In the late 1800s, Dr. J.S. Dieffenbach, a Prussian surgeon, discovered that crossed eyes could be surgically corrected by weakening the stronger of two eye muscles. Dieffenbach deduced by analogy that stuttering also must be caused by an imbalance between the muscles of the tongue. Simply remove a portion of the muscle, he theorized, and the problem would be solved.
Hundreds of stutterers, thrilled at the prospect of a cure, lined up outside his door for the opportunity to be strapped to a table and have the back third of their tongues cut out.
"This was before the days of anethesia, and a lot of people died," says Dr. David Rosenfield, a neurologist with Baylor College of Medicine and the Methodist Hospital's Stuttering Center. "It shows how desperate stutterers were -- and still are -- for a cure. Through the years, they have tried everything from rubbing potions in their scalps to operations to all kinds of hocus pocus."
Today, there are approximately 1 million stutterers in the United States, according to the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS). About 1 percent of adults and 4 percent of children stutter -- boys four times as often as girls.
Some children stutter because they can think faster than they can talk, says Frances J. Freeman, a speech pathologist at the Callier Center for Communicative Disorders at the University of Texas at Dallas. Eighty percent of child stutterers speak normally by the time they are adults.
Stutterers often look for "the quick fix" cure for their problem, says Martin Adams, head of the communication disorders program at the University of Houston. "In some respects," he says, "they are just as desperate for a cure as terminal cancer patients."
As a result, the stutterer often falls prey to high-priced treatments and devices promising instant cures.
"People are hustling us naive human beings," says Michael Hartford, a stutter who founded Washington's National Council of Adult Stutterers. The council once sent for a "No Stutter Aid," which promised fluency for $98.95. "It was a hearing aid-looking device that generated a ticking sound," he says. "You were supposed to talk in time to the clicks. It worked to an extent, but you ended up doing everything in time to the clicks. That's not communication."
No one is sure what causes people to stutter, and experts at the American Speech-Language-Hearing Association agree that there are no simple cures.
There are indications that the tendency to stutter is genetic, experts say, but environmental stresses are also a factor. Most stutterers experience their worst bouts of stuttering when under stress or emotional tension, such as ordering food in a restaurant, talking on the telephone or speaking in public, according to NINCDS.
For example, Lynn Heltman, a 35-year-old Washington demographer, said her stuttering "was mostly due to family tensions and pressures I put on myself to succeed. I didn't start stuttering until I was about 11. I've grown out of most of it . . . I decided it was okay not to be perfect."
While previous stuttering therapies focused on the problem's psychological roots, says Rosenfield, "people are now looking at the motor task of speech and asking, 'How does the brain do it?' Stuttering seems to be a motor problem rather than a psychological one, although we don't know why."
Speech is a combination of voiced and nonvoiced sounds that occur when two folds of muscle tissue (vocal cords) vibrate, says speech pathologist Freeman. Voiced sounds -- such as "b," "d," "z" and the vowels -- are created when the vocal folds are closed and vibrating; nonvoiced sounds, such as "p," "t" and "s," are created by opening the vocal folds widely so air passes through without vibration.
"In normal speech, we rapidly open and close the vocal folds to produce syllables which smoothly combine voiced and voiceless sounds," she says. "Stuttering blocks occur when the muscles that open and close the vocal folds contract simultaneously and prevent smooth, easy, coordinated closing."
There are two primary therapeutic approaches that ease the struggles of the stutterer, according to William H. Perkins of the Stuttering Center at the University of Southern California.
The first approach gives the stutterer skills to make him or her sound like a fluent speaker -- skills that must be used at all times to avoid relapse. Specialists design individualized programs using one or a combination of the following:
*Rate control, or prolonged speech, teaches the stutterer to prolong vowels and speak rhythmically. The technique is almost universally effective, but reduces speech to a slow drone.
*Air flow, or breath management, works on the assumption that if the stutterer keeps air flowing through the utterance of a sound, then it becomes impossible to stutter.
*Extended length of utterance "lets stutterers invent their own fluency skills instead of telling them what skills to use," says Perkins. The therapist sets up a list of single-syllable words to be mastered before the stutterer goes on to more difficult words and phrases. This form of therapy tends to work well with children.
Ron Anderson, a 42-year-old architectural photographer, used breathing skills to minimize his stuttering. "A lot of therapies will leave you with speech that's not usable on the outside world," explains Anderson, who says stuttering runs in his family. He has been receiving speech therapy at a local clinic since 1981. " My treatment makes me rethink how to speak by breathing a certain way and not starting a sentence too quickly."
The second treatment approach encourages stutterers to change their attitudes. "The stutterer learns to live with the problem instead of fighting it," says Perkins. "The theory is that as the stutterer is willing to stutter openly, it becomes easier." After using this technique, some stutterers continue to struggle with speech, but not as much, while others become fairly fluent.
Michael Hartford, founder of the National Council of Adult Stutterers, considers attitude adjustment the best therapy for him.
"I used to think I had to do everything possible to avoid stuttering," says Hartford, who used to deny his speech disorder but now accepts it with ease and grace. "Avoiding it makes the whole burden heavier; it just makes it harder for me to communicate. If I can be with someone, making eye contact and communicating, then I don't care if I stutter. In fact, I don't even consider that a stutter."