About the Author: Peter Louw is an author and poet who lives in the beautiful city of Cape Town, South Africa. Trained as a lawyer and admitted as an advocate, he nevertheless found that his stutter made it difficult to follow this career, and instead became a court reporter, journalist, editor, and translator. His books include a collection of poems and two books on stuttering. He has a blog titled Stuttersense (424,069 pageviews up to August 2021) and a Facebook group, Stuttering as a Mindbody Disorder. Peter believes that there is a need for change within the area of stuttering. He feels that the role of the subconscious mind in stuttering, as well as stress and the repression of hidden emotions, are not sufficiently acknowledged within the stuttering community, and hopes that a new focus on them will help bring the much needed change we want to see.

Exploring possibilities for change: Is stuttering a “mind-body” disorder?

Is stuttering a psycho-physiological, aka “mindbody” condition? For the past few years this question has been haunting me. Because if it is, it could change how we see stuttering and how we treat it. 

In other words, is it part of that strange family of disorders in the hotly disputed no man’s land between the mind and the body? Is it related to irritable bowel syndrome (IBS), many other digestive issues, tension headaches or migraines, unexplained muscle pains and many other stress / anxiety-based health complaints? And if so, can this information help us to deal better with our stutter?

Stress can manifest physically

A few years ago I came across an article in a sports magazine discussing “tension myositis syndrome”, a.k.a. The Mindbody Syndrome or TMS. TMS, according to the article, is a stress/anxiety-based syndrome with an open-ended myriad of symptoms ranging from digestive issues to lower back pain. At the time I had immense problems with my lower back. This was at the time of my retirement from a large financial company after twenty years – a very relevant fact, as will become clearer later. I used to get excruciating back spasms, seemingly out of the blue and not dependent on the physical movements I made.

X-rays and MRI scans showed mild disc narrowing, regarded normal for my age, and various health professionals concluded that this was causing the pain. However, the pain pills, creams, physiotherapy and an epidural injection failed to bring relief, and so I began to read up on TMS.

TMS is the term coined by the pioneering Dr John Sarno, MD (1923 – 2017), who was professor of clinical rehabilitation medicine at New York University School of Medicine. His concepts have since been further developed by various physicians (who have all written books about it), notably Drs Howard Schubiner, Marc Sopher, David Schechter and others. The basic idea is that stress, and particularly repressed, hidden emotional stress, can manifest physically (and sometimes also psychologically).

Getting in touch with secret feelings

Treatment entails becoming aware of this secret emotionality – getting in touch with your deepest feelings. A major tool to achieve this is the technique of journaling, that is, writing about and fully exploring one’s feelings in, for instance, a diary.

And that’s what I did. I followed a structured journaling program in which I had to answer carefully selected questions intended to probe the unconscious mind and expose what I had hidden from myself. Amazingly my back pain began to disappear as I unearthed what had caused it – I had repressed my secret fears around retirement! My subconscious mind had worried about post-retirement life, reduced income, getting older and losing my health, and the certainty of eventual death. Consciously I had not given it much thought, but my subconscious mind must have felt very threatened indeed.

Intrigued by my recovery from back pain, I began to wonder about this TMS. Officially it is not (yet) recognized in the mainstream medical community as a true syndrome – yet it had helped me, and many others if the reviews of Sarno’s books on Amazon can be believed. Could it perhaps also explain a few other unexplained health issues which had impacted my life – such as stuttering? Could developmental stuttering be a type of TMS, an early onset TMS? 

Blocking may trigger the repetitions

Taking this line of thought further – if TMS can result in tension-based spasms of the muscles of the lower back, as happened in my case, can it perhaps also result in tension spasms of the vocal-cord muscles, resulting in stuttering?

Such an explanation fits in with my experience of stuttering. For decades I had been using the Passive Airflow fluency technique, which is based on the hypothesis that speech repetitions and prolongations are actually efforts to deal with blocks. The airflow approach states that repetitions, prolongations and blocks are not just aspects of stuttering – the repetitions and prolongations, being struggle behaviors aimed at resolving the blocks, are actually the result of the blocks. The blocks themselves seem to entail a tension-related “freezing”, or “locking”, of the vocal cord muscles.

For instance, a stutterer who repeats, is like an athlete who is unable to scale a high wall – he will retrace his steps (repeat the sounds already spoken) in order to make another effort at scaling the obstacle, which is the next sound to be spoken. But that sound cannot be readily pronounced because his vocal cords are in freeze mode. This would explain the physical part of stuttering.

Not fighting or fleeing, but freezing

And this led to another intriguing question: When our vocal cords go in freeze mode, is it because of the “freeze” in the fight-flight-freeze stress response? This, again, makes sense. I suspect that we channel our tensions to our vocal cords, in the same way that some people channel their tensions to other parts of their bodies, such as the digestive system. The tension is generated by day-to-day stress as well as inner, and often unconscious, anxiety.

Day-to-day stress does play a role in TMS, according to Dr Sarno, but not as much as inner anxiety, in particular psychological repression. What is repression? Well, it is something everybody does all the time! And it makes life much easier. Repression means the “forgetting” or ignoring of unacceptable or unpleasant emotions or thoughts, pushing them back into the subconscious mind. For instance, most of us don’t dwell on everything that can go wrong all the time. We tend to forget or ignore negative emotions such as rage, sadness, fear or uncertainty. 

Repression happens outside of our awareness; it is an unconscious process. (When we are aware of it, it’s known as suppression, which happens consciously.) We don’t know that we ignore or forget certain emotions or information that might hurt us or otherwise be unacceptable to us. It is a defense mechanism to protect us from emotional overload and anxiety. Our minds would be overwhelmed if we were to be made aware of everything that comes to us through our senses.

Bottling up the emotions

Some people, however, seem to repress more than is usual or healthy. Very often they are by nature more sensitive than average – called Highly Sensitive Persons (HSPs) after the excellent research by the famous psychologist Dr Elaine Aron. (Most people who stutter are in fact HSPs, according to the research by Dr Libby Oyler, CCC-SLP. High Sensitivity is mainly an inborn trait.) Sensitive children seem to be more susceptible to develop TMS. If too much emotional material is bottled up, it may cause inner conflict which will in turn result in tension. That tension may then seek a physical or psychological outlet. For instance, the tension generated by the TMS defense mechanism may hit the muscles of the digestive system, causing a spastic colon – or, for example, the speech muscles, resulting in speech blocks and stuttering. This effect would, of course, be increased by the usual day-to-day stress to which everybody is exposed.

One of the problems with repression is that, being a subconscious process, it’s hidden and cannot readily be picked up by researchers, speech professionals, people who stutter, and parents of stuttering children. MRI and other scanning systems are unable to differentiate between repression and other mental activity. As a result it is not possible to pinpoint or prove repression. It’s therefore no wonder why some researchers have, erroneously in my opinion, concluded that the cause of stuttering is not psychological. They missed the hidden repression which causes tension that leads to people tensing their vocal cords.  

Another key element of TMS is conditioning. Once the above mentioned process is in place, it quickly becomes established through conditioning. Not only the repressive mindset, but also the physical expressions of that mindset will be reinforced as time passes and neural pathways are formed.

Expressing stress through speech

Now, you may ask: Are you saying that people who stutter (PWS) are neurotic, or otherwise mentally disturbed? No, most PWS are just like other people; most people, whether fluent or not, are exposed to stress and carry some repressed emotional baggage (some more than others), it’s part of being human. The only difference is that PWS express their stress and repressed emotional material through their speech. Others may express these in other ways, like getting a migraine or a digestive or skin issue. 

But if stuttering is a form of The Mindbody Syndrome (TMS), how can this insight perhaps help people who stutter? We can learn much from how other mindbody symptoms are dealt with, such as journaling, relaxing, meditating, and getting in touch with hidden emotions.

Above all we need a new mindset. If the key to stuttering is psychological repression, it might be helpful to explore its opposite: expressiveness and assertiveness. Instead of holding back and bottling up, we need to let it out. Instead of repressing deep-seated feelings of anger, fear, sadness etc. we need to acknowledge and fully feel them, even if they are hard to deal with. If they unconsciously accumulate they could elevate stress levels and impact on fluency.

Do not repress – express!

So these days I journal daily. I write honestly about who and what has made me unhappy in the past, and is stressing me in the present, and why. In the same way I also express my fears for the future. Repressed rage is the usual suspect in mindbody issues, so I focus on expressing and really FEELING my anger, thereby getting it out of my system. In my electronic diary I rant, scream, curse or cry. Others I know scream while driving alone in their car – a great place to let it all out!

As this is a mind-body issue driven by tension, I also try to manage my general stress levels through physical activity, meditation, and relaxation procedures. And because the mind-generated tension eventually reaches the speech organs I also use the Passive Airflow fluency technique, to reduce the localized tension on the vocal cords.

In addition I have memorized a series of daily affirmations, to gradually change the subconscious mind:

1. Stuttering is due to TMS, not a structural abnormality.
2. TMS is a harmless condition, mainly caused by my repressed emotions.
3. The principal emotion is my repressed anger.
4. I will not be concerned or intimidated by stuttering.
5. I will not obsess over stuttering – it is just a symptom.
6. I will shift my attention from the stutter to emotional issues.
7. I intend to be in control, not my subconscious mind.
8. I will not repress, but do the opposite: I will express!
9. I will be assertive and not hold back.
10. I will refrain from perfectionism and goodism.
11. As an adult I am not the vulnerable child I used to be.     

A last word …

The above holistic view of stuttering and its treatment has become the roadmap in my journey to better speaking. Not only is it the change I wish to see – to a large extent it is now my reality. It has enhanced my retirement years immeasurably, and my only regret is that I didn’t have this knowledge many decades ago. But … I probably would have rejected it then. As the saying goes, “When the student is ready, the teacher will appear.”   

 

References:

Abbass, A., & Schubiner, H. 2018. Hidden from view: A clinician’s guide to psychophysiologic disorders. Psychophysiologic Press.

Aron, E. N. 1999. The highly sensitive person: How to thrive when the world overwhelms you. Thorsons.

The Psychophysiologic Disorders Association (PPDA). 

Sarno, J. E. 1998. The mindbody prescription: Healing the body, healing the pain. Warner Books.

Sarno, J. E. 2008. The divided mind: The epidemic of mindbody disorders. Duckworth Overlook. 

Schubiner, H. 2011. The King’s Speech as Mind Body Syndrome: Finding your Voice and Reclaiming your Life. 

The Tension Myositis Syndrome Wiki.