Exploring possibilities for change: Is stuttering a “mind-body” disorder? – Peter Louw

Peter LouwAbout the Author:

Peter Louw is an author and poet who lives in the beautiful city of Cape Town, South Africa. Trained as a lawyer and admitted as an advocate, he nevertheless found that his stutter made it difficult to follow this career, and instead became a court reporter, journalist, editor, and translator. His books include a collection of poems and two books on stuttering. He has a blog titled Stuttersense (424,069 pageviews up to August 2021) and a Facebook group, Stuttering as a Mindbody Disorder.

Peter believes that there is a need for change within the area of stuttering. He feels that the role of the subconscious mind in stuttering, as well as stress and the repression of hidden emotions, are not sufficiently acknowledged within the stuttering community, and hopes that a new focus on them will help bring the much needed change we want to see.

Exploring possibilities for change: Is stuttering a “mind-body” disorder?

Is stuttering a psycho-physiological, aka “mindbody” condition? For the past few years this question has been haunting me. Because if it is, it could change how we see stuttering and how we treat it. 

In other words, is it part of that strange family of disorders in the hotly disputed no man’s land between the mind and the body? Is it related to irritable bowel syndrome (IBS), many other digestive issues, tension headaches or migraines, unexplained muscle pains and many other stress / anxiety-based health complaints? And if so, can this information help us to deal better with our stutter?

Stress can manifest physically

A few years ago I came across an article in a sports magazine discussing “tension myositis syndrome”, a.k.a. The Mindbody Syndrome or TMS. TMS, according to the article, is a stress/anxiety-based syndrome with an open-ended myriad of symptoms ranging from digestive issues to lower back pain. At the time I had immense problems with my lower back. This was at the time of my retirement from a large financial company after twenty years – a very relevant fact, as will become clearer later. I used to get excruciating back spasms, seemingly out of the blue and not dependent on the physical movements I made.

X-rays and MRI scans showed mild disc narrowing, regarded normal for my age, and various health professionals concluded that this was causing the pain. However, the pain pills, creams, physiotherapy and an epidural injection failed to bring relief, and so I began to read up on TMS.

TMS is the term coined by the pioneering Dr John Sarno, MD (1923 – 2017), who was professor of clinical rehabilitation medicine at New York University School of Medicine. His concepts have since been further developed by various physicians (who have all written books about it), notably Drs Howard Schubiner, Marc Sopher, David Schechter and others. The basic idea is that stress, and particularly repressed, hidden emotional stress, can manifest physically (and sometimes also psychologically).

Getting in touch with secret feelings

Treatment entails becoming aware of this secret emotionality – getting in touch with your deepest feelings. A major tool to achieve this is the technique of journaling, that is, writing about and fully exploring one’s feelings in, for instance, a diary.

And that’s what I did. I followed a structured journaling program in which I had to answer carefully selected questions intended to probe the unconscious mind and expose what I had hidden from myself. Amazingly my back pain began to disappear as I unearthed what had caused it – I had repressed my secret fears around retirement! My subconscious mind had worried about post-retirement life, reduced income, getting older and losing my health, and the certainty of eventual death. Consciously I had not given it much thought, but my subconscious mind must have felt very threatened indeed.

Intrigued by my recovery from back pain, I began to wonder about this TMS. Officially it is not (yet) recognized in the mainstream medical community as a true syndrome – yet it had helped me, and many others if the reviews of Sarno’s books on Amazon can be believed. Could it perhaps also explain a few other unexplained health issues which had impacted my life – such as stuttering? Could developmental stuttering be a type of TMS, an early onset TMS? 

Blocking may trigger the repetitions

Taking this line of thought further – if TMS can result in tension-based spasms of the muscles of the lower back, as happened in my case, can it perhaps also result in tension spasms of the vocal-cord muscles, resulting in stuttering?

Such an explanation fits in with my experience of stuttering. For decades I had been using the Passive Airflow fluency technique, which is based on the hypothesis that speech repetitions and prolongations are actually efforts to deal with blocks. The airflow approach states that repetitions, prolongations and blocks are not just aspects of stuttering – the repetitions and prolongations, being struggle behaviors aimed at resolving the blocks, are actually the result of the blocks. The blocks themselves seem to entail a tension-related “freezing”, or “locking”, of the vocal cord muscles.

For instance, a stutterer who repeats, is like an athlete who is unable to scale a high wall – he will retrace his steps (repeat the sounds already spoken) in order to make another effort at scaling the obstacle, which is the next sound to be spoken. But that sound cannot be readily pronounced because his vocal cords are in freeze mode. This would explain the physical part of stuttering.

Not fighting or fleeing, but freezing

And this led to another intriguing question: When our vocal cords go in freeze mode, is it because of the “freeze” in the fight-flight-freeze stress response? This, again, makes sense. I suspect that we channel our tensions to our vocal cords, in the same way that some people channel their tensions to other parts of their bodies, such as the digestive system. The tension is generated by day-to-day stress as well as inner, and often unconscious, anxiety.

Day-to-day stress does play a role in TMS, according to Dr Sarno, but not as much as inner anxiety, in particular psychological repression. What is repression? Well, it is something everybody does all the time! And it makes life much easier. Repression means the “forgetting” or ignoring of unacceptable or unpleasant emotions or thoughts, pushing them back into the subconscious mind. For instance, most of us don’t dwell on everything that can go wrong all the time. We tend to forget or ignore negative emotions such as rage, sadness, fear or uncertainty. 

Repression happens outside of our awareness; it is an unconscious process. (When we are aware of it, it’s known as suppression, which happens consciously.) We don’t know that we ignore or forget certain emotions or information that might hurt us or otherwise be unacceptable to us. It is a defense mechanism to protect us from emotional overload and anxiety. Our minds would be overwhelmed if we were to be made aware of everything that comes to us through our senses.

Bottling up the emotions

Some people, however, seem to repress more than is usual or healthy. Very often they are by nature more sensitive than average – called Highly Sensitive Persons (HSPs) after the excellent research by the famous psychologist Dr Elaine Aron. (Most people who stutter are in fact HSPs, according to the research by Dr Libby Oyler, CCC-SLP. High Sensitivity is mainly an inborn trait.) Sensitive children seem to be more susceptible to develop TMS. If too much emotional material is bottled up, it may cause inner conflict which will in turn result in tension. That tension may then seek a physical or psychological outlet. For instance, the tension generated by the TMS defense mechanism may hit the muscles of the digestive system, causing a spastic colon – or, for example, the speech muscles, resulting in speech blocks and stuttering. This effect would, of course, be increased by the usual day-to-day stress to which everybody is exposed.

One of the problems with repression is that, being a subconscious process, it’s hidden and cannot readily be picked up by researchers, speech professionals, people who stutter, and parents of stuttering children. MRI and other scanning systems are unable to differentiate between repression and other mental activity. As a result it is not possible to pinpoint or prove repression. It’s therefore no wonder why some researchers have, erroneously in my opinion, concluded that the cause of stuttering is not psychological. They missed the hidden repression which causes tension that leads to people tensing their vocal cords.  

Another key element of TMS is conditioning. Once the above mentioned process is in place, it quickly becomes established through conditioning. Not only the repressive mindset, but also the physical expressions of that mindset will be reinforced as time passes and neural pathways are formed.

Expressing stress through speech

Now, you may ask: Are you saying that people who stutter (PWS) are neurotic, or otherwise mentally disturbed? No, most PWS are just like other people; most people, whether fluent or not, are exposed to stress and carry some repressed emotional baggage (some more than others), it’s part of being human. The only difference is that PWS express their stress and repressed emotional material through their speech. Others may express these in other ways, like getting a migraine or a digestive or skin issue. 

But if stuttering is a form of The Mindbody Syndrome (TMS), how can this insight perhaps help people who stutter? We can learn much from how other mindbody symptoms are dealt with, such as journaling, relaxing, meditating, and getting in touch with hidden emotions.

Above all we need a new mindset. If the key to stuttering is psychological repression, it might be helpful to explore its opposite: expressiveness and assertiveness. Instead of holding back and bottling up, we need to let it out. Instead of repressing deep-seated feelings of anger, fear, sadness etc. we need to acknowledge and fully feel them, even if they are hard to deal with. If they unconsciously accumulate they could elevate stress levels and impact on fluency.

Do not repress – express!

So these days I journal daily. I write honestly about who and what has made me unhappy in the past, and is stressing me in the present, and why. In the same way I also express my fears for the future. Repressed rage is the usual suspect in mindbody issues, so I focus on expressing and really FEELING my anger, thereby getting it out of my system. In my electronic diary I rant, scream, curse or cry. Others I know scream while driving alone in their car – a great place to let it all out!

As this is a mind-body issue driven by tension, I also try to manage my general stress levels through physical activity, meditation, and relaxation procedures. And because the mind-generated tension eventually reaches the speech organs I also use the Passive Airflow fluency technique, to reduce the localized tension on the vocal cords.

In addition I have memorized a series of daily affirmations, to gradually change the subconscious mind:

  1. Stuttering is due to TMS, not a structural abnormality.
  2. TMS is a harmless condition, mainly caused by my repressed emotions.
  3. The principal emotion is my repressed anger.
  4. I will not be concerned or intimidated by stuttering.
  5. I will not obsess over stuttering – it is just a symptom.
  6. I will shift my attention from the stutter to emotional issues.
  7. I intend to be in control, not my subconscious mind.
  8. I will not repress, but do the opposite: I will express!
  9. I will be assertive and not hold back.
  10. I will refrain from perfectionism and goodism.
  11. As an adult I am not the vulnerable child I used to be.     

A last word …

The above holistic view of stuttering and its treatment has become the roadmap in my journey to better speaking. Not only is it the change I wish to see – to a large extent it is now my reality. It has enhanced my retirement years immeasurably, and my only regret is that I didn’t have this knowledge many decades ago. But … I probably would have rejected it then. As the saying goes, “When the student is ready, the teacher will appear.”   

 

References:

Abbass, A., & Schubiner, H. 2018. Hidden from view: A clinician’s guide to psychophysiologic disorders. Psychophysiologic Press.

Aron, E. N. 1999. The highly sensitive person: How to thrive when the world overwhelms you. Thorsons.

The Psychophysiologic Disorders Association (PPDA)

Sarno, J. E. 1998. The mindbody prescription: Healing the body, healing the pain. Warner Books.

Sarno, J. E. 2008. The divided mind: The epidemic of mindbody disorders. Duckworth Overlook. 

Schubiner, H. 2011. The King’s Speech as Mind Body Syndrome: Finding your Voice and Reclaiming your Life

The Tension Myositis Syndrome Wiki. 

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Comments

Exploring possibilities for change: Is stuttering a “mind-body” disorder? – Peter Louw — 17 Comments

  1. Welcome and thank you for reading my article! I hope you found it interesting. I am excited to be part of the ISAD Online Conference for the first time, and look forward to your comments!

  2. Peter I want to thank you for introducing this to me 3 years ago. I’ve been following tms principles ever since. I know stuttering is a mindbody syndrome and I know it will cure me soon. I’ve already come such a long way changing destructive patterns and behaviour that fuel my stutter. I’ve put old emotional patterns to rest that were no longer serving me. I’ve discovered things about me that have opened my eyes, how paranoid I’ve been and how repressed anger has come to the surface upsetting people without me being aware why. I’ve cured many conditions with this tms knowledge including chronic back pain, acid reflux, skin conditions, burning up, old accident knee pain, prevented hair loss! New pains I get rid of and more ailments I can’t remember! Tms explains how most stutterers don’t stutter when they’re angry, how you can be fluent one minute then stutter on exactly the same words the next minute. I’ve always known stuttering isn’t the real me, and tms explains exactly why, that it’s our subconscious protecting us from emotional pain or conflict, helping us to survive

    • Many thanks for your kind words, Stu! It’s so great that this concept has helped you. I know what you’ve had to deal with and how you tackled them all with perseverance and dedication. Your experiences resonate with me as I’ve also had to face some of the physical issues you mention. It has been an eventful period for me too, these last three years. It’s a gradual process but we’re getting there!

  3. Peter is a torch bearer for countless PWS like me who have done almost everything to get rid of their stuttering with no lasting results. He has actually lit a flame of hope no matter how far out it may be but as soon as one starts SEEING it the despair slowly starts to fade away.
    This concept of healing is relatively new to our community and actually so too simple to grasp that I had to spend a couple of years figuring out how it actually works!
    I am certain that this MindBody healing has the power to CURE stuttering provided we do the recommended work wholeheartedly BELIEVING in the process. And as the best act of kindness Peter is always available for help.

  4. Dear Altaf, thank you so much! Much appreciated! Indeed this concept of healing is new for our community. It’s a different paradigm and I’m still learning new things about it every day! Ironically the basic principles have been around for years, but it was mostly applied to chronic pain issues. We can learn so much from those who have been using these methodologies to address other psycho-physiologic disorders.

  5. Hello Peter,
    First off I just wanted to say I am so happy I found your post. What a wonderful piece filled with so much insight. After reading I feel like I better understand not only stuttering and it’s intricacies, but my own subconscious tendencies and how my own body responds to stress. I have never heard the term Highly Sensitive Person (HSP) before and well I can say with full confidence that I am one!
    I am a student currently pursuing a degree in Communicative Disorders and am here seeking to better understand Fluency Disorders. The idea of stuttering being a Mind-Body Syndrome makes so much sense to me, I felt like i had multiple ‘A-ha’ moments while reading your article.
    I see that you are from South Africa, and I am curious what therapy was like for you and when it started. Did it begin in primary school? Or was it something you had to seek out privately?
    I recently took a neurology class and learned about the development of neural pathways as you mentioned, it is amazing that we have the ability to reinforce those pathways and not the one’s that may not be serving us anymore (or ever were). I love the idea of holistically treating fluency challenges, and I think incorporating affirmations like the ones you listed are so important. I personally use affirmations and find them so useful in rewiring my own subconscious. As a clinician someday I hope to help other work on building new healthy pathways, and I will take your words with me. I have so much I could touch on after reading your paper, but I will end with a thank you for sharing. It was a pleasure.
    Sincerely,
    Jessie Redmon

    • Dear Jessie, many thanks for your kind response – much appreciated! Yes, the concept of the Highly Sensitive Person (HSP) for me too was a real eye opener when I first became aware of it. I read Dr Aron’s bestseller “The Highly Sensitive Person” and recognized myself on each page, and it made me understand myself so much better. I wish I had known about this when younger! Armed with that information I would have taken better life decisions. Apparently 1 out of 5 persons is an HSP, but within the stuttering community this ratio increases to 4 out of 5. It seems many poets, artists, writers, inventors and other creative people are HSPs. I do think that High Sensitivity plays a major role in stuttering, as it apparently does in many if not all mindbody disorders. High Sensitivity is a wonderful trait, but it comes with a price, in the form of vulnerability to stress and anxiety.
      To answer your question: I had speech therapy at age 13 at the speech department of a local university. It consisted of reading aloud to rather pretty student clinicians, and walking around on campus having to ask strangers the time while having to stutter artificially three times on each word. I found this forced stuttering terribly embarrassing and a nightmare, though it did help my speech, so that after some weeks I was discharged as “cured”. For a few months I was in fact totally fluent, but eventually the stutter returned – with a vengeance.
      With the wisdom of hindsight I now realize what had happened. The speech therapy had a psychological impact – the mere fact of being treated by “experts” who I presumed knew what they were doing had reduced my stress and anxiety levels. Eventually, however, the stutter reappeared because the usual psychological stressors in my life were still in place and in time reasserted themselves. And the artificial stuttering was effective because it simply acted as a distraction.
      It is great that you are pursuing a career in communicative disorders and that you are interested in a holistic approach! I’m sure you are on the right road with this and that it will take you very far indeed. Many thanks again for your comments!

      • Peter,
        I am officially ordering the book! How interesting that the ratio increases in the stuttering community. I can imagine that other communities also have more Highly Sensitive People. I am excited to explore more on that. How curious.
        And also what an interesting therapy experience that must have been for you. I can imagine a young boy on a big campus (like the one I attend now, that makes me, a 26 year old, nervous) and how intense that must have been. It is also interesting that because you trusted the professionals you assumed that you in fact were ‘cured’. Because what else were you supposed to think?! But really you are the expert! And when I become a clinician I plan to treat my clients as such, and let them lead their therapy and set their own goals in regards to fluency. Thank you so much for your reply and sharing so much with me, and best of luck to you.
        Much respect from California,
        Jessie

  6. Hi Peter, I am a student currently in my master’s program pursuing a degree in Speech-Language Pathology and am here as part as my graduate course on stuttering. I just wanted to say what a thought-provoking post that was filled with awareness on the concept of mind-bodying healing for the stuttering community. As a future SLP, it is important for me to be aware of this distinction between repression and expression so I can meet my clients where they are at in their journey. I think often times professionals working with PWS forget they are dealing with human-beings who have a plethora of emotions that accompany their stuttering. First recognizing that, meeting them where they are at, and then helping them to express, not repress! I hope to help future clients find a route that is healthy and beneficial to them to express themselves.
    Best,
    Kaeley Heath

  7. Dear Peter,

    Thank you for your insightful take on the origins of stuttering and for sharing your own personal stuttering experience. I find the theory of Mindbody Syndrome causing stuttering very intriguing and I hope that more research is put into exploring the concept of stress and repressed emotions as they relate to stuttering.

    Your comments about stress manifesting physically reminded me of a concept I learned about when I was training to work with children in the foster system– Adverse Childhood Experience scores (also known as ACE scores). High ACE scores are associated with increased stress in children. This can result in elevated stress hormones such as cortisol, which directly impact physical development in the brain, immune system, metabolic system and other organs. The impact of these hormones on critical stages of development can ultimately lead to chronic illness later in adulthood.

    Do you think that the repressed stress that leads to stuttering may similarly have hormonal origins? Perhaps this is a way that the Mindbody Syndrome might be explored further in the medical field?

    Thank you again for your insightful paper!

  8. Hello Laura, and thank you for your comments and interesting and difficult question! As far as I’m aware, stuttering is not due to hormonal issues – the panel of experts might be able to enlighten us. Within the mindbody community, it is generally thought that a particular personality – rather than biochemical factors such as hormones – is more prone to develop a mindbody issue. Children or adults with TMS (The Mindbody Syndrome) tend to be Highly Sensitive Persons (HSPs), perfectionists, worriers and self-critical, good problem solvers and copers, people-pleasers, a bit compulsive, tending toward introversion and avoiding conflict, not relaxing well and with a thirst for information. These traits make them more susceptible to stress and anxiety, also encouraging repression of their daily worries. So as you can see, the focus within the TMS community is rather psychological and not hormonal. But it’s certainly an interesting possibility that you mention! It’s a principle within the TMS world that a structural (including hormonal) cause should be ruled out before TMS healing methods can be tried. Thanks again for your question!

  9. Hi Peter,
    I truly enjoyed reading your article! It has provided me with great insight and a different perspective on how I should approach the topic of stuttering. I love it when you talk about how TMS can stem from stress and how this idea relates to stuttering. Our vocal cords consist of muscles but it never occurred to me how they can also be affected by stress like any other muscle in our body! I do want to hear about your opinion of singing as a relaxation technique for our vocal cords.
    I also appreciate you for providing us with daily affirmations and I will use this one day to help out PWS once I become a speech therapist. Your paper is truly inspiring!

    • Dear Isalosagcol, thank you so much for your kind comments and great feedback – it’s so nice that you found my article interesting! To answer your question: from a mindbody perspective, singing is extremely important and useful as it is emotionally highly expressive – and expression is the opposite of repression, which according to mindbody theory is a big factor in mindbody issues. When we sing, we let it all out, we don’t “hold back” – and the mindset of “holding back” (repressing, being defensive and protective) seems to be a major driver behind stuttering. No wonder that most of us don’t stutter when we sing! There are the exceptions too, such as the late stuttering expert Dr Joseph Sheehan, who stuttered even when singing, but in such cases it seems that they (perhaps unconsciously) “hold back” to such an extent that they are unable to express themselves through singing. (Also keeping in mind that conditioning also plays a powerful role, so that repressiveness can be strongly reinforced as the years pass.) So yes, when we sing, most of us don’t hold back and therefore do not generate the type of tension which would impact our vocal cords. I hope this makes sense! Thanks again for your question and for reading my article!

  10. Hi Peter!

    Wow, what an amazing read! I know a significant issue with SLPs today is that they follow textbook therapy, without actually taking the time to understand the client, their thoughts/emotions, and other factors that could cause stuttering.
    What are your thoughts on integrating speech therapy & psychotherapy in a specialized clinic? Not only for PWS, but for all clients. That has always been a thought.

    Suzanne Perez

    • Hi Suzanne, thank you for reading my article and the positive feedback! Integrating speech therapy and psychotherapy in a specialized clinic surely is a great idea and a step in the right direction. Most psychotherapists do wonderful work, but few know much about stuttering. The ideal for PWS would be to be supported by a psychotherapist who is not only “mindbody-aware” but also has expertise in stuttering. I’m involved in both the mindbody and the stuttering world, and in my experience, stuttering is a tricky and difficult type of mindbody issue, also because most stuttering is developmental, starting in early childhood, so that the disorder, when adulthood is reached, has had many years in which to establish itself through conditioning; whereas many other mindbody issues such as Irritable Bowel Syndrome (IBS) etc. usually start at a later age so that it’s relatively easier to overcome. So the point I want to make is that it’s really hard for a PWS to do-it-yourself and go it alone – we need support from outside. So your idea of such a specialized clinic is great! I hope it will be taken further! Kind regards.

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