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THE STRUGGLES OF SPEECH: A PERSONAL AND LITERATURE REVIEW

Rosenfield, David B. MD

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Dr. Rosenfield is Director of the Speech and Language Center and Director of the EMG and Motor Control Laboratory at the Methodist Hospital Neurological Institute in Houston, TX.

STUTTER • BY MARC SHELL • 341 PAGES • HARVARD UNIVERSITY PRESS 2005

Choose any neurology or basic medical text of your liking, and look up “stuttering” in the index. You can't find it! Although stuttering afflicts over four percent of children and over one percent of the adult population – so every thirty seconds at least one person destined to stutter as an adult enters the planet – the condition is seldom found in our classic textbooks. Indeed, stuttering has never accessed the nosology of disease of processes.

No self-respecting physician recommends a particular singular treatment for the symptoms of back pain or headache or chest pain. Rather, we query the cause of the symptom, take an appropriate history, perform the appropriate examination, and pursue the necessary investigations. This is because back pain can be secondary to ovarian cancer, kidney stone, herniated disc, or other disturbances, all requiring different and separate treatments.

Yet, for various reasons, this is precisely what too often occurs in the field of speech disturbance: Singular treatments are recommended for disturbances in which the symptom becomes the sign and both become the disease. Thus, individuals recommend therapy for stuttering (that is, symptom = sign = disease), presuming that this is a homogenous disturbance, which it is not. People stutter for different reasons, just as patients may have back pain for different reasons.

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Figure. Any neurolog...
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Stutterers often find themselves the object of ridicule, social stigma, and encounter multiple problems in their lives. Despite the fact that there are over three million adults who stutter in this country and tens of millions more throughout the world, they receive little attention from the medical community, and certainly less attention in the neurology community when compared to other ailments much less prevalent.

Enter Marc Shell, Irving Babbitt Professor of Comparative Literature at Harvard University. Dr. Shell's book, Stutter, provides a description of stuttering that takes us through his own personal tribulations of wrestling with his speech impediment, while addressing his polio and the world around him. At times, Marc Shell would simply not talk, rather than stutter. Other times, he would struggle to get his words out; or he would substitute one sound for another, circumlocuting the difficult target (saying, for example, “goo-goo-goo-see you later,” instead of struggling to say, “goodbye”). Speech was a constant struggle.

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The Enigmas of Speech

Shell is neither a neurologist nor a neuroscientist. Rather, he is a Professor of English and knows the literature well. He could present himself as a victim but he does not. Rather, Dr. Shell asks why it is that people, like himself, stutter. As he tries to unravel this enigma of speech that has blanketed him throughout life, he reminds us that a young child who stutters may be petrified to give a book report in front of his class, yet, with similar embarrassment, sings in front of everyone with perfect fluency. Why is that?

Why do people stutter mainly at the beginning of words and phrases but not at the end of a word? For example, no stutterer says, “Where is the hospital-l-l-l?” Rather, he or she will say, “Wh-Wh-Where is the hospital?” Why does stuttered speech improve when one adds a particular rhythm or cadence to the speech? Why do people never stutter when they sing?

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References to World Literature, Research

Shell asks all these questions, intercalating his answers with quotes and references from Hamlet, the Aeneid, Of Human Bondage, and multiple other sources, extending to Moses, Winston Churchill, and Marilyn Monroe. The book provides an incredible array of references to the world's literature, and no reader can put down the book without having increased their literary knowledge and acumen. Literature is Shell's forte and he covers it well.

For instance, Virgil employed a particular rhythm to his Aeneid, which was spoken at the time, so that he could produce the output fluently, without stuttering. Where else, other than in Stutter, can one glean that information, explaining how one of the world's greatest literary masterpieces was templated and filtered such that the output was possible without stuttering? The motor processing of speech vastly influenced the content of language.

Stutter discusses the multiple abnormalities in structure versus function among dysfluent individuals, commenting on genetic investigations, as well as studies in brain imaging, motor control, delayed auditory feedback, and pharmacology. The book will interest anyone querying how the brain orchestrates output of sound, in particular speech.

The book does not summarize the neuroscience of stuttering. However, that is not the author's purpose. What the book does accomplish is provide information pertaining to investigations of how our brains produce normal speech and how that speech can become abnormal. At the same time, Shell intersperses the story of his battle to try to speak without the added burden of speech therapy, which requires him to make conscious a process that most of the world does unconsciously, producing that which is most human – speech.

Shell cleverly and skillfully weaves us through the world's literature, focusing on people who stutter such as Virgil and Somerset Maugham, as well as fluent colleagues, such as Shakespeare, and Geoffrey Chaucer, Billie Holliday, Bob Dylan, and Francis Bacon. Any neurologist with an interest in literature, speech, language, or cognition will enjoy this book. And, any of us who don't will find that Stutter opens cognitive doors and will delight you.

©2006 American Academy of Neurology

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