Therapy informed by the social model & neurodiversity

We want to affirm, especially for the young people out there, that it is okay to stutter. We believe that not only is it okay to stutter, but people who stutter should be empowered to speak however is most comfortable for them – even if that speaking style contains pauses, repetitions, and blocks.

— NYC Stutters (2020)

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• Educators to integrate the diversity agenda into speech and language therapy training to enable future therapists to consider the philosophical underpinnings of their role and approach.
• Forums for therapists to examine their underlying values, role and scope of practice.
• Meaningful collaboration to rethink the scope, focus and role of future stammering therapy for CYP & adults.
• Open, public debate about social and ethical implications of research in the fields of neuroscience and genetics.
• Research into what matters for people who stammer.
• Balanced investment of funding.
• Accessible research findings & conferences.

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Still it appears to us that the answer will be forthcoming if we as a field are serious about engaging in a partnership between researchers and the population of people who stutter, for people who stutter can provide the most meaningful metric for determining whether a treatment is viable.

— Yaruss & Quesal (2004)

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It is critical for professionals to realise that people with lived experience are best situated to drive the effort for changing how our society thinks about stuttering. Professionals bring resources and credibility to the table which can be very important for public attitude change, and they can play a supportive role to improve social conditions. However, people who stammer themselves are best positioned to promote the agenda of their community in terms of actions and policies that effect their lives.

— Boyle (2019)

• 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.

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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)

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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.

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

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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.

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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.

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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)

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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.

• ‍The blurt. Stutterers pepper their language with so-called “fillers” that ostensibly sit outside of, and even detract from, the message. We sometimes grimace and groan in the act of speech. In addition, we sometimes find ourselves in the midst of speaking sounds, words, or phrases we didn’t fully intend.‍
• The misfire. The phenomenon of stuttering includes both prolongation and repetition. Stuttering can extend the opening sounds of a message (e.g. ---aaaaaaaagree or bo-bo-bo-book), which an ableist grammar recodes as misfires that communicative parties can tacitly agree to ignore.‍
• The stall. A repetition can be a redundant redundancy (one that serves no discernable purpose), like repeating most of a sentence multiple times to get a “running start” on the difficult finish that was long ago anticipated by our impatient interlocutor. Or, in a hard block, the voice suddenly and unexpectedly runs dry. A word stops in your throat, and you must wait for infra-bodily traffic to clear while the absence of meaning gapes wide and dangerous in the social world.‍
• Crossed wires. A regular experience for stutterers, crossed wires describes the state of “talking past each other” that might begin when one party “mishears” the other and then feedbacks error into the conversation.‍
• The swerve. Clinicians prefer the term “avoidance” to describe the strategy stutterers employ when we sense an oncoming phoneme over which we expect to trip. I might, for example, begin to say “I agree” but change course, swerving around a potential misfire to substitute on the fly: “I don’t know.”‍
• The cut-off. This accident is one of attempted repair, caused when interlocutors or bystanders rush to the scene of an accident, interrupt, and reimpose order by attempting to predict and finish the stalled (or otherwise damaged) message according to a dominant grammar.‍
• The gridlock. Stuttering ferociously at the front of a queue, for example, halts the flow of information, people, and capital; it stalls a lane of traffic and tempts impatient honks in the form of tapped toes and glances, as everyone waits for an undetermined time until information and thus bodies will once again flow free.

You have to see yourself in society to be a part of that society

Visual activism to confront and challenge societal preconceptions:

Look → Think → Act

Simi Linton (1998) in Claiming Disability: Knowledge and Identity quoted by Rosemarie Garland-Thomson:
 "We wield that white cane, or ride that wheelchair or limp that limp” … luxuriate in that stammer?

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The portrait invites us to stare, engrossed perhaps less with the “strangeness” of this woman’s disability and more with the strangeness of witnessing such dignity in a face that marks a life we have learned to imagine as unliveable and unworthy, as the kind of person we routinely detect in advance through medical technology and eliminate from our human community.

— Garland-Thomson (2009)

Flaunt the visible marks of disability. The relish with which disabled people can live their identity and present themselves to the starees.