About the author: Robert van de Vorst (Netherlands, b. 1985) has completed his Master degrees in Musicology and piano (both with distinction) at the University and Conservatory of Amsterdam. He currently works at the Vrije Universiteit of Amsterdam, besides teaching piano privately in his home town. As a musician and person who stutters, he is interested in exploring the relationships between music, language and human behavior.

Introduction

Music and stuttering are both powerful, enigmatic and sometimes even mysterious phenomena. One contains obviously a great positive force, pure joy and often making people cry of happiness, while the other is usually associated with struggle, fear and even despair. I have personal experience with both. As I began to see the similarities between what ‘struggling at the instrument’ and stuttering were about, I started to gain insights I would probably not be able to gain in the absence of ‘the other’. In this paper I would like to share some similarities between the two.

Most people experience only the beautiful, enjoyable side of music, often when they listen to their favorite songs and artistic heroes. Many people also get ‘moved’ in a literal sense when they spontaneously tap with their feet or begin to dance. And yet, besides all the glory music has to offer, many amateurs and professionals experience limitations, struggle, nervousness pain, injury, anxiety and frustration as a result of their musical practice. Through my own experiences and observing those of others, I came to the conclusion that these symptoms have partly to do with the innate presence (or lack thereof) of talent – the ability to naturally communicate musical ideas through the ‘instrument’. However, lack of talent may not cause injury, pain or frustration, similar to that a predisposition to stutter doesn’t necessarily mean that a person is condemned to stutter his entire life. Important as well is how the person reacts to his own limitations, his self-image, what he expects from his self, possible environmental pressure as well as personal characteristics such as perfectionism, compulsiveness, obsessiveness and anxiety.

This may explain why there are musicians who are extremely passionate, musically brilliant and excellent artists, and yet suffering from a distorted relationship with the instrument, music and themselves. More concretely, it is often about a mismatch between the – not seldom idealistic – ideas, concepts and intentions in the mind of the artist and the (lack of) innate knowledge and ability to realize these intentions. By comparison, this would roughly parallel the demands and capacities model that is used for stuttering (Starkweather, 1987). A Person Who Stutters (PWS) may speak ‘fine’ (despite being neurobiologically impaired) when being alone, or when the social situation or language complexity is relatively low-demanding. However, when the demands exceed ones abilities, fluency mostly decreases.

Some of the things I mentioned above happened to me both at the piano and during speech conversations and I strongly believe that the roots of these phenomena were very similar; they just manifested themselves through different parts of the body.

However, one must be cautious comparing speech stuttering with ‘stammering at the instrument’ – as it is once called (Bluemel, 1930). First and foremost, speech stuttering itself is heterogeneous, with probably different causes and factors contributing to different individuals and groups (Yairi, 2007). And secondly, what is stuttering? Or, what makes stuttering really stuttering? Is it about the degree of disfluency or more about the feeling of loss of control? Despite these complexities, I think musical stuttering and speech stuttering share come interesting parallels which could be worthwhile to explore a bit further.

Music, language, stuttering and singing

Although musicologists don’t fully agree with each other about every detail within this subject, we can safely state that music and language share at least some remarkable similar characteristics (Patel, 2003). Virtually every existent human culture in today’s world contains the presence of both language and music. As the famous Polish composer Frédéric Chopin said: “we use sounds to make music just as we use words to make a language” (Eigeldinger, 1979).

Talking about stuttering, language and music, singing cannot be left out. Why do many PWS sing fluently? There is probably no single clear-cut answer to that question. An often heard explanation is that, during singing, another part of the brain gets activated which temporarily by-passes problems in areas active during speech (Alm, 2005). This explains why so many stuttering treatment programs use prolonged and intonated speech as a tool to improve fluency. Besides, songs mostly have a definite structure from a temporal perspective: music provides a clear meter and rhythm.  Other than that, singing is generally considered to be less demanding from a linguistic, emotional and social communicative point of view, which may lead to more sense of ease, relaxation, flow and a reduction of anxiety and communicative pressure.

It is interesting to note that Frédéric Chopin, the composer who wrote almost exclusively for the piano, always advised the following principle to his students (Von Grewingk, 1928):

‘Il faut chanter avec les doigts!’ (Translated: “you have to sing with your fingers”)

It may indeed be the case that, also at the instrument, a ‘singing’ way of playing may help in solving problems and likely improve fluency of execution. An explanation on how to get this ‘singing sound’ out of the piano is beyond the scope of this article, but it is mainly about

creating a musical image which enables you to listen and follow with your inner ear how a tone continues to sound and connects with its subsequent tone (instead of ‘attacking’ each note percussively and independent from each other). It’s about experiencing and perceiving what is between the notes, which provides one a more ‘complete’ picture of the music. This can help tremendously relaxing the muscles of the playing mechanism, creating a condition for more fluency of execution. It then may at least partly explain why “choral reading” (speaking or singing in unison with others) and fluency devices like Delayed Auditory Feedback (DAF) dramatically decrease stuttering in (some) PWS. Because – especially in the initial stage – it almost automatically promotes a person to ‘actively listen’ to a secondary auditory signal (Armson & Kiefte, 2008).

Something remarkable I have discovered is that, by slowing down records of true virtuoso musicians, you will hear that they basically keep a ‘singing sound’ all the time, even during the fastest and trickiest passages. Their playing apparatus thus actually moves rather regular and quiet. However, their mind and ears work rapidly together which seems to point at their capacity to process many things simultaneously and quickly one after another. When someone is rushing, stumbling and missing notes, it is often said that the ‘fingers move faster than the mind and the ear’.

Cognitive neural processes

A PWS may then be more vulnerable and sensitive for processing complex information within a certain time-frame (Jones, Fox & Jacewicz, 2012; Weber-Fox, Spencer, Spruill & Smith, 2004), which is in line with the fact that PWS are slower in encoding semantic information (Bosshardt, 2006).

All this would also fit with scientific reports about deficiencies and under-activation of the left-hemisphere in PWS (Chang, 2011; Chang, Kenney, Loucks & Ludlow, 2009; Watkins, Smith, Davis & Howell, 2008), possible linguistic issues (Bloodstein, 2002; Ratner, 1997) and motor coordination problems not only restricted to the speech apparatus (Chang, Kenney, Loucks & Ludlow, 2009; Max, Caruso & Gracco, 2003), but for example also during finger-tap sequences (Smits-Bandstra , De Nil & Rochon, 2006) and bimanual tasks (Zelaznik, Smith, Franz & Ho, 1997; Webster, 1990).

Given this information, it may be exciting then to investigate more about the underlying neural mechanisms of people while playing the piano. A few brain imaging studies have been done with people playing the piano (Parsons, Sergent , Hodges & Fox, 2005; Sergent, Zuck, Terriah & McDonald, 1992). Interestingly, there seem to be some shared neural networks between piano playing, speech and singing. It is probably too premature to speak about a significant similarity but it may not be excluded that a deeper understanding of musical fluency and disfluency could possibly lead more insight about speech fluency and stuttering as well.

Partly related to this, is the fact that recovery of stuttering in adults, as concluded by Kell et al., seems to be critically dependent on left Brodmann Area  (BA) 47/12 in the orbitofrontal cortex, an area in the brain associated with higher processing of language (Kell et al., 2009). Strikingly, in a study from 2003, Levitin and Menon indicated BA 47/12 to be involved in processing temporal coherence in music, and by extension, those aspects of the musical signal that contain its meaning. And in another article from 2006, Vuust et al. concluded that the same area (BA 47/12) is activated when musicians keep the main meter in a polyrhythmic context and suggested that left lateralized processing in BA 47/12 may be linked to metrical competence.

If we transcribe this principle to speech, could it then be that the regular continuity of sound and airflow represents the main meter, and the specifically timed movements of the articulators the counter pulse, for example? And would a successful integration of these basically restore fluency?

Psychological reactions and personal temperament

Although these ‘mechanical’ issues may play an important role in stuttering, it must not be neglected that learned behaviors and reactions can be a big part of one’s (experience of) stuttering too. It is commonly acknowledged that stuttering is often triggered by psychological factors and can be maintained and worsened by one’s temperament and subjective beliefs, opinions and emotions. Anxiety and over-control are common among people who stutter and many musicians deal with similar issues such as stage-fright and fear of playing.

Interestingly, I witnessed quite some musicians, myself included, who seemed to be able executing certain passages without too much trouble when playing alone, but screwing them up during concert. How can this be explained? My experience is that while playing alone, these passages were not being played perfectly at all, but seemed somehow to get out quite well, despite a less than competent working mechanisms behind it. In stressful situations, the already weak system ‘breaks’ much sooner, causing trouble and even more fear and uncertainty. Observing this phenomenon in music, it once more confirmed my personal experience and scientific fact that, at least in the majority of cases, stuttering (during speech or at the instrument) is not caused by anxiety or psychological problems, only triggered or aggravated by it.

Another type of condition which can strongly affect and be affected by ones psychological state of mind is Focal Dystonia (FD), a task-specific movement disorder characterized by a loss of voluntary motor control in extensively trained movements. Its prevalence is about 1% of all professional musicians and in many cases it terminates a performance career, since there is no definite ‘cure’ (Altenmüller & Jabusch, 2010). Different types of dystonia have been characterized as stammering with walking, stammering with writing and stammering with instruments, … etc. (Bluemel, 1930). There are both similarities and differences from a cerebral point of view between stuttering and dystonia (Alm, 2005), but striking is that musicians with dystonia have more anxiety and perfectionist tendencies than healthy musicians. While anxiety and perfectionism do not cause stuttering, heightened social anxiety has been observed in PWS (Craig, 2000) and a link between perfectionism as a possible personality characteristic and the development and maintenance of stuttering has been suggested. (Riley & Riley, 2000; Amster, 1995). Interestingly, musicians’ dystonia usually starts relatively late (in contrast to stuttering, which onset is typically very early) and the person may therefore be better able reconstruct the circumstances which may have lead to the disorder. This in turn could shed more light on factors which could lead to persistent stuttering since it is unknown to this date why some people grow out of stuttering, while others continue to suffer from it (Chang, 2011).

Conclusion

Especially the last statement shows that still a lot about these issues is poorly understood. In my view a cross-disciplinary approach may enable us to gain more insight about how these complex phenomena work.

My personal progress of understanding about many of the things that I spoke about came largely through music. Future research about stuttering should not neglect this area, because if anything, music has the capacity to shed light on what could otherwise be eternally mysterious, hidden and indefinable.

References

Alm, PA. (2005). On the causal mechanisms of stuttering. Doctoral dissertation, Dept. of Clinical Neuroscience, Lund University, Sweden. http://theses.lub.lu.se/postgrad/.

Altenmüller E, Jabusch HC. (2010). Focal dystonia in musicians: Phenomenology,  pathophysiology, triggering factors, and treatment. Medical Problems of Performing Artists, 25: 3–9.

Amster, BJ. (1995). Perfectionism and stuttering. In C. Starkweather & H. Peters (Eds), Stuttering: Proceedings of First World Congress on Fluency Disorders, II: 540-543. Nijmegen, Netherlands: Nijmegen University Press.

Armson J, Kiefte M. (2008). The effect of SpeechEasy on stuttering frequency, speech rate, and speech naturalness. Journal of Fluency Disorders, 33: 120-134.

Bloodstein, O. (2002). Early stuttering as a type of language difficulty. Journal of Fluency Disorders, 27: 163-167.

Bluemel, CS. (1930). Mental aspects of stammering. Baltimore, Williams and Wilkins.

Bosshardt,  HG. (2006). Cognitive processing load as a determinant of stuttering: summary of a research programme.  Clinical Linguistics & Phonetics, 20 (5): 371–385.

Chang S-E, Kenney MK, Loucks TMJ, Ludlow CL. (2009). Brain activation abnormalities during speech and non-speech in stuttering speakers. NeuroImage, 46:  201–212.

Chang S-E. (2011). Unraveling the mysteries of stuttering with neuroimaging. (invited article). Cerebrum, Dana Foundation: http://dana.org/news/cerebrum/detail.aspx?id=33796

Craig A. (2000). The developmental nature and effective treatment of stuttering in children and adolescents. Journal of Developmental and Physical Disabilities, 12 (3): 173-186.

Eigeldinger J-J. (1979). Chopin vu par ses élèves. Édition révisée. Neuchâtel: La Baconnière.

Jones M, Fox E & Jacewicz E. (2012). The effects of concurrent cognitive load on phonological processing in adults who stutter. Journal of Speech, Language, and Hearing Research, 55 (6): 1862-1875.

Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H & Giraud, AL. (2009). How the brain repairs stuttering. Brain, 132 (10): 2747-2760.

Levitin, DJ, Menon V. (2003). Musical structure is processed in ‘‘language’’ areas of the brain: a possible role for Brodmann Area 47 in temporal coherence. NeuroImage, 20: 2142– 2152.

Max L, Caruso AJ, Gracco VL. (2003). Kinematic analyses of speech, orofacial nonspeech, and finger movements in stuttering and non-stuttering adults. Journal of Speech Language and Hearing Research, 46: 215–232.

Parsons LM, Sergent J, Hodges DA, Fox PT. (2005). The Brain Basis of Piano Performance. Neuropsychologia, 43: 199-215.

Patel A. (2003). Language, music, syntax and the brain. Nature Neuroscience, 6 (7): 674 – 681.

Ratner N. (1997). Stuttering: A psycholinguistic perspective. In R. F. Curlee and G. M. Siegel (Eds.) Nature and Treatment of Stuttering: New Directions. Boston: Allyn & Bacon.

Riley G & Riley J. (2000). A revised component model for diagnosing and treating children who stutter. Contemporary Issues in Communication Science and Disorders, 27: 188-199.

Sergent J, Zuck S, Terriah & McDonald B. (1992). Distributed neural network underlying musical sight-reading and keyboard performance. Science, 257: 106–109.

Smits-Bandstra S De Nil L & Rochon E. (2006). The transition to increased automaticity during finger sequence learning in adult males who stutter. Journal of Fluency Disorders, 31 (1): 22-42.

Starkweather, C.W. (1987). Fluency and stuttering. Englewood Cliffs, NJ: Prentice Hall.

Von Grewingk M. (1928). Eine Tochter, Alt-Rigas, Schülerin Chopins. Riga, Löffler.

Vuust P, Pallesen KJ, Bailey C, van Zuijen TL, Gjedde A, Roepstorff A & Østergaard L.  (2006). It don’t mean a thing… Keeping the rhythm during polyrhythmic tension, activates language areas (BA47). Neuroimage, 31 (2): 832-841.

Watkins KE, Smith SM, Davis S & Howell P. (2008). Structural and functional abnormalities of the motor system in developmental stuttering. Brain, 131: 50-59.

Weber-Fox C, Spencer R, Spruill III JE & Smith A. (2004). Phonological processing in adults who stutter: Electrophysiological and behavioral evidence. Journal of Speech, Language, and Hearing Research, 47: 1244-1258.

Webster WG. (1990). Evidence in bimanual finger-tapping of an attentional component to stuttering. Behavioural and Brain Research, 37 (2): 93-100.

Yairi E. (2007). Subtyping Stuttering I: A review. Journal of Fluency Disorders, 32: 165–196.

Zelaznik HN, Smith A, Franz EA, & Ho M. (1997). Differences in bimanual coordination associated with stuttering. Acta Psychologica (Amsterdam), 96 (3): 229-243.