SOME NOTES ON THE STAMMERING PROBLEMBY RALPH REED, M. D.CINCINNATI, O.EARLY in my work in the field of psychoanalysis, I felt thatif a few stammerers were studied intensively by the psycho-analytic method, the solution of the nature of this difficultywould be readily arrived at. I still believe that psycho-analysis will answer many questions with regard to stammering, butI do not believe that it solves the problem of this disorder in any-thing like the complete and clean-cut way in which it has succeeded insolving the problem of many of the other psychoneuroses.I have now investigated in greater or less psychoanalytic detail,some twenty cases of stammering. The most striking thing that to mewas elucidated, was the fact that a series of stammerers will eventuallycontradict almost every theory that has ever been set forth, withregard to the nature of this disease. I believe that there have beenmore absurd and illy digested theories of stammering set forth, thanwith respect to almost any other psychoneurotic disorder. I studiedBleumel's Stammering and Cognate Defects of Speech, very carefullyyears ago, and found nothing in it of any value to me whatever. Ican say the same of practically every theory of this disease that hasbeen since advanced, including the work of both Swift and Scripture.I am unable to find that stammerers invariably possess what has beendescribed as the stammering monotone or that their auditory mem-ory or power of visualization is defective or that they were born left-handed and had been trained to use the right, etc. The bestsummary of the stammering problem, I have yet seen, is Coriat'cStammering as a Psychoneurosis (The Journal of Abnormal Psychol-ogy, February-March, 1915).Every stammerer certainly suffers in some degree or other froman inferiority complex, but to say this is not saying much. The merediscovery and confrontation of the patient with his inferiority com-plex will accomplish but little. Sometimes this seems to be the resultof the stammering alone, or again it rests upon unconscious fixationsthat it is the duty of the psychoanalyst to unearth. Not every stam-merer has been teased or made to feel humiliated by his defect; atleast I have seen several who have insisted that they never sufferedin this way.161162 Some Notes on the Stammering ProblemA few other facts with regard to stammering that are infre-quently, if ever mentioned, may be of some interest here. Stammer-ing does not invariably begin after the age of five or six. I saw onecase in a child of three who had stammered persistently ever since shebegan to talk. Stammering constantly tends toward spontaneousrecovery; * one rarely sees a stammerer older than thirty or forty; itis essentially a disease of adolescence. I have never yet seen a stam-merer who invariably stammered on a limited and definite number ofconsonants, or as some prefer, vowels. A stammerer may stammeron any word or at any time. As most every one knows, stammeringvaries greatly on different days, even from one hour to another, but Ihave noted the peculiar fact that there are often certain subjunctiveclauses coming in the course of a stammerer's conversation, which arespoken easily and readily. The cause of this will be later commentedupon. I have not even found that a stammerer will constantly speakworse to strangers and better to friends, worse away from home andbetter at home, or vice versa, yet the intensity of the stammering seemsto vary in the most unusual and extraordinary ways. Another pointmay be of interest here, as having a bearing upon what I shall later sayas to the causation of stammering, and that is; if at the time of speak-ing an effort is required of the stammerer in some other direction thanspeech, he will usually speak better. If, in reading, the attention canbe partially directed away from the word or phrase immediately beingread, he is much more likely to read it without stammering. This isone secret of the improvement secured by stammering schools thatinculcate a change of voice tone or rhythm. The attention of thestammerer is merely diverted to some extent from the essence of speech,to some secondary factor.Of course, most stammerers can sing and speak to rhythm. Ihave more than once, on the first interview, considerably impressedpatients by asking them to talk with the rhythm of a metronome. Fre-quently this is a discover}' to them, as they had not previously knownthis to be possible. But as some one has aptly put it; the stammerercannot go about for the rest of his life, beating time to his conversa-tion. I may say that I have tried various methods of correcting stam-mering by rhythm, change of modulation, etc., and nothing nowremains except to condemn them one and all, absolutely and com-1 Individuals who have stammered will usually rationalize their recovery. They attributeit to one factor or another, sometimes their own "will power." I believe that actualattainment in other directions has the most important influence.Ralph Reed 163pletely. It may be well enough to remark here that in my opinion,the one thing to avoid in treating the stammerer, is the directing of hisattention in any way whatever, to his speech per se.After all, there does not seem to me to be any profound mysteryin the stammering problem. Of course, as every one knows, the stam-merer can speak as well as any one else, as is evidenced by the fact thatvery frequently he does speak with ease and fluency. Stammeringis not essentially a speech defect at all, any more than writer's crampconstitutes an essential deficiency in the ability to write. The onlyreason that the stammerer does not recover with the same readinessthat the victim of writer's cramp recovers, is because he cannot, as thepatient with writer's cramp can, forego the effort to speak for asufficiently long period of time to give him the opportunity of regain-ing his speech confidence. But this is not to say that stammering isalone a mere habit fear. It is very much that, to be sure, but it is alsoa true anxiety neurosis, dependent upon a complex group of uncon-scious factors.The essential physical mechanism of stammering, I believe, isnothing more than an undue amount of energy overflowing into themuscles of speech. If I attempt to pick up my pen from the desk, itis obvious that if I do not put sufficient energy into the muscles of thefingers and hand the pen will fall from my grasp. It is equally obviousthat if I put forth too much energy the hand will become cramped