Monday, October 10, 2011

On the threshold of stuttering

Having experienced the challenges of stuttering as well as severe headaches, I have recently become interested in the similarities between these afflictions. In particular it would seem that both have a ‘threshold’, below which stuttering as well as headaches do not occur (counting out the consistent or non-situational stutterer who stutters irrespective of the situation – more about this later in this post).

In an excellent book on headaches and migraine – Heal your Headache – by a neurologist, Dr David Buchholz, it is stated (on page xxii): “If you can keep your total trigger level below your threshold for activation of migraine, the mechanism will not become activated and you’ll be symptom-free.”

Dr Buchholz’s book is receiving very high rates from readers at the Amazon website, with more than 250 reviewers giving it five stars. Since reading the book and applying his ideas my headache problems – which I feared had become chronic – have all but disappeared, so I’m taking everything he says very seriously. One of his ideas is that most headaches are really part of what is known as migraine – what we call migraine is simply a very severe headache, at the far end of the headache spectrum. A light headache, then, is a minor form of migraine.

In Dr Buchholz’s view, many things can trigger the headache mechanism: stress, dietary triggers (inter alia caffeine, chocolate, MSG, nuts, processed meats / fish, citrus fruits, onions, aged cheeses, yogurt etc. etc. – quite a list!), bright light, too little or too much sleep, hormones, eye strain, changes in barometric pressure (eg. air travel) etc. etc. All these triggers have a combined impact, and if the total impact exceeds your headache threshold, the mechanism is activated and you will start developing a headache. The higher you exceed your threshold, the more severe the headache will be.

This made sense to me and was in line with my own experience of headache. It also explains why it is so difficult to identify any particular trigger as a headache trigger, as a single trigger may not be sufficient to result in a headache and so be identified as the “cause” of the headache. So, for instance, just eating a bar of chocolate may not result in a headache because the threshold may not have been reached. However, when OTHER triggers are also present (such as eating chocolate while also stressed, or while also having slept too little), that chocolate may just be enough to take you over the threshold and cause a headache.

The headache of stuttering

This theory of headache, and particular of a headache threshold, makes sense. And what’s more, it’s relevant for people who stutter. Because don’t we who stutter situationally also have a stuttering threshold? When we stutter, is it because we have exceeded our stuttering threshold? Conversely, if we don’t stutter, is it because we are “below” our threshold? I believe that that is exactly the case.

I believe that when we have a “good day” of fluency, it is because we live and speak below our threshold level. Conversely, when we have a “bad day”, we continuously exceed our stuttering threshold.

 It follows that, in order to improve our fluency, we need to avoid exceeding our threshold. This means managing our stress so that the tension on our vocal cords does not rise above the level at which they will “freeze”, thereby resulting in what is known as stuttering. I have found this model of stuttering – managing one’s stress as well as one’s vocal cords so as to keep vocal-cord tension as low as possible – to be very helpful in managing my speech better.

The idea of a stuttering threshold is not new and has been worked out by Dr Martin Schwartz in his (now free online) book Stutter No More (which in my view is one of the best - and most underrated - books on stuttering ever). According to Dr Schwartz, the horizontal threshold line is not the only level of importance in stuttering. There is a second line (usually below the threshold) indicating base-level tension (I prefer to call it base-level stress). Base-level stress is the total of all the general stresses impacting on your nervous system.

Then there is a third factor indicating localised vocal-cord tension (which Schwartz calls "speech tension"). Vocal-cord tension is usually above your base-level stress – in other words, it fluctuates between your base-level stress and your threshold. Check out the following diagram illustrating what happens when John, who has to say his name, reaches his threshold:

When you don’t stutter, your localised vocal-cord tension is below your threshold, and usually above your base-level stress. When you do stutter, it means that vocal-cord tension has exceeded your threshold.

Note that base-level stress is not a static line – it can rise or fall depending on your general stress. If your stress is high, the margin between your threshold and your base level shrinks. In other words, you have less space in which to speak without stuttering.

Conversely, if your stress levels are very low, the margin in which you can speak fluently increases dramatically. For more information on the stuttering threshold, check out the chapter in my online book which you can read HERE.

I believe that this model of stuttering is correct, that it is a huge step forward in understanding stuttering and that it is not getting the attention it richly deserves.

Last but not least – what then about the non-situational stutterer who seems to stutter irrespective of tension levels? Non-situational stutterers seem to be in the minority, with most stutterers being situational. It could be that the non-situational stutterer’s threshold is unusually low, so that he / she lives and speaks above the threshold on a permanent basis. Or else the individual’s base-level stress is so high that the margin within which he can speak fluently is minimal or non-existent, resulting in a permanent state of exceeding the threshold. Or else his speech tension remains consistently high, exceeding threshold and not fluctuating much. 

Looking at it from a different angle it could be argued that this person’s vocal-cord tension and / or base-level stress has / have become chronic and very well-established, in line with the general principles of learning and conditioning.

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