Miriam tells us about her experience of developing a psychogenic stammer.
I woke up one Friday morning and quickly looked at my clock, realising I was running late. As I jumped up quickly, I felt a really intense pain pierce through my shoulder. I was quite taken aback and fell straight back down onto the bed.
As I rang my company to tell them I wouldn’t be able to work, I was incredibly confused to realise that I couldn’t get my words out. I assumed this was because of the pain I was in (caused by my shoulder). I thought to myself ‘I’ll just have a rest and hopefully the medication from the GP will sort out my pain’. However, as the day progressed, I realised perhaps the shoulder pain and speech difficulties were unrelated. My stammer got worse and at points I wasn’t able to get any words out at all.
After following the advice of 111, I ended up in A and E being checked over by a neurologist. We had a bit of a laugh about how ironic it was that I was a Speech and Language Therapist and that I was in hospital because of a stammer. As I had anticipated, the doctor ruled out my stammer being caused by a stroke and told me that his suspicion was that I was experiencing a psychogenic stammer. A psychogenic stammer typically results from emotional trauma or even emotional stress. The doctor told me not to worry and that it would probably go away in the next couple of days.
Feeling relieved, I walked out of A and E, flagged down my friends and proceeded to explain what the doctor had said with significant difficulty (because of the stammer). My friends were understandably confused by what was going on and how dramatically my speech had changed. They were perplexed at how suddenly it had come on. I assured them it was nothing to worry about.
The next month saw me signed off work by the GP. I kept thinking how ironic it was that my job is to help people with their communication in court and here I was unable to work and struggling to express myself without stammering. I quite hilariously and incredibly fortunately ended up having Speech and Language Therapy from my old lecturer from university. And this whole slightly bizarre, terrifying, and confusing ordeal was all put down to stress. And therein lies the mystery that is psychogenic stammers and how they come about.
What is a stammer?
The first question friends asked me was, “What is the difference between a stammer and a stutter?”.
Stammering and stuttering both mean the same thing, with stammering being the preferred term in the UK and stuttering being more commonly used in America. Stammering is a neuro-developmental issue that typically first emerges between 2 and a half to 3 years of age. Within the UK adult population, the ratio of men-women that stammer is around 4:5, affecting approximately 1% of adults.
There are two types of stammers: developmental stammers, or the type I was experiencing, acquired stammers.
The most common stammers are developmental which occur in early childhood. However, stammers can also develop later in life when someone has never stammered before as a child.
Causes of a stammer
Developmental stammering can be genetic or due to subtle differences in the brain structure or the way the brain processes speech signals.
It can also be caused by speech motor skills problems, where someone with a stammer tends to be slightly slower at making the movements involved in speaking, for example, getting the voice started in the larynx or moving from one speech sound to another.
Acquired stammering can be caused by a head injury, stroke, or a progressive neurological issues. It can also be caused by drugs, medicines or because of extreme distress or psychological trauma.
Situational or environmental factors can also impact stammering. For example, people may stammer more in situations where there is more time pressure or when talking to large groups of people.
Some, but not all, adults who stammer experience elevated levels of anxiety in situations where they feel they will be judged by how fluently they can speak.
How stammering may present
People who stammer may:
- Repeat how words e.g., ‘but, but, but I went…”
- Repeat a single sound or syllable e.g., m-m-m-manage”.
- Prolong or stretch sounds e.g., ‘ssssometimes’.
- Look as though they are tensing up.
- Try and physically push the word out by making other movements (tapping finger, stamping etc).
Impact of having a stammer in court
My world felt like it had changed dramatically over night. I am naturally a very fast talker, with lots of opinions and plenty to say and share. Suddenly I felt a huge amount of stress and frustration every time I wanted to say something. I noticed how I wouldn’t want to tell a joke with friends because it took too long to get to the punchline and I would have bored myself in the process.
I noticed how I would flip between being frustrated when people would finish my sentences, and being disheartened when they wouldn’t just understand what I was trying to say. But the biggest impact for me was not being able to go back to work.
As an intermediary, part of our role is to stand up in court and address the judge about the recommendations we are making to support someone to participate within their proceedings. Whilst I am naturally very chatty and confident in most areas of life, public speaking is something I hate. All eyes on you, silence in the room, the very overwhelming sense that you aren’t coming across as articulate as you sound in your head.
Whilst I had my time off work to recover, a fear loomed in my head: how on earth am I going to be able to get back to court and speak with a stammer? How am I going to be taken seriously when I can’t even get my words out?
For many of the people we support, their first time in a courtroom will be when they are attending their trial (in criminal cases) or proceedings (in family cases). They will understandably be feeling overwhelmed, entering an incredibly alien environment, with wigs and gowns, posh barristers, words that don’t make sense, not being able to speak out if they disagree with something someone is saying. And then the terrifying ordeal of giving evidence from the witness box; being cross examined for hours on end by lawyers who seem ten times more intelligent and skilled than your average person.
I was suddenly more aware than ever before that the stress of the courtroom will only magnify a person’s stammer and communication difficulties. I realised that the stress I felt even speaking to my friends, who know me well, are patient and were in no way judging me, was nothing in comparison to the stress of trying to give you side of the story in incredibly intimidating environment when the stakes are so high. And with stammers, it is a vicious cycle. The more stress you are experiencing, the worse your stammer seems to get: a frustration which is quite hard to articulate to someone who has not experienced it for themselves.
How intermediaries can help in court
As intermediaries, there are a number of strategies and recommendations that we can make to the court to ensure someone is able to give their best evidence.
Strategies to help with expressing themselves:
- The most important recommendation we can make for someone with a stammer is to allow them plenty of time to speak and respond to the question. It is incredibly important not to rush them, or assume they have nothing to say if there is a prolonged pause.
- The advocate asking the questions should remain calm and not react if a someone gets stuck on a word.
- Alternative strategies could include providing a person with a notebook to write down the word with which they are struggling.
- Intermediaries can intervene if they think the person has been cut off before they have been able to express themselves.
- The intermediary can recommend that advocates pool their questions together, so as to avoid repetition of questions and minimise the time the person has to give evidence for.
Strategies to reduce stress:
- One of the main things which can exacerbate a stammer is stress. Therefore, it is crucial to ensure the environment in which someone is giving their evidence is as comfortable as possible.
- The intermediary can recommend the use of screens or the use of a video-link when a person gives their evidence.
- Before giving evidence, the intermediary can ask the court to allow the person have a familiarisation visit to the witness box and a chance to answer neutral questions, so they get used to what it feels like to speak in court.
- When someone is giving evidence, it will be of even greater importance for them to have regular breaks due to the increased cognitive demands.
- Allowing them to have a family member/ friend in the courtroom while they give evidence may also help to reduce their stress.
The Michael Palin Centre (https://michaelpalincentreforstammering.org/) is an organisation which helps individuals who stammer from all around the world. A recent report from them stated seeing a significant increase in referrals to them over the past 18 months. They attribute the increase in referrals partly to the increased anxiety and the impact of talking on online platforms, which can put people who stammer on the spot. Between April 2020 and March 2021, the helpline received more than 2200 calls, more than double the amount in the previous year.
I was incredibly fortunate. The month off work combined with the Speech Therapy I received seemed to work. I have been back working for almost 3 months now, completely stammer free. My stammer disappeared one day, as quickly as it came on. But not everyone is as fortunate as I am and some people have to deal with challenges and stigma which comes with experiencing dysfluency difficulties long term.