Is stuttering a manifestation of TMS?

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Is stuttering a stand-alone speech defect, or part of a broader mindbody disorder known as TMS (tension myositis syndrome, aka The Mindbody Syndrome)?

TMS, which was first put on the map by the pioneering Dr John Sarno, MD, is not an officially recognised medical ailment even though some prominent doctors accept that it exists. Though TMS is usually associated with chronic pain such as lower-back pain, many other disorders such as ulcers, sinus problems, carpal tunnel syndrome, certain headaches / migraines, dry eyes, night muscle cramps, heartburn, eating disorders, "growing pains", chronic fatigue syndrome, various skin disorders, OCD, panic attacks etc. etc. may actually be camouflaged TMS - physical (and sometimes psychological) symptoms having an underlying subconscious base.

Spasmodic dysphonia, another speech disorder involving the vocal cords, may also be TMS-related; but stuttering is seldom thought of as perhaps being a form of TMS, in some cases at least, even though a comparison yields interesting results. Both TMS and stuttering are stress-related; and in both cases, muscle cramps / spasms or muscle “locking / freezing” play a major role (lower-back TMS: tension-related muscle cramps in the lower back causing pain. Stuttering: conditioned struggle reflexes in response to a tension-related “locking” of the vocal-cord muscles).

‘Knowledge therapy’

Dr Sarno regards repressed, unconscious psychological rage – or other repressed emotions such as fear, shame / guilt or sadness – as a major cause of TMS. According to him, TMS acts as a distraction, being a rather rough-and-ready defensive and survival technique from the more primitive parts of the brain; by creating pain or other disturbance through tension-induced hypoxia (lack of oxygen) via the autonomic nervous system (ANS), the conscious mind is distracted away from the inner conflict (which the primitive mind regards as more threatening than the actual external symptom). Other experts believe that TMS is the “inner child's” way of signalling its distress. TMS could therefore also be seen as rough “messages” from the subconscious, from the inner self, that all is not well and that corrective steps are needed.

Perfectionists apparently are highly susceptible to TMS. Perfectionism and "goodism" (the tendency to be as ethical and moral as possible; actually also a form of perfectionism) are particularly enraging to the subconscious "id" (the primitive inner animal / child-like part of the brain).  

Treatment for TMS consists of soothing the inner child, doing certain self-help exercises and, in severe cases, counselling; some people are cured simply by reading a book on TMS, thereby bringing to consciousness the psychological underlay of their physical symptoms, and becoming aware of long-hidden emotions that manifest themselves as ailments.

All this will sound pretty crazy if you share the mindset of modern Western medicine with its strict mind-body division. Don't get me wrong - Western medical science has reached fantastic heights in the past century and should be respected for that; but it suffers from a blind spot when it comes to the grey area between mind and body. Western medicine's epic breakthroughs in the modern age, thanks to its focus on the material body, has seduced it to disregard the more hazy area of mindbody health.

 I must admit that I would not have written this article five years ago. I'm not really into unconventional medicine; but some years ago I had the misfortune of suddenly experiencing excruciating lower-back pain. I won't bore people with the details, but after following the usual conventional route of MRI scans and an epidural injection, without much success, I basically solved my back problem by reading a few TMS books and following their advice. So in my experience, TMS is real. Since then I suspect that some of my other, mainly stomach-related, previous ailments were actually TMS-related. I'm even wondering whether my lifelong stuttering, though mild these days, is part of TMS and whether TMS treatment will have an effect on it. 

A vicious circle

TMS is, of course, radically different from current mainstream views on stuttering. Current mainstream thinking regards developmental stuttering as a neurological disorder, with the cause or causes not being psychological in nature. I have no doubt that stuttering has a genetic and neurological component, and that some kids are predisposed to begin to stutter. But does this exclude the possibility of unconscious psychological factors in the period when children begin to talk?

Let's consider the onset of stuttering, usually between the age of 3 and 5. For some predisposed kids, overt stress seems to be the trigger; for instance, some children begin to stutter after a traumatic incident such as a car accident, or after having been bitten by a dog, or after a parental divorce. Here the stress trigger seems clear.

In most cases, however, the stress is not so obvious. It could be argued that the actual learning of language also involves stress triggers: the child needs to master complex grammar, new meanings and difficult pronunciations, all of which could overstress a still immature speech system.    

But perhaps a psychological stress trigger is also possible? Consider, for instance, the following scenario: a child, perhaps rather sensitive by nature, wants to please his parents (as most kids want), but soon learns that anger (fighting / resisting), a normal response to ordinary day-to-day irritations and part of the fight / flight / freeze reaction, is frowned upon. He quickly adapts to this by repressing his "fight" response and instead initiates the "freeze" response (if "flight" is not an option); in other words, he does nothing and keeps quiet (perhaps starting on the road to a degree of introversion - but that's another story which I won't go into here). Repressing the fight response, however, merely relegates his anger to his subconscious, so that unconscious rage begins to build up. The same may happen with other emotions that the child may regard as socially inappropriate, such as sadness, fear and anxiety. And built-up unconscious emotions, so Dr Sarno has taught us, can generate tension and seek a physical outlet.

In this particular, genetically predisposed individual the outlet is the vocal cords that “lock” or “freeze”  - as per the pioneering work of Dr Martin Schwartz, who was instrumental in identifying the role of the vocal cords that freeze when overstressed. Apparently some people are genetically and neurologically predisposed to direct their tension to their vocal cords, just as others direct their tension to other body parts. And so the stress response of freezing becomes a physical “freeze” of the vocal-cord muscles; and the child begins to stutter - the actual sound or word repetitions are simply conditioned reflexes in response to the vocal-cord freeze. The stuttering, in turn, will increase the unconscious inner rage and stress, so that a vicious circle is created, established and strengthened over the years.

The TMS argument can be taken even further. TMS experts would argue that mindbody issues are often symbolic; that the mindbody often chooses a particular body part to symbolically communicate its message. In his book The Great Pain Deception, Steven Ozanich says, in discussing spasmodic dysphonia, that the vocal cords are common targets of tension since the voice is a mechanism of expressing self. In the same way, TMS-related shoulder pain may indicate that the subconscious mind feels that it is "carrying the world on its shoulders". 

A major question would be the following: if stuttering is a type of TMS, is that TMS still active in adulthood; or did the TMS only occur in early childhood, so resulting in stuttering and creating the conditioned responses, after which the TMS itself receded so that the conditioned stuttering remained as a leftover, continuing into adulthood? In the case of this last-mentioned scenario, TMS treatment will obviously not have any effect.

Major implications for treatment

If the stuttering of some people is indeed a type of TMS, it has major implications for treatment. For instance, if unconscious rage is identified as a driver of stuttering in an individual, he could perhaps be helped by focusing on assertiveness. Assertiveness could be seen as a “civilized”, subdued and socially acceptable form of anger, thereby tapping into, channeling and discharging the unconscious rage. (For a short summary of assertiveness as a tool in improving fluency, check out THIS CHAPTER of my free online book, Coping with Stuttering. And for an excellent TED talk on how a few assertive body positions will actually change your body chemistry to make you more relaxed and assertive, click here.)

A major part of TMS treatment is to convince the client's conscious as well as subconscious mind that the problem is fundamentally psychological and NOT structural (after, of course, having excluded the possibility that there is indeed a serious structural defect or injury). This convincing is necessary so that the subconscious mind - the level at which the problem arises - will stop trying to distract you by means of the symptoms. If the subconscious mind becomes aware that its distraction tricks no longer work, it stops its mischief.  I know, it sounds unbelievable - but it works. The proof of the pudding lies in the eating. So many people are benefiting from TMS treatment that it needs to be taken seriously.

Applied to stuttering, it would mean that you have to be convinced, and have to convince your subconscious, that unconscious emotions drive your stuttering. 

A complicating factor, of course, is that stuttering is usually developmental, with onset before school-going age, which means that the years or decades of stuttering and its conditioned components - the force of habit - will need to be taken into account. In TMS, conditioning and learning play a major role, and one can expect that the power of conditioning will be a formidable obstacle for those who want to tackle their stuttering through TMS treatment. However, the TMS treatment may stop the stutter from being fed by the subconscious source, ultimately leading to it withering away.  

Finding your own way

All this is of course speculation; even if it has merit it may be extremely difficult to convince both speech experts and people who stutter, as there is a lot of resistance to the seemingly very alternative and way-out TMS concept ... most people prefer to listen to conventional, officially accepted medical advice. Also, many people hate the idea of having to deal with "mental" issues that still carry the stigma of perhaps being "crazy", and may be unwilling to face their inner demons, preferring physical treatments that are socially acceptable and easier to handle.

Most speech professionals, again, will say that the psychological approach to stuttering has long since been discarded, and that the focus these days is on neurology and brain scanning. They will be quick to tell you that Freud, the father of modern psychology and of psychoanalysis, did not succeed in treating people who stuttered (even though we have come a long way since Freud, with our knowledge of psychology and stress having expanded enormously since then).

So once again it is up to the individual with an open mind to try and find his own way, and experiment with this, or any other, approach which makes sense. Fortunately a small but growing number of doctors are embracing the TMS concept and treating patients accordingly.   

If you're interested in TMS, check out the TMS Wiki site HERE where you will also find a growing list of disorders that may actually be types of TMS. For an excellent introduction to TMS, read Dr John Sarno's Healing Back Pain: The Mind-Body Connection . And for a very comprehensive book on TMS in its many manifestations, have a look at Steven Ozanich's The Great Pain Deception: Faulty Medical Advice Is Making Us Worse. It may radically change the way you view health. And isn't stuttering a part of health? Or else read any of the other books by Dr Sarno, for instance The Divided Mind: The Epidemic Of Mindbody Disorders.  Also consider joining the Facebook group on TMS.

For those who stutter and wish to experiment with this approach, I would suggest that you (1) work on adopting an assertive manner just before speaking, as mentioned above; and (2) carefully read one or more of the TMS books, such as The Great Pain Deception mentioned above, substituting the word "pain" with "stuttering". In other words, read the books as if it were all about stuttering instead of chronic pain. If the stuttering of some people is indeed a type of TMS, the chronic laryngeal blocks may just be the subconscious mind's way of distracting you away from unconscious emotions. Try to re-read these books as often as possible so that the concepts sink in deep into your subconscious, where the real healing occurs; (3) keep a daily journal of your experiences with and feelings about your speech - journalling is a highly successful tool used by TMS sufferers (4) follow a TMS treatment course, again doing the exercises as if it were about stuttering. A free online course can be found at the TMS Wiki ; or do the exercises in the book Unlearn Your Pain, by Dr Howard Schubiner , a medical doctor and TMS practitioner; or any other TMS workbook; (5) join the Facebook group "Stuttering as a mindbody disorder" HERE:  

Feel free to provide feedback in the comments section below if you are experimenting or have experimented with TMS treatment for stuttering. PS Don't be upset when things get worse before they get better! This is typical in TMS treatment, as the subconscious tries to maintain the status quo when it notes that things are changing. TMS treatment is a journey; so be sure to join the TMS Facebook support group mentioned above.

Update January 2017: According to new research, there are indications of reduced blood flow to the brain's speech centres during stuttering. This could strengthen the argument that stuttering is a type of TMS. Keep in mind that, according to the TMS experts, TMS symptoms are physiologically effected by a reduced oxygen supply to the affected area. It could be that the central nervous system reduces the blood flow to the speech centres, thereby reducing the oxygen supply to those areas, so messing up these centres and resulting in the dyscoordination of the vocal cords and the resultant vocal-cord freezing that in turn results in stuttering. Check out this research article.