What do we lose when we make a child who stammers fluent? – Patrick Campbell

About the Author: Patrick Campbell is a stammerer and children’s doctor living in Cambridge, England. He has an interest in how public and self-stigma intertwine to produce disability for people who stammer and how this debilitating process can be altered through seeing positive value in stammering. He recently co-edited the book Stammering Pride and Prejudice: Difference not Defect (http://www.jr-press.co.uk/stammering-pride-prejudice.html). In his spare time, Patrick enjoys 5k runs.

People who stammer speak in a unique way that is fundamentally different to people who are fluent. It is generally thought by society that this different way of speaking is less desirable and less useful than fluency. However, as articles published here in previous years have vividly shown, this is not always true (Constantino, 2016). We, as individuals and a society, can grow and gain through having people who stammer speaking in society.

I want to take you through the other side, the anti-matter, of this argument around stammering helping our society to grow. I want to explore what we may lose when we make someone, in particular a child, who stammers become fluent.

There is a question I like to hear people who stammer try to answer. You have probably heard it yourself. It is one that floats around our community, popping up in podcasts and at conferences. In its classic form, it riffs on a scene from the film the Matrix and goes a little like this:

If as a child you had the chance to take a blue pill, which makes you fluent, or a red pill, with which you keep your stammer, which one would you take it?

I have heard quite a few people tackle this question over the years. I have tackled it myself too. In my experience, the answer often begins with a pause – and not because the person is caught in a block. Rather, it is because coming to an answer can be tricky. It involves a weighing up of life with a stammer.

Life with a stammer can be difficult and depressing, and perhaps most people do end up opting for the blue pill, but the question often forcibly reminds us that stammering has brought some good. While some of this good is tinged in a ‘what-doesn’t-kill-me-makes-me-stronger’ kind of vibe that could be true of any of life’s difficulties, some of it might not be. We may have had unique experiences through stammering: a great conference we once went to, a close friend who also stammers we got to know, or a career path we would have otherwise not followed. The answer tends to come with a few ifs and buts, a bit of toing and froing.

Yet, when it comes to children who start to stammer the question of whether to have therapy that will increase the chance of returning fluency is generally met with a conclusive – no ifs, no buts – answer: Yes. There is a disconnect here, between the difficulty people who stammer can have weighing the question of whether they would have wanted a cure for their stammer and the ease with which society encourages young children who begin to stammer and their families to engage in therapy aimed at returning them to fluency1.

The pause taken by some adults who stammer faced by the ‘red’ or ‘blue’ pill question asks us to do the same for children who stammer: to take a moment to reflect on what may be lost when a child who stammers is made fluent.

An advocate

Life is hard for people who stammer. We live in a society that is ill-suited to our way of speaking. Each day we may meet with well-definable physical barriers – like voice automated telephone systems – but more often we meet nebulous, pervasive stigma from society. The result is that people who stammer struggle in education, earn less at work, and have more mental health problems than people who are fluent (Butler, 2013; Gerlach et al, 2018; Iverach et al., 2009).

We need to fight to remove the attitudinal, environmental and structural barriers in our society that cause people who stammer to suffer. Nearly all other rights movement have depended upon groups of individuals with lived experience of oppression and discrimination to improve society. For example, the move towards acceptance of LGBTQIA+ people by society has been drive in the most part by LGBTQIA+ people themselves – protesting, changing laws and influencing others. People with lived experience of dysfluency are central to changing our world for the better for those who speak differently. We lose vital potential advocates when we encourage children who begin to stammer to become more fluent.

A thermometer

Dystopian science fiction authors have often pictured a world in which humans are genetically engineered to prevent impairments and disabilities; rarely, have these worlds been a good place to live. The ability of a society to include and accept those with perceived ‘weaknesses’ tends to mirror its fairness and goodness.

A person who stammers can act as a thermometer for whether society is fair and accepting of difference. The difficulties that come with stammering – shame, embarrassment and a decreased chance of living a fulfilling life – are much more often related to stigmatisation of stammering in society than the physical act of stammering itself. If we make children who stammer fluent then we cannot take the temperature of acceptance in our society.

A source of diversity

The changes to the genetic code that make people more likely to stammer are a natural biological event. Evolution has created a process by which each human is subtly different. This is beneficial to our society, as this diversity allows us to utilise each individuals’ unique attributes and characteristics. Stammering is one of these characteristics that can bring benefits to society if it is supported in the right way.

Take the positive impact of the stammered voice on music for example. There are several songs that have become iconic because of their stammered vocals: My Generation by the WHO, Lola by the Kinks and You Ain’t Seen Nothing Yet by Bachman-Turner Overdrive. If we all spoke fluently, music for one would be the worse for it as there would have been little inspiration for these tracks.

A ticket

Many of us have had a great time at stammering conferences. Whilst we may buy airplane, train, and bus tickets to go to these events, our tickets are really given to us when we begin to stammer.

The stammering community is a unique one, and without it my life and many others would not have been the same. Support groups for people who stammer are a safe space in which we can share our worries about stammering, but they also become places to reflect on the bigger questions of life. Conversations around stammering can allow us to explore deeper and more existential issues – like how to accept ourselves as we are, approach our greatest fears and authentically connect with one another. The conversations I have had around stammering have made me a better person in ways unconnected to speech.

A child who is made fluent by therapy loses a ticket into the stammering community and the deep and meaningful conversations and friendships that can be found there.

A wordsmith

The list of writers who stammer is long and noteworthy: Lewis Carroll, John Updike, Somerset Maughan, Adlos Huxley, Philip Larkin. I do not find this a surprise. Stammering gives us a relationship with language that is inaccessible to those who are fluent. This relationship can be a difficult one but it is also one filled with new possibilities and permutations. Blocking, repeating, and word-swapping can all be seen as failures to communicate but at the same time they open up avenues of speech that go unexplored in people who are fluent. Words themselves also have more texture as you stammer – you can feel their weight in your throat and lips as you stammer.

My favourite stammering novelist is David Mitchell. A few years ago, he gave a beautiful speech called ‘Thirteen ways of looking at a stammer’2 at the 2014 World Stammering Congress in Holland. In it, he thanked his stammer for being ‘a practical course in linguistics’ for his career. He went on:

“Back when I was 12 or 13…I used to have to ‘self-autocue’ all the time… I learnt that words a finely-calibrated things, whose meaning or force can be adjusted by inflection; that a single stress on a syllable can alter the centre of gravity of a phrase. I also learned about lexical register, that some words and phrases sound more educated and adult and Latinate, while other words and phrases are more ‘street’, more ‘teen’, maybe more Anglo-Saxon… What I want to say is that nowadays as a professional writer, I use this practical knowledge of the mechanics and electronics of speech every single day, and I bless it. Sometimes the difference between a curse and a blessing is about 20 years.”

If David Mitchell had been given ‘early intervention’ as a child and became fluent would he have written the books I love?

Here, I have envisaged some positive things that may be lost if children who stammer are encouraged to become fluent. I do not wish to deny that some people do grow up to see stammering as a curse and would jump at the chance to have taken the blue pill. However, I do wish to challenge the taken-for-granted opinion we can hold that it would be best if all children who stammer could be encouraged to speak fluently. Not every person who stammers comes to see their speech in strongly negative terms: some grow up to see it as a minor nuisance, and others still a gift.

I think nearly all people who stammer would agree stammering shapes us in ways that are both tangible and intangible. When we make a child who stammers fluent – for better or worse – we change who they will become and what our future society will grow to be like. We should weigh the decision with care.


I would like to thank Christopher Constantino and Kathryn Bond for their insightful comments and suggestions. Chris also coined the great phrase ‘stammering novelist’ to describe David Mitchell. I would also like to acknowledge Katy Bailey for her description of stammering as a canary for ‘social toxins’ that begun my own reflections what stammering brings to society. Furthermore, I owe a debt of gratitude to all the contributors to our recent Stammering: Pride and Prejudice: Difference not Defect book who have challenged and changed my own thinking on stammering in many ways (available at http://www.jr-press.co.uk/stammering-pride-prejudice.html).


1 At times writing this, I worried I was arguing against a strawman. Therapy for children is rarely simply ‘fluency-orientated’. Nearly all therapists take a holistic view looking at the child as well as their communication environment. Many therapists may not even see fluency as the primary outcome of therapy for young children who stammer. Nevertheless, the evidence base that early years stammering therapy rests on is clear that a return to fluency (or reduction in syllables stammered) is an important therapeutic outcome (de Sonneville-Koedoot et al., 2015; Jones et al., 2005; Millard, Zebrowski, & Kelman, 2018). Whilst these therapies (and the individual variants of them therapists choose to use) may also look to improve the general communicative environment, manage stigma, and educate parents, the predominant methods of therapy today have a basis in a drive to facilitate fluency.

2 The speech can be found in print online or on youtube as a video (https://youtu.be/IJM0eqfq5fE): https://www.stotteren.nl/images/nieuwsbrief/13_Ways_of_Looking_at_a_Stammer_David_Mitchell.pdf. It was also turned into a lovely print book by Bundesvereinigung Stottern und Selbsthilfe e.V. (the German Stammering Association).


Butler, C. (2013). “University?… hell no!”: Stammering through education. International Journal of Educational Research. Retrieved from https://www.sciencedirect.com/science/article/pii/S0883035513000220

Constantino, C. (2016). Stuttering Gain. International Stuttering Awareness Day Online Conference. Retrieved from http://isad.isastutter.org/isad-2016/papers-presented-by-2016/stories-and-experiences-with-stuttering-by-pws/stuttering-gain-christopher-constantino

de Sonneville-Koedoot, C., Stolk, E., Rietveld, T., & Franken, M.-C. (2015). Direct versus Indirect Treatment for Preschool Children who Stutter: The RESTART Randomized Trial. PloS One, 10(7), e0133758.

Gerlach, H., Totty, E., Subramanian, A., & Zebrowski, P. (2018). Stuttering and Labor Market Outcomes in the United States. Journal of Speech, Language, and Hearing Research: JSLHR, 61(7), 1649–1663.

Iverach, L., O’Brian, S., Jones, M., Block, S., Lincoln, M., Harrison, E., … Onslow, M. (2009). Prevalence of anxiety disorders among adults seeking speech therapy for stuttering. Journal of Anxiety Disorders. https://doi.org/10.1016/j.janxdis.2009.06.003

Jones, M., Onslow, M., Packman, A., Williams, S., Ormond, T., Schwarz, I., & Gebski, V. (2005). Randomised controlled trial of the Lidcombe programme of early stuttering intervention. BMJ , 331(7518), 659.

Millard, S. K., Zebrowski, P., & Kelman, E. (2018). Palin Parent–Child Interaction Therapy: The Bigger Picture. American Journal of Speech-Language Pathology / American Speech-Language-Hearing Association. Retrieved from https://ajslp.pubs.asha.org/article.aspx?articleid=2709702

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What do we lose when we make a child who stammers fluent? – Patrick Campbell — 28 Comments

  1. Hi Patrick – I really like this perspective. If all of the children with the propensity to stutter do not and instead gain or reclaim fluency, what then do we have? A generation of children who will miss out on all of the gain to be had by those of us who stutter who have come before. These children won’t get the ticket to the stuttering conferences and galas which gives us the special opportunity to experience the sensation of being wrapped in the arms of our tribal elders who will teach those children how to stutter and still lead their best lives. That would indeed be such a loss, one felt by us the minority 1%. The majority 99% will not know or feel what that is like.

    I hope we are not extinguished simply for the convenience of the 99% fluent world. I dare say nothing else might not compare to this unconditional community we are invited to and encouraged to stay as long as we like.

    Thank you for sharing this. For some, it may seem nothing but a bunch of jargon. To we who stutter, it is our life line that we refer and depend on.


    • Dear Pam,
      Thank you for your kind words. They mean a lot. I very much enjoyed meeting you this year as part of our community (something I have gained from stammering) and hope to see you again soon.

  2. Just when I thought I’ve heard everything I needed to hear, you come along and write something completely new. Sheer brilliance, Patrick. Especially the part where you ponder if David Mitchell would have written the books you love. Thanks for the new perspective.

  3. Thanks for sharing, Patrick. I am a graduate student at Idaho State University studying Speech-Language Pathology. I am currently taking a fluency class and have been learning a lot about the dichotomy that you discuss in your article. It is my understanding that our professor takes a view very similar to yours in that we shouldn’t set goals for our fluency clients to be perfectly fluent through therapy but rather we should help them improve their confidence, self-efficacy, and acceptance of their stammer. I agree with this view as well, however, when given the chance for someone to take a blue pill to end their stammering, I believe that it would be better for them to take it than to not. The problem with reality is that there is little evidence (according to my limited knowledge) to support successful therapy when the goal is perfect fluency. If there was a guaranteed treatment to help all people get rid of a stammer, I believe everyone should take it. It is my opinion that some of the points that you brought up about how life would be altered for those who attained perfect fluency can be applied to almost everything. For example, if I didn’t apply to transfer to a different college, I would have never met my current wife and may have married someone else. So, to say that life would be different is obvious but to say it would be better or worse is impossible because there would be no way of knowing. So, I agree that we shouldn’t target fluency in therapy with children and instead we should help them with their confidence, self-efficacy, advocating for themselves and others, and acceptance because by setting a goal for a child to become fluent is setting a child up for failure (in most, if not all, cases).

  4. Patrick, I enjoyed your article and the unique perspective on people who stutter. I have never looked at things from this perspective before and found it fascinating. I especially liked it when you said: “Stammering is one of these characteristics that can bring benefits to society if it is supported in the right way.” I wonder what the right way is? How can people who stutter and those who don’t help to advocate so that stuttering/stammering is eventually supported in the mainstream the correct way?

  5. Hi Patrick,

    Thanks for this thought-provoking paper.

    It seems that you would have children who stammer go through the misery that I and many others went through, just so that society might benefit from them when they are adults. To me, this seems exceptionally cruel. It also reminds me somewhat of that Lenin chap, who was so determined to create a better society that he ignored, and perhaps encouraged, individual suffering.

    Yes, many of us who stammer have found our way in the world, and found our own “stammering gain”. I feel exceptionally fortunate that I was able to do this, and today to be in a position where I support people who stammer in my country and around the world, and that support comes from a firm belief in the power of Acceptance of our stammering.

    However, for most of my life I lived in misery due to my stuttering, with thoughts of suicide being a constant companion. We know, too, of PWS who have not been as fortunate as you and I have been, and have taken their own lives. As an adult, today, I would not take the pill to cure my stuttering. On the other hand, I sincerely wish that there had been a cure for stammering when I had been a child, so that I would not have gone through the significant trauma that I did. It’s seems thoughtless and insensitive for you to want me to go through that.

    Regarding PWS contributing to society, you have chosen a few good examples, but I wonder what the balance would look like if you were to take all PWS into account. Creative talents such as David Mitchell come along and contribute to society, even if they don’t stammer. And really, would the world be so much poorer without those 3 songs that you mentioned?

    Any difficulty a person faces has the potential to create strength in that person, and to guide that person to be a force for good in the world. But forcing a child to go through trauma in the hope, or perhaps in the belief, that that person will contribute to society due to the trauma that he went through, is, in my opinion, simply wishful thinking, and also incredibly selfish.

    I find it very easy to live my life with two parallel approaches: Do what I can to help children who stammer to get help that might enable the stammer to pass, and to help children who stammer and their families, and youth and adults who stammer, to use acceptance of their stammer as a foundation for growing and thriving. The two are not contradictory. If we can prevent the potential trauma, we should do so. If we have not been able to prevent the disability from establishing itself, we embrace it and empower ourselves from that point. By the way, therapy for children who stammer is not necessarily fluency-focused. It should not be, as focus on fluency only increased the fear and anxiety.

    Just to be clear, I completely agree with the “Difference, not Defect” philosophy. When we have reached our vision of A World that Understands Stuttering, my opinion can certainly change. I work hard, at great personal cost, to achieve that vision, and I am happy to do so. Until then, we continue with the parallel paths I described.

    Thanks a lot

    • Patrick thank you for sharing such a thought provoking paper. It truly is eye opening, and made me think about things from a different perspective than I have before. Thank you for that. I saw that you are a children’s doctor. I bet that when you talk to some of your patients who might be concerned about their own Childs speech you can offer different perspectives and opinions to them that some may not be able to. Do you think that the change in technology and how everybody communicates with people from all around the world has changed the views of “normal”? I mean now people can communicate within seconds without even opening their mouths. Maybe that is where the disconnect of “normal” and “acceptable” as you were talking about lie. Just thinking out loud.
      Keep up the good work.

      • Hi, I think this is a really valid point. We communicate faster and in much more regimented ways than ever before. Joshua St. Pierre has talked about how our neo-capitalist society shapes our approach. We are in a society which may demand fast and efficient communication and denigrate those who cannot provide this.

    • Hanan, thank you for your honest and thoughtful response to my post. I value the feedback and your voice and own powerful narrative. Your point is heard, but I still feel stammering can be something fundamentally valuable to society.

  6. Thank you for this wonderful contribution and providing insight into the true depth of the stuttering experience. Your paper provides such a unique perspective, you are right being a person who stutters is a positive attribute. I am currently studying to be a speech language pathologist and one of my favorite moments in graduate school was hearing a client say that they were proud of their stutter and that they stuttered wonderfully today. Within your paper you emphasize that stuttering allows people to be an advocate, a thermometer, a source of diversity, a ticket and a wordsmith. These points are all so true and something I hope to instill in other people who stutter in my future practice.

  7. Hello Patrick,

    I share your vision of a world that is more accepting of, and welcoming to, people who stutter. However, I find myself deeply troubled by the notion that we should keep kids stuttering for the sake of “diversity,” or a “future society” – or for any outcome that does not take into account the desires and best interests of those individual children, and hold their well-being paramount.

    In addition to being a person who stutters, I am a school speech-language pathologist and a consultant in the area of stuttering for my school district. Over the years, I have worked with many children, mostly school-age, who stutter, and I have been immersed in this work for some time. Not once have I ever worked with a school-age child who stutters who did not express some version of the desire to “stop stuttering” or otherwise have an easier time talking. Many preschool children have expressed the desire to “stop stuttering,” too. In fact, we know that more than half of preschool children who stutter are aware of their stuttering and develop negative perceptions about their ability to communicate, which becomes increasingly apparent as age increases (Boey et al., 2009; Vanryckeghem, Brutten, & Hernandez, 2005). The thoughts, feelings, and experiences that my students have shared with me show that universally, even at an early age, they have suffered, as I suffered, in a multitude of ways because of their stuttering. We also know from the literature that children who stutter often have negative thoughts and feelings regarding their communication difficulties (Andrews & Cutler, 1974; De Nil & Brutten, 1991); that when compared to peers who do not stutter, school-age children who stutter are viewed as less popular, and are more likely to be rejected and bullied (Davis, Howell, & Cooke, 2002; Langevin et al.,1998, 2003; Stewart & Turnbull, 2007; Blood et al., 2010); and that stuttering can negatively impact a child’s quality of life in a variety of ways (e.g., Yaruss & Quesal, 2004; Campbell, 2003). Therefore, early intervention in stuttering may influence not only the way children talk, but also reduce their suffering and improve the overall quality of their lives, not only in early childhood, but throughout the lifespan.

    Approximately 80% of preschool children who stutter will recover (Smith & Weber, 2016). For the remaining 20%, hope may be on the horizon. There is reason to predict that “dramatically improved diagnostic and treatment strategies for preschoolers will contribute to a significant increase in the rate of recovery from stuttering” (Smith & Weber, 2016). The window of time within which stuttering typically emerges, and recovery or persistence occurs, is approximately 2 to 6 years (Smith & Weber, 2016). Imagine deciding, for the sake of diversity, or a future society, or one’s taste in literature, to close the pathways to recovery for preschool children, swing open the gates to persistent stuttering, and decide for these 2- to 6-year-old children that they are going to stutter for a lifetime, even though they do not want to, and do not have to. In my view, such a decision would be singularly cruel, and unconscionable.

    Rob Dellinger

    • Rob, this is a powerful comment. I appreciate that we strongly disagree and are never likely to agree. I suppose my key critique of your comment would be that ‘stuttering’ really isn’t causing the problems you mention for children (e.g. negative thoughts and feelings, decreased quality of life), rather prejudice and discrimination (bullying) from their society towards their way of speak. Stammering is linked only through stigma to these negative life outcomes; it is not the cause in most cases. It would be good to meet one day and properly talk this through.

      • Hi Patrick, I’d look forward to the opportunity to sit down and talk through this complicated topic with you, whether you and I end up agreeing with one another or not. It seems to me it’s much better to talk through challenging topics and differences face to face, rather than to communicate over screens. I appreciate your generosity and willingness to dialogue with me despite the obviously strong opinions I shared on the topic. Regardless of our differences, I know that you and I both have the best interests of people who stutter at heart. Best,

        • Patrick, one more thing– I realized that in anticipating a face-to-face conversation with you, I neglected to address your suggestion that prejudice and discrimination, not stuttering itself, were causing the problems (i.e., negative thoughts and feelings, decreased quality of life) that you noted I’d mentioned. Although we may continue to disagree substantially about a few things, I’d be interested in exploring our disagreements, attempting to find some common ground, and clearing up any misconceptions that may exist. I feel sure we could instantly find some common ground on the topic of the pain that negative listener reactions can cause us, and on the value of continuing efforts to educate the public, reduce stigma, and shape public attitudes in a positive manner. However, to your point, the way listeners react to stuttering is not the only thing that can make stuttering a problem for people. The internal experience of the moment of stuttering itself – e.g., the unwanted feeling of being out-of-control, and the flight-flight-freeze response that may accompany it—and the anticipation of having future difficulty talking also present problems for people who stutter, almost universally. Also, I worry about purposefully keeping kids stuttering – and suffering—now, in the service of the long-term goal of changing the hearts and minds of a future society. While we are waiting for the word to change, a lot of unnecessary harm may be done to children. And we may be waiting a long time. Looking forward to our conversation one of these days.

  8. Thank you for sharing such a well thought out and eye-opening paper! It is important that there is diversity in the world, and people who stammer only contribute to the cause. You shared unique ideas that if we make children fluent, we will lose advocates for people who stammer, and those children could lose an important connection to a community of supportive people who are there to help. This article has only helped me understand more about why it is so important to accept people as they are.

  9. Dear Patrick,
    I really enjoyed your paper. I especially liked how you mentioned the fact that in science fiction books, disabilities and stammers are gone, and how those societies never work out. As a future speech pathologist, do you have any advice on a good balance of helping people feel more comfortable with their stutters, rather than getting rid of it?

    Thank you,

  10. Patrick,

    Your article provided a different perspective than I had heard before – that stuttering isn’t just a difference, but rather a beneficial characteristic. My favorite of your reasons is the “wordsmith” since I find myself listening more closely to what people who stutter say since I have the same feeling – that what is said is more meaningful. I understand that good things can come out of hard times, but it seems like it would be very little consolation to the child in the middle of it. Do you have any ideas to support children to be as resilient and positive when they are initially facing trying times?

    Thank you,

    • That is a really good question Jessica! I’m just working on a blog post to answer this very question. In short, we need to create an environment at home and in education that empowers and supports the child to speak how they want to speak.

  11. Thank you for sharing! I really took away a lot from your article. Something that really stuck out to me was the section about the ticket. If a child learns fluency early, they will never be able to open up about how they actually feel about their stammer. Do you have any advice for children who stammer on how to be confident in themselves and be able to talk with more confidence?


  12. Patrick,
    This has really made me think on a different level than I ever had, and I greatly appreciate it. I do have a question though. Is that part of a person (or “ticket”) really taken completely away if they are made fluent? I am asking because I feel that those experiences prior to being made fluent are still a part of that person regardless of their current fluency. They still processed emotions and experiences prior to being made fluent and I think those emotions and experiences have still helped shape them into whoever they become.
    Again, thank you for the wonderful read!

  13. Hi Patrick,
    I found your paper to be incredibly inspiring. As a student in speech-language pathology, I’ve been learning about the importance of the individual accepting their stutter. Having worked with children who stutter, this paper emphasizes what I’ve been learning even more because I hadn’t thought about other aspects that may be influenced or lost when pressures of achieving fluent speech are placed upon the individual. I feel like your paper will help me to better communicate with clients and their parents regarding their unique perspective people who stutter have because of the different examples that you discussed.


  14. Hello Patrick,

    I am a Speech Language Pathologist graduate student currently taking a fluency disorders course this semester. Our instructor for this course recommended to explore and read others’ stories and articles, in order to learn more about stuttering at the International Stuttering Awareness Conference. After reading your article, I enjoyed learning about your perspective on how stuttering changed your life. There are so many positives that stuttering can bring in our lives that people may forget or not be aware of. As a future Speech Language Pathologist, I want to help my clients have a positive outlook on life even with their stutter, so my question is at what point in your life did you turn stuttering to a positive? Did you go through many hurdles in order to find the positive outlook?

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