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The stammerer frequently has a neuropathic history or a constitutional tendency
to this condition. He may have experienced a severe disturbance of the nervous
system due to shock, accident or fright, e.g., one boy was pushed off a pier into the
water by a rough companion, another set a room on fire. Some sufferers begin to
stammer after the shock of an operation for the removal of tonsils and adenoids.
Illness is a frequent determining cause, and in some cases it is the aftermath of
scarlet fever or diphtheria. Again, in some cases, rheumatic fever or subacute
rheumatism are factors in the causation. The common association of rheumatism
with chorea, the greatest cause of inco-ordination in children, is well established.
This connection is so close that cases of chorea have been sent to the centres as
stammerers. In all these cases the fact underlying the muscular inco-ordination is
the nervous instability so often found in rheumatic disorders.
One of the most noticeable features of a stammerer is his strained and anxious
expression. Even in repose this is seldom absent and it becomes intensified as soon
as he attempts to speak. When he actually begins to speak, another characteristic
exhibited by all stammerers to a greater or lesser degree is at once evident, namely,
the muscular tension which is an outward and visible sign of mental tension. The
latter is there all the time, but except to the initiated observer it is, perhaps, not so
evident until the effort of speaking makes it so marked as to be unmistakable. In a
severe case this hypertonicity will nearly always be accompanied by muscular spasm.
The worst type from the point of view of treatment is the laryngeal spasm. This
type takes longer to learn to relax and, therefore, to cure than any other.
In the examination of persons suffering from cerebral paralysis, who are often
of a very high mental grade, it was noticeable that general muscular spasm and
athetosis was often aroused by attempts at utterance. This was especially so when
the response required considerable mental effort. Thus it was more marked with the
more difficult mental tests than with the easier ones.
It should not be necessary to tell parents that fault finding or ridicule increase a
stammer and yet this has to be done repeatedly, although it is not always the
harassed mother with slender means and a large family who needs advice on this
point. Investigation reveals a distressing number of parents holding a totally wrong
view of the children they bring for treatment.
As regards the patient, one of the symptoms of the inferiority complex is
extreme self-consciousness. He blushes easily, is often emotional, sometimes
almost hysterical, but worst of all is his acute sense of difference from his fellows,
inseparable from his condition, unless the stammer is a very mild one. This feeling
of inferiority or inadequacy will gradually colour his whole personality ; he does not
confine it to speech ; he begins to doubt himself in other directions as well, e.g., his
ability to do good work, or to establish contact with his fellows. In extreme cases
he may go about with a hanging head, be unable to look people in the face and will
avoid responsibility, preferring always to keep in the background. He is hypersensitive
and in constant fear of ridicule. As Locke said in 1690 : " Defected minds,
timorous and tame, and low spirits are hardly ever to be raised and very seldom
attain to anything."
This inferiority complex may be due, more especially in a child, to environment.
Constant discouragement and fault-finding will gradually undermine self-confidence
and a child whose manner, appearance or achievements are the subjects of continual
adverse criticism can hardly fail to develop an inferiority complex.
Stammering, then, is associated with a condition of instability of the nervous
system and enuresis and delinquency. The relationship in the last-mentioned
complaints has been attributed to the same cause. Dr. Verner Wiley made some
notes on the signs of physical instability and the type of mental instability found
in non-defective delinquents examined by him. His results, given in the School
Medical Officer's Annual Report for 1929, page 82, show that of 401 cases at Pontonroad
Place of Detention, 26, or 7.3 per cent., suffered from enuresis and six
cases, or 1.7 per cent., stammered. In another group of 522 consecutive cases of
stammerers 36, or 6.9 per cent., suffered with enuresis.