Sunday, October 16, 2005

Fluency without psychology

This is a question on a ISAD conference page to which I replied:

Most of stutterers are almost fluent if they speak with loud voice being alone. Also I can forget my stuttering and speak expeditiously and absolutely fluently when I am alone in room or in car etc - I know that in fact nobody can hear me, although I imagine that I talk to other people. When I really talk to other people (even friends), I start to stutter quite strongly. WHY I can’t in this case to speak fluently like being alone? WHY I can’t transfer exercising situation to real life? How could I talk to other people as fluently as alone? Actually I have some answers (psyhological tension, etc) but I’m not satisfied with these answers. Still I do not realise very well, why I can’t talk to other people in the same fluent way like alone. Maybe this point (speaking with other people in the same way as speaking alone) could be bigger part of stuttering therapy for adults.

This is one of the most intruiging aspects of persistent developmental stuttering. It is the main challenge for people who believe that psychological issues are only consequences or re-enforcers of symptons. Many things about PDS are still uncertain, but I think there is/are explanations.

1) We need to realise that such effects not only happen in PDS. For example, a friend of mine is a doctor, and he told me that many Parkinson patients have very little shaking before the doctors enter the room, and heavily start shaking during the visit! Or nearly deaf people also have good and bad days and good and bad situations where their hearing deteriorates or becomes better. But no-one would suggest that the variability of their condition is proof of a psychological origin of their condition.

2) Situations with increased stuttering are typically situations where the brain has more work to do. When you are alone, your brain has far less work. But when you are around people (or think that you are around people), your brain has so much more workload: applying a social filter, coordinating the appropriate body language, increased stress, increased tension, responding to other people's ideas, future scenario analysis of your planned message and so on. If you think of stuttering as an unstable speech system, it is clear that more work means less stability. Like a road with road repairs is free of traffic jam on a Sunday, but not a Monday morning at 8.

3) Point two only explains why in some situations we should stutter more on average. But it does not say why sometimes we can be very fluent, even in situations of more workload. So I now distinguish between variability of stuttering, and fluency-enducing effect. Often, we mix the two: we put "less stuttering" equal to "more fluency". The two might well not be the same!!

4) According to a theory developed by Per Alm, Uni Lund, broadly speaking, there might be TWO pathways in the brain that regulate speech: an automatic one, and an active-control one. When you focus on your message, your brain runs the speaking for you (you speak without thinking about how to speak), and when you are focused on how you want to speak, you take control of your speech system. Once you have accepted this theory and you assume that PDS is instability of the automatic mode, everything makes more sense. If a person with PDS uses his active-control mode (like speaking with a foreign accent, imitating someone, speaking loudly, speaking in chorus, speaking in rhythm and so on), s/he becomes more fluent, because the unstable automatic mode is not used or only partially used. This would in my view explain the phenomena. OK, the details might turn out to be different, but at the very least I (or rather Per Alm) have shown that it is POSSIBLE to explain the effect WITHOUT mysterious and vague reference to psychological factors.

Check out my previous posts on Per Alm's work: here, and here.


Anonymous said...

No. Sorry but I think your conclusion is the wrong way round.

If I just speak, speech is automatic and fluent, as you described when speaking alone. If I am too keen to impress the other person(s) then my anxiety about how well I will be able to present myself interferes with just passing on my thoughts: and so the presentation goes from bad to worse - the basis of a lot of romantic comedy!

Emphasis on the meaning of the comunication interferes with the communication of the meaning. This is not a linear, cause-effect relationship: speech is emergent and the ingredients are crucial. Many stammerers may be overegging the cake!

Lots of content on the BSA site allude to stammering being reduced when the person is tired or otherwise distracted - the value of diaphragmatic breathing is less to do with breath control than providing a distraction, as are the other examples you give of occasions of fluency- all very complex tasks.

Where stammering is a result of a brain injury the situation is different - and just how many brain injured members of the British Stammering Association are there?

Tom Weidig said...

I think it is still consistent with my theory. I said that there are two speech systems, an unstable automatic one and a stable active-control one. So when "you just speak", you are using your unstable automatic system, and you are fluent because your brain does not have a big work load. "If you are keen to impress the other person..." means that your brain has in general more work load, and thus the unstable automatic system becomes unstable and you stutter or stutter more.

The point really is that you are putting the cause on "the meaning of communication" whereas I say that the impact of "the meaning of communication" i.e. the brain has a bigger workload which makes your speech system more unstable. And the system can only be more unstable, because it is unstable in the first place. Normal fluent speaker do not put more or less meaning in communication than people who stutter but why do the normal fluent speakers do not stutter?

Anonymous said...

Tom, I really value you insight on this. It was great to read.

If what you say is true about variability in Parkinson’s etc, why is it that Stuttering "gets no respect" and it is passed off as wholly psychological?

Keep up the great work on your blog!

Tom Weidig said...

I am not sure. Humans have a tendency to rationalise their failures. Dysfluncies correlate with psychologically more difficult / active states in which normal speakers sometimes stutter, too. Speech is also the main communication channel of ourselves. In a sense, we regard speech as the face of our abstract mind, and for example our ears or muscle control as part of our physical body.

Anonymous said...

No it still doesn't make sense.

'When you focus on your message, your brain runs the speaking for you (you speak without thinking about how to speak), and when you are focused on how you want to speak, you take control of your speech' Exactly, and by trying to take control you mess it up by getting into a loop!

You are also assuming that the 'automatic system' is 'unstable'. What is the evidence for the 'instability'? Stammering is not evidence either for 2 speech mechanisms or for instability of one of them.

Why are some people nervous, some confident, some disinhibited, some depressed; why do some people believe the earth is flat? Brain instability is a worrisome reason, is it not? It is their 'model of the world' which is at issue not structural abnormalities in their brains. PET scanning or functional MRI show associations between behaviour and brain structure: but only associations and not causal relationships - a very common error ( I don't mean obvious structural insults like tumours or strokes etc.)
And what about the brain injury?

Also, I said the 'meaning of communication' not the 'meaning in the communication' which, latter, I take to be the information conveyed by the words themselves. The meaning of the communication relates to the content of the sentence, like this one, but also how I want to be seen by you and others who read this; how I want to see myself in responding to your reply; how my history of communicating my ideas and my 'self-esteem' is enhanced or reduced by my use of language and other behaviours like your response - will you take me seriously or dismiss me as a misguided theorist.

Stammering is no one's fault. I say again, it is Emergent behaviour like loving, being happy and sad. I do not believe there is a single cause of stammering because there is no such thing as cause-effect. Cause -effect thinking permeates western culture in many ways and, sadly, promotes the idea of blame. Thinking from the point of view of Emergence blame doesn't enter into the scenario, since there is no cause-effect.

The model of Emergence makes sense of this type of behaviour in terms of subjectively and objectively observable behaviour rather than metaphorical speculation.

Tom Weidig said...

Yes, I assume the automatic system is unstable. The evidence is there. It comes from brain imaging studies (both on the activation level and the structural level). And there exists a PhD thesis by Per Alm: I have included the abstract in my post.

I did not say that stuttering gives evidence for two systems. There is non-stuttering research that concludes the existence of two systems. And using this model, variablity in stuttering can be easier explained.

There is a lot of brain research indicating that being constantly nervous, confident, disinhibited, or depressed is mostly related to physical effects and not to a model of the world.

You say that brain research shows "only associations and not causal relationships - a very common error". I think, the correct statement is that associations do not NECESSARILY express causal relationship. So an association can imply a causal relationsip or not. So it is perfectly possible that many of these associations are indeed causal relationships.

If you do not believe in cause and effect, I suggest you should not drive a car anymore, take medication, or watch TV, because all these things are only possible to construct if you use cause and effect.

Anonymous said...

I quote from 'The Researcher is In' 16 October 2005.
'According to a theory developed by Per Alm, Uni Lund, broadly speaking, there MIGHT be TWO pathways in the brain that regulate speech: an automatic one, and an active-control one.
Once you have ACCEPTED this theory and you ASSUME that PDS is instability of the automatic MODE'
'POSSIBLE to explain the effect WITHOUT mysterious and vague reference to psychological factors'.
(partly my capitals)
You talk in this article of 'mysterious and vague references to psychological factors' and then go on to quote from Per where 'suggestions' and 'propositions' are made - isn't this as ''vague and mysterious' as any other 'hypothesis".

I teach advanced driving, am a medical practitioner and watch lots of TV. The behaviours, and indeed the science involved in all of these, are Emergent and cause-effect doesn't come near to explaining what goes on.

If I get nervous then the activated neurons will show on a PET scan. To then say that what shows on the scan is the structural cause of my nervousness is nonsense. Mind is an Emergent property of brain. Ingredients do not cause a cake.

Given 2 systems, which from the above article seems to be a hypothesis in any case,why does one have to be unstable and is there evidence for this instability other than stammering?

Flat earth believers see what supports their beliefs - we see what we look for from our particular point of view. That point of view, not always easy to see for ourselves, is our model of the world.

Personally I like cause-effect, it is simple and less challenging and suffices, on a superficial level, to explain life the universe and everything. Also it allows me to blame other people and God and the Devil for my problems
but it is ultimately inaccurate and doesn't help me mature.

What do you WANT to believe about stammering, Tom?

Anonymous said...

There is the 2 loop theory of stuttering which comes close to your own theory. Riley et al. (1997) discussed the medial or inner loop system which may be “abnormal “ in PWS. The authors suggest that this inner loop is concerned with spontaneous speech and is regulated by the striatum (part of the basla ganglia involved in the planning of movement and of other processes of executive function).

The more “active” the striatum, the more fluent the speaker. However, increased dopamine in the striatum will cause hypometabolism (less activity) and prevent it from working efficiently. This is the basic assumption of the dopamine theories of stuttering.

Riley and McGuire’s work states that the striatum can be avoided all together by using the outer loop. The outer loop is “activated” by using fluency shaping techniques, sticking a device in your ear, chorale reading or basically anything different from the typical speech process.

This theory fits in nicely with the new theories on drugs and stuttering. Basically, if you reduce the levels of Dopamine in the striatum pharmacologically , then it will work more efficiently. joe D.