This case history was published in 1982. I have updated it with footnotes indicated by bracketed letters. The cause of stuttering remains unknown. The treatment of adults with the affliction, according to todayʼs authorities in the field, can never produce a complete cure. The factors now thought responsible for the disorder have been reduced to just a few, with the emphasis in research focusing on genetic abnormalities and alterations in neurophysiology. Emotional factors are now considered to play no part in causing the condition.
Stuttering is a disorder in which the rhythm or fluency of speech is impaired by interruptions or blockages. The etiology remains obscure, with each school of therapy advocating its method of treatment based upon certain theoretical constructs. The many theories and therapies advanced all differ in some respect from one another. Older concepts of specific causality have given way to the impression that multiple factors combine, in ways yet unknown, to produce the stutter. Widely divergent treatments have produced beneficial results, and there is probably some truth in almost every theory advanced. [A] Hahn (1) believes that clinicians who subscribe to different theories may each claim success, based upon the idea that overlapping factors in treatment account for cures, or that differences between therapies are more theoretical than real. Also, the data as to improvement may not be accurate because of unscientific methods used to determine the results.
An initial response to the treatment of stuttering is often noted and is sometimes quite dramatic. Perkins (1) reports in his 1973 study that while 70% acquired normal speech, more than one-half of these subsequently relapsed. The incidence of relapse in the treatment of this disorder has been so common that there is disenchantment now with any measure that brings about immediate fluency. Initial success is often seen in the treatment of many conditions, but such breakthroughs with new techniques often cannot stand the test of time and the promise of therapy is not fulfilled.
Stuttering, like the biopathies of cancer and schizophrenia, has classical scientific explanations that remain without an integrating common functioning principle. Wilhelm Reich's discovery of the natural flow of energy within the organism and the formation of armoring or blockage to this flow, with subsequent symptom formation, offers a scientific understanding that can be useful in the treatment of stuttering. An overview of the major theories (1) advanced to explain this age-old affliction will help place the energetic concept in better perspective.
Coriat (1) expounds a psychoanalytic view that holds that the condition is a psychoneurosis that is caused by persistence into later life of early pregenital oral nursing with oral sadistic and anal sadistic components. Here the act of stuttering represents the resistance against the sudden discharge of oral eroticism. Blanton's theory (1) holds that the primary cause of stuttering is a fear state that prevents the cortex from exerting control over the organs of speech. Fletcher's concept is that fear, dread, anxiety, and worry have their genesis in specific childhood experiences that were associated with efforts at talking and, in this supposition, the problem is not seen as vocal utterances, but rather an inability in certain social situations to talk to people. Dunlap reasons that speech difficulty is a habit that can be broken and recommends that perception, thoughts, and feelings must be directed toward the future response and not toward the present habit. The Orton-Travis theory in the 1930s was very popular and held that cerebral dominance was affected with a change in handedness and that this produced the stutterer. Left-handed persons most usually have dominance in the right hemisphere, and switching handedness was thought to weaken the dominant and strengthen the nondominant so that the two hemispheres became equal in strength, producing disharmony. Unilaterality was taught to strengthen the dominant hemisphere, but laterality research did not support the theory, and it was noted that the majority of children whose handedness was changed did not stutter. [B] Other views of the disorder emphasize conflicting speech patterns, semantic theory, operant conditioning, and the learning theory of behavioral scientists. [C] From an energetic point of view, the most intriguing observations refer to the stutterer's physical perceptions and muscular contractions or movements. A theory was advanced that there was a deficiency in the ability to visualize, and body relaxation techniques, with breathing, singing, and vocalization, were recommended. It is interesting that these techniques are similar to Eastern meditation techniques, for we currently understand such methods to be effective by shifting energy from the left to the right cerebral hemisphere.
For most stutterers, the interruption of speech is associated with feelings of strain or tension. These are usually located in the muscles of articulation, but may be felt elsewhere in the body. It was observed by Solomon (1) that an individual who stuttered could momentarily release the speech with distraction brought about by some involuntary muscular action such as moving an arm or leg or breathing. Sometimes breathing movements reveal antagonism between the abdominal and thoracic regions. Electromyographic studies of the masseter muscles have shown evidence of defective synchronization, while other studies have found that tension was recorded primarily in the jaws, front of the mouth, front of the chest, and in the abdomen, and secondarily in the inside or back of the throat and front of the tongue.
Unusual eye movements associated with the stuttering block have been found with both oral reading and spontaneous speech. Vertical twitches of the eyes and prolonged fixation, with inhibition of or increased eye blink, have been noted. Dilation of the pupils is variable; one study indicates greater dilation during speech, with increases in pupil diameter during stuttering, and another reports a contraction of pupils at the onset of speech. Also, during the block, stutterers often give evidence of considerable inability to perceive auditory or visual stimuli. These observations are clear evidence of a disordered flow of energy that affects the ocular segment.
The following case history describes the treatment of a stutterer, and some preliminary conclusions about the disorder are drawn.
A 28-year-old, single black man, came for therapy specifically because he stuttered. The onset was shortly after he began to speak. He was an only child, born to strong-willed parents; he describes his mother as supportive and quite religious and his father as dominant and stubborn. Father punished him for crying and often demanded that he "shut up." Breastfeeding was precipitously terminated when mother became ill when A was 8 months of age. He walked at 1 year and was toilet trained by 2 years. He recalls biting playmates as a child and remembers that this was spanked out of him by his father. His handedness changed from left to right at about age 21/2. [D] He had always felt uneasy with people, relating with difficulty and lacking self-assurance and confidence. He was obsessed with the thought that people were looking at his mouth. As an adolescent, women were attracted to him, but he was shy, distrustful, and had developed a tough and nasty attitude to mask the anxiety and insecurity he felt. He was an average student in school.
A six-month treatment at age 16 with a speech therapist was not helpful. Initial dating and sex commenced at age 19, and masturbation began a year later. His interest in Eastern philosophy, yoga, and meditation began at age 14, and, when he returned from the Viet Nam conflict, in which he excelled as an officer, he joined an ashram to follow the teachings of guru Maharaji. For six months, he describes himself as "blissed out," with a month of perfect speech, totally free from stuttering. This remarkable event occurred after he felt loved and in the grace of the guru and experienced episodes of profound crying. In the month that he did not stutter, he perceived energy moving up and down the front of his body between his throat and genitals, with an altered consciousness he has not experienced since. This state could not be sustained, and stuttering resumed its prior frequency. He has recently, for the first time, experienced the sensation of energy movement in his abdomen. This perception of himself gives him a three-dimensional quality and is remarkably different from the “nothing" feeling between neck and genitals that is usual for him. When he perceives the streaming sensations in his body, he feels more solid, clear, and focused and, on these occasions, he is able to speak without difficulty. The reestablishment of a freer flow of energy within his organism has brought with it an increased self-assurance and confidence and an ability to see the world about him with better perspective. Up to now, this state has been rare and fleeting, but there is some indication that he is moving in this direction.
Biophysical examination revealed a tall, well-proportioned, heavily armored man, whose most striking areas of contraction were his ocular and oral segments. His eyes appeared glassy and showed suspicion and anxiety, and he blinked frequently. Open contact with me could not be maintained, and he squinted and looked sideways at me with suspicion—veiled disbelief or frank doubt. His jaw was retracted, and so rigidly held, it could not be moved passively. The submental muscles were extremely tense and the entire cervical musculature, extending into the upper thoracic area, was held. The diaphragmatic area, too, was rigid, and the lower segments were armored but less than the areas above the diaphragm. He could not open his eyes fully to express fright, and, when he raged, it was with loud, short shouts, choppy blows, and murder in his eyes. He could kick well and with great force. Interestingly, he rarely stuttered in my presence. This has continued to be true up to the present time. The diagnosis, based upon past functioning, character, and distribution of armor, is that of a catatonic schizophrenic with an oral repressed block.
Characterologic work has focused mainly on reality-testing of his goals and ideas and clarifying his perceptions. Initial work included uncovering enough of his resentment toward me as a therapist and a white man to allow treatment to go forward. Month after month of shouting and hitting, often combined with biting on a sheet, as his eyes flashed murderous rage at me, have reduced the grip of armor sufficiently to allow the perceptions of streaming in his body. Direct work on his musculature has not had much result; it appears either too hard and unyielding, where reachable, or too deeply lodged in the floor of the mouth, palate, and throat to be accessible. The focus of work has always returned to the head and especially to the eyes, which he now circles smoothly. He is able to maintain contact while breathing, and his expression has softened. He is aware now that he blinks often and is much more able to recognize when he goes out of contact.
A great deal of oral rage, shouting, and cursing still needs to be directed toward me, especially the strong racial feelings that have not yet been expressed. He stutters less and, although the impediment is still very important to him, he has returned to college and is doing quite well academically. He is married, has a young daughter, and works long hours, holding two jobs. His plans to succeed in the world of business are now feasible, given his strong drive and a more realistic perception of himself and the world about him.
Summary
A case of a 24-year-old, black, male stutterer has been presented. Orgone therapy seems especially adapted to the treatment of this case because of the strong somatic components evident in the disorder. Classical science has recognized the somatic components: Barbara (2) views stuttering as a symptom and defines it as a "disturbance in the smooth flow of speech owing to tonic and clonic spasms involving the functions of respiration, phonation, and articulation. Tics and spasms near to or remote from the speech mechanism are frequently associated." These physical manifestations are none other than the result of severe energy stasis, the removal of which is one of the major challenges of orgone therapy.
Treatment has focused on releasing rage, especially in the ocular, oral, and cervical segments, and on reestablishing contact with the eyes. The most striking feature of the case is the cessation of stuttering when the patient's eyes are in contact and he feelingly perceives the existence of his abdominal segment. We conclude that orgone therapy, with its approach of concomitantly freeing up physical armor and handling character resistances, offers a promising method of treatment for stuttering.
REFERENCES
1. Hahn, E. F.: Stuttering, Significant Theories and Therapies. Stanford, Ca.: Stanford University Press, 1943.
2. Atieti, S., Editor: American Handbook of Psychiatry, Vol. 1. New York: Basic Books, Inc., 1959.
ADDED REFERENCES
[A] Stuttering in an adult is considered incurable. J. Scott Yaruss, associate professor in communication science and disorders at the University of Pittsburgh School of Health and Rehabilitation Sciences and co-director of the Stuttering Center of Western Pennsylvania, stated, in the December 13, 2005 edition of the Scientific American: “There is no known cure for stuttering, though many treatment approaches have proven successful for helping speakers reduce the number of disfluencies in their speech.”
[B] The Orton-Travis theory held that stuttering results from a conflict between the right and left cerebral hemispheres as they fight for control of the structures that facilitate speaking. Forcing a left-handed child to use the righthand was thought to result in the loss of normal one-sided brain dominance, and this imposed change was thought to cause stuttering.
[C] Today, in 2011, the causes put forth as to the cause of stuttering have undergone significant revision. The Stuttering Foundation now holds there are only four factors most likely to contribute to the development of the disorder. These are (1) genetics (family members who stutter), (2) child development (children with other speech and language problems or developmental delays), (3) neurophysiology (processing speech and language differently from those who donʼt stutter), and (4) stutterers and family dynamics (high expectations and fast paced life styles).
Of these four factors, brain research (neurophysiology) and genetics now head the list as the most important, and most promising, areas to investigate. This is because areas of over and under activity in the brain have been identified with positron emission tomography (PET) scanning, and because gene mutations causing genetic variations have been singled out in a small percentage of stutterers.
Dennis Drayna, a geneticist and senior author of a study appearing in the New England Journal of Medicine (February 10, 2011), estimates there are three gene variants that account for 9% of all stutters. He said, as quoted by msnbc.com, “Itʼs really is not an emotional disorder. It doesn’t come from your interactions with other people.” He is also quoted as saying that stuttering “is almost certainly a biological problem.” Such statements are in keeping with todayʼs mechanistic approach to understanding medical disorders.
[D] Hand switching or other emotional traumas, such as the abrupt cessation of breastfeeding, do not always precipitate stuttering. This raises the question: Why does one individual subjected to an emotional shock develop the affliction while another does not? Additionally, why do most children who begin to stutter do so without, apparently, having been traumatized?
I theorize, based on Reichʼs work and my experience, that emotional shocks will manifest as symptoms only if there are a confluence of factors. These include, but are not limited to: the innate sensitivity of the child, the severity of the shock, and the age at the time of the traumatizing event. Also important is the degree to which the parent is in contact with their child. To the extent they are able to empathize, they will sense the impact that an event has had, and how much comforting is necessary to console their distressed infant. Finally, the development of jaw and throat blocks are often determined by whether the child was allowed to speak up and/or express feelings, especially of rage and crying.
