Chapter X: In Conclusion 303 (4)

The supersensitive child, having seen or heard something that profoundly shocks him, or having committed some petty or really serious fault, feels, on the one hand, that he has a shameful secret he must guard carefully, and, on the other hand, fears that people can read his secret in his eyes. Hence, he develops feelings of awkwardness and embarrassment when others look at and speak to him. He fidgets, blushes, stammers, trembles; in a word, displays all the symptoms indicated by the term bashfulness. In the course of time one of two things will happen: either increased knowledge will reassure him, and he will, as the saying is, outgrow his bashfulness; or the hidden fear and shame--even though the original occasion for them may have completely lapsed from conscious remembrance--will fix themselves firmly in his mind, causing a habit of bashfulness which may torture him all his life.

Whether this new theory as to bashfulness of the chronic type holds good invariably, it is as yet impossible to say. Certainly, it has been verified in an astonishingly large number of cases. Time and again, applying some one of the delicate methods by which they tunnel into the most obscure recesses of the mind, medical psychologists have dragged into the full light of conscious recollection forgotten memories which the victims of bashfulness themselves recognise as connected with the onset of their abnormal timidity. Often their bashfulness completely disappears, or is markedly abated, as soon as the memories responsible for it are recovered. Or, when an immediate cure is not wrought, one is pretty sure to result after an explanation of the evolution of the trouble and the application of appropriate suggestions to develop self-confidence and will power.

To illustrate by citing a few instances from life, let me give first the case of a young New England man, who, as usually happens, did not resort to a physician until his bashfulness had begun to interfere with his earning a livelihood.

"I have not the slightest idea what is the matter with me," he told the neurologist whom he consulted, "but the fact is that for a good many years I have felt strangely timid when meeting people. I believe I am naturally of a courageous disposition--certainly I do not suffer from cowardice in the ordinary sense--but I actually blush and tremble if spoken to suddenly or looked at intently. Lately I notice this has been growing worse."

"Can you tell me," the physician asked, "just when you first noticed that you were bashful?"

"No, I am sorry to say I can't. I only know that it began while I was a boy."

Nevertheless, by the aid of a method of psychoanalysis, or psychological mind-tunnelling, it was ascertained that, subconsciously, he did know exactly when his bashfulness began, and also was well aware of its cause. From among the forgotten, or only vaguely remembered, episodes of his boyhood there emerged, with exceptional vividness, a memory-picture of the time when he first went to work. He recalled with painful intensity the figure of his employer, a stern, cold, hard man, with piercing eyes.

"Those eyes seemed to be on me everywhere I went. They seemed to be watching for the least mistake I might make. I began to wonder what would happen to me if I did make mistakes. Then I began to feel incompetent and to fear that he would notice my incompetency. I grew nervous, awkward, timid. Whenever he spoke to me, I jumped, I blushed, I trembled. After a time I did the same when anybody spoke to me."

"And sometimes you still think of that first employer who frightened you so much?"

"I try not to, but I know I do."

To the neurologist the cause of his patient's bashfulness was now evident. The fear, the anxiety, the over-conscientiousness engendered by the employer's attitude, working in the mind of an ultra-impressionable boy, were quite enough to initiate a habit of abnormal diffidence. Tactfully, the physician made this clear to the patient; earnestly he impressed on him the idea that the unpleasant experience of which he spoke was a thing of the past, and was nothing of which he now need stand in dread; and tirelessly he reiterated the suggestion that the patient had it in his own power to exorcise the demon of bashfulness created by the painful subconscious memory-image of those early days. In the end he had the satisfaction of sending him on his way rejoicing in a perfect cure.

Strikingly different in its inception is a case that came under the observation of Doctor Bechterew. In this instance the patient was a young woman of excellent family and most attractive appearance. The symptom of which she chiefly complained was an abnormal blushing. When with the members of her own family, no less than with strangers, she would, at the least provocation, feel the blood suffusing her face and would turn distressingly red. To avoid this, she kept much to herself, and led a lonely, miserable life.

Questioned by Doctor Bechterew as to the length of time she had been thus afflicted, and any prior occurrences which might have given her a real and urgent reason for embarrassment and blushing, her answers at first were wholly unenlightening. But little by little, probing with the skill of the trained psychological cross-examiner, he drew from her the details of a pathetic experience.

At the age of seventeen, it appeared, she had been thrown much into the company of a married man old enough to be her father. A friendship had sprung up between them, but, on her part, there had certainly been no thought of anything beyond friendship, until one evening at a garden party he asked her to walk with him in a secluded part of the grounds.

"While we were talking together," she confided to Doctor Bechterew, "he suddenly asked me if I cared for him--if I cared enough to leave home and spend the rest of my life with him. His avowal of love shocked and shamed me. I hastily left him and, with burning cheeks, rejoined the other guests.

"As soon as possible, I made my excuses and went home. It seemed to me that my face betrayed my secret. Afterwards I could not speak to or even think of that man without blushing. Now that you have made me recall the circumstance, I feel sure that out of that terrible experience has gradually been developed the habit of bashfulness and blushing which has made life almost unbearable to me."

Contrast with this a third case: the case of a young Jew, robust and alert-looking, a wagon driver by occupation, who applied to the Vanderbilt Clinic in New York City to be treated for what he vaguely termed a "nervous trouble." Referred to Doctor A. A. Brill, already mentioned as a specialist in nervous disorders, he confessed that the malady for which he sought relief was nothing more or less than bashfulness.

"It may seem strange to you," said he, "that a fellow like me should be bashful, but I am so timid when with strangers that I scarcely know what I am doing. I speak and act like a fool; my hands tremble; I trip over things."

"Can you give any reason why you should feel so awkward and embarrassed?"

"Not the slightest. I often have tried to explain it to myself, but all to no purpose. As far as I can tell, it is without a cause."

"Still, it must have a cause, and we will do our best to discover what that is."

Step by step, in the course of several days' investigation by psychoanalysis, Doctor Brill led the patient through the details of his past life. In this way it was definitely ascertained that the bashfulness of which he complained dated from his twelfth year. Delving among the forgotten memories of that early period, Doctor Brill presently unearthed one which the patient, the moment he recalled it, recognised as being coincidental with the beginning of the excessive timidity that had brought him such suffering.

It was the memory of a boyhood escapade that had at the time caused unusual remorse, shame, and fear of discovery. He had fancied that others could read in his eyes what he had done; he became afraid to look at people or to have them look at him. Awkwardness, embarrassment, bashfulness grew apace, and remained characteristic of him even after he had forgotten all about the affair from which they sprang.

Thanks, however, to the recovery of this lost memory-image, and of other subconscious reminiscences which had intensified the feeling of shame, it was now possible for Doctor Brill to institute psychotherapeutic treatment that eventually resulted in a cure. Incidentally, it also resulted in materially improving the young man's position in life. Freed from his bashfulness, he developed unexpected ambition, and eventually became the owner of a well-paying business.

Similarly, boyhood weaknesses and failings, carrying with them profound feelings of shame and apprehension, were found responsible for the bashfulness experienced by Doctor Hartenberg's dish-washing patient and Doctor Bechterew's visitor with the black spectacles.

Always, in truth, the story seems to be the same: there has been in the chronically bashful man's early life some specific shock, fright, or anxiety, which, provoking in a supersensitive mind feelings of extreme embarrassment, has established a bashfulness that may not fully yield to any method of treatment until the remote and usually forgotten cause is recalled to remembrance.

Happily, this requirement is not always necessary. As an eminent medical psychologist once said to me:

"It is my experience that, in many cases, a cure can be brought about simply by developing the patient's will power, either through suggestion in hypnosis, or through psychic re-education in the normal waking state. In such instances, it is enough to explain to the patient that his bashfulness undoubtedly had its origin in some shock which he has forgotten; that while, in the beginning, he may have had reason enough for feeling bashful, that reason has long since been outlived; and that his present bashfulness is actually nothing more than a bad habit, the result of self-suggestion.

"Attacking the problem this way and applying strong counter-suggestion, it frequently is possible to effect a cure without a tedious preliminary ransacking of subconscious memories. When, however, this method fails, psychoanalytic investigation becomes indispensable."

Manifestly of even greater importance than the cure of bashfulness is its prevention. This, on any theory of its causation, and especially on the view here advanced, is primarily a matter resting with parents. The appearance in a growing boy or girl of symptoms of habitual uneasiness and embarrassment when with other children or older persons should be regarded as a reason for real anxiety. Actually, however, as in the case of children who show extreme or persistent jealousy, most parents are inclined to dismiss such symptoms from their minds with the careless remark, "Yes, he's bashful; but that's nothing. He'll outgrow it." Unfortunately, he may not outgrow it without definite aid and guidance.

For one thing, the effort should immediately be made to develop in him interests, whether scholastic or athletic--preferably both--that will take him out of himself. Whatever else may be said of bashfulness, it is always, like selfishness, a sign of excessive preoccupation, conscious or unconscious, with thoughts of self. The bashful boy, no less than the bashful man, is abnormally self-centred. And, besides endeavouring to weaken his extreme egoism, there should be a systematic attempt to cultivate self-control and self-reliance; while, at the same time, his confidence should be tactfully sought, to draw from him a statement as to anything that is particularly perplexing or worrying him, and thereby to gain a vantage point for effectually banishing doubt and anxiety from his mind.

To banish doubt and anxiety from his mind! I am put in remembrance of another serious life handicap, allied to bashfulness in having as a basic element lack of self-reliance and self-confidence, and, like bashfulness, originating in childhood experiences. This handicap is the habit of futile doubting and reasoning, whether about matters of importance or matters of no importance. In some people the habit of futile doubting is so extreme as to amount to a veritable disease. Again, let me make use of an instance from real life to bring out concretely the condition I have in mind.

To a neurologist in the city of Washington there came a man thirty years of age. There was nothing in his appearance to set him apart from other people. He was intelligent-looking, well dressed, well mannered, and he did not seem at all out of health. But this, in effect, is what he said to the neurologist:

"Doctor, I have come to you as a last resort, and if you cannot help me I do not know what I shall do. I am mentally all in pieces. My mind is so weak that I cannot even decide what clothes I ought to put on.

"My indecision shows itself the moment I awake in the morning. I start to get up; then it occurs to me that perhaps I ought not to get up immediately. So I lie down again, wondering just what I ought to do. I am beset by doubts. Not until somebody enters my room and insists on my rising can I bring myself to do so.

"At once a terrible conflict begins within me as to the clothes I should wear. Every article of my clothing has to be carefully considered. It is as if a vital problem had to be solved. Sometimes, after I am dressed, the thought strikes me that my underwear may be too light, or too heavy, or that something else is the matter with it.

"Then I have to undress and put on fresh underwear, which I minutely inspect. Or, perhaps, it is my shirt that troubles me, or the pattern of my neck-tie, or the suit I have put on.

"Always I fear that I have made a mistake in some way. Dressing consequently becomes an endless process to me. Even with help--and I nearly always have to be helped--it is two or three hours before I am finally dressed."

Consider also the case of a morbid doubter who was successfully treated by that well-known New England medical psychologist, Doctor Boris Sidis. In this case, doubting was only one of several disease symptoms. Here, somewhat abridged, is Doctor Sidis's own account of his patient's indulgence in trivial doubts:

"The patient is troubled by a form of _folie de doute_. He is not sure that the addresses on his letters are correctly written; and, no matter how many times he may read them over, he cannot feel assured that the addresses are correct. Some one else must read them and assure him that they are addressed correctly.

"When he has to write many letters, sometimes a sudden fear gets possession of him that he has interchanged the letters and put them into the wrong envelopes. He has then to tear open the envelopes and look the letters over again and again, to assure himself that they have been put by him into the right envelopes.

"Similarly, in turning out the gas jet, he must needs try it over again and again, and is often forced to get up from bed to try again whether the gas is 'really' shut off. He lights the gas, then tests the gas jet with a lighted match, to see whether the gas leaks and is 'really' completely shut off.

"In closing the door of his room, he must try the lock over and over again. He locks the door, and then unlocks it again, then locks it once more. Still, he is not sure. He then must shake it violently, so as to get the full assurance that the door has been actually and 'really' locked."[11]

This second illustrative instance brings out vividly a fact that deserves to be emphasised--the fact, namely, that, at bottom, these doubting manias are only exaggerations of a phenomenon of common occurrence. There are times when virtually everybody is tormented by doubts regarding matters that ought not to cause any indecision or perplexity. Moreover, while comparatively few people feel the need of going to a physician to be cured of abnormal doubting, there are many others who might advantageously seek the specialist's aid. People are often blind to their great weakness in this respect, though their friends may see clearly that their vacillation with regard to things great or small constitutes a defect that of itself accounts amply for their inability to make headway in the world and rise above mediocrity.

Like the Washington neurologist's patient, if in less degree, there are people to whom the choice of clothing presents a prodigious problem. To others, the choice of foods is a never-ending puzzle. At every meal they find themselves sadly at a loss to decide what they shall eat. Others, again, acting in much the fashion of the young man treated by Doctor Sidis, conjure up visions of possible mistakes and mishaps in connection with the writing and mailing of letters, the opening or shutting of doors and windows, the carrying of umbrellas, etc. Also, there are doubters of a kind well described by an observant physician:

"There are people who doubt whether their friends really think anything of them. They think that, though they treat them courteously, this may be only common politeness, and that they may really resent their wasting their time when they call on them. They hesitate to ask these people to do things for them, though, over and over again, the friends may have shown their willingness, and, above all, by asking favours of them in turn, may have shown that they were quite willing to put themselves under obligations.

"They doubt about their charities. They wonder whether they may really not be doing more harm than good, though they have investigated the cases, or have had them investigated, and the objects of their charity may have been proved to be quite deserving. They hesitate about the acquisition of new friends, and doubt whether they should give them any confidence, and whether the confidences they have received from them are not really baits."[12]

Here, decidedly, we have a state of affairs not only breeding unhappiness, but involving a vast waste of nervous energy. This it is that chiefly makes the yielding to trivial doubts a menace to human welfare. To conserve energy for useful purposes, we are so constituted that ordinarily the little acts of everyday life--our rising, dressing, eating, attending to household or business details of a routine character--are done by us automatically. We take it for granted that we do them correctly, and, usually, we so do them. If now and then we make a mistake, we think little about it. Rightly, we regard it as of no account, compared with matters of more importance. Thus we conserve our energy for our life work. Whereas the doubter about trivialities fritters his energy away.

And, now, taking up the question of the causation of this costly habit of doubting about trivialities, let us turn once more to the cases of the two morbid doubters who consulted the Washington and Boston specialists.

In both of these cases, psychological analysis was undertaken to ascertain the causes of the exaggerated tendency to doubt. In both it was found that the patients had been subjected in childhood to conditions almost inevitably productive of a profound distrust of self. This was particularly true in the Washington case. The patient in this case was the only son of parents whose love had led them to be over-solicitous about him. When he was a little fellow they could not bear to have him out of their sight, lest something should happen to him. They had anticipated his wishes, done for him things that he might very well have done for himself; and, when he did attempt to do things for himself, they intervened to help him.

The result was an enfeebling of his consciousness and of his will. The man grew up without initiative. People had always done things for him, had always decided things for him. How could any one expect him to decide anything for himself? It was not that he was naturally weak-minded, weak-willed; it was that his training had engendered in him conditions making for mental confusion and instability of purpose.

Such was the outcome of the neurologist's psychological study of his case. It held the possibilities of a cure, through psychic re-education, having as its starting point the emancipation of this child of thirty from slavish dependence on his parents. And, in the end, after nearly two years of patient effort, a cure was actually effected.

In the second case, distrust of self had been produced in quite another way. This patient's parents had not spoiled him by over-attention. On the opposite, they had not given enough thought to the importance of developing in him emotional control, the need for which was particularly indicated in his early childhood by great dreaminess and sensitiveness of disposition. His special need for training in the control of his emotions was further evinced by the violence of his reactions to happenings of a disturbing nature. Once, for instance, when he unexpectedly met a deformed, paralysed man, he fell to the ground in a faint.

This should have been sufficient warning to his parents that they must make every effort to stiffen his character and to protect him from needless shocks. As a matter of fact, they exposed him to conditions that would have been harmful to any child. During his early years he was thrown much into the company of an old grandfather afflicted with sundry physical and mental ailments, among them the doubting mania in an extreme form. Also, he was allowed to witness the death agonies of several relatives.

All this was bound to leave a lasting imprint on his mind and his nervous system, filling him with vague fears, both as to life in general and, in particular, as to his own ability to live successfully. It was impossible for him to escape the knowledge that he did not endure the difficult and the unpleasant as well as other children did. And, with this knowledge, distrust of self, a sense of inferiority, took firm hold of him.

Nevertheless, he contrived to get along passably until he entered college. He was nervous and a little "queer," but not markedly so. When, however, ever, he found it necessary to study unusually hard for some examinations, a breakdown came. Various disease symptoms, physical and mental, developed in him, including the habit of perpetually fretting and doubting about things of small significance. In his case, that is to say, faulty training in childhood had laid the foundation for a serious psychic weakness, to the full development of which a physical condition--fatigue--had acted as the immediate cause.

In most cases of morbid doubting that have been psychologically analysed, parental mistakes have similarly become apparent. There may be--there usually is--a constitutional tendency to nervous troubles. But the parents have not appreciated this. Or, if they have appreciated it, they have failed to offset it by education especially designed to strengthen the will and inspire self-confidence, and by measures having as their end a sound physical upbuilding. Also, they have failed--and this is of the utmost importance--to externalise the personal interests, so that self-consciousness shall be at a minimum.

This does not mean, however, that the unfavourable results of the parental mistakes cannot be remedied later in life. There is reason to believe that, even in most extreme cases of morbid doubting--except the comparatively few cases where organic brain disease is responsible for the doubting--it is possible to effect a cure. As has been said, both of these patients were cured, and their cases may be regarded as fairly typical of this variety of mental affliction at its worst. Accordingly, when the tendency to trivial doubts is less marked, there is the possibility not only of cure, but of self-cure, provided that the doubter recognises exactly wherein he is deficient.

Self-consciousness, timidity, distrust of self, a conscious or subconscious feeling of inferiority, and often a lack of physical vigour--these are the elements that chiefly contribute to the growth of a tendency to anxiety and indecision about trivial things; these are the weaknesses that specially need to be overcome. As a preliminary measure, the doubter should make it a rule to take exercise daily in the open air, and to see to it that his living and sleeping quarters are kept well ventilated.

Indecision, even in the most energetic of men, is frequently a resultant of deprivation of fresh air. To reach decisions, to settle doubts quickly, a well-nourished brain is indispensable. And no brain can be well nourished unless the blood flowing to it is amply supplied with oxygen. Of all persons, therefore, the habitual doubter is in need of plenty of fresh air and of physical exercise to build up his organism as a whole and increase his powers of resistance to fatigue. For the same reason, he needs an abundance of good food.

Physical upbuilding, moreover, will have the desirable effect of increasing his power of concentrating attention on some serious life interest. This, above everything else, is what the doubter needs to do. He must develop an ardent interest in something worth while--his work, a useful hobby, occupation of some sort. The trivial doubter--the doubter of any kind--is pre-eminently a man or woman devoid of a keen life interest. If a life interest were present, there would be neither time nor inclination to dissipate energy in useless doubting. If you, my reader, recognise in yourself one of the doubting kind, you will appreciate the truth of this. You will admit that you have little enthusiasm for your work, little interest in anything that would keep you from being too occupied with thoughts of self.

Developing such an interest, self-consciousness will diminish, self-confidence will grow. Gradually, less and less attention will be paid to the petty details of daily existence that formerly gave so much concern. They will be pushed more and more into the background of the mind, will be managed automatically, as it was intended they should be managed. No longer will your indecision be a source of pitying, perhaps amused, comment by your friends. Instead, they will have occasion to comment, with pleased surprise, on the vigour and promptness of decision in all things that has taken the place of the old indecision.

One word more:

Exactly as hygienic measures are helpful in the cure of indecision in adults, so are they helpful to prevent the development of indecision--and bashfulness--in children. Parents will do well to bear this in mind. But, as in the prevention of selfishness, jealousy, and so forth, reliance on hygienic measures alone is not enough. It is all very well to see that children get plenty of good food, abundant muscular exercise, and much life in the open air. This is excellent and necessary. Also, however, they must be given wise moral training--training that will make it habitual for them to think and act vigourously, to keep their emotions well in hand, to be interested in much besides themselves, and to develop the feeling of self-confidence and the spirit of initiative.

Now, let us turn to still another preventable and serious life handicap having its origin in the days of childhood--the handicap of stammering.

FOOTNOTES:

[Footnote 11: "Studies In Psychopathology," 1907, pp. 22-23.]

[Footnote 12: J. J. Walsh's "Psychotherapy", p. 736.]

STAMMERING

VII

STAMMERING

There lies convenient to my hand at this moment a thin, pamphlet-like volume that tells the story of one of the strangest, among the many singular and tragic blunders which medical science has made in its progress to knowledge. It is a translation from the German of Doctor J. F. Dieffenbach's "Memoir on the Radical Cure of Stuttering." Assuredly, Dieffenbach's "cure" was radical enough, for it consisted in nothing less than the excision of a large, wedge-shaped section from the stammerer's tongue! In this little book, published in 1841, and embellished with several ghastly full-page engravings, is described, with great professional gusto, the first of these terrible operations as performed, without the merciful aid of any anesthetic, on an unhappy boy of thirteen. The result was a "complete success." Says Dieffenbach, writing a few weeks after the operation:

"At the present time not the slightest trace of stuttering remains, not the slightest vibration of the muscles of the face, not the most inconsiderable play of the lips. His speech is, throughout, well toned, even, and flowing."

Thus was inaugurated a period of butchery that lasted until--almost before the year was out--it was observed that those "cured" by this sanguinary means usually began, before long, to stammer as badly as ever, and also that those who were not "cured" had a tendency to die. Yet Dieffenbach was no charlatan, no "quack." He was a reputable surgeon who honestly believed that he had discovered the true remedy for stammering. And, if the passage of time has intensified the tragedy and absurdity of his method and has relegated his glowing account of it to a place in the literature of medical curiosities, there is this to be said of him--that he has had plenty of successors who have erred almost as seriously in their attempts to solve the problem presented by the widespread and baffling malady of stammering.

In fact, up to within quite recent times the record of the struggle against stammering has been one of continuous failure. There has been a steady accumulation of methods of treatment, from surgical operations of a less drastic type than Dieffenbach's to the use of various articulatory and respiratory exercises and devices, without any appreciable effect in the diminution of stammering. Even to-day the great majority of physicians and lay specialists--to whom, by a sort of tacit agreement, the medical profession has largely relinquished the task of dealing with stammering--labour to next to no purpose. At this very moment there are in the United States at least three hundred thousand persons who stammer, fully half of whom stammer so badly that they are severely handicapped in the gaining of a livelihood. Thousands of these have resorted to medical advice, or have attended so-called schools for stammerers, with lastingly beneficial results to few. Small wonder that there is, among stammerers and their friends, a tendency to believe that stammering is one of the hopelessly incurable maladies of mankind.

And this would undeniably appear to be true, as regards many stammerers. On the other hand, it may confidently be said that nearly all cases of stammering are actually susceptible of marked improvement, often amounting to 75 or 90 per cent. of a cure; and that a number of cases can be completely cured. Such a statement, to be sure, could not have been safely made even a few years ago. This for the reason that only lately has there been any really systematic effort by scientifically trained investigators to study the phenomena of stammering, with a view to ascertaining, with scientific exactness, its true nature and causation.

Stammering, it has long been recognised, is not a malady of uniform symptomatology, like tuberculosis or typhoid fever. No two stammerers stammer precisely alike. They stumble over different letters and sounds; time, place, and circumstances have varying effects on the degree of their stammering; and the physical spasms and contortions that so often accompany this trouble differ in different stammerers. There is, too, a great variation in the onset of stammering. Mostly, it is true, it manifests itself in childhood, from the age of four to eleven. But it may not set in until much later in life; and, when it does begin in childhood, it begins under much diversity of conditions.

Sometimes a child stammers almost as soon as he has learned to speak, though seldom, if ever, coincident with the learning. Often, the first appearance of stammering follows some disease like measles or diphtheria. Or, again, a child who has been speaking quite well, suddenly begins to stammer, and persists in stammering, after being brought into contact with people who are themselves stammerers.

"I was entirely free of stammering," declares a clergyman, in a typical statement, "till I was five years old. At that time of life there was a gentleman who occasionally came to my father's house, and stammered very badly. I distinctly remember one afternoon trying to imitate him; when, unfortunately, he heard me, and was very indignant. So ashamed were my parents at my conduct that, after he had gone, I was taken to task and punished severely for it. Ever since that night I have been afflicted with this most distressing malady, in spite of all my efforts to overcome it."

Compare a statement by a Philadelphia physician, Doctor D. Braden Kyle:

"Several years ago I saw three interesting cases of stammering. Two of the cases were imitation. These two lads, who were associated with a boy several years older, the worst stammerer I ever saw, clearly imitated him. As they were constantly together, the imitation was almost continuous. They certainly developed into expert stammerers. In less than two years they were confirmed stammerers, and it was impossible for them to speak at all without stuttering and stammering."

Facts like these, I repeat, have long been observed and commented on by specialists in the treatment of stammering; but they have, for the most part, been dismissed as mere "oddities," while emphasis has been laid on the single fact that, in the majority of cases, stammerers have had parents or other relatives who themselves stammered. "Heredity," consequently, has been assumed to be the one and sufficient explanation of all stammering; and it has also been assumed that what is inherited is either an anatomical or a physiological defect. Hence, in too many instances, the use of the surgeon's knife; and, hence, the invention of innumerable systems designed to train the stammerer in the correct use of his breathing and articulating organs--in a word, systems intended to teach him how to talk.

But, as even the most enthusiastic exponents of these corrective systems are now beginning to appreciate, whatever else the stammerer may need, he does not need to be taught how to talk. For he can talk well enough on occasion. Nothing is more significant, from the standpoint of assisting to a clear understanding of the nature of stammering, than the fact that there are uncommonly few stammerers who have any difficulty in speaking when nobody is with them. On this point, every stammerer with whom I have been in touch is in remarkable agreement, and others who have had a far wider acquaintance with stammerers testify to the same effect. For example, Mr. Charles L. Rowan, of Milwaukee, a gentleman who has stammered for years and has made a close study of the subject, informs me:

"When I am alone--and the same is true of other stammerers--I have no speech difficulty whatever, and can talk or read aloud for hours with ease. It is only when I am with others that I halt and stammer in my speech. Sometimes I talk in my sleep, and the folks tell me I do not stammer then. But, if I am dreaming, and in the dream imagine myself talking, it is always in a stammer.

"I have also noticed that most stammerers talk better when the subject is light and frivolous than when it is something serious. And they talk better when conversing with people whom they regard as inferiors. I know a man who is a section foreman, and he says he can give orders to his negro and Mexican labourers perfectly, but if the roadmaster comes along he cannot talk to him at all."

And a stammerer from Spokane, Washington, informs me:

"I would like to say that there are periods when I can talk much better than for corresponding periods. Indeed, there are times, generally a few days at a time, when it is most difficult for me to talk with even a slight degree of correctness; and, then, there are periods of as long, or longer, duration when speech seems to flow with more ease, though never perfect, except for a few words in succession."

More than this, according to one diligent investigator, the majority of stammerers fail to stammer if addressed in such a way that their replies are made without their realising that they are talking. Says this observer:

"Suppose a stammerer is engaged in a deep study and unaware of your presence. You speak to him softly. He answers readily, without hesitation, in an absent manner. Again, you ask a careless question, implying by your manner that you do not expect or desire an answer; to this he quickly and easily replies also. Now, look straight at him and pointedly interrogate him. See, when it becomes necessary for him to speak, how he is thrown into confusion."

It has further been found that most stammerers are at their worst when in the presence of strangers. Some stammer scarcely at all when at home with their relatives and intimate friends. On the opposite, there are some who stammer worse than usual when with relatives. Not so long ago I learned of one stammerer--a young lady who had stammered from early childhood--whose trouble was most in evidence when she was talking with her mother. Almost all stammerers, too, enjoy temporary relief from their speech defect when greatly startled, angry, or otherwise excited.

Decidedly, then, it is not from anatomical or physiological inability to speak that a stammerer suffers. It is, rather, from a psychological inability. That is to say, the facts just mentioned indicate strongly that stammering is primarily a mental malady--that it is due to the presence, in the mind of the stammerer, of some idea or ideas that inhibit the normal functioning of the organs of speech. This conclusion is confirmed by the additional circumstance that nearly every stammerer who has been questioned on the subject admits that he is perpetually tormented by a haunting dread of not being able to express himself clearly to others, and so of exposing himself to their ridicule, contempt, or pity. Many, indeed, affirm their conviction that if they could only overcome this dread they would be free from their affliction. "I believe," is a characteristic utterance of stammerers, "that if I were to wake up some morning with total forgetfulness that I had ever stammered, I should never stammer again."

Still more significant is the fact that, of the many methods which have been invented for the treatment of stammering--and which include such curious devices as beating time with every word, and wearing artificial supports under the tongue--all have had to their credit a certain--however small--proportion of genuine cures. This would suggest, not that they have been intrinsically valuable, but that, in the cases cured, they so impressed the mind of the stammerer with their therapeutic virtue as to banish his long-entertained belief that he could not talk like other people. For that matter, recent experiments go to bear out the view that almost any method, no matter how fantastic, will cure some stammerers, if only they have a lively faith in its efficacy.

For example, there was once brought to the Boston City Hospital a woman of thirty-five, who, though formerly speaking without any difficulty, had begun to stammer in a frightful manner, following a violent quarrel with her husband. She could utter scarcely a sound, except weirdly inarticulate noises, and these only by a great effort. The physician to whom her case was entrusted soon became satisfied that she was suffering mainly from a profound belief that she would never be able to talk again; and he therefore endeavoured to reason her out of this, but to no purpose. Finally, he abandoned the attempt, and, after leaving her pretty much to her own devices for several days, impressively said to her one morning, in a tone of great authority:

"Well, Mrs. Blank, I have been looking carefully into your case, and I find there is one way certain to cure you. It may be a little painful, but I know you will not mind that, as long as it is going to make you entirely well."

So saying, and with an air of the utmost confidence, he began to apply to her an electric current, just strong enough to make her wince. Only a few treatments of this sort were found necessary to enable the hospital authorities to discharge her as cured--and she stayed cured.

Of late, consequently, with growing recognition of the dominant psychic factor in stammering, there has been an increasing tendency--though as yet it is far from universal--to employ psychological methods in treating stammerers. The effort is made to instil confidence in the sufferer--to convince him that he need only exercise his will power to bring about his own cure. In a good many cases, and frequently with gratifying results, resort is had to hypnotism, the "suggestion" being reiterated to the patient, while in the hypnotic state, that in the future he will experience none of his overwhelming sensations of dread and anxiety and will speak as fluently as persons who have never stammered. Or he may be treated by psychic re-education, which consists essentially in the development of volitional control by suggestions tactfully imparted in the ordinary waking state. All of which unquestionably marks a tremendous advance over the theories and practices based on the alleged anatomical or physiological defects of stammerers.

There is this to be added, though, that, sanely beneficial as is the psychological treatment of stammering, it often happens that the confidence-inspiring suggestions given to stammerers do not "take." The stammerer, albeit he may perhaps show improvement for a time, remains without clear articulatory power. When this occurs, the natural tendency among those treating him--in view of the demonstrated truth that stammering is the effect of a peculiar state of mind--is to throw the blame on the patient instead of on the method. Yet, actually, it is the method that is at fault--or, to be exact, it is the failure to apply the method, which itself is thoroughly sound--in such a way as to remove from the stammerer's mind not only the fear that haunts him and helps to perpetuate his stammering, _but also the ideas in which his stammering originated_.

Here we come to the central fact in the whole problem of stammering--a fact which, when it is widely enough known and appreciated, is certain to exert a far-reaching influence on the prevention of stammering, as well as its cure. Until very recently, few have been aware of this fact except a small group of foreign investigators, physicians with a psychological training, whose special business it has been to determine scientifically the possibilities, the limitations, and the exact procedures to be followed in supplementing, by wholly mental treatment, the ordinary medical and surgical treatment of disease. Impressed by the predominance of the mental factor in stammering, these investigators were particularly impressed by some of the peculiarities mentioned above--as, the ability of almost every stammerer to speak well when alone or when in a state of abstraction. Such peculiarities, they knew from long experience, bore a strong resemblance to oddities in the behaviour of victims of hysteria, psychasthenia, or other psychoneurosis, in all of which disorders there is a tendency for symptoms to disappear when the sufferer's attention is momentarily withdrawn from them. Accordingly, it seemed to the investigators quite possible that, in the last analysis, stammering was not so much a disease in itself as a psychoneurotic symptom.

They were well aware, for reasons already set forth in these pages, that psychoneurotic disorders have their origin in emotional disturbances of one sort or another, which, occurring to a person of nervous temperament or rendered neurally unstable by a faulty upbringing, react adversely on the entire organism. Exactly what happens is that the emotional disturbance--whether it be a fright, a grief, a worry, or what not--while perhaps completely forgotten by the victim, so far as conscious recollection is concerned, remains subconsciously alive in his memory, is ever seeking to emerge again into conscious remembrance, and, failing to do this, takes its revenge, so to speak, by the production of disease symptoms ranging from mere eccentricities of thought and behaviour to symptoms mimicking those of true organic disease.

Also, the investigators knew that the particular form these mentally caused symptoms take depends chiefly on the kind of suggestions received from the sufferer's environment. If he chances, for instance, to have a relative or a friend who is a paralytic, he may, in time, develop pseudosymptoms of paralysis himself. Or, if his nervous equilibrium be sufficiently upset, he may develop them from merely hearing or reading about them. Whatever the symptoms he manifests, his malady is curable--precisely as it was produced--by mental means alone. Often, a counter-suggestion, to the effect that henceforth the psychoneurotic person will be perfectly well, is enough to work his cure. Or, permanently curative effects may be had only when, by special techniques devised for the express purpose of rummaging through the subconsciousness, the forgotten memory, or memories, responsible for the psychoneurosis are brought to light, and the specific suggestion directly or indirectly made that from that time they will do no harm. Sometimes, experience has shown, the mere recalling of them to conscious remembrance is enough to put an end to the disease symptoms they have caused.

On the view that stammering is similarly a psychoneurotic symptom, and that, when it fails to yield to treatment by general suggestion, it is because the subconscious memories underlying it are too intense to be thus subdued, this group of investigators undertook to treat it as they would any stubborn psychoneurosis. The outcome of their experiments has been such that I feel justified in declaring that science has at last penetrated to the true inwardness of stammering. These psychologically trained physicians have taken stammerers who had well-nigh exhausted their hopes and their resources in a futile quest for normal speech, and, after subjecting them to the searching methods of psychological analysis, have sent them on their way rejoicing, either in a perfect cure or in a lasting improvement far beyond their expectation.

Citing a few instances of actual occurrence, a German member of the group, Doctor B. Dattner, was once consulted by a stammerer of thirty-six, who had been burdened by his speech defect from boyhood. He had first stammered, he told Doctor Dattner, after an attack of diphtheria, at the age of nine; and he had for some time been treated on the supposition that the diphtheria had caused a peculiar kind of throat paralysis.[13] This treatment failing, he had sought relief by other means, always without more than temporary benefit. Like many another stammerer, he spoke of the abnormal dread that harassed him, especially when with strangers, and expressed the belief that if he could conquer this he would be free from his stammer.

"Ah, but," Doctor Dattner pointed out, "do you not realise that, after all, your dread is caused by--not the cause of--your stammer? It has helped, doubtless, to keep it alive and to aggravate it. But it has not been the thing that originally made you stammer. That we must seek elsewhere."

"You mean in the attack of diphtheria?"

"Not at all. I mean in something that happened to you before you had diphtheria--something which so exceedingly distressed you that it was continually uppermost in your thoughts, and which finally worked on you so much that when your nervous system was weakened by the diphtheria it gave rise to your stammering. Now, we are going to try to discover what that something was, and, when we have done so, it will be possible really to cure you. Can you recall any particularly disagreeable incident of your childhood occurring at any time before you were ill of diphtheria?"

"No," said the other, after a little reflection, "I think that I was perfectly happy as a child, and certainly I was treated kindly."

"Just the same, something must have happened at that period to disturb you very much. Let us find out, if we can, what it was."

To this end, Doctor Dattner now made use of the "free association method of mental analysis," which consists in requesting the patient to concentrate his attention on his symptoms, and state without reserve the thoughts coming to him in connection with them--the theory being that, if there is any exceptionally distressing idea underlying them, the current of his spoken thoughts will, soon or late, reveal it. In the present instance, this method at first brought forth only trivial and commonplace memory associations. But, after a time, a reminiscence of intense emotional colouring suddenly emerged.

It related to an episode of the stammerer's eighth year, shortly before his attack of diphtheria, when he was pounced upon and frightened almost into convulsions by a huge black dog. This had virtually faded from his conscious memory; but now, as he sat in the quiescent mood enjoined on all patients undergoing psychoanalytic treatment, it welled up into full recollection, every detail of it being vividly recalled--the sight of the dog, the emotions of fear and horror, the hysterical shrieking that followed his escape, the difficulty his parents had in convincing him that he was unharmed. He used to lie awake, he remembered, thinking of the dog; he used to dream of it; the thought of it was always with him.

"Precisely," said Doctor Dattner, drily. "And, you see, the thought of it is still with you, for look how graphically you have described it all. The trouble is that it has been leading an independent existence, as it were, in the depths of your mind, with all its original emotional intensity. Your stammering, I can assure you, has been nothing more than the external manifestation, the symbol, of its continuing presence, and of the deadly power it has had over you--sensitive, impressionable child that you must have been. But I can also assure you that your stammering will now come to an end; for we have not only found its cause in the subconsciously remembered shock of your boyhood, but we have actually removed that cause by the very fact of recalling it to your conscious recollection and, consequently, finding a normal outlet for the repressed emotions."

Altogether, it had required just six hours of psychoanalysis, at the rate of about an hour a day, to recover this horror-encrusted memory of the stammerer's childhood. But, with its recall, and strikingly validating Doctor Dattner's confident prediction, he once more began to enjoy the blessing of a facile, flowing speech.

In another case--treated by the American neurologist, Doctor Coriat, who has made extensive use of psychoanalytic methods--the patient was a man of middle age, who stammered not only when he spoke, but even when he wrote, repeating letters and syllables in anything he tried to put on paper. He had been to two stammering schools and had been discharged from both as cured, but each time had speedily relapsed.

As in the case of Doctor Dattner's patient, psychoanalysis demonstrated that the causal agency of his stammering was a lingering subconscious remnant of distressing emotional states experienced in childhood. Only, in this instance, the distressing states related, not to an unexpected, stupefying fright, but to painful reveries indulged in as a child, and occasioned by certain unpleasant stories he had been told regarding the end of the world and the fate of the sinful.

"These," he recalled, "took complete possession of my mind. I became convinced that the end of the world could not be long delayed, and I was in an agony of terror. Constantly I kept asking myself what I should do to escape destruction. I knew I was a bad boy--very bad. Nothing could atone for the sins I fancied I had committed. But I kept my fears to myself; I did not dare confide them to others. Night and day I worried about them, picturing to myself the terrible happenings of the approaching time of doom."

Until psychoanalysis brought them up to the surface of consciousness, he had long ceased to think of these foolish imaginings of childhood. He had as entirely forgotten them as though he had never entertained them. But, as the event showed, it was their malign influence, working on a nervous system already infirm by defects of inheritance, that had produced a psychoneurosis which, in his case, had taken the form of a speech disorder through the suggestions unconsciously absorbed by watching his mother, who likewise suffered from a peculiar variety of stammering.

Another of Doctor Coriat's patients--a young woman--impressed him, from the day of her first visit, with her extreme timidity and self-consciousness. Both were so pronounced as to be abnormal, and he immediately suspected that they, in common with her stammering, would be found linked with subconscious memories of occurrences that had tended to deprive her of proper appreciation of her abilities and rights. She proved a good hypnotic subject, and, knowing that in hypnosis long-forgotten events are easily recalled, Doctor Coriat questioned her as to her previous history.

"Can you remember," he asked her, "just when it was that you began to stammer?"

"It was when I was a very little girl."

"Had any one or anything greatly frightened you before then?"

"Yes."

"What was it?"

"It was my father."