Chasing the Fluency Gods

When it comes to stuttering, what is the cost of seeking fluency?
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When it comes to stuttering, what is the cost of seeking fluency?
Katherine Preston. (Photo: Andreas Serna)

Katherine Preston. (Photo: Andreas Serna)

Katherine Preston could feel her heart racing as she dialed the number. Go to voicemail, she willed the call, please go to voicemail. Working as an investment writer for a London asset management firm, Preston avoided the phone whenever possible. Now she was forcing herself to get back to a client who'd been trying to reach her all day.

The client answered the call in a posh, haughty accent. Preston tried to introduce herself, but she couldn't; she kept getting stuck on the "K" of "Katherine." The man laughed and asked if she'd forgotten her name. Suddenly, the entire office seemed to go completely silent. So Preston did the only sensible thing: She pretended to lose reception and quickly walked to the bathroom.

"I was actually concerned that I would pass out, that I was going to run out of air."

Back then, Preston spent a lot of time hiding out in the bathroom. She first remembers stuttering when she was seven years old. Her parents had given her a ballet outfit for her birthday, and she flew down the stairs of their London townhouse to show it off to her godmother. But when she tried to say the word "ballet," her voice hung on the first syllable. The physical sensation of stuttering felt like being dunked under water every time she tried to speak. Still, she never wanted to admit that it bothered her—in fact, years later, in the interview for her job with the asset management firm, she'd promised her bosses it wouldn't be an issue.

Her search for answers to the struggle with her speech prompted Preston to write the memoir Out With It: How Stuttering Helped Me Find My Voice, which was published in 2013 to strong reviews.

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Stuttering occurs when there is a glitch in communication between the brain and the speech mechanism, which results in a temporary closure of the vocal cords. The body compensates with a variety of responses, including gasping and muscular tension. These responses vary widely from person to person.

"Particularly for a child, it's an absolutely terrifying experience," Preston says. "I was actually concerned that I would pass out, that I was going to run out of air."

One day not long after she first remembers stuttering, Preston's parents gently broached the topic of speech therapy. For two weeks over summer vacation, Preston sat in a room with other children practicing speech exercises, dramatically extending certain sounds so that one syllable would flow into the next. The experience, like many that followed, left her briefly, euphorically fluent. "My stutter was like some good-for-nothing husband," Preston writes in her memoir, "who would be sweet for weeks on end and then come back to push me around."

There are two basic camps when it comes to the treatment of stuttering: fluency shaping and stuttering modification. "Imagine the Sharks and the Jets," Preston writes, "but with a lot less dancing and a lot more strongly worded letters."

Fluency shaping involves transforming a person's way of speaking through techniques such as deep, diaphragmatic breathing in order to reduce or eliminate stuttering. Stuttering modification, on the other hand, calls on the speaker to change her manner of stuttering to minimize the anxiety that surrounds it. This might involve techniques like repeating a stuttered word or stuttering on purpose while consciously trying to reduce tension in the body.

Dave McGuire is the founder of the McGuire Programme Beyond Stuttering. McGuire struggled with a stutter in the early years of his life. As an adult, he heard about an opera singer who claimed to cure stuttering with diaphragmatic breathing—taking deep breaths from the diaphragm and speaking a few words on each breath. McGuire combined diaphragmatic breathing with psychological techniques he had learned in an earlier stage of his search for a solution. He felt he'd finally found an effective treatment. "Having really believed that you could improve stuttering a bit, but mostly you had to accept yourself as a cripple when it came to speaking," McGuire says. "This was like, you'd been in a wheelchair all your life, and now you're not only walking, but you're dancing, you're running, you're playing tennis."

McGuire began training others in his method. When a participant stutters, he or she is encouraged to say, "Can I cancel that?" and try again. The McGuire Programme creates success evaluations each year; successful participants are evaluated as being "free from the fear of stammering most of the time."

"We don't accept ourselves as people who stutter. We accept ourselves as people working very hard to overcome a stutter. There's a big difference."

Dr. Heather Grossman, director of the American Institute for Stuttering, sits toward the other end of the spectrum. Grossman trained as a speech pathologist in the 1980s. At the time, most speech pathologists followed a behavioral model, acting almost like athletic coaches. They'd go through speech exercises with patients, praising fluency, having them try again when they stuttered—not unlike the techniques now used by the McGuire Programme.

But Grossman was concerned to see patients becoming increasingly tense. "Maybe even more scary to me was the idea that in the moments the person most wanted to use those tools, that's when they were least available to them," Grossman says. Eventually, she transitioned to a method focused more on stuttering modification and self-acceptance.

These two approaches—McGuire's and Grossman's—reflect different end objectives. As McGuire puts it: "We don't accept ourselves as people who stutter. We accept ourselves as people working very hard to overcome a stutter. There's a big difference."

Grossman rejects the idea that self-acceptance is a form of resignation. "If you define 'overcome' as living a fully authentic life where stuttering is completely independent of what you do, then you have overcome it," she says. "The overcoming means it's not holding you back."

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Years before her workplace troubles, when Katherine Preston was a child, she began developing tricks to pass as a fluent speaker. Through trial and error she found she didn't stutter if she spoke in accents, swore, sang, or interrupted people. Of course, these weren't the most polite or useful strategies, so Preston began avoiding difficult words by simply replacing them with others.

This is a common response, according to Grossman: "You'd be surprised by how far it goes. Sometimes people will say a name that's not their name, or they'll not date a guy whose name starts with a letter they feel might betray them, or they won't go to a college because people are going to ask and you can't say 'Binghamton.'" The psychological effects of such avoidance can be devastating. "What ends up happening is that you almost become an inauthentic version of yourself because so many of the things you want to say, you're not saying," Grossman says. "By the time you reach your late teens or early twenties, you feel like you're literally living in a jail."

Dr. Heather Grossman working with a client at the American Institute for Stuttering in New York. (Photo: American Institute for Stuttering.)

Dr. Heather Grossman working with a client at the American Institute for Stuttering in New York. (Photo: American Institute for Stuttering.)

Preston used these tricks to maintain an appearance of fluency throughout high school and college. Her tiny frame earned her the nickname "Petit" from her friends at Durham University—a nickname she liked because it had nothing to do with her stutter.

After college, Preston began working as a journalist, but found the constant communication with strangers taxing. "I'd walk miles around London before calling up a story lead," she says. Working on a piece for the Telegraph's society section, she found herself farcically chasing Rod Stewart around an art gallery, trying to get his comment on contestants of the X Factor. She stuttered when they spoke and, though she can't be sure if her memory is playing tricks on her, she remembers the music legend telling her journalism wasn't the field for her. After a year as a reporter, Preston moved to asset management, where she could hide behind the safety of her desk.

"By the time you reach your late teens or early twenties, you feel like you're literally living in a jail."

But in the bathroom of her London office, re-playing that phone call in her mind, Preston was forced to confront her unhappiness. The next morning, she called Anne Blight.

Blight is the founder of the Starfish Project, a non-profit speech therapy course in the United Kingdom. The course lasts three days and focuses on "diaphragmatic re-training (costal breathing), avoidance reduction therapy, and positive attitude development." Participants wear cloth belts around their chests and practice taking deep breaths from the diaphragm before trying to speak.

Preston had been through the program at age 16, in preparation for college interviews. She'd been impressed by Blight's warm, direct manner, and had enjoyed bonding with other people who stuttered. But she hadn't felt comfortable incorporating the chest belt into her teenage life.

After Preston's breakdown in the office, Blight welcomed her back and urged her to commit to the program. Two weeks later, Preston and her mother drove to a session held in a barn on the southern coast of England. She began to experience the giddy fluency that had drawn her to Starfish in the first place. On the drive home, Preston and her mother laughed as she called directory assistance again and again.

But Preston knew something wasn't quite right. "I had this technique that meant I could speak fluently," she says, "But I could only speak fluently in a way that made me unhappy." Because the costal breathing technique requires a certain slow, measured way of speaking, she found it hard to be spontaneous, to tell jokes, to create any kind of natural rhythm.

So Preston made a radical decision: She quit her job and came to the United States to research and write a book about stuttering—what would become Out With It. "I had these extremely altruistic thoughts about how I was going to help other people by talking about something that had been a taboo for ages," Preston says. "But in the back of my head, I thought maybe I would stumble upon the answer that would help me. And I thought that answer would be fluency."

In the U.S., Preston began talking not only to speech therapists and researchers, but people from all walks of life who'd struggled with stuttering—from New Mexican ranchers to big cat conservationist Alan Rabinowitz to the actress Emily Blunt. Preston learned about the many forms of treatment for stuttering, some relatively mild (vitamin supplements) and others extreme (electric shock therapy).

One of the people Preston encountered was Dr. Gerald Maguire, chair of psychiatry at the University of California–Riverside, and one of the leading researchers on stuttering (not to be confused with Dave McGuire of the McGuire Programme). Maguire helped to shed light on the connection between psychology and stuttering, a complex, oft-misrepresented relationship. (The popular 2010 film the King's Speech, for example, was widely criticized for suggesting King George's stutter was the result of childhood trauma.)

"Stuttering is a neurologic condition associated with regions of the brain that control the timing and initiation of speech," Maguire says. Although psychology can play a role in the exacerbation of symptoms, it is not the root cause: "It's a neurological disorder that can have psychological presentations, but it's not psychologically based," he says.

Meeting Maguire proved to be the next major moment in Preston's quest. "It was the first time I felt that this wasn't my fault, that stuttering had its genesis in our brains," Preston says. "That was a really interesting piece of the puzzle for me." She began to think of stuttering as something she had been born with, rather than something she had failed to overcome.

There is contention among the experts on this notion of personal responsibility. "Success in our program boils down to if the person is willing to put in the work, develop courage, and persevere," explains Dave McGuire of the McGuire Programme. "It's like success in anything: time and effort. Some people just aren't willing to do this." Heather Grossman objects to this line of reasoning. "Some people just really have more stuttering in their bodies, and they don't have the same level of motor proficiency," she says. "Statements like that ignore the natural variability. And when you see someone who is able to be very fluent, and you're the one who's not, it really does make you feel like a big fat loser."

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Visiting a Boston Starbucks toward the end of her research, Preston decided to try out voluntary stuttering, a technique in which the speaker stutters on purpose, even more so than they would naturally. Grossman calls it "the antithesis of chasing the fluency gods."

Stuttering intentionally is considered one of the most direct ways to behaviorally undo years of avoidance strategies. It's also effective at separating the physiological experience of stuttering from the anxiety that almost always accompanies it.

Grossman describes this as a process of systematic de-sensitization. At the American Institute for Stuttering, she encourages participants to experiment with voluntary stuttering on the phone, in stores, even on the subways of New York City. "You train your body to be tolerant of stuttering," she says.

This tolerance may actually lead speakers to stutter less often. A key component of voluntary stuttering is simply putting it out there—"advertising"—by saying things like, "I stutter, please give me a minute."

"There's this voice that tells you, 'Don't stutter in front of this guy, he'll never ask you out,'" Grossman says. "And then as soon as you think that, you stutter tight. It's really quite amazing."

The idea of stuttering voluntarily seemed revolutionary to Preston after so many years of fighting for fluency. Waiting in line for her coffee, fingers clenched and chest tight, Preston could feel the eyes of those behind her boring into her back. Finally at the front of the line, she began to order, stuttering on the word "tall."

"A tall coffee?" the barista suggested. Preston was tempted to nod, but she persisted, stuttering on every word, until she'd managed to order a tall soy latte.

Holding the coffee in her hands, Preston began to envision a resolution more complex than pure fluency. "It was how I was going to be at ease in a body that sometimes made that quite hard," she says.

Preston still stutters, and she doesn't pretend it's always easy. In fact, she writes in her memoir, "I still have days when I would really quite like to order a sandwich without watching the waitress act as if I have morphed into some alien creature."

And though she still uses some of the techniques she learned through her research—including voluntary stuttering—she's moved beyond seeking treatment. "I have learned to laugh at my stutter, to play with it, to appreciate the connections it instigates, to acknowledge the times when it is a pain in the arse and to work with the voice I have to say the things that I feel are most important," she says. Preston now speaks at conferences, teaches public speaking courses, and writes articles to debunk misconceptions about stuttering.

Preston has often asked herself whether she'd take a pill to eliminate her stutter. For years the answer was a definite yes, but now she's not so certain. "It would take something away from who I am," she says. "I don't think my world would be a more happy or fulfilled place without my speech. In fact, I think it could be much less interesting."

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