• A hypothetical scenario involving a child, Conor and his parents who go to see SLT, Róisín.
• While hypothetical, it is based on a range of real-life experiences of the author.
• It highlights the parents’ desire that part of SLT professional identity be “able to cure”.
• SLT resistance of that identity and choice to be an ally to Conor.
• The process of considering available evidence and seeking support from those with more experience in order to negotiate an identity regarding the type of alliance she will offer.
• Resistance of normalising discourse regarding fluency.

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Brian and Sandra – parents of Conor aged 3.4

• Conor – advanced language development, no concerns re speech errors.
• One day, out of the blue, Conor begins to repeat words and part-words.
• Sandra is surprised, then worried and… she reacts.
• Brian remembers his mother saying that one of his brothers had difficulty with speech but grew out of it.
• Conor continues to repeat, begins to prolong sounds and sometimes no sound comes out when he tries to say a word. 
• Sandra and Brian decide it's time to go to a speech and language therapist and they meet Róisín.
• Their story about Conor – about their role - about Róisín and her role – their expectations.

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Róisín

• Róisín is 25 – has been working in same job since 21 – first class honours – manager affirms her excellence  - more complex cases – wider range. 
• Anne, specialist in stuttering/fluency disorders is on maternity leave so case is assigned to Róisín.
• Róisín consults the evidence – Fluency shaping approach with lots of evidence. 
• Has notes from in-service Anne gave – decides to go with indirect approach and start with education – but assessment first including taking case history.
• And the plot thickens – Sandra ..(and Brian) want stuttering gone asap  - yes parent sessions are fine – but when is she going to see Conor and fix his speech?

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Conor

• Conor loves fun – he likes lots of things, running, painting, lego, and he has lots to say.
• He has noticed that some words seem to have a mind of their own recently and it’s like they get stuck.
• Mom and Dad have said nothing -  he has noticed they go very quiet and just look at him.
• One day last week, Granny Annie was minding him in the car and he was talking to her when a word was getting him stuck.
• She told him to “slow down, take a deep breath and start again”. 
• He could not see her face, but she sounded a bit something different.
• Note to self – try to not let words get stuck! 
  

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Assessment day for Conor

• Went   lovely place with loads of toys and met Róisín who played with me and talked to Mom and Dad.
• She made a video of me.
• Mom does that sometimes too.
• I wonder why? 
• Róisín seems to get stuck on some words too – not sure why I am here but Róisín has the best Lego and I am making an amazing bridge.
  ‍

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Roisin's dilemma

• Wants to help – who? Conor? But parents want fluency.
• Her CPD, while limited, has her thinking that focusing on fluency might not be best choice. 
• She takes her dilemma to supervision.
• She Googles and finds StutterTalk. 
• She contacts the SIG/CEN.
• She decides that she needs to talk with parents about some of the difficulties she sees with focusing on fluency. 
  

My contribution to The Stammering Collective was a talk reflecting on my work carried out over the last 10 years in relation to public understanding and awareness of stammering.  I questioned how stammering is perceived and defined by the public, spoke about how we might change wider understanding of stammering, and how we might be able to move beyond popular narratives of “overcoming” stammering.

Media engagement has been part of my professional roles with the Irish Stammering Association, the Irish Association of Speech and Language Therapists and the International Communication Project. A consistent theme I have promoted in print media, online publications, and in radio and television interviews is that, essentially, it is ok to stammer. Furthermore, it need not be seen as a negative quality needing to be fixed and it should certainly not limit the possibilities for an individual. These messages need to be repeated.

As the talk was intended as a conversation starter, it did not have a neat conclusion. Public engagement will continue over the coming years. I look forward to seeing where the conversation leads to in 2032 and again in 2042. I would hope that the “overcoming” narrative has changed and that I am able to listen to many more stammering voices on my hologram device. I also hope that these stammering voices are talking about lots of interesting things beyond the topic of stammering.  

Publication

The action of making 
something generally known.

— Oxford Dictionary

The format that the text / typeface is packaged in is as important as the textual content or typeface itself. Kind of like how in JJJJJerome’s work, there’s an interesting relationship to song or score sheets, through his use of a publication that is linked to his music. The format of this requires a unique level of engagement from the reader and listener.

Since I created the first issue of Dysfluent, I have been thinking about how the format of a publication defines the intent behind the work. It made me think about while there is a certain power to publication, there is also a quietness and consideration to it. At least from a design or artistic perspective, it requires a great deal of engagement from the viewer.

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Protest

A statement or action expressing disapproval of 
or objection to something.

— Oxford Dictionary

Recently I have been thinking of this concept of display, or posters, or for lack of a better term, protest.

Protest to me is really interesting from a creative or design stand point. For a person to display a poster, it is a deliberate act of reflecting an inner voice or identity, for the world to see.

I think of teenagers pinning up posters in their bedrooms, and of people marching on the streets voicing concerns. There is a certain passion or aggression (maybe not the right word?) to the idea of posters.

How does the idea of protest or display speak to earlier discussions on stigma?

I was interested to see what Fiona showed earlier in our talks, that banner where children visualised their stammer. There is something really nice there in terms of displaying their dysfluency.

It gets me thinking then. What is the content of the posters? What do they say? Do they need to say anything? or can they just be visualisations of dysfluency?

The Questions we need to ask

Who needs to change? What do they/we need to change?

Acknowledging the natural variation, the unique skills, experiences and traits of neurodivergent children.

— Constantino (2018)

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Client who stutters

What do they understand about stuttering? And their stuttering in particular?

Cons for the Client

• Exposure: "I stutter".
• Risk of failure.
• Lack of acceptance by self and others .

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The Speech and Language Therapist

What do we understand about stuttering? Turn the tables on the process of normalising judgement As therapists we need to enquire into what a person thinks of the judgement they have been assigned. What if stuttering was the norm? If stuttering was cool…

Cons for the Therapist

• Exposing beliefs contrary to the medical model.
• Perceived risk of ‘failure’.
• Lack of acceptance by peers, clients and client's families.

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Who needs to change?

How do we do this? Is this our responsibility alone?

• Ourselves as SLTs
• Families.
• Parents.
• Teachers.
• Employers.
• School systems.
• Health services.
• Shop keepers.

• How the meaning/cultural currency of feelings/emotions change over time.
• Emotions as shaped by cultural/political forces‍
• Representation of emotions in literature/film as revealing of the power structures at work.
• ‘Affect’ is used in different ways in different fields (neuroscience, psychology and literary/cultural studies).
• Sara Ahmed, Lauren Berlant and Sianne Ngai – critics for whom affects are crucially connected to structures of power (social/cultural/political); also interested in how affective states stretch our capacity to name them but haven’t cut loose from language and cognition.
• Sianne Ngai (Ugly Feelings), she’s interested in those feelings that are seen as unproductive/marginalised.

Hercule Poirot: I pity you, Norton… how very sad to find that this great and beautiful world is so foul and disappointing. And your mother, I pity even more.

‍Stephen Norton: M-my m-m-mother? You pity my mother?

Hercule Poirot: To endure the agony of bringing you forth only to discover that she had nurtured in her loins such wickedness – is that not worthy of pity?

Stephen Norton: It is you who is n-not worthy! She m-m-meant the world to m-me!

Hercule Poirot: And you to her?

Stephen Norton: She l-loved me… l-loved me m-m-more than… m-more than…

Hercule Poirot: Did she ever hold you, Norton, as mothers do? Stroke your hair… kiss your cheek?

Stephen Norton: She… she… she…

Hercule Poirot: Scared you, did she not? She pushed you away!

— Christie (1975) ITV adaption (2013)

This ‘still-here’ can only mean speaking. Not language as such, but responding and not just verbally – ‘corresponding’ to something.

In other words: language actualized, set free under the sign of a radical individuation which, however, remains as aware of the limits drawn by language as of the possibilities it opens.

This ‘still-here’ of the poem can only be found in the work of poets who do not forget that they speak from an angle of reflection which is their own existence, their own physical nature.

This shows the poem yet more clearly as one person’s language become shape and, essentially, a presence in the present.

The poem is lonely. It is lonely and en route. Its author stays with it.

Does this very fact not place the poem already here, at its inception, in the encounter, in the mystery of encounter?‍

I find something as immaterial as language, yet earthly, terrestrial, in the shape of a circle which, via both poles, rejoins itself and on the way serenely crosses even the tropics: I find a… meridian.

With you and Georg Büchner and the State of Hesse, I believe I have just touched it again.

— Celan (1960)

6A01.1 Developmental speech fluency disorder.

International Classification of Diseases for Mortality and Morbidity Statistics.

Developmental speech fluency disorder is characterised by frequent or pervasive disruption of the normal rhythmic flow and rate of speech characterised by repetitions and prolongations in sounds, syllables, words, and phrases, as well as blocking and word avoidance or substitutions. The speech dysfluency is persistent over time. The onset of speech dysfluency occurs during the developmental period and speech fluency is markedly below what would be expected for age. Speech dysfluency results in significant impairment in social communication, personal, family, social, educational, occupational or other important areas of functioning. The speech dysfluency is not better accounted for by a Disorder of Intellectual Development, a Disease of the Nervous System, a sensory impairment, or a structural abnormality, or other speech or voice disorder.

• Fluent ↔︎ Stuttered
• Medical models ↔︎ Social models
• Speech restructuring therapies ↔︎ Neurodiversity

<hr>

Authentic self as fluent

Authentic self is repressed by bodily power (pathology). We can liberate the self by restoring normal functioning.

• Behavioral therapy.
• Medication.
• Surgery.

<hr>

Authentic self as stuttered

Authentic self is repressed by social power (ableism). We can liberate the self by rejecting fluency.

• Stuttering pride.
• Activism.
• Creative expression.
• Identity is always relative.

<hr>

Identity is always relative

There is no true self to be emancipated, there is only different selves constituted through power relations.

I am constantly being encouraged to pluck out some one aspect of myself and present this as the meaningful whole, eclipsing or denying the other parts of self.

— Lorde (1984)

<hr>

A rejection of authenticity does not necessarily lead to determinism.

We are free in so far as we continuously rebelling against the ways in which we are already defined, categorized, and classified.

I would say in a few words that if either of these methods is able to be adopted with success on occasions in an easy and agreeable manner, a real step has been gained towards overcoming the affection; but if the sufferer is told to persist in uttering er, or to sing or roar out his words on all occasions, and trust to these as his infallible remedies, he will probably fail, for the remedies are so much worse than the disease that all sensitive minds would instinctively shun them with horror, and despond the more in consequence.

— Monro (1850)

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‍

<hr>

Other Examples of Stuttering Humour in Victorian Culture

• Humorous songs such as “The Stuttering Lass”.
• Minor characters in Victorian popular fiction.
• The celebrated theatrical character of Lord Dundreary performed by Edward Sothern. First appearance in the play Our American Cousin (1858). “Dundrearyism” in the periodical press.

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<hr>

• Anthologized throughout the nineteenth century in numerous anthologies of wit and humor, as well as  recitation manuals.
• In many of its incarnations, the “two stammerers” joke concludes with two people who stammer coming to blows because they each misperceive the other’s stammer as mockery.  

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<hr>

• Disability viewed as a human rights issue.
• Direct challenge to the medical model & institutions within which most SLTs have been trained and work.

Calls into question:

• Principles upon which therapy is based.
• Roles of therapist/client.
• Language.
• Range of therapies offered.
• Types, forms and aims of research into stammering.

<hr>

If speech language pathology is the intervention that stuttering activists seek from the government, medicine and private sphere, there is at least a conversation to be had about its medical necessity […] The stutter itself is only a negative bodily development if making people occasionally wait an extra two to ten minutes is a pathological emergency. This is all just to say, the burden should be on speech pathologists to prove their legitimacy on something more than merely auditory aesthetics.

— Richter (2019, p.73-74)

<hr>

Call for action

• Ethical responsibility.
• Locating therapy discourse within wider disability/neurodiversity discourse.
• Call for broader focus of therapy to address roles that self-identity, society and social stigma play.
• Drive to enrich and enhance professional accounts.
• Co-authoring therapy knowledge.

“One of these days I’m going to have to hang a sign on that door,” Agent Samson used to say. She was probably thinking along the lines of SPEECH THERAPY LAB, though a more appropriate marker would have to be read FUTURE HOMOSEXUALS OF AMERICA. We knocked ourselves out trying to fit in but were ultimately betrayed by our tongues.

— Sedaris (2000)

In the first short story of David Sedaris’s 2000 collection, Me Talk Pretty One Day, Sedaris recounts four months of his 4th grade year, in which he was removed from class once a week at 2:30 on Thursdays to meet with the acerbic school speech therapist he called “Agent Samson” to treat his lisp. Her clients were all lisping boys, he noticed, and none of them conventionally boyish, and he jokes that if there were a sign on her door it should not read “Speech Therapy Lab” but “Future Homosexuals of America.” At this young age Sedaris already has an inkling that speech impediment, in his case lisping, is related to sexuality, a personal affectation continuous with a dislike of sports or a love of making one’s own curtains. Sederis taps into a cultural trend that includes the identification “gay voice,” and that states that one can read sexuality off the voice, particularly the male voice, through how one speaks, what one says, or what one does not say.

With expressions like “stuttering pride” and “coming out of the stuttering closet,” activism by people who stutter explicitly ties its historical struggles and political goals to queer liberation, and queer theory has offered a verdant store of language and concepts for re-imagining dysfluent speaking as a kind of queer form of being in the world. Moreover, these intersections point towards the critical potential of the dysfluency itself as a kind of queer object, an object that presents a problem for sexual and gender norms, as well as conventional forms of reading, expression, and time. I am interested in how the experiences of being queer and a stutterer interpenetrate, and how each informs the other. In the few first-person accounts I read from queer people who stutter I often saw the authors comparing their social encounters as queers and as stutterers. One person notes that homosexuality was removed from the DSM in 1973, but that stuttering or “child-onset dysfluency disorder” remains. Another said that they were encouraged to embrace their queerness but to cure their stutter, and that speech therapy for them amounted to a form of conversion therapy. What I saw were not necessarily similarities but cases in which people embody two marginal positions, where one could have been treated like the other, and was not. How do queerness and stuttering misconnect with each other? Returning to Sedaris: of interest to us in Sedaris’s story is the detail that there was no sign on Agent Samson’s door, and that “Future Homosexuals of America” does not substitute for other language but for an absence of language. Agent Sampson’s is a door with no writing that suggests that as much as her door clearly opens for a certain kind of boy, it offers no clear language for that child, and the name of the certain type of boy who goes through it for a certain type of speech remains in some sense unspeakable. Sedaris is not cured of his lisp, but rather like many young stutterers develops an enormous vocabulary in order to avoid the sibilant s. The s is occulted in Sedaris’s speech, and this haunting, unspeakable s produces not a reduction in language but an excess of language in the form of the enormous vocabulary. How might we think of writers as people who work by suppressing language? This connection between the unspeakable and the excess of language conceptually ties dysfluency to the emergence of male homosexuality as a pathological category in the 19th century.

<hr>

I've had therapy to help deal with the way my parents reacted when I came out, but the therapist never insinuated that things would be easier if I was less gay. On the other hand, the speech therapy I've had as an adult focused very strongly on how things would be easier for me if I was more fluent.

— Elias K (2015)

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Sexuality between men had, throughout the Judaeo-Christian tradition, been famous among those who knew about it at all precisely for having no name – ‘unspeakable,’ ‘unmentionable,’ or ‘not to be named among Christian men’.

— Sedgwick (1985)

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The unspeakable transformed in the 20th century to what she calls a “byword” likely most familiar in Lord Alfred Douglas’s phrase, “the love that dare not speak its name.”

Like Sedaris forming his vocabulary around the absent s, the unspeakability of male homosexuality did not correspond to a dearth of language about it, but what Michel Foucault famously refers to in The History of Sexuality as “a steady proliferation of discourses concerned with sex… a discursive ferment that gathered momentum from the eighteenth century onward.” For the Victorians male homosexuality may have been occulted in the language, but:

Silence itself – the things one declines to say, or is forbidden to name, the discretion that is required between different speakers – is less the absolute limit of discourse, the other side from which it is separated by a strict boundary, than an element that functions alongside the things said, with them and in relation to them within over-all strategies… There is not one but many silences, and they are an integral part of the strategies that underlie and permeate discourses.

— Foucault (1976)

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The Victorians implicitly made the connection between homosexuality and stuttering. James Malcom Rymer’s fictional autobiography The Unspeakable: or, the Life and Adventures of a Stammerer, explores this link. Riley McGuire’s research on this novel argues that attaining mature heterosexual masculinity is predicated on attaining a fluent voice.

Freud’s famous diagnosis of stuttering as anal-sadistic is comprised of a few brief remarks made in passing. His more substantive thoughts on stuttering actually come earlier in a case study about woman with adult-onset stuttering and various neuroses. But the psychoanalytic understanding of stuttering as the unresolved frustrations of the narcissistic tendencies of the anal stage has captured more minds. Stuttering, after all, is the most uncomfortable type of shit-talk. But the threat of stuttering to masculinity also appears to be explained by the impediment’s root in anality, with its association with sexual submission, women, and the end of gender. There is a productive queer reading to be made about the threat of stuttering and the moral panic around sexual submission in gay male culture. At the end of his famous essay Is the Rectum A Grave? Leo Bersani finds in fantasies about the rectum “the place where the masculine ideal of proud subjectivity is buried”. Bersani offers a mythological location in which to reimagine the value of sexual submission. Besides being the “death” of male dominance, the anus is also the death of sexual difference, for we all have one.

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics.

— The American Speech And Hearing Association (ASHA) (2007:1)

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Identity


• Etymological root refers to sameness but often seen as what makes me unique – who I am.
• Medical model/social model.
• Narrative Practice – viewed as “public and social achievement”.
• Co-constructed in “the trafficking of stories about our own and each other’s lives” White (2007, 182).

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The process of professional identity

• Individual process but co-constructed.
• Multiple identities.
• Fluid, dynamic.
• Therapeutic exchanges.
• Stories told and interpreted.
• Cultural Influences.

<hr>

How are identities constructed?

O’Dwyer and Leahy (2015)

• Postmodernist thinking – multiple identities are available to an individual at any given time.
• Narratives play a large role in how we construct and re-construct these identities for ourselves and for others.
• Narratives are how we make sense of our experiences and this meaning-making in turn leads to a sense of identity. Bruner (1986: 143) explained that ‘narrative structures organise and give meaning to experience’.  Riessman(2008: 8) states that ‘individuals and groups construct identities through storytelling’ and that these identities are fluid.

<hr>

SLTs – multiple identities*

• An individual speech and language therapist has multiple identities available to them at any time.
• More aware of some than others and how conscious/aware they are of any identity at a given time varies.
• Intrapersonal and interpersonal factors influence how these identities are negotiated and renegotiated.
• These identities are negotiated in their interaction with the people they see for therapy and their families/carers.
• “Through clinical interaction clients and clinicians negotiate who they are and the roles they play in the therapy story.” Simmons-Mackie and Damico (2011:44)
• If a particular identity gets validated through these interactions, it takes hold and is performed regularly, If not validated, gets renegotiated.

*O’Dwyer, M.  and Leahy, M.M. (2016). There is no cure for this:  An exploration of the professional identities of speech and language therapists’, Journal of Interactional Research in Communication Disorders, 2, 149-167.

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Who are speech and language therapists working with children and adults who stutter and their families?
 Possible identities: