail, dont feel bad- and start all over again! That is all I can say, based on my three decades of health care experience in India!
      Best wishes!