Free Self-Treatment Guide & Book

Written by Matthew O’Malley

Traduction Française – Lhomme Animal Social etc.

INTRODUCTION

Human connection is at the core of our existence.  It is a fundamental and deep human need.  We yearn to connect.  While I believe there are spiritual reasons for connection, I view human bonding and connection through an evolutionary lens in the explanations below.  The synopsis is an accurate summary.  However, it is also just a brief glimpse into the deeply intertwined roles of human connection and stuttering.  The full version is more detailed and as a result is significantly more revealing.

SYNOPSIS

Connection, approval and belonging are deep needs of the human as a social animal.  The opposite of connection, approval and belonging is rejection, shame, humiliation and abandonment.  Evolution and survival has shaped the human need for connection and belonging.  As a result, a situation which presents the possibility of social rejection, abandonment and/or disapproval is perceived as a threat to one’s very survival.  Social rejection is as feared as death, because evolutionarily, to be ostracized from the group did equal death.  A person must be accepted into groups to survive in the wild.  In addition, a human child is helpless to survive on his/her own.  They must bond and connect to survive.  This fuels the child’s fear of abandonment which also equals death.  Because lack of acceptance and belonging are perceived as survival needs subconsciously, when these needs are threatened, the subconscious of the human perceives this threat the same way it perceives a predator threatening physical harm or death.  The mind, body and nervous system, as a result, react the same way to a threat of social rejection and/or abandonment as they do to a threat of physical death.  The response the human system has to these threats has been termed the fight/flight/freeze response.  The fight/flight/freeze state is an anxiety laden state designed to provide maximum energy to muscles that enable a human to fight or flee from a predator.

The above explains why people often fear public speaking as much as death and why they can enter into powerfully anxious states during these experiences.

The person who stutters often faces a social situation perceiving the possibility of social disapproval and/or rejection.  In these situations, the person who stutters enters into the anxiety ridden state of fight/flight/freeze as this threat of social rejection is treated subconsciously as a threat of death.

Speech is movement.  It is a fine motor act.  It is the contraction and relaxation of muscles.

There is a threshold potential for any muscle fiber that must be reached for it to contract including  speech muscles.  If an impulse to the muscle is too weak to meet this threshold, the movement/muscle contraction will not occur.  Speech muscles are low energy movements of the fine motor variety.

The fight/flight/freeze response is designed to enable a human to maximize the power and ability of gross motor muscle performance.  To achieve this, the body alters its postural readiness, its muscular tension and many aspects of the nervous system.  These alterations which occur in the body and nervous system of the person who stutters in a social arena based on entering the fight/flight/freeze state, negatively affect the fine motor ability of speech resulting in increased stuttering (using fine motor muscles like those needed for speech is not of high importance in a life or death scenario).  The fight/flight/freeze state negatively affects the ability of the person who stutters to reach the aforementioned threshold potential for muscular contraction in speech muscles, resulting in increased and prolonged speech “blocks” and stuttering.  The subtle and unpowerful movements of the speech muscles are not what the fight/flight/freeze state is designed to enable.  Contrarily, the fight/flight/freeze state is designed to maximize powerful muscular groups to empower the human to fight a predator with immense force or flee danger with maximum speed.  The many alterations that accompany the fight/flight/freeze state have detrimental effects on the person who stutter’s ability to initiate and execute low energy, fine motor speech movements, thus exacerbating stuttering symptoms (blocks and repetitions).

All of the above results in significantly increased rates of social anxiety in the person who stutters compared to the general population.  Experiences of disapproval, rejection and/or abandonment due to stuttering can be considered traumas and when the person who stutters re-enters social arenas, past memories of “trauma” are triggered and their entrance into the fight/flight/freeze state repeats and is reinforced.  “Unsuccessful” interactions where the person who stutters feels disconnected or rejected lead to a shame state following interaction.  These shame and anxiety states are usually deeply ingrained into the subconscious.  The person who stutters often knows consciously they should not be anxious or ashamed.

Interaction is a fundamental part of functioning in society, yet it often provokes fight/flight/freeze reactions in the person who stutters.  A highly interactive day for a person who stutters with social anxieties, can be likened emotionally to a day in the wild with a high number of near death encounters.  Repeated exposure to this has a cumulative effect over time.  It often leads to exhaustion, frustration, and other unpleasant emotions.  It can also lead to avoidance of interaction.  This results in people who stutter falling far short of meeting their needs for human connection, which can lead to isolation, loneliness and other unpleasant emotions.

In looking towards treatment, intense cognitive behavioral therapy (CBT) to reframe the fear of rejection and abandonment (ultimately a fear of death) would yield positive outcomes.  In conjunction with CBT, a disciplined, consistent practice of mindfulness and meditation would likely lay groundwork to reverse/diminish anxiety and shame.  Both of these elements of treatment would require intensity over a long period of time to achieve lasting and impactful results.  In addition, EMDR (eye movement desensitization & reprocessing) could be utilized to reprocess powerful experiences of social rejection and/or humiliation due to stuttering.  Other treatment options exist.  An effect of working through the underlying fears would firstly be relief from the pervasive amount of anxiety in one’s life.  In addition, an effect would likely be improved fluency as one would not enter into the fight/flight/freeze state as often.  This work would also likely lay a foundation to achieve better outcomes with treatments designed directly to improve the fluency of speech.

FULL VERSION

The National Stuttering Association (NSA) is the largest organization of people who stutter in the world.  Their slogan is “You are not alone.”  This slogan, which resonates with many people who first discover the NSA as well as with its existing members, is revealing about the nature of the struggle of the person who stutters.  This struggle is often one of loneliness; of not being understood; of being unable to express one’s self and be seen for who one really is.  It is a struggle of isolation; of disconnection; of shame; even humiliation.  This is why the slogan “You are not alone” resonates with many of the millions of people who stutter.

To feel alone, isolated, and disconnected is painful.  Why?

We are social beings.  We are an interdependent species.  We are mammals.  We inhabit the body and neurophysiology of a social animal and all that comes with that.

An aside before diving deeper:  I know that we are human beings and there are aspects of our nature that are different from other animals.  Also, I am aware of varying spiritual views on our nature as human beings.  I have my own spiritual views which view the human as much more than its animalistic characteristics.  However, this does not detract from the body of evidence which supports our commonalities with other animals and the information one can glean about ourselves based on these commonalities.  In addition, I will be discussing the importance of connection/bonding to people.  There may be deeper reasons for the existence of connection/bonding (spiritual ones) than to meet our evolutionary/biological needs (I believe there are), but for the sake of this post, I am viewing connection through the lens of the social animal.  Much information is gained about what happens during a stuttering experience as well as why stuttering is a much larger difficulty than just a struggle to speak fluently by viewing it through this lens.

In continuing, as stated, we are social animals.  The brain and body we inhabit is the result of billions of years of evolution.  This evolutionary process has shaped many of our desires and needs as well as many of our fears.  As humans in this finite universe, we are beings of need.  We are all familiar with the need we have for air, food , and water.  These needs are obvious.  However, we are less informed on just how deep some of our other needs are; a few in particular include our need for connection, approval and belonging.

Our need for connection, approval and belonging is very deeply ingrained into us, biologically.  Evolutionarily, our systems for reward and punishment have been attuned to reward us for things that increase our chances for survival and punish us for things that decrease it.  To bond and connect with others is very rewarding (we feel good).  On the contrary, to be isolated and alone is “punishing” (we feel bad; our needs aren’t met).  The positive emotions we feel when we connect with another person is indicative of the importance our evolution places on being connected with others.  The negative emotions we feel when we are disconnected or isolated from others is also indicative of our need to connect and belong.  We feel the pangs of not meeting these needs through feelings of loneliness and isolation.  Our very survival depends/depended on our interconnectedness and our emotions served as guidance to ensure we met these needs to increase our chances for survival.  (More will be explained on this in a bit when abandonment and shame are explored.)

To take it even further, there are varying degrees of connection and disconnection.  We can feel mildly connected to someone; an acquaintance that we like.  We can have a friend that we feel somewhat close to.  Even further, there are extreme levels of approval, acceptance and belonging.  We can be celebrated by groups of people.  We can be promoted at work.  We can have an intimate partner.  We can be popular.  We can be seen as an important member of our family; of our workplace; of any organization.  We can become famous.  We can be celebrated and heralded by the masses.

As the level and scale of connection, approval, belonging and acceptance goes up, usually the positive feeling we get from it corresponds.  It feels good to be accepted by our families.  It feels good to be promoted at work.  It feels good to be celebrated for an accomplishment.  All these things on varying levels feel very rewarding to us as we are meeting our deep need for connection, approval, belonging and acceptance.  These experiences can put people on powerful highs.

On the other hand, there are varying degrees of disconnection; of disapproval; of rejection.  With these varying degrees, there are corresponding levels of suffering.  Some examples of lighter states of disconnect include feeling indifferent to someone.  We can interact with someone and feel misunderstood or judged.  We can dislike someone.  We can be embarrassed in front of someone.

Then, there are the more extreme states/emotions of disconnect.  These emotions are powerful.  We can feel shame; we can feel humiliation; we can feel abandoned.  Shame, humiliation and abandonment are deeply painful.  These emotions are the opposite of feeling deeply connected to, approved of, celebrated by and important to another or others.  They are extreme levels of disconnection and as a result (since connection/belonging is a deep need), these states/emotions are deeply painful as we are at the polar opposite of meeting our need for connection.  They can be felt strongly and can put people into some quite negative emotional places.

To feel shame is to feel unlovable.  To feel humiliated is to feel deeply disconnected and outcasted.  To feel abandoned is to feel like you don’t matter; like your primary attachment or caregiver doesn’t care for you.  In the end, as I will demonstrate, these emotions are perceived as death by the human subconscious and our nervous system reacts the same way it would to having a predator on one’s tail.

Shame, humiliation, and abandonment are the opposite of connection.

Why can these feelings be so deeply painful though?

Of any species on earth, the human, by far, takes the longest period of time to mature to a state of independence.  When a baby is born, he/she is utterly helpless to survive.  As a result, the baby is completely dependent on another person or other people to provide for their every need.  This period of complete dependence for survival is several years after birth in the human.  Quite literally, during this period of dependence on others, if the child goes uncared for, he/she will die.  If the child does not bond strongly enough with an adult who cares enough for the child to provide for their every need, the child will die.  As stated earlier, evolution has shaped our needs over an extremely long period of time.  The primary factor that shapes our needs evolutionarily is survival; life and death.  We can easily see our needs for food, water, and air.  What happens if we do not meet these?  We begin to starve.  We’ll do anything to get food if we go long enough without it.  We begin to get thirsty if we have no water.  We begin to panic if we have no air.  We subconsciously know that if we do not get these things, we will die.

Just like evolution has shaped our reaction to not meeting our need for air, food, and water, it has also shaped our reaction to not meeting our need for connection, approval and acceptance.  With connection and bonding as a child, if we do not connect with a caregiver who will take care of us, we will die.  Abandonment/disconnection literally equals death to a child and when a child perceives disconnection/abandonment, their subconscious has been evolutionarily shaped to view it as a threat to their very mortality.  They react accordingly.

An example situation which showcases this reaction is as follows:  Have you ever seen a child whose Mother left their side for the first time?; maybe they were dropped off at daycare or put in their crib alone for the first time.  Because evolutionarily, these children’s subconscious has been programmed to perceive separation from their caregiver as a threat of death, they launch into a desperate and inconsolable fearful emotional place, often for a lengthy period of time.  The child has entered into a state of complete panic as they have been separated from their very source of life and sustenance.  They are in a state of heightened fear and experience the emotional state of abandonment which is the equivalent to staring death in the face.

As evolved mammals and social animals, this fear of abandonment and the deep need for attachment/connection reaches far beyond the rational mind.  It is instinctual, irrational and deeply wired into our neurology.  If it goes unmet, fear and anxiety arise.

This need for connection does not disappear when we become adults.  Evolutionarily, as an adult, it is still quite beneficial to our chances of survival to connect and bond with others for numerous reasons.  As stated earlier, we are social animals.  We seek to be in “groups” or “families” or “tribes”  as we are much better equipped to survive in this manner.  Also we have hierarchical social systems and our place in this hierarchy is important to us.    We are wired to have a role within our social system and we desire being a valued member within our group.  We feel we must bring value to a group in order to be a part of it.  We must be approved of, “liked”, and accepted to be embraced as part of a group.  Being a part of a group is very advantageous to our survival (pre-civilization mainly) and this is why being disapproved of, shamed, humiliated, abandoned or even “disliked” can be painful and can put us into a place of fear and anxiety.

To reflect on this, think about the powerful emotions you may feel when you begin to feel connected and bonded to someone you are attracted to.  Think about the powerful emotions you feel when you feel very disconnected (a breakup etc.) from the same person or another whom you are/were connected to.  These emotions are indicative of our deep need for connection.  These scenarios can even stir up subconscious emotions that served us in childhood like abandonment (equals a fear of death).

LET’S LOOK AT SOME RESEARCH ON THIS

There is emerging research and interest into our need for connection.  Matthew Lieberman is a pioneering researcher on the human need for connection.  An article written in Scientific American focuses on this research.  Garreth Cook (2013), the author of the article writes, “When we experience social pain — a snub, a cruel word — the feeling is as real as physical pain. That finding is among those in a new book, Social, and it is part of scientist Matthew Lieberman’s case that our need to connect is as fundamental as our need for food and water.” Matthew Lieberman is interviewed by Cook as part of the article as well.  Lieberman goes on to say (2013), “The things that cause us to feel pain are things that are evolutionary recognized as threats to our survival and the existence of social pain is a sign that evolution has treated social connection like a necessity, not a luxury.”  Lieberman also states, “Across many studies of mammals, from the smallest rodents all the way to us humans, the data suggests that we are profoundly shaped by our social environment and that we suffer greatly when our social bonds are threatened or severed.  When this happens in childhood it can lead to long-term health and educational problems.  We may not like the fact that we are wired such that our well-being depends on our connections with others, but the facts are the facts.”

BOTTOM LINE ON CONNECTION

As people/humans, connection and bonding with others is a deep need across the life span and when this need goes unmet or there is a scenario that threatens the fulfillment of this need we will feel it powerfully.

STUTTERING & MEETING OUR NEED FOR CONNECTION

As you are reading the above, if you are a person who stutters or are familiar with stuttering, I would guess you are seeing some links between what I wrote and stuttering.

Meeting the need for connection is often an anxiety-ridden and frustrating task for the person who stutters.  It is commonly more of an experience of disconnection that accompanies interaction for the person who stutters.

For most people who stutter, there is a constant attempt to not stutter.  This is because over years of experiences, the person who stutters has come to the conclusion that stuttering is something that is not accepted, celebrated nor approved.  The person who stutters acquires this feedback and belief based on listener reactions over years.  This is why there often ends up being a deeply embedded shame surrounding the stutter as the person who stutters has come to believe the stutter is unlovable (unlovable in this context means it will not be accepted nor embraced nor celebrated; it may even be ridiculed or laughed at).  Because the person who stutters is just like any other person, they have a very strong desire to be liked and accepted.  As a result the person who stutters becomes obsessed with trying to hide the stutter because if it is seen, they believe subconsciously they will not be approved of nor accepted.  It’s basically, if the person who stutters, stutters, they will not meet all of the needs I was discussing above; approval, belonging, acceptance, being celebrated.  Quite the contrary; the person who stutters often experiences the opposite of meeting this need.  Therefore, the subconscious belief forms that the person who stutters must not stutter to be celebrated/liked/approved of.

All too often, shame, embarrassment and even humiliation are a big part of one’s stuttering journey.  Even more common is just awkwardness in interaction and an overall experience of disconnection.  The person who stutters often feels as though who they are is not seen in an interaction.  They are not able to say what they want to say, how they want to say it and therefore feel a level of disconnect during interaction.  There is an ingrained belief that they will not connect if they stutter.  There is an ingrained belief that if they stutter they will not be accepted; they will not be seen for who they are; they may be ridiculed; they may feel like an outcast.  The person who stutter often has a conscious belief that does not say this, however, they still feel the emotions of these subconscious beliefs.  The underlying fear is that they will not meet the evolutionarily based survival need for acceptance, approval, connection and belonging.  It boils down to fear of death and the mind and body launch into a state of fighting for survival.  Fear of not meeting this need launches any individual into a state of extreme anxiety.  It just so happens that people who stutter have had an abundance of interactive experiences that threaten their ability to meet this need for acceptance, belonging and connection and  therefore have a lot of stored memories of feeling unapproved, rejected or worse.

Because connection, belonging, and acceptance are such deep needs which are rooted in our drive to survive, the stuttering journey can be a very difficult one.  It can be filled with unconscious shame, anxiety and frustration as the person who stutters often cannot find a good enough approach to meet their need for connection, approval, belonging, and acceptance.

Support groups like the National Stuttering Association often have a profound impact on people because for the first time their stuttering is celebrated and welcomed (the opposite of rejection and ridicule).  This meets the need for connection, acceptance, and approval which the person who stutters is often longing for.

In the end, to stutter is to not survive and therefore stuttering in situations that are perceived to be important (talking to a boss, talking to a potential date) is perceived by the subconscious to be life or death.  Because of this, the person who stutters can launch into the fight/flight/freeze response (also known as the stress response) which in the end can affect speech.

FIGHT, FLIGHT, FREEZE

Next we will explore the mind/body reaction to the threat of disconnection.  This reaction has been termed the fight/flight/freeze response.  Before continuing, let’s define it.  The fight/flight/freeze response is a stress response activated as a result of a perceived threat or perceived danger.  This response powerfully manifests in the brain, body, and throughout the nervous system in various ways.  The ways in which the brain, body, and nervous system change when in the fight/flight/freeze state are too numerous to construct a complete list.  However, some examples include increased blood flow to certain muscles and decreased blood flow to others; tensed muscles; increased energy available to large muscle groups; increased heart rate; constriction of blood vessels; alterations in hormonal release; alterations in the secretion of adrenaline, epinephrine, and norepinephrine and the list goes on.

In further exploring the fight/flight/freeze response, Maureen Werbach (MA-LCPC) (2015) states, “The stress responses, fight, flight, or freeze, help us in situations where we perceive physical or mental threat…we see the physical symptoms of stress as well as thoughts that dictate the stress response of fighting or fleeing.  We perceive both a growling tiger and a snarky comment by a coworker as threatening. Although completely different types of threat our bodies activate the same stress response.”

In adding to this and also further linking the fight/flight/freeze response to social interaction, Dr. Glenn Croston, in an article titled, The Thing We Fear More Than Death: Why Predators Are Responsible For Our Fear Of Public Speaking, states (2012), “Our fear of standing up in front of a group and talking is so great that we fear it more than death…it seems odd that we’re so afraid — what are we afraid of, anyway?  What do we think will happen to us?  We’re unlikely to suffer any real or lasting harm — or are we?  The answer seems to lie in our remote past, in our evolution as social animals.”  He adds, “Failure to be a part of the social group, getting kicked out, probably spelled doom for early humans.  Anything that threatens our status in our social group, like the threat of ostracism, feels like a very great risk to us.”  In the same article, Kip Williams (2012), a professor of psychological science from Purdue is quoted saying, “Ostracism appears to occur in all social animals that have been observed in nature.  To my knowledge, in the animal kingdom, ostracism is not only a form of social death, it also results in death.  The animal is unable to protect itself against predators, cannot garner enough food, etc., and usually dies within a short period of time.”  In continuing to illuminate this, the article states(Croston, Dayhoff, 2012), “The fear is not just about public speaking, but is also faced by many others who are faced with getting in front of a crowd and performing like athletes, actors, and musicians.  As a social psychologist, teacher, and a sufferer of social anxiety, Dr. Signe Dayhoff suffered through intense fear of public speaking every time he got up to teach a class.  “My tongue stuck to the roof of my dry mouth and I couldn’t swallow, I blushed, sweated and trembled,” he said.  Eventually it got so bad that it interfered in his ability to do his job.  Getting help, he found he could deal with the situation better.  “As I recovered 12 years ago, using cognitive-behavior therapy, patience, persistence, and practice, I found that nearly 20 million individuals at any one time suffer from some form of social anxiety.  They fear being negatively evaluated in anything they do; fear being rejected; fear being abandoned.”  In closing the article, Dr. Croston states (2012), “When faced with standing up in front of a group, we break into a sweat because we are afraid of rejection.  And at a primal level, the fear is so great because we are not merely afraid of being embarrassed, or judged.  We are afraid of being rejected from the social group, ostracized and left to defend ourselves all on our own.  We fear ostracism still so much today it seems, fearing it more than death, because not so long ago getting kicked out of the group probably really was a death sentence.”

In looking at the above case put forth on our deep need for connection, in conjunction with the research of Matthew Lieberman (furthers the case on our need for connection), combined with the explanation our deeply embedded fear of social evaluation and ostracism as well as the fight/flight/freeze response we can begin to draw some new conclusions.

Lack of connection is painful because connecting is a deep need for us.  It is even more painful if it is not just a lack of connection but a state of extreme disconnection.  Extreme disconnection comes in the form of shame and humiliation.  It can come in lesser forms too like an interaction that is “awkward”.  The need for connection is so deeply wired into us that when this connection is threatened our brain/body activates the same fight/flight/freeze response that would be activated if we realized a tiger was on our tail and we were in mortal danger.  Evolutionarily, a threat of shame, humiliation or disconnection is a perceived threat to one’s survival.  When this situation crops up, a person enters into the fight/flight/freeze response.

To sum up even more briefly, when a person enters a situation involving interaction with another person or people, and this person believes on some level that they may be disapproved of or may feel shame, disconnection or humiliation, the person enters into the fight/flight/freeze state.  This threat is very commonly perceived in interaction for a person who stutters.

Sidenote:  The above is what is behind the high prevalence of social anxiety disorder in the person who stutters, which is 40% or higher (Blumgart, Tran, Craig, 2010).

Quickly, the purpose of the fight/flight/freeze response is directly related to movement of the body.  In the fight/flight/freeze state a person’s nervous system and body are altered significantly.  Its purpose is to enable the gross motor skills and large muscle groups to operate at absolute maximum capacity to fight, flee or even freeze dead still.  During this state, fine motor skills (which speech is) are of less importance.  I will explain a bit more on this later, but keep this in mind as I discuss speech and movement.

SPEECH IS MOVEMENT WHICH IS MUSCULAR CONTRACTION

Speech is a complex task involving the formulation of language.  However the physical performance of speech is movement.  When a person “speaks out loud”, movements of various parts of the person’s body are required.  It is a fine motor task.  The speaker must move their lips, tongue, and jaw which is nothing more than the contraction and relaxation of muscles.  The speaker must move muscles associated with the inhalation and exhalation of the lungs.  They must move muscles that enable vibration of the vocal folds.  The important point here is speech is movement.  When a person speaks out loud, they must move their bodies.

Speech movements are subtle movements.  They are movements of fine motor and not gross motor.  In other words, they are not powerful contractions of the large muscle groups.  They are subtle movements/contractions of small muscles.  The energy required to utilize the intrinsic muscles of the vocal folds, for example, is miniscule in comparison to the energy required to utilize the quadriceps of the leg in an all-out sprint.

THE NEUROLOGY OF MUSCULAR CONTRACTION AND MOVEMENT

Movement is simply the relaxation and contraction of muscles.  Any time we move our bodies to walk, run, speak, etc., muscles are contracting and relaxing to achieve this.

There is a well-known principle of the nervous system and of muscle contraction and it is called the “all-or-none law”.  The all or none law states that a nerve or muscle fiber either will fully respond to an impulse/stimulus or it will not respond at all depending on the strength of the impulse/stimulus.  Stated differently, a muscle or nerve fiber does not “half-respond” or “quarter-respond”.  It either responds fully to a stimulus or it does not respond at all.  To further illuminate this process there is something called “threshold potential”.  In order for a muscle or nerve to “respond” or “fire” or “contract”, the impulse/stimulus that it receives must be above a certain strength in order for it to be over the “threshold potential”.  If the impulse/stimulus is above the “threshold potential” the muscle or nerve fiber will respond or contract.  The muscle or nerve fiber also does not respond more strongly to a stronger impulse.  It either responds or it does not.  There is no variation in magnitude of its response/contraction.

Clarification:  Yes we can contract entire muscles (for example, the bicep) at varying strengths.  However, each individual nerve/muscle fiber contracts only at one strength.  When we exert more force with a muscle, more fibers have to fire.  The above refers to an individual fiber.

So muscle fibers either contract or they don’t depending on the strength of the stimulus which is received by the muscle fiber.  If the impulse (action potential) received is above the “threshold potential” the muscle will contract.  If the impulse received is below the “threshold potential” the muscle will do nothing; it will not respond.

As stated, speech is movement which is the contraction and relaxation of speech muscles.  Therefore the above “all or none law” applies to speech muscles.  When a person who stutters goes to speak and “blocks”/stutters resulting in no movement, it is because the muscles did not contract.   (Note: to say a word requires multiple movements – some people who stutter who have repetitions will make the first speech movement and then “block” on the next one)  That’s the exact description of a speech block.  You know what to say and how you want to say it and you go to say it and the movements (muscular contractions) don’t happen.  The signal for the speech movements is likely below the threshold potential therefore it does not happen.  As I will make the case, this problem gets worse in the fight/flight/freeze state as the neurological system alters significantly to enable and perfect gross motor movement which inhibits one’s ability to perform fine motor tasks (like speaking).  This is why people who stutter have increased stuttering in “feared situations” because their nervous system is in an altered state of fight/flight/freeze which is not designed for the precision and subtlety of the fine motor movements of speech.  It is designed for gross motor movements of large muscle groups.

AN ADDED NOTE ON SPEECH MOVEMENT – Naturally fluent speech is automatic meaning the movements are executed without conscious effort or control.  Speech movement is complex and speaking fluently likely requires the output of speech movement sequences.

ANOTHER NOTE ON THE NERVOUS SYSTEM:  There are two systems that must work together to enable voluntary movements and disable involuntary movements.  These two systems are called the direct loop and the indirect loop.  The direct loop “wants” to move all of our muscles all of the time.  The indirect loop “wants” to prevent all of our movement all of the time.  These two loops must work in balance for us to move when we want and not move when we don’t want.  If these systems are not working properly or in sync, you get movement disorders like Parkinson’s disease.  To learn the basics of this system further, here is a link provided to two videos by The Khan Academy.  One explains the direct loop and the other explains the indirect loop.  Many believe this system to have a large role in stuttering.

WHAT IS THE PURPOSE OF THE FIGHT/FLIGHT/FREEZE REACTION?

The purpose of fight/flight/freeze is to enable movement.  The reaction that our brain, nervous system and body undergo when we perceive a threat (physically dangerous threat or a social threat) is to ready the body for action.  In particular, the purpose of the fight/flight/freeze response is to maximize the ability of the gross motor system which controls our largest skeletal muscles.  It is to get the nervous system and the muscles ready to perform movements and actions that would be impossible when one is not in this state.  You’ve likely heard stories of mothers or fathers lifting up cars which had their child trapped under it etc.  This extreme strength is enabled by the alterations that occur in the body and nervous system to allow gross motor muscles maximum performance when it enters into the fight/flight/freeze response.

The fight/flight/freeze response alters postures in the body and causes certain areas of the body to tense and “ready” for action.  It’s effect on muscles is profound.

In the fight/flight/freeze response, the body readies to fight with extreme amounts of strength or flee with extreme amounts of speed.  In order to do this, the nervous system alters.

These alterations hinder a human’s ability to perform fine motor tasks like speech.  Remsberg (1986) states, “Extra blood nourishment for your large muscles means less for your small muscles involved in say, finger dexterity, and eye-hand coordination.  Thus fine motor movements that ordinarily are easy may become impossible.”

A QUICK WORD ON TRAUMA, FIGHT/FLIGHT/FREEZE & MOVEMENT

Many people today believe trauma to be something that affects a person psychologically.  It is something that happens to us mentally.  While there is truth to this perception, it is also quite incomplete.  In addition to its psychological impact, trauma manifests physiologically in the nervous system and in the body.  It is very much an event/state that falls into the “mind-body” category.

Dr. Peter Levine has spent the vast majority of his career exploring and understanding trauma.  He is the author of multiple books on the subject and is well-known for his pioneering work on understanding its nature as well as improving the treatment of trauma.

To understand trauma, Levine dove deeply into the fight/flight/freeze response partly by studying animals who experience this state.  His widely held and respected views are that when an animal (including humans) enters into a state of fight/flight/freeze, there is a tremendous amount of energy that builds up in the nervous system.  This energy builds up to mobilize the large muscle groups in preparation to fight a predator or flee from a predator as fast as the animal can.  There is also a freeze state where the animal is to be perfectly still to escape the predators awareness.  In addition, there is a state called “tonic immobility”.  When an animal encounters a threat that is so large it deems it is unable to win a fight and it is unable to flee successfully, they will often enter a state of tonic immobility.  In this state, the animals muscles go completely limp and their perception of pain goes numb.

Levine goes on to explain that when a human enters a state of fight/flight/freeze, it is in a state that is utterly saturated with survival energy.  This energy is so vast and powerful, that animals in the wild often perform odd movements after an encounter which put them into fight/flight/freeze to release and dispel all of the pent up survival energy.  As humans where social norms are strongly followed, one is often not in a situation where it is socially acceptable to release this pent up energy following a fight/flight/freeze state.  When this survival energy is not released, it often stores in the nervous system and affects functioning and can result in “mind/body” conditions.

Trauma is a more broad term than many believe as well.  A situation where a child gives an oral presentation and is ridiculed and humiliated would be considered trauma.

LOOKING AT AN INTERACTION OF A PERSON WHO STUTTERS

A person who stutters enters a social arena and identifies a couple individuals whom they would like to connect with.  The need to connect, be accepted and approved of is one that is deeply wired into the human neurology.  Therefore this the person who stutters desires approval and acceptance as they approach these individuals with whom they would like to connect.  Based on past experiences of stuttering and subsequent disapproval, there is a fear in the person who stutters as they approach this interaction.  This fear is based on a fear of death and as the person who stutters approaches a powerful anxiety takes hold as they enter into the fight/flight/freeze state.  This fight/flight/freeze state alters the functionality of the nervous system and alters their ability to control fine motor ability (speech specifically).  Speech movements are not what the fight/flight/freeze state is designed to enable.  It actually hinders this ability making stuttering more pronounced.  The person who stutters interacts and converses.  It is awkward.  They block and stutter.  They notice the interaction is not going well and the other person is taken aback and even disapproving or worse.  The person who stutters stays in a heightened state of anxiety throughout the interaction.  When it concludes, the person who stutters leaves feeling drained and as if they did not connect how they wanted to.  They feel a disconnect as they could not interact how they wanted and therefore did not impress nor connect with the people they interacted with.  This moves them into a state of shame; even humiliation.  They can dwell in it involuntarily for periods of time following an interaction.  This shame is an experience of deep disconnection.  It is subconscious.  The person who stutters can logically know they have nothing to be ashamed of but still feel it.  It can even be described as a feeling of death since evolutionarily we are programmed to perceive lack of connection, disapproval and rejection as death.  The next time the person who stutters enters an interaction, this cycle repeats.

CLOSING WORDS

Being connected to, accepted by and important to other human beings is a deep need for people.  It cuts to the core of human existence.  Threat to this connection is subconsciously perceived as a threat to one’s mortality in the same way having a tiger on one’s tail would be perceived.  When the threat of embarrassment, shame and/or humiliation presents itself, the mind and body launch into a state of fight/flight/freeze to protect against a fatal threat.  This significantly alters the nervous system and how it operates to perform motor movements and muscular contractions.  This alteration in the nervous system and in the body affects the ability to make speech movements in the person who stutters, thus exacerbating stuttering symptoms, explaining why people who stutter often can speak fluently while alone and not in front of others.

In viewing stuttering through this lens, I feel compelled to look at how this understanding of the stuttering condition can shed light on treating it.  This view of stuttering strongly pushes me to place treatment of anxieties and shame ahead of directly treating speech.  I believe that reframing the subconscious perception that acceptance and belonging are life or death situations in interaction would be fruitful both in lowering anxious reactions as well as increasing fluency.  Some ideas that come to mind for this are methodologies like cognitive behavioral therapy in conjunction with mindfulness and meditation and possible eye movement desensitization and reprocessing.  Other options exist.  As stuttering is a persistent problem, it is likely these methodologies would have to be applied intensely for an extensive period of time to alter a person who stutter’s subconscious perception of interaction.  Laying a foundation of intensely treating the social anxiety aspect of stuttering would allow for improved treatment outcomes with therapies more directly related to improving fluency.

MORE THOUGHTS

Connection therapy – Disconnection is a core problem often for a person who stutters.  For some people who stutter, if they feel deeply connected to someone, stuttering can lower or disappear.  If they are absolutely certain, they will be understood, valued and approved of even if they stutter, the stutter can disappear.  Also, I have noticed personally as a person who stutters, that if I have a conversation with someone where I feel very connected, this connection carries over into other parts of the day and my speech improves.  Feeling connected and fluency may have a deep relationship.  Knowing this and designing treatment with this in mind could yield results.  Lidcombe somewhat follows this though I do not believe the ideology behind the design of Lidcombe is based on the above.

The subconscious tries to find solutions to problems.  The problems it looks to solve are it attempts to make sure we meet all of our needs.  Since connection, approval, belonging etc. are deep needs, and often as people who stutter there is a struggle to meet this need, the subconscious becomes obsessed with fixing stuttering as it sees this as an obstacle to connection and approval.  On a larger scale the “perfect self” or the “best version of ourselves” that we have in our minds is the version of ourselves that we believe is most lovable.  By lovable, I mean the “ideal self” is the one we want to become because we believe we will be most accepted, celebrated and approved of if we become it.  This ideal self is an attempt by the subconscious to help us meet our need for connection.

The area of the brain that controls movement and inhibition of movement also receives and evaluates incoming sensory information as well as information from internal organs and states and assigns all of this emotional meaning.  This allows for the context of the environment as well as what is going on in our body (posture, blood pressure, etc.) to affect motor functioning which could contribute to why environmental factors can affect stuttering severity.

People who do not stutter are no different in their desire to connect and be liked.  The listener reaction to stuttering (the listener can become nervous) often is one of their own fear of not connecting and having awkwardness in an interaction.  When they interact with someone who stutters, they often feel like their attempt at connection is in jeopardy and it can put them into an anxious state.

I propose that the problem in stuttering is that the person who stutter’s “threshold” for speech movements is around the same level of the strength of the impulse that is sent to make speech movements.  As a result of this, sometimes the impulse reaches the threshold potential and the speech muscles contract.  However, other times the impulse sent to the speech muscles is weaker and it is not above the threshold potential for muscular contraction.  This is when a person who stutters blocks.  In fight/flight/freeze, there are alterations in the nervous system that affect the person who stutters ability to reach the threshold potential for speech movements.

Boiling everything down, to stutter is to die on a subconscious level.

Works Cited

Blumgart, E., Tran, Y., & Craig, A. (2010). Social anxiety disorder in adults who stutter. Depression And Anxiety, 27(7).

Cook, G., & Lieberman, M. (2013, October 22). Why We Are Wired To Connect. Retrieved March 18, 2017, from https://www.scientificamerican.com/article/why-we-are-wired-to-connect/

Croston, G. (2012, November 29). The Thing We Fear More Than Death: Why predators are responsible for our fear of public speaking. Retrieved March 18, 2017, from https://www.psychologytoday.com/blog/the-real-story-risk/201211/the-thing-we-fear-more-death

Remsberg, C. (1986). The Tactical Edge: Surving High Risk Patrol (1st ed.). Calibre Press Inc.

Werrbach, M. (2015). Fight, Flight or Freeze: The Stress Response. Psych Central. Retrieved on March 22, 2017, from https://psychcentral.com/blog/archives/2014/07/31/fight-flight-or-freeze-the-stress-response/