This Article was written by Kyu-won Hwang of the Canterbury Speak Easy Assn. as part of the course work for one of his psychology courses.

Introduction

In one of the Developmental Psychology lectures I had been attending this year (2002), the lecturer kept emphasizing the following point while discussing the definition of the term development. He defined development as a lifelong process and it can be best described from a multi-factorial point of view.

Not long after that, I realized that this definition could also be utilized to portray the nature of a speech disorder called stuttering. I myself am a person who stutters. Hence, my experience of growing up with stuttering and having done research of my own has convinced me of this. Stutterers, or people who stutter, try their hardest to gain fluency, which is taken for granted for most people. They tend to go through all forms of therapies in pursuit of fluency. Their efforts sometimes persist throughout their lifetime because a universal, permanent cure has never been found. Of course effective stuttering therapy programmes are abundant and stutterers can learn how to speak fluency to 2an acceptable degree by attending any of these programmes. Nonetheless, the gains tend to be short-lived none of the programmes has been able to provide solid, long-lasting solutions (Craig & Calver, 1991). For these reasons, it often becomes a lifelong battle for stutterers to discover any method that will bring them fluency and to maintain their learned fluency it throughout their lives. Furthermore, the cause of stuttering tended to be viewed from only one perspective in the past — psychological, physiological, linguistic, neurotic, or whatever. But recent advancement in research and technology has allowed researchers to have a deeper, better understanding of the disorder. Now there is a growing consensus in the field that stuttering should be understood in terms of multiple factors — physiological, psychological, and environmental factors (Starkweather & Givens-Ackerman, 1997). Consequently, stuttering can be best understood in the same the way in which developmental psychologists look at the concept of development.

The reason why I mentioned stuttering from the beginning is because the main theme of this essay is to explore the effects of stuttering on the development of people who stutter in a number of aspects. For that purpose, I will assume that stuttering acts as a developmental organizer for stutterers. Developmental organizer refers to an event or a set of events that occurs at (typically) early phases of development and exerts their influences on various aspects of future development throughout lifespan (Keenan, 2002). Therefore, what I am assuming here is that the development of stuttering disorder will elicit a variety of changes in people who stutter.

This essay will first deal with discussion on the nature of stuttering. Then it will be followed by analysis of the contents of an autobiography written by a stutterer and related journal articles. The analysis will show the influences of stuttering on people’s development with theoretical consideration from Erikson’s psychosocial developmental theory. Yet, Eriksonian theory will not be one single focus of this essay. Rather, how stuttering affects people who stutter will be looked at from a range of perspectives. In that way, I believe that we will be able to gain a better understanding of the developmental impact that the disorder has on stutterers’ lives.

There are three books that I referred to for the developmental analysis: Stuttering-Life bound up in words written by Marty Jezer (1997), who is an American person who stutters, The stutterer’s survival guide by Nicholas Tunbridge (1994), and Stuttering: science, therapy, and practice by T. David Kehoe (1998). The authors of these books are people who still stutter or stuttered in the past. Moreover, I will refer to my personal experiences occasionally.

Incidentally, I will only use the pronoun ‘he/his/him’ when referring to the third party in this essay. The use of the male pronoun makes sense because over 80% of all people who stutter are male and this essay is about stutterers. Of course, this is not a manifestation of sexism in any way. Rather, it is for the sake of simplicity.

How Does Stuttering Affect People Who Stutter?

Van Riper and Erickson (1996) offer the following definition of stuttering: "Stuttering occurs when the forward flow of speech is interrupted abnormally by repetitions or prolongations of a sound, syllable, or articulatory posture, or by avoidance and struggle behaviours" (p. 254). Obviously this is a nice, clear-cut definition. As stated, stuttering may be defined in rather a simple and clear manner when it is considered from the viewpoint of speech therapy. However, when stuttering is talked about in terms of its impact on people’s lives, any single definition cannot precisely describe all the emotional and physical baggage that comes with it. Therefore, I will discuss stuttering from a perspective somewhat different from the conventional point of view.

As Starkweather and Givens-Ackerman (1997) point out, stuttering is a devastating communication disorder which affects approximately 1% of the population at any given time. It occurs regardless of time, culture, or race. The oldest record of stuttering in history appeared in the ancient Egyptian recordings some 4,500 years ago. Unlike most language disorders, stuttering tends to dominate a person’s life. It controls the person’s sense of identity by making speaking, which is such an easy task for almost everyone, an agonizingly painful experience. Since spoken language is very essential part of human life, stutterers are very likely to constantly experience frustration, shame, humiliation, anger, and resentment, and develop a sense of inadequacy and even guilt (Starkweather & Given-Ackerman, 1997). In this sense, stuttering can be viewed as a kind of disability that inflicts pain on people’s lives.

Stuttering is also a remarkable disorder in terms of its variability (Kehoe, 1998; Van Riper & Erickson, 1996). Stuttering differs from most disorders in that it is not always obvious. Stutterers look perfectly normal until they open their mouth and start to stutter. Another mind-boggling fact about stuttering is that stutterers always do not stutter. This feature of stuttering is what makes it so unique as well as frustrating. Deaf people do not have sudden burst of good hearing. Paraplegics cannot sometimes rise out of their wheelchair and walk. But stutterers can produce perfectly fluent sentences at times. They can often speak fluently when they are alone, reading in chorus, singing a song, by changing their manner of speaking, thinking differently, or even seeing their speech therapist walk into the room. However, this kind of temporary fluency does not give stutterers much confidence in their speech (Jezer, 1997). It tends to make next bout of dysfluency more difficult for stutterers to accept, and they will try harder not to let stuttering happen again. Quite often their hardest attempt not to stutter ends in failure. In my opinion, this only reinforces a sense of uncertainty and insecurity among stutterers themselves.

Another interesting feature of stuttering is that stutterers usually have poor awareness of their own stuttering (Kehoe, 1998; Starkweather & Given-Ackerman, 1997). In the midst of a speech block, they may feel mentally ‘blank’. Some researchers have found that stutterers feel as if they are passing out, yet they know they will stay conscious somehow. They lose awareness of where they are, what they are doing, whom they are speaking to, or anything in their immediate environment (Van Riper & Erickson, 1996). One person who stutters talks about his stuttering moment, "When I stutter, my mind would come to a kind of blank state for a second, a kind of pause. I can’t feel anything and can’t think" (Cited in Kehoe, 1998). After this horrible moment passed by, many stutterers typically feel ashamed, embarrassed and even guilty. Some researchers suggest that repeated exposure to this kind of negative communication experiences could be a contributing factor that makes people who stutter develop a poor attitude toward speaking (e.g., Miller & Watson, 1992).

In addition, stutterers possess a wide variety of coping strategies that they have developed to get through their difficult times. These strategies are often referred to as ‘tricks’. The most common trick is avoidance (Peters & Guitar, 1991; Starkweather & Givens-Ackerman, 1997). The most common form of avoidance is word and situation avoidance. Stutterers typically avoid speaking words that they think will be hard to say and substitute it with a similar word that they think is going to easy for them to speak. Sometimes it works but at other times they may say a word that is not really appropriate for the speaking context. What is more important for stutterers is whether they have gotten the word out of their mouth, rather than whether they have successfully conveyed their meaning. Besides, people who stutter tend to avoid situations in which a great deal of speaking is required (e.g. social occasions, interviews, group discussions, public speeches, etc.). Without a doubt, this avoiding tendency has quite adverse effects on social and vocational developments of stutterers.

Now that we have considered some of the important features of stuttering, it is time to look at the gist of Erikson’s theory and how it might be utilized to explain stutterers’ lives.

Based on Freud’s psychoanalytic theory, Erikson expanded it and developed his own theory of eight psychosocial stages. According to Erikson (1951), human infants are born with some basic capacities and distinct temperaments. But as they grow older, babies go through dramatic changes on the way to adulthood. While each individual is growing up, he or she passes through eight developmental stages what Erikson named psychosocial stages. Each stage is characterized by a different conflict that must be resolved by the individual. Erikson called this conflict a ‘psychological crisis’. The term crisis does not mean an unusual set of events but an ordinary set of stresses and strains. Erikson argued that, when the social environment makes new demands on people and they try to adjust to those demands, a crisis arises. The individual faced with a crisis basically has two choices in coping with the crisis — in an adaptive or maladaptive way. Erikson maintains that only when a crisis in a certain stage is satisfactorily resolved, the person can have sufficient strength to move on to the next stages of development. If the person copes with a certain crisis in a maladaptive way, the result will be more struggles with that issue later in life (Miller, 1989). The following is a summary chart that captures important points of the eight stages of psychosocial development.

Stage	Ages	Basic Crisis
Infancy	Birth – 1 year	Trust versus Mistrust
Toddlerhood	1 – 2 years	Autonomy versus Shame/Doubt
Early Childhood	2 – 6 years	Initiative versus Guilt
Late Childhood	6 – 12 years	Industry versus Inferiority
Adolescence	12 – 18 years	Identity versus Role Confusion
Young Adulthood	19 – 40 years	Intimacy versus Isolation
Middle Adulthood	40 – 65 years	Generativity versus Stagnation
Maturity (Old Age)	65 – Death	Integrity versus Despair

On the other hand, Peters and Starkweather (1990) investigated the development of stuttering throughout the life span, and have come up with a set of five developmental phases. These phases are;

Phase 1	2 – 6 Years	Preschool period
Phase 2	6 – 12 Years	Early school years
Phase 3	12 – 17 Years	Puberty and early adolescence
Phase 4	18 – 30 Years	Later adolescence and early adulthood
Phase 5	30+ Years	Maturity

Although this set of the five phases seems a little bit simpler than Erikson’s eight-stage model, I believe that both of them are somewhat comparable to each other and that the model of Peters and Starkweather (1990) presents more valid points for the purpose of this essay. Hence, I will put more weight to their model of development, at the same time, trying to integrate those two models in my attempt to analyze the developmental course of people who stutter. Of course this does not mean that Erikson’s theory will not be abandoned at all, but due to the restriction of essay space, I will restrict my discussion to early and middle stages of life.

Since the onset of stuttering typically begins between 2 and 5 years of age (Peters & Guitar, 1991), the first few stages from Erikson’s model might not be totally relevant. But let’s have a brief look at those stages for the theory’s sake.

The first stage of Erikson’s psychosocial development is the infancy (Birth to 1 year). The important event in this stage is feeding. Infants depend totally on other people for their survival. Therefore, they must be able to completely trust their parents or caregivers for providing food, warmth and affection. If these needs of the infant are met consistently and responsively by the parents, the infant will not only develop a secure attachment with the parents, but will also learn to trust their environment in general. If not, infants will develop a sense of mistrust towards people and their environment. Either way, simply because of the fact that infants cannot talk, there is not much significance for the development of stuttering at this stage.

Erikson argued that the crisis babies face in Stage 2 (Age 1~2) is autonomy (independence) versus doubt (shame). Self-control and self-confidence begin to develop at this stage. Toddlers learn to walk, talk, use toilets and feed and dress themselves. This is how they strive for autonomy. At this stage, a parent’s level of protectiveness will determine the child’s ability to achieve independence. If parents encourage their child to take initiatives, he will develop a sense of confidence in future situations that involve choice, control and independence. If parents are overprotective and disapproves the child’s independent behaviour, he may develop a sense of shame on his behaviour, or have doubt about his abilities. Again, this stage is not of great importance because toddlers are just beginning to learn a language. The following are the detailed discussion of the set of five phases suggested by Peters and Starkweather (1990).

The Phase 1 of Peters and Starkweather (1990) meshes with Erikson’s third stage of development. This stage ranges from 2 and 6 years of age. This period is also when a stuttering problem tends to occur most. One of the most prominent features during this time is very rapid developments in language. Normal children have mastered sufficient linguistic skills by age 2, and past this point, a developmental explosion occurs in all aspects of language — syntax, semantics, pragmatics, phonology, etc. This rapid development of language is contrasted with the moderate speed of brain development needed for speech motor control. Spoken sentences get longer and are uttered at a faster rate. So it is natural for children to tumble over their speech from time to time. However, for the children with a predisposition to stuttering, this motoric task can be too difficult and they produce an unusual amount of dysfluency. Children at this stage come to have an understanding that speech is what they do with their mouth, throat, and lungs, but have not yet learned to develop logical solutions to their problems (Piaget, ?). Consequently, if children find some word ‘stuck’ in their mouth, they employ a strategy that works for most of the cases — push it. They are still unable to consider other options such as gentleness and slow movement. If a child is stuck with a word out, then he tries to push it out. If the word does not come out right away, he pushes harder. Such a strategy will only make lock the vocal cords tighter. The child’s pushing and forcing make his/her oral muscles more tense, and he/she keeps doing so to the point where the muscles can no longer move in a smoothly coordinated fashion. This phenomenon has some important implications for Eriksonian stages 2 and 3.

It was discussed before that children in Eriksonian Stage 2 will develop confidence in future situations. This includes confidence in their ability to express themselves, too (Peters & Starkweather, 1990). If a child continuously fails in verbally expressing himself, this increases a chance that he will develop a sense of shame and doubt of his ability to communicate effectively later in life. This outcome can be seen in the finding that adolescents who stutter have a poorer self-perception of communication competence than those who do not stutter (Blood, Blood, Tellis, & Gabel, 2001). Then what about Stage 3?

Erikson (1951, 1982) suggests that the most vital event in Stage 3 is to achieve independence. The child continues to be assertive and take more initiative. For children at this stage, it is essential for adults to help them to make sure that the child’s initiative is accepted no matter how small it may be and learns to accept failure without guilt. If the child is not given an opportunity to be responsible and do things on their own, a sense of guilt may develop. He will come to believe that whatever he wants to do is wrong. Therefore, the reaction of adults to the child’s behaviour is a critical factor for determining the level of his sense of guilt.

When it comes to stuttering, many children who stutter tend to have developed considerable amounts of shame and guilt about their speech by the time they go to school (Starkweather & Given-Ackerman, 1997). Quite often, these feelings are the outcome of the child’s reactions to negative responses that his parents or important adults show to his dysfluency. Parents who react negatively to their child’s stutter send a message that stuttering is shameful. As the child grows older, he often develops a strategy of denial to offset this strong sense of shame. Jezer (1997) also recalls in his book that he used to deny his stuttering problem as a young child. He writes he had to "bury the ache that stuttering caused me to create a strong and positive self-image" (p. 87).

This phase coincides with Eriksonian Stage 4 (Industry versus Inferiority). School is the important event at this stage. Children learn to make things, use tools, and acquire the skills to be a productive worker. Interaction with peers at school becomes increasingly important to children. If the child can discover pleasure in a wide array of events to deal with (e.g., academics, group activities, friends), he will develop a sense of competence. If not, he will develop a sense of inferiority.

Children at this stage begin to automatize speech motor control and their language skills become more refined. The automatization of speech gives children a new freedom which allows them to concentrate only on what they want to say, not on how to say it. However, this advantage is compensated by the loss of plasticity of development of speech motor control. For most children, this will not be a big concern, but it can cause a great deal of hardship if children still have erroneous fluency patterns. Especially, the fact that children begin their schooling at this stage may pose a serious problem for a school-aged child who stutters.

Now, the child is separated from his parents and his main source of influence becomes his peers. The importance of peers and spending a large amount of time make opportunities for comparison. This comparison makes it important for children to be viewed as the same as the rest of the peers. Acceptance or rejection of the peer group becomes more important than approval of the parents. Unfortunately, for a stuttering child, his disorder is bound to stick out and he will face the possibility of teasing. Teasing creates a major social crisis for the child who deviates from the norm—fluent speech. Teasing at this stage sets the ground for the child to develop an attitude that anything is better than stuttering. It also reinforces the already present sense of shame, which causes the child to develop a sense of inferiority. The child is likely to develop two kinds of inferiority: One is the sense that he is just not good at talking, and the other is a sense that he is inadequate as a person (Peters & Starkweather, 1990). Speech is often so closely related to one’s self-perception that being a ‘lousy’ speaker feels very much like being an incompetent person. This manner of perceiving themselves plays an important role in their identity development.

At this stage, motoric and linguistic developments are slow and linguistic skills tend to be stable. This is the point of time when the physiological changes of puberty start. But few cases of the onset of stuttering at this stage are known. More importantly, there are great social changes during adolescence that mostly revolve around one’s sense of identity.

The Eriksonian stage corresponding this phase is the stage four where the crisis of identity versus role confusion arises. This is the time when adolescents ask themselves the question "Who am I?" Adolescents are in search of an identity that will lead them to adulthood. Erikson argues that the healthy resolution of all earlier conflicts serves as a foundation for the search for an identity. Adolescents who have successfully dealt with earlier conflicts are ready for the identity crisis. If the adolescent solves this crisis successfully, he will come out of this stage with a strong identity, and ready for the future. If not, the adolescent will sink into confusion, unable to make decisions and choices about vocation, sexual orientation, and his role in life in general.

The above notions of Erikson’s have some relevant points to the identity development of stuttering adolescents. In the previous sections of the essay, it has been shown how stuttering can cause a sense of shame and inferiority in stuttering children. On the basis of this notion, it can be postulated that those inferiority feelings of the children made it extremely difficult for them to successfully deal with the psychological conflicts of the earlier stages. As a result, the earlier conflicts have not been completely solved, which leads the adolescents to role confusion. This role confusion is precisely manifested in the self-perception that adolescent stutterers have developed by this stage.

Quite often, adolescents who stutter develop a firmer mindset to see their ‘stutter-self’ only, not other aspects of themselves. They may be good at something other than speech, but the issue of stuttering becomes so ingrained in their psyche that they lose confidence in their abilities to cope with the demands of their lives and blame any failure on stuttering. Jezer(1997)’s writings illustrate this.

Also, adolescents who stutter realize that their stuttering poses a real threat to vocational and romantic success (Peters & Starkweather, 1990). Take a problem of dating for an example. For a boy who stutters, his fear of stuttering often outweighs his desire to have a date, therefore, he never asks a girl out. In this way, adolescent who stutter frequently abandons many possibilities of having a normal social and romantic life.

This is the stage where social and emotional changes that started in adolescence continue on to young adulthood. One’s sense of identity becomes firmly established, and for those who still stutter, their tendency to identify themselves as stutterers is now fully developed. One thing to take a notice at is that, by this stage, stutterers come to possess a wide variety of coping strategies that they have developed to get through their difficult times. These strategies are often called ‘tricks’. The most common trick is avoidance (Peters & Guitar, 1991; Starkweather & Givens-Ackerman, 1997). This includes avoiding speaking words that the stutterer thinks hard to utter and avoidance of situations in which a great deal of speaking is required. Many stutterers develop a large pool of vocabulary because they keep avoiding words and substitute them with words that they feel comfortable saying (Tunbridge, 1994).

In young adulthood, according to Erikson (1982), the most important events are love relationships. He maintains that no matter how successful we are with our work, we are not developmentally complete until we are capable of intimacy. Intimacy means a person’s ability to relate to someone else on a deep, personal level. At this stage, the task which young adults face is to develop intimate relationships with others. Adults who have developed a sense of identity will be willing to be open and committed another individual, therefore, succeed in forming a meaning relationship. Those who have not will fear a committed relationship, feel isolated and unable to depend on anybody in the world.

According to this view, stutterers tend to fail to develop a ‘healthy’ sense of identity — an identity as a whole person, not just a stutterer — in adolescence, and this leads them to fail in intimate relationships and spend a lonely, isolated life. Of course this is not the case for all stutterers. The course of development, even for stutterers, is never a fixed, unchangeable one-way process. Many people who stutter manage to form meaning relationships despite their severe verbal disability and maintain happy relationships. But that certainly does not mean Erikson’s theory is totally wrong. Indeed, stuttering influences the formation of adult romantic relationships. In one study, researchers found the adverse effects of stuttering on stutterers’ social lives (Hayhow, Cray & Enderby, 2002). It was found that many people who stutter viewed their stutter as a great obstacle to forming relationships, making it hard for them to speak to the opposite sex. Some stutterers even stated that they had failed to get married because of their stuttering.

In this phase, general motor skills remain stable and are gradually starting to decline. This motoric stability comes together with stability in emotional and social development. Probably due to this stability in all aspects in life, the severity of stuttering among many people tends to decrease (Peters & Starkweather, 1990; Kehoe, 1998). People begin to abandon tricks and avoidance behaviour and often make productive attempts to recover from their disorder. During these attempts, there may be regrets over paths taken or not taken earlier in life.

The corresponding Eriksonian stages to this phase are the generativity versus stagnation stage (middle adulthood) and the integrity versus despair stage (late adulthood). I am unable to discuss those two stages any longer due to the limited space, but one may as well keep in mind the fact that, by late adulthood, most stutterers have learned to accept their disability and believe that they have lived fulfilling lives in their own terms. Indeed, Jezer (1997) writes, in the final chapter entitled No Such Things as Failure;

In this essay, I attempted to present a general picture of how a speech disorder of stuttering can influence the development of people who stutter, with a special focus on the development of their sense of identity. The essay briefly examined the developmental impact that stuttering has on each of developmental phases throughout the life span. Erikson’s theory of psychosocial stages was adopted to look into the psychological world of stutterers. To my best knowledge, this essay is the very first attempt to analyze the psychological development of stutterers in combination with Erikson’s theory.

To recap, in their childhood, some children who exhibit symptoms of stuttering start to develop a sense of shame and inferiority because they tend to think that they cannot express themselves effectively and are unable to compete verbally against their friends and peers. If their stuttering problem remains the same in later stages of life, the sense of inferiority becomes stronger and gets deeply embedded in their identity as they grow older. After that, they often develop an attitude to view themselves only through the narrow window of stuttering and the identity as a stutterer can become deeply-rooted in their psyche.