Harry asks a sensible question:
You say :
"Let me be crystal clear. I certainly view social anxiety as a consequence of stuttering and not the cause of stuttering."
...and then late add :
"There is no doubt in my mind that the shame and fear associated constitutes a significant part of the psychological and social handicap that we experience and modulates the frequency and severity of stuttering events."
Isn't this a contradiction? So, the fear and shame modulate the frequency of our stuttering, and yet you do not beleive that it is the cause?
Surely, it causes some of the stuttering. Take away the fear or shame (eg. when we speak to an animal, or a baby, or to ourselves), and most of the stuttering disappears.
The ultimate cause is the neurobiological deficiency, because:
1) Without the neurobiological deficiency, we would never have started stuttering in the first place. (which creates mal-adaptation of learned behaviours and unhelpful beliefs.)
2) Without the neurobiological deficiency, we would have far less difficulties controlling our speech fluency in a demanding speaking situation. (which makes it difficult to unlearn learned behaviours and change unhelpful beliefs.)
A proximate cause is the learned behaviours and beliefs, because they modulate stuttering.
A good analogy is:
Example: Why did the ship sink?
o Proximate cause: Because it was holed beneath the waterline, water entered the hull and the ship became denser than the water which supported it, so it couldn't stay afloat.
o Ultimate cause: Because the ship hit a rock which tore open the hole in the ship's hull.
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