Stuttering: Is It Biological or Psychological?

by Team Stamurai

Hearing Dr. Gerald Maguire talk, it’s almost impossible to guess that he has stuttered since childhood. Currently, he is one of the leading experts on the medical treatment of stuttering in the world.

Dr. Maguire is a Professor and Chair of Psychiatry and Neuroscience at the US Riverside School of Medicine. Along with conducting research on the medical treatment of stuttering for over two decades, he has been treating his own stutter with common and not-so-common antipsychotics.

Psychiatrists may prescribe antipsychotic drugs for the treatment of psychosis, bipolar disorder and schizophrenia. Some of the antipsychotics that have a positive impact on stuttering include second-generation antipsychotics risperidone, asenapine, and olanzapine.

Many of these compounds are not yet approved for the official treatment of stuttering.

More than 70 million people stutter worldwide. It includes around 1% of the adults. Several children show tendencies of speech dysfluency while growing up. While many children outgrow stuttering by the time they are around 6 or 7 years old, there are exceptions. 

These exceptions include US presidential candidate Joe Biden, actors James Earl Jones & Emily Blunt, and singer & songwriter Ed Sheeran.

Could Stuttering Be Entirely Neurological?

It is a popular belief that anxiety and fear cause stuttering. The use of antipsychotics for the medical treatment of speech dysfluencies begs the question – is stuttering psychological or biological?

Early research has mistakenly attributed stuttering to anomalies in the vocal cords and voice box, emotional trauma, anxiety, and even bad parenting! According to J. Scott Yaruss, some researchers and speech-language pathologists (SLPs) have always suspected neurological problems to be the underlying cause of stuttering.

Yaruss, a leading SLP at Michigan State University states that the first proof that could back up the hunch of their team came from a report of altered blood flow in the brains of people who stuttered.

Thanks to advancements in diagnostics, neuroscientists have observed minute but important differences in the brain structure and function of those who stutter.

Why Is It Wrong to Attribute Stuttering to Genetics Only?

According to the Stuttering Foundation of America has stated that there is no “reason to believe that stuttering is caused by emotional trauma”. 

The National Stuttering Association has stated that stuttering is “not caused by emotional problems or ‘nervous disorders’. Stuttering is not a result of faulty upbringing.”

Scientific evidence and publications by reputed organizations like the ones mentioned above suggest that stuttering is an inherited condition with little dependence on emotional state. 

According to Peter Wolson, a training, and supervising psychoanalyst, psychoanalytic psychotherapy may be an option for the treatment of stuttering in individuals whose speech disfluencies stem from internal conflicts due to disturbances in their families and relationships.

Focusing exclusively on the biological causes of stuttering rules out the importance of the emotional trauma or internal conflicts of the person who stutters. Put simply, calling it entirely biological can be misleading.

Can Psychotherapy Impact the Intensity and Frequency of Stuttering?

In many interviews, David Siedler, the writer-producer of The King’s Speech speculated that in his real-life Bertie (King George VI) benefited from Lionel Logue’s “talking cure”. 

Siedler, who also stutters, has an uncle who received speech therapy from Logue. According to his uncle, a large part of Logue’s therapy included encouraging the client to talk about their family, friends, and others who may have had a strong impact on their life.

Seidler has concluded multiple times that Logue must have used Freudian psychoanalysis on Bertie and his uncle. Although his uncle did call the psychoanalytic method “utter rubbish”, by the end of his therapy he didn’t stutter anymore.

Decades later, Jack Welch, CEO of General Electric confided in talk show host Piers Morgan that he stutters. Although he didn’t have someone like Logue to listen to him, his mother imbibed confidence and courage in him from a young age. 

His mother reinforced his confidence by stating that his brain worked faster than his ability to express his thoughts and ideas.

Jack’s mother was instrumental in developing his belief that whatever he wanted to say was worth saying.

Is It Possible for Stuttering to have Psychological as well as Physiological bases?

As Luc F. De Nil, an associate professor and chair of the graduate department of speech-language pathology at the University of Toronto precisely put it – stuttering has biological as well as psychological etiologies. 

Children who develop stuttering have a predisposition to the speech dysfluency.

Other factors such as environmental stress, emotional trauma, listeners’ reactions, and anticipatory anxiety play crucial roles in the maintenance of stuttering.

Over the years, researchers have gathered several facts about how stuttering develops, which highlight its physiological as well as psychological nature.

  1. 4 males for every 1 female stutter.
  2. The male predominance is similar to several genetic (biological) disorders including Tourette’s syndrome, and Down Syndrome.
  3. 1% of the world’s population stutters.
  4. Acquired stuttering highlights the importance of neural systems in speech fluency.
  5. Several psychoactive compounds such as Ecopipam can treat stuttering in children and adults.
  6. Psychoanalytic therapy is effective in treating stuttering in both adults and children.

What Does Current Genetic Evidence Suggest About the Nature of Stuttering?

In 2001, Dennis Drayna received a strange and interesting email that stated 

“I am from Cameroon. My father is a chief. He has had three wives. I have 21 siblings and half-siblings, almost all of us stutter. Could there be something in the family?”

At that time, he was unprepared to make a journey to West Africa based on an email. So Drayna, now a world-renowned geneticist, shared the email with Francis Collins (Director of the National Institute of Health). 

Collins encouraged him to travel to West Africa and later to Pakistan.

In Pakistan, marriage between cousins allows recessive genes to be expressed and the extensive studying of linkage. 

Drayna’s dedicated research and data collection finally led to the discovery of the mutations in 4 genes – GNPTAB, GNPTG, and NAGPA from Pakistan and AP4E1 from Cameroon in those who stutter. 

However, none of the genes that Drayna and his team discovered have a direct connection to speech production or processing. These are genes that encode lysosomal protein and function in the brain.

An NIH study published in 2019 was finally able to determine the difference between the brains of those who stutter and those who don’t. In the mice model, the ones that produce stuttering-like gaps and pauses have fewer astrocytes in their corpus callosum.

It would be Myopic to Deem Stuttering as Entirely Biological in Nature

It is still unclear if these 4 genes only play a role in controlling lysosomal functions. Many genes in our bodies have more than one function. Moreover, scientists are sure that there are more stuttering-related genes, yet to be discovered. 

Therefore, calling stuttering purely biological could be short-sighted and limiting. King George VI discovered that his stuttering had roots in the neglect and oppression he faced from his father during his formative years. Thousands are waiting for their Lionel Logue to explore the emotional or psychological stress at home or school that precipitated their stutter.

It takes a combination of environment, emotions, and genetics to set off stuttering. Just like one cannot deny the biological bases of stuttering, one should not deny its psychological etiology as well.

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