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Historical and Learned Beliefs about Stuttering a.k.a. The Sordid Tale of Stuttering’s Checkered Past. 1. Stuttering’s history is as long as human’s history. a. Some early references Chinese writings from 4000 B.C.E. Clay tablets in Mesopotamia ~2500 B.C.E. Early Biblical references

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Historical and Learned Beliefs about Stutteringa.k.a.The Sordid Tale of Stuttering’s Checkered Past

The Sordid Tale of Stuttering

1 stuttering s history is as long as human s history
1. Stuttering’s history is as long as human’s history

a. Some early references

  • Chinese writings from 4000 B.C.E.
  • Clay tablets in Mesopotamia ~2500 B.C.E.
  • Early Biblical references
  • Egyptian Hieroglyphic

The Sordid Tale of Stuttering

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Ancient Egyptian Hieroglyphic depicting stuttering

From Frank Silverman, 2003

The Sordid Tale of Stuttering

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b. History repeats and builds on itself
  • Everything we know and believe today grew out of rich history
  • Even the bad ideas have helped us

c. Parallels to medical practice and knowledge

  • Our predecessors were physicians and medical healers
  • Changes in who practiced medicine and the methods of practice influenced beliefs and treatments of stuttering

The Sordid Tale of Stuttering

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Prior to the Greek Classical Age

a. Early physicians were priests and priestesses

        • Strong mind, body, spirit connection
        • Tx involved rituals to heal the body, psyche, and spirit
        • Herbs, fasting, bathing rituals, and offerings to gods and goddesses

The Sordid Tale of Stuttering

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~400 B.C.E.

Hippocrates moved healing professions away from religion and mysticism (spirit connection) but retained the body-psyche connection: The Four Humors Model.

The Sordid Tale of Stuttering

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Ancient Greece & Rome (400 B.C.E. – 500 A.D.): A Problem with the Tongue

a. The Four Humors Model – linking of body and psyche; spirit removed from the equation.

    • Diseases of the body happen because emotions and temperament are out of balance
    • Re Stuttering: the actual disorder wasn’t the speech defect but an imbalance in the humors that caused the tongue to malfunction

The Sordid Tale of Stuttering

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The Four Humors (Cont’d)

The Sordid Tale of Stuttering

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b. Hippocrates (460 – 377 B.C.E. – tongue too dry and engorged with black bile

  • c.Cornelius Celsus (~100 A.D.) – too much humidity in the brain causes a lingual paralysis; dry out tongue, person, and brain

The Sordid Tale of Stuttering

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The Middle Ages & Renaissance: Four Humors Catches On

a. Background of the times

        • In Europe, medical knowledge and practice under the control of the Catholic Church
        • Common treatments based on Four Humors: tongue too wet
        • Deep breathing to quell spasms of the glottis
        • Cut the lingual frenulum.

The Sordid Tale of Stuttering

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b. Expansion of knowledge about stuttering
  • By 900 – stuttering tends to occur on initial sounds; more common in males.
  • By 1300 Bernard Gordon: all children go through phase of being non-fluent

c. 1500s – beginning of scientific revolution

  • State of medical knowledge

The Sordid Tale of Stuttering

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d. 1500s & Scientific Revolution (Cont’d)
  • Heronymus Mercurialis and the Treatise on the Diseases of Children (1583).
  • Don’t treat stuttering until age 7
  • Caused by deep thought, lack of sleep, and too much sex

The Sordid Tale of Stuttering

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5. 17 century: Age of Enlightenment and Scientific Revolution

a. Deepening split between religion and science

b. Most observable aspects of stuttering documented

  • Onset in childhood
  • High recovery rate
  • All core behaviors
  • 1st sound of 1st word
  • Singing and alcohol make it better
  • Anxiety makes it worse
  • Sex ratio
  • Temperament

The Sordid Tale of Stuttering

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c.Scientific beliefs at the time
  • Problem with hyoid bone (Morgagni)
  • Imitation (Robert Boyle)

d. Religious beliefs

  • Cotton Mather (1680 – 1728)punishment for sin of anger and pride

The Sordid Tale of Stuttering

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18th Century – Enlightenment & Empirical Observation Continue

a. Mind, body, spirit connection completely severed

      • Illness or ailment must be caused by something observable in the body
      • Attention shifts to physiology behind speech and voice production
      • Phoneticians worked with people who had defective pronunciation, including stuttering

The Sordid Tale of Stuttering

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b. Associationists revisit the mind and body connection
  • Moses Mendelssohn (1729-1786)“A collision between many ideas flowing simultaneously from the brain.”
  • Erasmus Darwin (1731-1802)Conflict between wanting to speak well and fear of failure (approach-avoidance)
  • Darwin’s self Tx

The Sordid Tale of Stuttering

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7. Early 19th Century – Pre-Industrial Revolution

a. Neurophysiology appeared as a new science.

b. Thoughts floating around France

  • Impairment in the nerves enervating tongue and larynx;
  • Tongue too short or frenulum too tight
  • Nervous affliction resembling chorea

The Sordid Tale of Stuttering

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c. Thoughts floating around England
  • Joseph Frank, M.D. – depraved habit
  • Speaking when lungs are empty
  • Vocal folds paralyzed by extreme contraction (blocks)

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d. Thoughts floating around the U.S.
  • Edward Warren, M.D. (1831) cause=neurological disorder aggravated by circumstances:
  • Begins as weakness in nervous system; then fear of stuttering causes person to stutter; then organs of speech develop habit (neurological predisposition; trigger incident for precipitating factor; habit for perpetuating factor.)

The Sordid Tale of Stuttering

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d. Thoughts floating around U.S. (Cont’d)
  • Elocutionists did most treating of speech disorders, including stuttering
  • Homeopathic remedies: bleed lips with leaches; eat Finnish insect repellant used on cows; eat goat feces

The Sordid Tale of Stuttering

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Surgery Craze of 1841

a. Interest in the tongue as chief culprit; interest shifted to looking at the neurological organization of the tongue and other articulators.

b. Johann Friedrich Dieffenbach (1792- 1847)

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c. Dieffenbach’s Theory
  • Stuttering is caused by spasm in the glottis that migrates up to the tongue and causes a lingual cramp.
  • Solution – interrupt the neurological impulse from the glottis so that it can’t get through to the tongue
  • Surgery technique: make horizontal cut across root of tongue; cut out a triangular wedge
  • First patient: 13 yr. old boy with severe stuttering; Jan. 7, 1841

The Sordid Tale of Stuttering

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d. The aftermath
  • Popular press picked up story
  • Surgeons instituted their own variations
  • May 1841, a patient died; then another; and another
  • Editor of Lancet steps in
  • Nobody cured; some experienced temporary fluency

The Sordid Tale of Stuttering

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Late 19th and Early 20th Centuries

a. By the 1850s, France, England, and U.S. looking for a physical cause; Germany, a psychological cause.

      • 1842 Markel: a failure of confidence in the ability to communicate
      • 1890 Reinhold: approach-avoidance conflict
      • 1915 Freud: a conflict of excremental functions – verbal constipation
      • 1930 Bluemel: a form of transient auditory amnesia

The Sordid Tale of Stuttering

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1930s American Midwestern universities charting new ground with stuttering
      • Samuel Orton: PWS are naturally left handed
      • Lee Travis: lack of hemisphere dominance
      • Robert West : Breakdown hypothesis – moment of stuttering is like a miniature seizure of speech muscles

The Sordid Tale of Stuttering

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10. Conclusion

a. Kernels of the past still alive today - Cause

  • Re: cause: physical problem; something with the brain; familial inheritance
  • Re: misconceptions: punishment for sin, thinking faster than one can talk; bad habits that can be broken; nervousness

The Sordid Tale of Stuttering

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b. Kernels of past - Treatment
  • Tx methods: speak slowly by stretching words; easy onset; control of airflow; cancellation; desensitization
  • Misconceptions: just slow down; relax; compose thought before speaking

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c. Where we are today: revisiting some old ideas with new knowledge, understanding, and tools of inquiry.
  • Familial Inheritance
  • Something with the brain
  • Treatments

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d. Missing some critical elements in understanding and treating stuttering.
  • Mind: thinking, feeling, self-talk, attitudes, emotional triggers, and emotional responses
  • Spirit: stuttering affects the soul and the soul affects stuttering

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e. Where we’re going
  • Work in genetics, neurology, behavioral psychology, physiology, psychosocial development, and emotional health will help us understand stuttering.
  • Understanding the mind-body-spirit connection will help us understand the wounding that happens as a person lives with stuttering.

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e. Where we’re going (Cont’d)
  • Therapy for stuttering may require the hands of medical, and mental/spiritual health workers.
    • Someone to treat the root cause
    • Someone to treat the speech behaviors
    • Someone to treat the wounding of the psyche and soul
  • The best therapy methods of today may be quack treatments tomorrow.

The Sordid Tale of Stuttering

references
References

Bloodstein, O. (1993). Stuttering: The search for cause and cure. Boston: Allyn & Bacon.

Bobrick, B. (1995). Knotted tongues: Stuttering in history & the quest for a cure. NY: Kodansha International.

Buhner, S.H. (1998). Sacred and herbal healing beers. Boulder, CO: Brewers Publications.

Readers Digest (1986). The magic and medicine of plants. Pleasantville, NY: The Readers Digest Association.

The Sordid Tale of Stuttering

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Rieber, R.W. and Wollock, J. (1977). The historical roots of the theory and therapy of stuttering. JCD 10(1), pp. 3-24.

Silverman, F.H. (2004). Stuttering and other fluency disorders. Long Grove, IL: Waveland Press.

Sternberg, E.M. (2001). The balance within: The science connecting health and emotions. NY: W.H. Freeman & Co.

The Sordid Tale of Stuttering

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Warren, E. (1837). Remarks on stammering. Amer. J. of Medical Science, 21, pp. 75-99. Reprinted in JCD 10(1), (1977), pp. 159-179.

Wollock, J. (1977). Hieronymus Mercurialis. JCD 10(1), pp. 127-140.

The Sordid Tale of Stuttering