November 11, 2011

3 Questions from Delhi WS

 The Delhi Workshop generated some questions; we are trying to answer them here, so that all the readers benefit.
  1. Is stammering neurological or psychological? What percentage of it is neurological?....... Rahul Das
  2. stammering समय के साथ-२ इतनी variable क्यों होती है?...... Balveer Singh 
  3. Many PWS say that they stammer only on some particular letters/vowels, is it true or its just another illusion/mystery stammering?....Pramendra 

1. Stammering is both neurological AND psychological, like many other medical problems. In the beginning, during childhood, it was predominantly a neurological phenomena: we were saying something and suddenly the impulse for the next word failed to come from inside the brain- and we stopped. In that pause, we were not unduly stressed, frightened or ashamed. As we grew up, we learned all these emotions, all these psychological reactions and developed an elaborate pattern: Shy, not-assertive, apologetic, speak softly, avoiding risks etc. etc. Dr Sheehan gave the example of Ice-berg to highlight this: 90% of our problems are hidden, un-observable. Only ten percent is visible/ audible (as when we stutter). Few therapists succeed at dealing with the 90%.. Other diseases too, like Peptic ulcer have a physical component (wound caused in stomach due to acid) as well as a psychological component, which could be both a cause as well as effect of the ulcer: You worry too much- so you produce more acid in stomach, which causes stomach ulcer. Also, because of ulcer, you become a chronically anxious person ("I may bleed to death"), short tempered, forgetful etc.

2. Why stammering is so variable?  Every disease is the outcome of interactions between our defense mechanism and an external factor (one or more, -sometime internal too). This interaction is influenced by many factors and this is why predicting outcome is very very very difficult, especially in stammering. A good example of such complex interactions would be weather forecasting: with all the latest super-computers, can we predict when exactly Monsoons will hit Delhi? Same way- we can only say that I am likely to stammer during interviews- but I may not. And this only adds difficulties for us and others around us: they are left INTRIGUED and we remain CLUELESS! 

The factors in the brain which influence, when we will stammer and how strongly-  are many: to name a few- neurotransmitters (brain chemicals), electrical activity in other neural pathways, memory, emotional states, learning, inner expectations, hearing our own voice and integrating it into forward movement of speech etc. To get a glimpse of this complexity please check this very good blog:
(If you think it is complicated, come and listen to my simplified presentation on causes of stammering in Bhubaneshwar!)

To give another example: we all know that windows (till vista) was very bad at memory management and was very slow if it had some big programs (like anti-virus) running in background. We may also know that it sometime hanged when you started too many programs. Now, if we ask an IT expert to tell us when exactly this machine is going to hang? on starting how many programs? after how many minutes? etc. etc. , it will be nearly impossible for him to answer. In the same way, human SPEECH is a very complex system, and has still not been fully understood. 

3. In our current understanding: we learn to associate certain sounds with our inner difficulties. So, the real culprit is inside- our learned behavior based on fear - not the WORD itself. If that was the case, we should not be able to say the same word when we are alone or in other non-stressful context. These word fears are like PHOBIAS- an internal phenomena. I once had great difficulty saying "Yes Sir" during roll call. I changed it to "Present, sir" - and then promptly began having difficulty with "Present, Sir" too! So, who is the culprit, word or my perception of threat?  Another example could be that of a man with addiction to alcohol. He may say: I dont care for drinks- but my boss today blasted me today for no reason; next day, he may say: It was my friend's birthday- I was very happy so..etc. Is his problem rooted in external circumstances? Of course, not. The problem is not outside, but we tend to externalise things in this way without realizing and wait for solutions too, to come from outside. 

Implications for therapy is big: because words by themselves have nothing to do with stammering, you CAN desensitize yourself to these words by bouncing or prolonging them with strangers on phone or in person. Yes, you will need an experienced pws to coach you.

No comments: