The real cause of stammering and its permanent cure : a treatise on psycho-analytical lines

STAMMERING AND ITS CURE

THE REAL CAUSE
OF STAMMERiNG

AND ITS PERMANENT CURE

A TREATISE ON PSYCHO-ANALYTICAL LINES

BY

ALFRED APPELT

SECOND EDITION

METHUEN & CO. LTD.

36 ESSEX STREET, W.C.

LONDON

' • • ■ ' • • •

.^

0

First Publighed .... August 17th 1911
Second Edition iggo

PREFACE

THE present treatise is the outcome of experiences
gathered in the course of unwearying researches
covering a period of more than twenty years.
During that time perseverance now and then threat-
ened to give way, and I was frequently tempted to
devote my mind to other tasks ; but the necessity which
must stimulate any humane person to pass on know-
ledge which is likely to benefit the community urged me
over and over again to continued activity in the domain
here treated. I was the more anxious to master the
details of the only reliable cure for stammering, since I
myself languished in the gloomy and mysterious fetters
of this agonizing complaint during my youth and early
manhood, and knew only too well how the pleasure of
conversation with friends and acquaintances is curtailed,
and how oral communication with strangers is not only
distressing but is sometimes prevented altogether.

I slaved my life out over breathing, vocal, and articu-
latory exercises by the aid of books; but, however much
I pondered over the cause of the suffering and watched
its different symptoms, all my pains proved futile, nor
was I spared the disheartening realization that those

vii

viii STAMMERING AND ITS CURE

fetters did but strengthen the more I worked to rid
myself of them. Eventually I decided to place myself
under the care of specialists who professed to be able
to eradicate the affliction. I visited institutes for the
cure of stammering — as many as three 1 — all in vain,
however. I am confident that I did my utmost to
carry out all instructions with the greatest conscientious-
ness and perseverance. The latter fact is, as a rule,
not admitted by the principals of establishments of this
description; they usually put down failure and relapse
to lack of eagerness and of will-power on the part of the
patient. I am sure that some of the specialists act
bona fide and are confident of the good quality of their
methods. But the fact remains that my hopes in all
three institutions ended in disappointment, and my ob-
servation that the fellow-sufferers whom I met at those
establishments also relapsed within a short time induced
me to investigate the cause of failure. I came to the
conclusion that by far the largest percentage (at leaH
00 per cent.) of those who have been discharged as
" cured " are, in reality, only seemingly cured, and,
when my investigations led me to discover that dread
of speaking and inner psychic resistances are the cause
of the complaint, I knew that mechanical exercises
would not remove such subtle difficulties, and that a
real and lasting cure was yet to be found.

Ha^^ng " gone through the mill " myself, I know the
mental suffering, the frequently desperate moods to
which those afflicted with an impediment of speech are

PREFACE ix

subject, especially if they have already called in assis-
tance at great sacrifice of time and money without
obtaining any lasting relief. A person who, in moments
of dread of speaking, has felt himself near a fainting fit,
owing to the enormous nervous strain, alone can con-
ceive how fettered speech affects the sufferer's mental
and bodily well-being, quite apart from the hampering
influences which he experiences in his professional work
or in his social relations.

In the interest of many stammerers I felt it, there-
fore, incumbent upon me to remove the veil of mystery
which has hung hitherto over the treatment of impedi-
ments of speech, and to enlighten them as to the real
nature and rational treatment of the affliction. Though
I have endeavoured to present the subject in the sim-
plest form possible, it was often not feasible to avoid
technical terms.

It may further be considered a shortcoming that
interesting matter has now and then been brought to a
conclusion, leaving the reader high and dry, so to speak,
just when interest was aroused. These broken themes,
however, mostly correspond with contacts at which the
subject becomes interlinked with the problem of ob-
sessions and hysterical symptoms, and these could not
be treated here.

As the application of psycho-analytical treatment is
still very little practised in the United Kingdom, I have
endeavoured (in Chapter IX.) to give its rough outlines.
I am, of course, well aware that the presentation of an

STAMMERING AND ITS CURE

actual case of stammering treated by psycho-analysis
would have elucidated considerably the different phases
of such a cure. A complete analysis would, however,
require a small volume to itself, and I am obliged to
reserve that publication for a later time.

In conclusion, I may add that, when composing this
treatise, I have thought primarily of stammerers as
likely to be my prospective readers. May this treatise
be instrumental in spreading a more correct view of
the true nature of their affliction in their circles, and
inspire them with hope, no longer a fallacious hope, but
one capable of realization ! If this wish be accomplished
I shall consider it as the best reward for my work.

ALFRED APPELT

CONTENTS

CHAPTER PAGES

PREFACE ._V

I. RETROSPECTIVE 1

II. FROM THEORY TO PRACTICE - - - - 17

III. MECHANISM OF SPEECH 45

IV. THE PATHOLOGY OF STAMMERING - - - 65

V. ETIOLOGY - 103

VI. GENERAL INFLUENCES OF THE EMOTIONAL

COMPLEX ON THE MIND - - - - 134

VII. CONSCIOUSNESS AND THE UNCONSCIOUS - - 151

Vni. THERAPEUTICS - - - - - -169

IX. THERAPEUTICS (contimied) - - . - 190

BIBLIOGRAPHY 223

INDEX -.--.-__ 227

XI

THE REAL CAUSE OF STAMMERINO
AND ITS PERMANI^NT CURE ., ^. ' .' .'.

\
CHAPTER I

RETROSPECTIVE

HISTORICAL references to the existence in past
ages of impediments of speech are both frag-
mentary and unreliable, owing to the incom-
plete observations of those times and the inability of
such observers, as there were, to discriminate between
the varied vocal defects that came under their notice.

One of the most notable and interesting of such
references is the excuse which the great Lawgiver,
Moses, tendered to God in his desire to escape from
the mission for which he had been chosen : "I am
slow of speech, and of a slow tongue," he said (Exod.
iv. 10). In God's reply, as Moses records it, we see that
defects of speech were regarded by the Jews as afflic-
tions equal to deafness and blindness : *' Who hath
made man's mouth ? or who maketh the dumb, or deaf,
or the seeing, or the blind ? have not I the Lord ? "
(Exod. iv. 11). This is instanced again in the prophe-
cies of Isaiah, where, in enumerating the blessings of
Christ's Kingdom (Isa. xxxii. 3, 4), he says : " And
the eyes of them that see shall not be dim, and the
1

2 STAMMERING AND ITS CURE

ears of them that hear shall hearken. The heart also
of the rash shall understand knowledge, and the tongue
of the stammerers shall be ready to speak plainly."

We will now turn from sacred to profane history.
According to Herodotus (iv. 135), Battos, the son of
Polymnestos, stammered in early childhood. His
'jafHiction, judging from the terms chosen by the his-
torian, manifested itself in an involuntary stoppage of
the voice or com{>lete unintelligibility. When grown
to manhood he asked the Pythian priestess, as the
oracle of the Delphic god, how he could get rid of his
agonizing ailment, and she recommended him to emi-
grate south to Libya. It is not improbable that the
association of his proper name, Battos, with the appel-
lative fSdraXos (stammerer), is due to the possibility
that young Battos received his name as a consequence
of his impediment.

In the case quoted above, we have been dealing with
some of the pathological and more serious of the
symptoms comprised under the term "stammering."
We will now make, through the instrumentality of the
greatest Greek comedian, the acquaintance of a lisper
whose defective articulation incited the refined
Athenians to ridicule him, even though he was one
of their most distinguished statesmen and military
leaders — Alcibiades. He is reported to have been
unable to articulate the letter r properly, substituting
/ in its place. Alcibiades, however, seems to have had
the gift of making a virtue of a necessity, and indulged
in his impediment with conscious coquetry.

The impediment of Demosthenes, who, with doubtful
justice, is claimed by many stammerers as their most
famous fellow-sufferer, comes more or less under the
same head. According to Cicero, Demosthenes was

RETROSPECTIVE 8

unable at the commencement of his brilliant career to
articulate the first letter of the name of that art —
namely, rhetoric — of which he was destined to become
the most notable interpreter. The articulation of the
letter r was to him such a stumbling-block that any
development of his genius as a rhetorician was threat-
ened with shipwreck, but ultimately he succeeded in
mastering his " slow tongue " and in making it a pliant
instrument of his powerful eloquence. The means he
used were those tedious exercises, which are sometimes
adopted, even in these enlightened days, by stammerers,
generally to their disappointment.

Judging from the Greek vocabulary, containing as it
does a large variety of terms relating to impediments of
speech, we are justified in the conclusion that a fair
number of persons thus afflicted were to be found
among the ancient Greeks. This conclusion is still
further justified when we find that Aristotle (Prob-
lem XI.) especially points out that there is some method
in their use, as they refer to particular forms of the
various defects of speech. Such distinctions were
doubtless of very ancient origin and entirely super-
ficial, relating merely to the impression which the
afflicted person made on those around him. The
stimulus given to every other art and science by the
development of the Greek language, seems to have had
little or no effect in aiding the physicians and sages of
ancient Greece to arrive at the formulation of any
satisfactory classification of defective speech. This was
undoubtedly owing to a complete lack of insight into
its nature and the causes from which it springs. The
occasional remarks which we find scattered in the works
of Hippocrates, Aristotle, Galen, and others, which bear
on this subject, are hypothetical and trivial. Aristotle

i

4 STAMMERING AND ITS CURE

alone seems to have had any view of the matter worth
mentioning, a view which held its ground and was
regarded as a dogma up to about the sixteenth century.

Amongst the Romans (as in the Mosaic era) we find
stammering and lisping classed equally with other
infirmities and peculiarities. The stammerer and lisper
had his special name (Balbus Blaesus); so had the
squinter, the bandy-legged, and the long-nosed person.
We also find instances of defective speech occasionally
mentioned in the works of Cicero, Valerius Maximus,
and Catullus, but we derive as little practical knowledge
of these ailments from the Latin-speaking occidentals
as from their colleagues of the East.

Throughout mediaeval times research was at a stand-
still; it was not until the sixteenth century that the
threads, which had been dropped, were taken up again.
Hieronymus Mercurialis ** (1584), who in his statements
on the subject repeatedly quotes the authority of
medical and other learned men of antiquity, dis-
tinguishes between Balbuties natnralis and Balbuties
accidentalis. According to his views, the cause of chronic
stammering is to be found in a humidity of the brain,
which disturbs the normal action of this "central organ,'*
whereas accidental stammering is caused by sudden
emotions and other influences, which injure the whole
nervous system. This conception — which rightly makes
the " central organ " the seat of the affliction — marks a
vital progress, and may be considered to be the fore-
runner of most of the theories which have held the
ground up to quite recent years, in spite of its faults
and dogmatism. But even this small amount of
advance was not kept up; on the contrary, the re-

NoTF.. — 44, 38, 9, 56, etc. These and all such subsequent
auiubcrs refer to the Bibliography at the end of the book.

RETROSPECTIVE 5

searches made by the medical men of the eighteenth
century — Hahn, Santorini, Delius, Morgagni — show a
deplorable regression, inasmuch as they regarded stam-
mering (which was not yet consciously separated from
other defects of speech) as the result of anatomic lesions
and malformations of the organs connected with speech.
The reproach which attaches to these eighteenth-
century physicians is equally deserved by the misled
"specialists" who, even up to recent years, owing to one-
sided and insufficient observation of the symptoms, have
defended theories which make weak and faulty conditions
of the organs of speech responsible for the impediment.

Kustner38 (1716) and Bergen 9 (1756) traced stam-
mering back to unsoundness of the muscles of the
speech-organs. Sauvage 56 (1771) thought that defective
speech was due to a certain weakness of the soft palate,
uvula, and root of the tongue, and the immobility
consequent upon such conditions. The conception of
Sauvage is closely associated with the hypothesis advo-
cated by Mme. Leigh and by Malebouche 42 (1841).
These authors attributed impediments of speech to a
weakness of the tongue which caused it to be kept
in an incorrect position during the act of speaking —
namely, at the bottom of the mouth instead of in the roof
of the mouth. This view is entirely contradicted by the
facts, which do not evince the phenomena referred to.

Hervez de Chegoin 17 (1830) thought he had discovered
the fundamental cause, when he drew his conclusions
from certain abnormal formations of the tongue. When
this member was short, or, owing to certain conditions
of the ligament, was hampered in its movements, he
considered that such conditions caused defects of speech,
which could be cured by a surgical operation.

According to Yearsly ^^ and Braid i' (1811), certain

6 STAMMERING AND ITS CURE

malformations of the tonsils and of the uvula can cause
impediments of speech, while Cormack 21 (1828) and
Beesel 6 (1843) laid the blame upon incorrect respira-
tion, or upon the '* misapplication of breath." This
was due to their one-sided and unmethodical manner
of generalizing the results of quite superficial observa-
tions. They did not investigate the cause which lies
at the root of such respiratory disturbances. A more
careful research would have shown them that their
theory had no scientific foundation whatever, and
that they were only substituting imperfectly observed
symptoms for primary causes. Several years previous
to the appearance of Cormack's theories, Itard^^ (1817)
had published a short treatise on stammering, which
deserves consideration, inasmuch as he is the first
author who treats this affliction as a pathological
symptom, which demands a place of its own among
the other defects of speech. In his opinion stammer-
ing is caused by a spasm induced by a weakness of the
motor organs of the larynx and tongue. This entirely
orginal view has had a most enduring influence on
the various authors who have, since that time, been
engaged in writing monographs, essays, and scientific
articles on the subject.

Du Soit 59 (1840) held the opinion that stammering
is a result of spasms of the respiratory organs, which
either take the form of tetanus or of a clonic spasm.
The physiologist Miiller 48 (1840) and the surgeon Dicf-
fenbach2l. (1841), following Arnott's 1 (1830) example,
considered themselves able to explain the nature of
stammering satisfactorily by assuming that it was
caused by spasms of the glottis — spasms which im-
parted themselves to the muscles of the tongue, face,
and throat by morbid association. Schulthess j*^ (1>530),

RETROSPECTIVE 7

who also put the ailment down to spasms of the glottis,
compared it with hydrophobia, and suggested the
terms " phonophobia " and *' lalophobia " as suited to
describe it.

In contradistinction to these efforts, which aimed at
the discovery of a circumscribed primary seat of the
disease, Angermann 8 (1853) was much influenced by
Itard in his view that, in an attack of stammering, all
the organs involved in the formation of sound and
syllables are at the same time seized by spasm.

In 1829 Serres d'Alais 2 approached the matter from
a somewhat different standpoint. As a result of minute
observations, he modified and defined Itard's views,
and finally classed two kinds of stammering, the ulti-
mate cause of both of which he found in an affection
nerveuse. One kind is characterized by clonic spasms
of the articulatory muscles, while the other is due to
tetanus of the muscles connected with respiration and
voice production.

The question as to the causes which induce these
spasmodic conditions, already opened up by Itard and
ignored by the authors above quoted, was answered by
later writers as follows : —

Marshal-HalH3 (1841) and Lichtinger^o (1844) con-
sidered stammering to be a reflex spasm caused by thf.
excito-motor spinal action predominating over cerebral
influence. They were of opinion that the impulses of
volition, regulated by thinking, did not have, in the
case of a stammerer, a sufficient amount of energy with
which to prevent the simultaneous interfering occur-
rence ol reflex actions — actions which, being indepen-
dent of the will, have their origin in the spine. The
disproportion between cerebral influence and spinal
action could be based, according to Lichtinger, either

8 STAMMERING AND ITS CURE

on the lowering of the cerebral energy or upon abnormal
excitation of the spinal cord. Accordingly, he discrimi-
nated between cerebral and spinal stammering, and
regarded causation as due either to morbid disorders
of the brain or of the spine. Klencke 36 in his work,
*' Die Stoerungen des menschlichen Stimm- und Sprech-
apparats," published in 1844, explains stammering as
** the outcome of a want of freedom of the soul with
regard to the stimuli of that most important part of
culture, speech." He also J&nds the deeper roots of
this *' want of freedom " in the functions of the spinal
cord and of the brain, being insufficiently co-ordinated ;
the action of the spinal system may be, in the case of
a stammerer, absolutely or relatively increased, and
may manifest the phenomena of excito-motor functions.
This " want of freedom of the soul " becomes apparent
primarily in the movements of the expiratory muscles
which, through spasm, adynamia, etc., are out of control
of the will and are at the mercy of innervation. Such
suspension is automatically followed by disturbing
symptoms in the muscles of the throat and larynx, and
ultimately, owing to the retained air working on large
groups of nerves, spasmodic contractions are produced
in the articulatory and facial muscles. Previous to
Marshal-Hall, Charles Bell 7 (1832) described stam-
mering as a " very partial chorea," and regarded it as
due to inadequate capacity properly to co-ordinate the
different actions required for fluent speech, consequent
upon a certain debility of the nerves which control the
organs of speech. This theory has had frequent sup-
port in comparatively recent times, and was particu-
larly adopted by Benedicts (1868), Rosenthal 53 (1870),
Guillaume 32 (1872), and Kussmaul 3T (1885).

Previous to Charles Bell and the authors who,

RETROSPECTIVE 9

together with him, had correctly located the seat of the
ailment in the brain, Voisin 6* (1821) and Rullier 55
(1828) had gone much more deeply into the subject
which had been treated, until their time, in so super-
ficial a manner. Voisin contented himself with a
general statement that the brain stimulates the muscles
of the organs of speech in an irregular and incomplete
way, but he failed to make this irregularity an object of
more exact investigation. Rullier, however, took great
pains in the investigation of this question, but he did
not succeed in finding a satisfactory answer. According
to his view, stammering is caused, in the first place> by
a disproportion between the rate at which the brain
produces thoughts, and that at which it transfers them
to the different stages of innervation ; and, in the second
place, by an incapacity of the organs of speech to
accomplish their task properly. The inability of the
parts to cope with the demand made upon them, when
profusion of stimuli come by quick turns (if we may so
speak), is, in his opinion, the cause of the spasmodic
inflexibility of the stammerer's organs. But the
" central organ " is exclusively responsible for this
phenomenon, owing to its precipitance.

Rullier's theory was almost literally adopted by
Colombat'-'O (1840), but, by going back to the distinc-
tion laid down by Serres d'Alais between tetanic and
choreatic stammering, he corrected one mistake of
Rullier's, and may be said to have contributed very
serviceably to the inquiry by substituting for Rullier's
etat d'hnmohilite spasmodiqiie his own etat tetaniqne
et conviihif. Colombat's theory, however, underwent
certain modifications at the hands of Blume i'' (181.3).
The trouble is not considered to be brought about by
central infiueuces alone, but is caused by a disturbed

10 STAMMERING AND ITS CURE

harmony between two concurrent factors — thinking and
speaking. Thus the disproportion can be caused partly
by a particular condition of the mind, and partly by
a peculiar formation or incorrect use of the organs of
speech.

We meet with similar attempts of amalgamation in
the investigations of Bonnet 13 (1841), Froriep and Ore 49
(1866), three defenders of surgical methods of cure.
Froriep, for example, says : " Stammering can be caused
either by a mechanical incongruity in the ' motive *
organs of the tongue (consisting in an abnormal degree
of tension and contraction) or by a psychic disposition,
the nature of which cannot be accurately defined."

The compromises above mentioned proceeded from
the wish to establish a practicable theoretic basis for
surgical operations which were highly recommended
for the removal of stammering by Dieffenbach, and were
carried out with sad results. The advocates of surgical
treatment either pretended to have seen successful
instances or expected to do so in the future.

Undaunted, in spite of these misdirected attempts
at treatment, and in spite of their finding favour in
large circles for a short space of time, science continued
to pursue the road opened up by Rullier.

Merkel 45 (1866), who himself suffered from the afflic-
tion of stammering, places its primary cause entirely in
the psychic sphere, — the sphere of the will. A debility in
this sphere may produce a disturbance of the equilibrium
between articulation and vocalization. Here Merkel is
in complete accord with Deleau,22 who, as early as 1829,
attributed stammering to weak impulses of the will and
insufficient innervating influences on the organs con-
nected with human speech. Merkel observed that
stammering was only possible with an initial vowel

RETROSPECTIVE 11

or consonant, but not with a combination of vowel and
consonant ; the conclusions he drew from this observa-
tion cannot, however, be maintained in the face oi
facts.

In Merkel's footsteps treads Thome C2 (1867), who
sees the fundamental cause of stammering in an ab-
normal working of the central nervous apparatus,
induced by the influence of certain emotions, which lead
to respiratory disturbances. He arranges the psychic
conditions which bring about this abnormal action into
two groups : (1) Embarrassment, uneasiness, lack of
confidence ; (2) Excessive rapidity of thought, coupled
with an endeavour to produce the thought with corre
sponding rapidity.

The question as to which portions of the stammerer's
brain are apt to work irregularly is answered by Ruff 51
(1885), who makes the statement or suggestion that the
centre of speech has accidentally been exposed to some
injurious influence, such as suffusion of blood, owing to
a sudden expansion of the bloodvessels of the brain, or
an insufficiency of blood, owing to a spasmodic contrac-
tion of the same vessels. Such detrimental conditions
would make the perfectly natural ability to speak,
which exists under ordinary circumstances, impossible
at that moment. The centre of speech may then be
said to be so disposed as to respond to any inducement,
however slight, to renew an attack of stammering.
The first disturbance, therefore, which is regarded as a
provoking cause of the affliction by this theorist, arises
from a lesion, a shock, or some extraordinarily intense
emotion.

Ruff's explanations show evident signs of having
been worked out under the influence of Coen's treatise,
" Das Stottern, Stammeln, Lispelu und alle uebrigeu

12 STAMMERING AND ITS CURE

Sprachfehler " (1883). Coen's main idea is this :
" Supposing an ordinary speaker suddenly becomes
subject to an intense emotion, one of the first results
thus induced is either the momentary loss of the entire
faculty of speech, or that his speech, which has hitherto
been fluent and natural, becomes clumsy and faulty.
What has happened? Owing to the intense emotion,
a sudden disturbance of the circulation of the blood has
been brought about. The blood rushes to the heart and
to the other inner organs, and, in consequence, there is
insufficient blood in the superficial parts of the body
(the face becomes pallid and the limbs tremble), while
the inner organs, including the brain and spine, are
suffused. This unusual congestion at once induces an
increase of pressure of blood in the organs concerned,
with the result that the nervous functions of the brain
and spine are immediately upset. This functional dis-
turbance becomes apparent, in the case of a stammerer,
in his short, weak, and irregular breathing, which
brings about either a sudden interruption of speech
altogether or a difficulty in speaking. The next
moment — that is, as soon as the stimulating cause has
passed over — the balance, both in the circulation of
blood and in the function of the nerves, is restored,
breathing becomes fuller, stronger and more regular,
and speech is as fluent and distinct as before."

In spite of Ruff's unmistakable indebtedness to
Coen, he has avoided the latter's fundamental error
by locating the supposed disorder in the centre of
speech.

Coen himself, casually pushing aside the irrefutable
observations of his predecessors, thought himself justi-
fied in putting down the aggravation of vocalization
and articulation, experienced by a stammerer, to his

RETROSPECTIVE 13

respiration being weak and irregular, and the conse-
quent lack of power at the moment of exhaling to
overcome the obstacles induced by the position of the
organs of speech. He was of opinion that the pressure
of the pulmonary air is, in the case of a stammerer,
lower than in that of an ordinary speaker. How Coen
explains the mechanism of the characteristic symptoms
is detailed on p. 80 of his book, " Pathologic und
Therapie der Sprachanomalien " (1889) : " As the nor-
mally innervated muscles of the * speech-apparatus ' —
when articulating the explosives k, p, t — are able to
offer considerable resistance against the feeble pressure of
the column of air, the bursting of the lock which producer
the sound cannot normally take place. In this way the
muscles are irritated, and are therefore seized with spas-
modic contractions ; the tongue is forced against the
roof of the mouth or the teeth, whilst the lips are
violently pressed together. In this state the patient
makes the greatest effort to overcome that obstacle, but
only with the result that the muscles are seized with a
tetanic cramp, which finds its expression in reflexes of
the muscles of face, head, the upper and lower ex-
tremities, etc." (Translation.)

The insufficiency and irregularity of respiration —
which by Merkel had been considered as one of the
factors in the mechanism of stammering — is, acording
to Coen, caused by an abnormal innervation. The
latter, again, is dependent on alterations which are to
be found either in the centres or in the superficial
channels of the nerves.

With Merkel, who considered the ailment to be the
outcome of an insufficient impulse of the will, Schrank 57
(1877) is, to a certain extent, in accord. He held the
opinion that the stammerer's will, during the act of

14 STAMMERING AND ITS CURE

speaking, is hampered and flurried by disturbing in-
fluences, generally consisting of feelings of dread, the
origin of which may be ascribed to varying causes
which would not affect an ordinary speaker. They may
be brought about, either by circumstances or outer con-
ditions, when their appearance requires an abnormally
increased psychic provocation, or may suddenly enter
as obsessions, without any external causation, into the
foreground of consciousness, absorbing the whole of the
attention which was previously fixed on other things.
Here there must be alterations of a pathologic nature
in the brain, analogous to those which are caused by
intense feelings of dread of an approaching necessity
to speak, and stammering is the result.

Near to the truth also came Wyneken and Denhardt 28
(1890), who found the cause of the affliction to be
lack of confidence and self-control. The will to speak,
during the time that the necessary movements have to
be innervated, is influenced by doubts which arise in
the stammerer's soul as to his capacity to do so, to such
an extent that the rational co-ordination of the move-
ments is upset, its place being taken by an irregular
and unbalanced play of the muscles.

An identical standpoint is taken by Ssikorski 60 (1894^
and L. Sandow (1898), who hold that stammering is a
psychoneurosis, based on a debility of the nerves in-
volved in the action of speech, while each paroxysm of
stammering is induced by psychic stimuli. The latter are
supplied either by dread of speaking, intense eagerness
to speak, or by too violent innervation when communi-
cating matters which seem of importance to the sufferer.
Ssikorski also gives an intelligent theory on the subject
of the greater immunity of the female sex from this
malady : " Owing to hereditary peculiarities, the motor

RETROSPECTIVE 15

centres of a woman's left cerebral hemisphere (whicli
contains the organ of Broca, the centre of speech)
develop, generally speaking, more quickly than a man's,
and seem, thanks to a more accomplished structure of
certain parts of the brain, less exposed to injuries than
those of boys. This accounts not only for the earlier
development of speech with girls, but also for other
psycho-motor specialities of women — viz., their skill in
dancing, singing, and needlework."

The latest authors on the subject — we will only
mention Earths (1904), Troemer 63 (1905), and Stekel 61
(1908) — have unanimously come to the conclusion that
stammering is solely a psychic ailment, in the centre of
which stands " dread of speaking." This, as a momen-
tum of inhibition, interferes with the automatic execution
of that function.

If we sum up the facts brought to light by research,
so far as they seem reliable, together with the positive
results of that research (apart from those observations
which refer to symptoms only), little more is left than
the theory that the affliction is of a central or psychic
nature induced by a disturbance of the will, the cause
of which, it must be acknowledged, has remained un-
explained up to quite recent years. The view which
placed the cause of the impediment in the outer organs
of speech may be looked upon as definitely abandoned.

From our necessarily hasty retrospect we gather that
what there has been of progressive discernment by no
means runs in strictly chronologic succession, but that
each step which brought us nearer the goal was attended
with many retrograde movements, and some entire de-
partures from the right road.

The authors who have written on the subject of
stammering, with more or less success, cannot all

X

16 STAMMERING AND ITS CURE

be touched upon within the limits of this opening
chapter, the object of which is merely to present
in as concise a form as possible the theories con-
cerning the nature of stammering which have come
before the public at various periods. We shall, how-
ever, have reason to quote in the following chapter
many authors who have not yet been mentioned, and
it will be seen that the bibliography of the subject is
extensive.

CHAPTER II

FROM THEORY TO PRACTICE

BEFORE we attempt to discuss the pathology,
aetiology, and rational therapeutics of stammer-
ing, it will be well to take a brief general survey
of the historic development of the therapy.

When some understanding of the psychic suffering at
the root of the distressing affliction which we are con-
sidering is arrived at, it is indeed surprising that not
until the last century was the necessity realized of
determining scientifically how such suffering might be
eradicated. Perhaps Mercurialis was the only physician
who bestowed care upon founding a treatment which
was logically based on actual theories of the nature of the
infirmity. Since, according to him, the complaint had
its primary cause in an inte^nperies frigida and humida,
he made it his task to fight these conditions with all
possible means. To this end, he recommended the
patient's sojourn in a warm and dry atmosphere, a
warming and parching diet, the avoidance of alcoholic
beverages, the administration of purgatives, the use of
embrocations with honey, salt, and especially with sage.
Associated with these means were exercises of the organs
of speech by continua locutia alia et clara.

The medicinal treatment of stammering by diet,
drugs, etc., was revived later on by Schulthess. In
accordance with his theory as to the cause of defective
2 17

18 STAMMERING AND ITS CURE

speech, he tried to attack the morbid inclination of the
glottis to seizure with spasm by administering remedies
similar to those used in convulsive diseases like epilepsy,
chorea, whooping cough, and so on. The importance
of speech drill, from which Mercurialis had expected a
certain amount of benefit, is of very little account in
the estimation of Schulthess. He looked for success
to such means as divert the sufferer's mind from his
affliction and occupy his imagination.

In the year that Schulthess published his book, a
French surgeon, Hervez de Chegoin, tried to establish
the advantage of operations for a particular kind of
stammering. As we have already mentioned, he laid
its cause to a faulty condition (shortness) of the liga-
ment of the tongue, which, in his opinion, necessitated
its being cut through. Hervez de Chegoin claims the
doubtful credit of breaking the first lance in favour of
surgical treatment for stammering. ( It was, however,
the well-known surgeon Dieffenbach who made the
treatment famous (or let us say infamous), and he must
bear the odium which is justly levelled against the ex-
ponents of this serious and disastrous error. January 7,
1841, may be regarded as the birthday of Dieffenbach's
process, which was carried out by cutting through the
root of the tongue (with or without the excision of a
sphenoid piece of that organ), and on March 8 of that
same year Dieffenbach was reporting on nineteen such
operations to the Institut de France.

The first news about the Dieffenbach treatment
reached France at the beginning of February through
the agency of the Press, and the idea was soon taken
up with keen interest. A former pupil of Dieffenbach's
— Philipps, of Belgian nationality — submitted two
stammerers to the operation on February 6, and re-

FROM THEORY TO PRACTICE 19

ported on their case at the Medical Academy in Paris.
When the paper was read on the IGth of the same
month several members of the Academy were cautioned
against acting rashly and without more intimate know-
ledge of the matter. However, the stone had started
rolling, and could not be so easily stopped. Several
French surgeons, despite the warning, continued to
follow the directions, which appear to have been given
together with the reports of Dieffenbach's alleged
successes. In April, Amussat had performed eighty
four operations. As great an activity in this domam
prevailed in the provinces as in the capital, Paris.
Nearly 200 stammerers in France alone submitted
to the operation in the course of the year. The
enthusiasm quickly spread to England, where incisions
in the tongue, and especially in the root of the tongue,
were practised as in Germany and France, the English-
men Yearsly and Braid, however, preferring to cut the
stammerer's tonsils and uvula. These two English
surgeons based this mode of operating upon the
erroneous conception that, owing to the supposed faulty
condition of the organs mentioned, they put obstacles
in the way of normal expiration, and should therefore
be removed.

In Berlin, Dieffenbach*s operation was performed
upon sixty stammerers. The enthusiasm which the
new method had at first provoked soon subsided, and
opportunity was made for a sounder examination of
certain facts which, for the time, seem to have been
entirely overlooked. Dieffenbach, from the beginning,
had not concealed the serious dangers which are
attached to the operation. As a matter of fact, his
method claimed its first victim in a very short space of
time. A student in Berlin paid with his life for trust

20 STAMMERING AND ITS CURE

in the surgeon's knife as a means of relieving him of
his impediment. A second victim was a patient of
Amussat's, who, having been operated upon on April 29,
died on May 17. It may be supposed that the surgeon
vainly endeavoured to diminish the significance of this
mishap. On June 1 he informed the scientific world
at large of his successes and — failures 1 Shortly before,
Guersant had raised his first cry of warning in the
" Gazette Fran^aise." He made the results of the opera-
tions, as far as they were known to him, a matter of
most conscientious investigation, and came to the con-
clusion that the advantage of surgical interference in
cases of stammering were, to say the least, very doubt-
ful and uncertain ; that surgical treatment, at the best,
only brought about an improvement in the more for-
tunate cases ; that no records of complete cures were
forthcoming, and that even life itself was seriously
endangered and had been known to have been sacrificed
altogether.

This was not the only frank admission of failure ; others
also who had tried the experiment found the courage
y to acknowledge their grave error. The end of the year
'^ 1841 saw also the end of what there had been of triumph
in the attempted surgical treatment of stammering,
though such operations continued to be carried out here
and there. In 1851, however, Romberg was able to
state that the surgical treatment of the affliction had
been '* rightly given up." Thus the blood-stained
campaign ended with complete defeat, bringing dis-
appointment to all who had hoped for relief, and some
amount of censure on those who had conducted it.

The complete futility of surgical treatment now
established, many a sufferer who had bled under the
knife of the most skilful surgeons sought help in insti-

FROM THEORY TO PRACTICE 21

tutioiis where efforts were being made to attack the
ailment in a more rational manner. The author has
himself met with stammerers who had undergone
operations, and out of several letters selects one which
is, to a large extent, synonymous with others.

"S ,

January 4, 1910.
" AuRtD Appelt, Esq.,

*' Dear Sir,

" I am a bad stammerer, and, like so many
others, have been under several treatments : first,

Rev. W , then Mr H , then Mr B , (six

consecutive months), and finally Mrs B , at whose

request I underwent three throat and nose operations to
widen the breath passages. In this way I have spent
the whole of my capital.

" I feel very sceptical as to obtaining permanent
relief, and shall be very much obliged to you if ... etc.,

(Signed) " F. P. B ."

In order to understand the history of the surgical
methods we have been considering, and to comprehend
the triumph (short-lived as it was) enjoyed by the many
famous medical men who were drawn into the vortex,
we must take into consideration a fact which we will
discuss later on in detail. A decrease of stammering
did undoubtedly take place in a series of cases, and we
ourselves have noticed a similar temporary improvement
after operations for other purposes, and after illnesses,
especially during the convalescent stage. Exhaustion
and relaxation, particularly of the organs connected
with speech, offer an explanation of that phenomenon.
A rational therapy must decline to accept such data,
since an improvement which may pofinihlif become
apparent immediately after the operation contains no

(/i

22 STAMMERING AND ITS CURE

guarantee of permanency. Any slight improvement
which may take place is not due to the operation;
rather is it due to auto-suggestion on the part of the
stammerer who, buoyed up by hope of relief at the
surgeon's skilful hands, momentarily experiences that
relief. It will be seen, later on, how great an influence
suggestion has in all cases of a neurotic character.

Next to medicinal and surgical treatment stand the
didactic or pedagogic methods which aim at recovering,
by means of instructions and exercises, the control over
the organs of speech, which the will has lost. The first
efforts in this direction (with the exception of those of
Mercurialis) were made at the beginning of the last cen-
tury, and continued, practically without suspension, even
throughout the era of Schulthess and Dieffenbach.
This mode of treatment has been generally adopted,
but crude and often absurd have been the measures
taken to shape the principles into a practical system !
Many and varied were the pedagogic ways and means
employed by " speech specialists," since the majority of
them seemed fully convinced that stammering could
only be removed under, what we will term, a didactic
treatment.

The first person who formulated an independent
system on these lines was the French physician Itard
(1817), noted for his treatment of the deaf and dumb.
He considered the phenomenon of stammering a
spasmodic condition caused by a congenital debility of
the nerves which stimulate the movements of the larynx
and tongue. Apart from the use of medicinal remedies,
he prescribed systematic gymnastics of the organs of
speech, such as reciting for adults and lecture posec for
children. He required the difficult syllables to be
specially practised. A fork, placed under the tongue

FROM THEORY TO PRACTICE 23

and encompassing the root of the tongue on both sides,
was the means used to strengthen that organ by com-
pelling it to work in spite of the obstacle. He also
recommended the placing of stammering children under
a foreign governess unacquainted with their language,
forcing them in this way to learn the foreign language
slowly, without indulging in their mother-tongue.

About the same time that Itard was before the
public, Dupuytren was trying to discover a cure for
stammering, and we learn from Rullier's dissertation that
he is supposed to have been successful in his treatment
of a young solicitor. This patient was made to speak
in a singing tone, marking certain intervals by a slight
movement of his foot. This proved to be a departure,
which became very notable. Colombat has always
been incorrectly regarded as the originator of this
attempted cure, which may be called the time-beating
method, Dupuytren's name, from some unknown cause,
having fallen into oblivion.

Itard and Dupuytren, who appear to have tried
their methods in a very limited area, were succeeded
by Mme. Leigh, an American lady who, left a widow
very early in life, was received into the family of Dr
Yates, a physician of New York. His daughter was
afflicted with an impediment in her speech, and it was
due to this circumstance that Mme. Leigh was in-
spired to take up the subject with great enthusiasm.
The failure of many attempts at a cure did not deter
her from following up the aim which was continually
before her, and she is reported to have ultimately
succeeded in curing Miss Yates. Elated by this first
success, she applied her system to other cases, and is
said to have obtained satisfactory results throughout.
Encouraged by so promising a beginning, she decided

24 STAMMERING AND ITS CURE

to continue her work, and established an institution for
stammerers in New York (1825), which boasted, at the
end of 1827, of no less than 150 *' cures." It may be
mentioned that there is some doubt as to whether
Mme. Leigh can legitimately claim to be the actual
originator of the method which bears her name. The
truth probably is that she owed her knowledge to a
Mr Broster of Liverpool, who, according to the state-
ment of Julius,* had been very successful on these lines
in Edinburgh, Liverpool, and London. Mme. Leigh
sold the secret of the method to a Belgian, Malebouche
by name. At first he was unable to give accurate par-
ticulars of the method ; a few years later, however, he
was able to supply the needed information in an article,
*' Begaiement," published in the " Dictionnaire de Mede-
cine et de Chirurgie Pratiques," 1830. According to
Mme. Leigh, during the futile efforts of the stammerer
to pronounce a word or letter, his tongue is lying too
deep at the bottom of the cavity of the mouth. The
compensation of this defect forms the salient point in
her so-called American method. The tongue has con-
tinually, even during a state of rest, to be kept in such
a position as to enable its tip to lie close to the front
part of the palate, or to the alveoli of the upper teeth;
and, since it was regarded necessary to maintain this
position even during the night, a small roll of wet linen
was then placed under the tongue. A series of vocal
exercises were supposed to increase the mobility of the
tongue and its capacity to carry out the directions of
the will. Reading exercises, together with a suitable
regulation of respiration, completed the system. Male-
bouche, on the whole, supported Mme. Leigh's views

* " Magazine of Foreign Literature on Therapeutics," pub-
lislied by Gerson and Julius, vol. xiv., p. 93.

PROM THEORY TO PRACTICE 25

and method, with the exception that he preferred to
lift the extended tongue against the palate. He further
advocated the pushing back of the lips as much as
possible, so as to increase the aperture. Malebouche
has, unfortunately, omitted to give the reasons which
led him to advise this unnatural position of the lips.
Up to 1841 about 400 stammerers were treated by
Malebouche, a fair percentage of whom did not derive
the slightest benefit.

Before Malebouche gave any description of Mme.
Leigh's treatment, it is easily conceivable that many
endeavours had been made to gain an insight into the
American system. Amongst those who unsuccessfully
tried to find out the secret was Cormack (1826), an
English physician in New York. Though he met with
disappointment, his efforts resulted in his devising
other means for the eradication of the impediment.
As he supposed the cause to be in defective breathing,
it was to the proper regulation of the respirations that
he turned his attention. According to his theory, most
stammerers try to speak with their lungs empty, In
order to remove this abnormal habit, Cormack pre-
scribes a deep inspiration at the beginning of a sentence,
and he requires that the words uttered should, as it
were, be voiced by a strong current of expiration.

Cormack's principles have maintained their place in
the therapeutics of stammering; his name, however,
was rendered obscure for a long time, owing to the
successes of others, and it was to Colombat that the
credit of the discovery, made by those we have named,
was attributed. Before the news of Cormack's experi-
ments had reached France, a distinguished medical
man of that country, Serres d'Alais, who was himself
subject to the atfiiction of stammering, dissertated upon

26 STAMMERING AND ITS CURE

the subject in an essay published in 1829. To a certain
extent his advice coincides with that of Corraack, both
insisting upon the necessity of a strong current of
expiration for the formation of words, Serres d'Alais
justifying this requirement by pointing out the fact
that, when stammering, the patient, with a superfluity
of energy, closes the larynx and prevents exhalation.
Upon this premise, D'Alais makes it imperative to in-
crease the pressure correspondingly of the column of
air thus enclosed, giving it additional force with which
to break through the resistances. He also advises the
separation of the different syllables from each other by
equal intervals and the exaggerated elongation of their
vowels. In order to intensify the current of expiration,
he recommends movements of the arms, which, in
accordance with the severity of the case and the pro-
gress of the patient, shall accompany the pronunciation,
either of each syllable or of the first syllable of each
sentence only.

Serres d'Alais, in a later publication, candidly admits,
by the way, that the ailment shows a tendency to
return whenever the patient's attention is diverted
from the method. In his system we evidently have the
foundation of the time-beating method, which, designed
already in outline in Dupuytren's treatment, gained a
reputation in France under Colombat, and in Germany
under Klencke and Blume. The following year brought
further publications on the subject by Bell and
Colombat, which gave evidence of the vigilant zeal
that was shown, practically and theoretically, by ex-
perts, who aimed at finding a remedy for stammering
and its attendant sufferings.

Arnott, an Englishman, who, like so many others,
saw in stammering nothing more than spasms of the

FROM THEORY TO PRACTICE 27

glottis, concluded that the complaint would yield when
the glottis was always kept open. To achieve this, the
stammerer must join all the words of a sentence
together, without pausing, in such a way that the glottis
shall be unable to close in the interval between two
adjoining words, the connexion required being made
by additional vowel sounds. Intonation also played an
important part in this system. Joh. Miiller and Otto
adopted Arnott's method later on, the latter demanding
strong respirations, the avoidance of any effort, and the
choice of a deep tone for the voice when speaking, in
addition to the system already described.

The feature of Colombat's treatment which stands
out most prominently is the application of musical time
to ordinary speech, an artificial expedient of which the
ordinary speaker knows nothing. The stammerer was
required to speak in single syllables, all the while
observing a certain rhythm by moving the thumb and
forefinger against each other. Later on Colombat
developed for this purpose a specially constructed
metronome, which he called " Muthonome du Dr.
Colombat de I'Isere." In addition to this system
of time-beating, he introduced into his method other
means which, nearly without exception, share the dis-
tinction of want of originality : the deep inspirations^
due to Cormack's suggestion ; the drawing back of the
tongue and the lifting it to the palate, recommended by
Mme. Leigh ; the drawing back of the lipsy added
by Malebouche ; while an apparatus constructed of
silver and ivory, placed under the tongue for the •,
purpose of pushing it back and keeping it in that
position, reminds us only too plainly of Itard's fork.

During the first two to four weeks* treatment the
patients were not allowed to carry on a conversation

28 STAMMERING AND ITS CURE

■with any but their fellow-sufferers or Colombat himself,
lest the success of the exercises should be annulled by
disturbing momenta.

The exercises started with single words, the series
being opened by those beginning with vowels; these
were followed by others with b, /, m, p, v as initial
sounds, and subsequently by d, j, g (before e and i),
chy I, n, r, s, *, g (before a, o, u), and c (before a, o, u).
Then followed the reading of single verses and sentences
in prose, and, later on, the relation of short stories in
colloquial language.

Colombat had a special genius for directing public
attention to his efforts, and used it. Renowned medical
men were among his referees. The Parisian Academic
de Medicine conferred on him the distinction of the
Monthyon Prize. Before long he established his Institut
Orthophonique, where, in course of time, over 600
stammerers received treatment, of whom more than
500 were discharged as cured, if we may trust his
credibility. Unfortunately, Colombat was no more
scrupulous in the respect of " cures " than many quacks
in the present day.

A method applied by Blume in Leipzig is also based
on the system of time-beating. He advised breathing
exercises alternating with exercises of the tongue,
requiring the abdomen to be drawn in for as long a period
as possible during the speech drill. As a means of facili-
tating this object, he recommended the shoulders being
raised at the beginning of each inspiration, lifting one
arm and dropping it very gradually, until the expiration
had ceased and the abdomen was completely contracted.
After the organs of respiration were thus regulated, he
made the patient jironounce the vowels with a deep
chest voice. Then followed the " correct " formation

FROM THEORY TO PRACTICE 29

of consonants, only worth mentioning here, because, in
those cases where d or t caused difficulties, he advised
the use of a short e before d and t, and insertion of an h
behind d and t. Thus, for example, such a sentence as
** Barking dogs don't bite " would be pronounced in
this way :

e-B-harking e-d-hogs e-d-hont e-b-hite."

Charles Bell, whose views on stammering were pub-
lished in 1832, was unable to give the sufferers any
better advice than to begin all sentences with a vowel —
advice which was based on the practical experience that
the " vowel initial sound " is exposed to disturbing
phenomena in a lesser degree, though it is by no means
put beyond the reach of spasmodic influences.

In the May of 1843 a sealed manuscript was deposited
at the Academy of Paris, which contained a new system
invented by Jourdant. This was done at the request of
Becquerel, who announced soon afterwards to that
learned society that, after having been treated without
success for twelve years by Colombat's method, he was
cured in as many days by that of Jourdant. Some time
previous to the opening of the manuscript the carefully
guarded system which it contained was violently
attacked by Colombat and Malebouche. Owing to this
opposition, Jourdant was induced to give Becquerel
authority to publish the secret. The immediate result
of this permission was Becquerel's " Traite sur le
begaiement," in which the author endeavoured to divest
Jourdant's views of their empirical character and to
recast them into a more scientific form.

" The stammerer expends his breath too quickly, and
thus prevents it from being made proper use of for the
production of vowels and consonants. It is imperative,

80 STAMMERING AND ITS CURE

therefore, to guard against this defect by regulating the
respirations properly. After inhaling, the stammerer
has to make a short pause, during which the chest
is expanded, while the abdomen is shghtly protruded.
Then follows the pronunciation of the word, the patient
maintaining the attitude described, and setting up
opposition to the chest and abdomen going back
suddenly. Thus, after the words are pronounced, a
sufficient quantity of breath will have to be retained for
a conscious act of respiration to take place. The whole
procedure is divided into three parts, each to be marked
by a movement of the thumb : (1) Inspiration with
pause ; (2) pronunciation of one word or several words ;
(3) expiration of the remaining air."

Becquerel had not treated more than a few stam-
merers when he was obliged to admit that the hoped-
for results were not forthcoming in several cases.
Nevertheless, he thought he would be justified in
warranting that the application of the method would
lead to satisfactory results in a proportion of trials.
In the same way that Malebouche tried to justify the
necessity of modifying Mme. Leigh's treatment by
pointing out the innumerable failures of his prede-
cessors, and just as Colombat blew his trumpet at the
expense of Malebouche's failures, so Becquerel, in his
turn, made good use of his opportunity of criticizing,
in anything but a favourable manner, the work of
Malebouche and Colombat. He informed his readers
that their methods had proved an absolute failure with
many stammerers, and that the impediment had returned
in its former intensity in the cases of many patients
who had visited Colombat's Institute. It may be
mentioned, en passant, that Becquerel, in later years,
developed Jourdant's method by combining with it the

FROM THEORY TO PRACTICE 81

gesticulation feature of that of Serres d'Alais, as we
gather fi-om a dissertation by Violette (a pupil of
Beequerel) published in 1858. We owe to the same
treatise the interesting information that Beequerel
became less confident of the success of Jourdant's
method as years went on, and ultimately even denied
the possibility of a " complete cure."

This is also the period which was marked by the
commencement of Emil Denhardt's treatment, though
it was not applied on an extensive scale until a quarter
of a century later, by Rudolph Denhardt. The latter
was the first expert who realized that stammering is
induced by psychic influences only, and that, in order
to effect a cure, it was necessary to apply counteracting
suggestions. Unfortunately, like all his predecessors,
he made the disastrous mistake of adding breathing and
speaking exercises to the psychic measures. Assuming
that a stammerer, when speaking, either entirely omits
the breathing movements required for phonetic pur-
poses, or carries them out in an incorrect manner, he
began by endeavouring to make the sufferer familiar
with the conscious use of the muscles of the ribs when
inhaling. The mouth must not be opened beyond the
breadth of a straw, as, otherwise, the usual abdominal
respirations set in, which, in his opinion, should not
take a prominent part in the formation of sounds.
Great care has to be taken to avoid a premature waste
of the inhaled air, and to ensure that the whole of the
inspiration be used for the formation of sound. The
words of a sentence have to be drawled and pronounced
in such a way that they are, as it were, borne by the
slowly escaping breath. The whole emphasis is put
on the vowel of the first syllable, whilst the articula-
tion of consonants is carried out as quickly and smoothly

32 STAMMERING AND ITS CURE

as possible. The stammerer has to concentrate his
attention on the vowels, and must particularly endeavour
to seize the first one with full effect, whereas he has to
consider the consonants as an inferior element in the
words, and to slur over them easily and quickly. Den-
hardt thought in this way to attack the tendency of the
stammerer to allow the articulation of consonants to
predominate over vocalization. He was also of the
opinion that a vigorous co-operation of the mouth,
especially of the lips, was of the greatest assistance
to the speaker. He further laid stress on the words
of a sentence being strung together in such a manner
that the whole sentence forms a single coherent word,
as it were. If the stammerer, after successfully com-
mencing the sentence, experiences difficulties as he
proceeds, he has to treat the word which has become
an obstacle, as he would treat the commencement of
a new sentence. He must inhale deeply, elongate the
first syllable, and, for a second time, must try to make
the sentence into one coherent word. Other rules were
made. The sufferer, for instance, should always speak
with both rows of teeth as far distant from each other
as possible, while a scarcely noticeable " h . . ." was to
be prefixed before the opening vowels, in case their
pronunciation offered any difficulties. At the outset
the patient was frequently placed before a looking-
glass, in order that he might see to advantage the
unbecoming contortions of his facial muscles, etc.

Denhardt has treated more than 2,500 stammerers,
and claims to have cured 93 per cent. The latter figure
is more than exaggerated ; as a matter of fact, his
permanent cures reach an appallingly small percentage.
Suffice it to say that the author has twice been treated
by Denhardt, and that neither he himself nor any of

FROM THEORY TO PRACTICE 88

the many fellow-sufferers he met at Denhardt's Institute,
and with whom he kept in touch afterwards, found a
permanent cure there.

The juggling with speech of everyday life, which we
have met with in nearly all the methods that have been
mentioned, is to be most severely condemned, quite
apart from the fact that tricks of any description can-
not possibly remove deeply rooted psychic resistances.
The worst instances are undoubtedly the time-beating
methods, such methods having no foundation in the
normal condition of natural speech at all. It must, of
course, be admitted that the stammerer's attention is
directed into other channels by those means, with the
beneficial result that the fatal thought of his affliction
does not have the chance of intruding as often as it
would do. Any system which binds the sufferer to use"
a way of speaking which deviates from the accustomed
form naturally reckons with that circumstance. So
long as the patient is able to make use of those artificial
'* crutches," the affliction actually decreases for some
time ; and it is in this restricted sense alone that we can
grant the right to the champions of such systems to
speak of " successes." Unfortunately, the person trained
in this unnatural manner only too soon finds himself
unable to make use of the " crutches " for any prac-
tical purposes. Even the slightest excitement may be
sufficient to give his train of thought another direction
altogether, with the result that, all artificial support
being completely knocked over, the stammerer finds him-
self a cripple still ! It is to be regretted that the time-
beating methods are still practised, particularly in the
United States of America and in Great Britain, where we
find tliom combined with vocal gymnastics (sometimes
even by the aid of dumb-bells), breathing exercises, etc.
3

34 STAMMERING AND ITS CURE

After this short digression we will return to our
chronologic reports.

Klencke has repeatedly given his views on stammer-
ing in detail, the last time he wrote being in 1866. In
his treatment he aimed at strengthening the mental
control over the respiratory organs and developing these
organs by systematic exercises. By various " drills,"
by means of which the phonic inspiration — the inspiratio
costalis — should take its proper place, the breathing
organs were brought to more intense acti\4ty. For
preference he apphed shouting (in order to strengthen
the vocal cords), gymnastics, fencing, swimming, cold
sponges, and, to strengthen the lips, he induced the
patient to speak for some time with his teeth closed.
In the second week the stammerer had to begin
practising vowels. After a deep inspiration a short
pause was made; then followed the elongated pro-
nunciation of " Ah . . ." until the store of breath was
exhausted. Combined respiratory and vocal exercises,
after a model devised by Klencke, came last.

The establishment of the right proportion between
vocalization and consonantal articulation was brought
about by mechanically aggravating the articulatory
movements. The most important feature, however —
the keeping of a fixed time — was also required by
Klencke in his system. In order to accustom the
stammerer to speaking according to time, he either
gave him a baton or induced him to move thumb and
forefinger towards each other, and thus to accompany
all his words syllable by syllable. The temptation to
leave off time-beating too easily led to a serious relapse.
Not until several years later would Klencke allow his
patients to lay aside these tricks.

Hand in hand with the respiratory exercises a psychic

FROM THEORY TO PRACTICE 35

and moral influence was supplied by the attendant in-
structor, the aim of which was to rouse the stammerer's
confidence, to give his soul a new verve, and encourage
his self-reliance and energy. Viewing the aetiology of
the affliction as he did, it is self-evident that Klencke
would also apply medicinal means. Being under the
impression that the cause was to be found in a disorder
of the nervous system or in scrofula, he endeavoured to
attack these causes by prescribing belladonna, opium,
iodide of potassium, etc. His chief point, however,
was the didactic side of the treatment, medical remedies
playing quite a secondary, but not always an unim-
portant part.

Chervin, another enthusiast in the cause, who prac-
tised in France and Belgium, required a period of
complete silence at the commencement of the " cure,"
a prescription derived very probably from Katenkamp,
who considered that the actual treatment of the patient
should not begin until he had abstained from speaking
for a period of six weeks. If within this time he
happened to have the misfortune to break silence,
he must regard the injunction as commencing again
from that day. The fundamental idea of this peculiar
proceeding (approved also by Wineken and others) was
adopted in Chervin's system, otherwise the latter does
not contain anything but forced gymnastics or training
of the respiratory, vocal, and articulatory organs, which
occupied the patient from 7 a.m. to 6 p.m. It would
be futile to reproduce a series of those exercises, as all
of them show clearly that the leading principle and the
main momenta are anything but new and original.

For the correct execution of the exercises the teacher
serves as a model to the patient. The principle of
*' imitation " laid down here will probably have been

36 STAMMERING AND ITS CURE

applied by anyone who has honestly tried to remove
impediments of speech. What is further recommended
by Chervin — such as slow speaking, opening of the rows
of teeth, the accompaniment of each syllable by a
** natural " movement of the hand — contains nothing
that we have not already met with.

Since the time of Mme. Leigh and Cormack, the
regulation of the respiratory functions occupied rather
an important position in the therapeutic prescriptions
relating to stammering. With the time-beating method
(especially in the style which is particularly associated
with Klencke's name) systematic breathing exercises
form, as it were, the basis of treatment.

This close connexion has, however, been broken up
in comparatively recent years by Coen, who, during the
first four weeks, filled the time exclusively with respira-
tory exercises. This training enables the patient
strongly and completely to inhale for fifteen seconds,
to retain the inhaled air for sixty seconds, and to regu-
late the expiration quite arbitrarily — i.e., the stammerer
has to leani at will to carry out the act of expiration
quickly and strongly, on the one hand, and slowly and
in a prolonged manner, on the other. Later on, both
inspiration and expiration are also practised in a com-
bination of intervals of certain durations. Not before
the beginning of the fifth week are vocal gymnastics
added to the treatment. These are arranged in such a
manner " that they are apt, on the one hand, to stimu-
late and strengthen the action of the muscles of the
larynx, and, on the other hand, to increase the elasticity
of the vocal cords and of the muscles of the thorax.'*
After a deep inspiration the single vowels are formed
as long and as loudly as the breath and the voice of the
patient will allow, making the tone gradually swell to

FROM THEORY TO PRACTICE 37

greater force, and then, as gradually, to die away. In
further pursuance of the exercises, the connexion of
several vowels during one expiration is then taken up :
n — e, a — i, a — o, a — u; a — e — i, a — e — o, a — e — u;
a — e — i — o, etc. In order to avoid too strong a tension
of the ligaments and the irrritation which would result
from it, Coen forbade his male patients to use the
falsetto notes. At the ninth week the exercise of the
so-called speech drill commenced, which consisted of
exercises in syllables and the reading of poetry and
prose.

To attack the abnormal innervation which is the
fundamental cause of the affliction, Coen applied
electricity, certain medicines (ferrum, quinine, and
opiates), and suitable hydropathic remedies, such as
cool demi-baths, to be taken daily.

The duration of the treatment generally averaged
about 140 days, though Coen mentioned 48 days as
sufficient for slight cases and up to 310 days for severe
ones. His statements in his different publications
about permanent cures and lasting improvements are
very contradictory. Like his colleagues in the present
day, he has not been careful to avoid *' terminological
inexactitudes."

As we saw, Coen (together with Klencke, Kussmaul,
and others) applied medicinal means in his treatment
of stammering in addition to his curative pedagogics.
The application of medicine as the chief part of a cure
has been tried in recent years, but never with any
success. Mercurialis, Schulthess, and Romberg were
altogether unsuccessful in their mode of treatment.
Now and then the efforts of medical and non-medical
advisers, enthusiasts in the department, have been pro-
ductive of very curious results. About twenty years

88 STAMMERING AND ITS CURE

ago a medical expert in defects of speech, Gerdts of
Bingen in Germany, applied a tincture consisting of
rectified alcohol, peppermint oil, and chloroform, the
object of the concoction being to "still the cramp of
the diaphragm," to which he attributed the cause of
stammering. Schmalz, whose name is respected in the
field of aural diseases, suggested an embrocation of
petroleum for the throat. The application of this
remedy produced, particularly in Sweden, a nearly in-
vincible distrust of any treatment for the infirmity, a
distrust which lasted for several years. Later on,
Langenbeck experimented on stammerers by inocu-
lating them with croton oil. Needless to say, this also

proved futile.

No doubt many more such instances could be re-
corded if everything that has gone on in the privacy of
the medical man's consulting room were made public.
One can easily understand that, until quite recently,
the non-success of treatment through the ordinary
channels of materia medica has necessarily caused
stammerers to seek rehef from their distressmg symp-
toms by other means, and electricity has been one.
Coen allowed electricity quite a secondary place in his
treatment; while others (among them men of renown)
thought that they had found in this science the most
valuable, if not an altogether conclusive, curative agent
for the complaint. Others, however, assumed a calmer,
and some even a sceptical, attitude towards this new
departure. Klencke declared positively that he had
never come across any lasting results from electrical
treatment, and Rosenthal's experiments proved that
the continued application of the inductive current to
the head, larynx, and hypoglossus was absolutely futile.
Unfortunately, owing to specious advertisements, the

FROM THEORY TO PRACTICE 39

conviction is deeply rooted in many minds, even in the
present day, that the " marvellous curative influence of
electricity " will ultimately triumph over the impedi-
ment, in spite of all previous failures.

To the medical faculty, then, we may attribute efforts
made (in all good faith, we are sure) to cure stammering
by applications of medicine and of electricity, as well as
the surgical operations of Dieffenbach seventy years ago.
Well-known medical men, who have made the deepest
possible study of the subject, have been able to cure
neither themselves nor others of this malady. This is
the chief reason why, gradually, the work was taken up
by non-medical men, some of whom have put forth
stupendous energy in their efforts to solve the difficult
and apparently insoluble problem. A host of minor
satellites, who have thrust themselves into the arena,
deserve to be pilloried, as being responsible for a shame-
less charlatanism, which blots the pages of the history
of this subject. Men of positively no education, with-
out experience, without insight into so much as the
nature of stammering, have the presumption to offer
their help and to describe their treatment (save the
mark !) as infallible. That such persons never entirely
disappear from the scene, but continue to maintain a
" successful " existence, must be considered a proof of
the regrettable fact that a large number of people are
still to be found who are easily cajoled and victimized.
It is, however, not only the illiterate who are thus
engaged ; sad to relate, many self-styled experts, with
education enough to make themselves well acquainted
with the subject, imitate systems, such as we have put
before our readers, and play a daring game with them.
Needless to say, these systems always come before the
public as the " quite new and original method of " so-

40 STAMMERING AND ITS CURE

and-so. And, crowning all other unscrupulous adven-
turers, we must not omit to mention the quack doctor
who eradicates stammering in little or no time with
some infallible drug.

After this digression, we are glad to return from our
necessary trip into provinces so unpleasant. We have,
however, but little to add to what has already been told
of the various modes of treatment.

In the course of the last thirty years a system for
the cure of stammering has found a very considerable
circulation in Germany and Austria, namely, that "origin-
ated " by Gutzmann of Berlin. It represents, however,
nothing more than a slightly altered imitation of Den-
hardt's method. Its notoriety was not due to the
merits of the system, but solely to its bemg adopted
by the Boards of Education, which, since 1886, have
endeavoured to attack the impediment while such
children as were affected were passing through the
scholastic period. Special courses of treatment under
trained teachers were provided. Similar efforts have
been made in Great Britain in recent years. While
respecting these praiseworthy endeavours, we fear that
the hopes entertained of success have not been realized.
Circumstances make it impossible for the treatment to
be individual, or to influence the pupil's life outside the
school, since the child, when once emancipated from
the teacher's suggestive control, necessarily falls back
into its old habits of stammering.

As far as we are aware, there have been no further
developments of treatment which can lay claim to any
originality up to the end of the last century. Many
so-called experts have wisely avoided publishing their
methods ; but, to judge of the results obtained by these
*' secret systems," it is very unlikely that the public

FROM THEORY TO PRACTICE 41

would be benefited were their " discoveries " made
generally known. Our own close investigations entitle
us to some amount of confidence in the assertion that
we should in these secret methods probably meet with
nothing but old acquaintances. To give only one illus-
tration, we will quote the principles of the system
developed by Beasley, which has been more or less
imitated in recent years by several other " specialists '^
in the United Kingdom. The fourteen rules of which
this system may be said to consist are as follows :

1. Think of clause to be spoken (imagine it written).

2. Drop lower jaw slowly and smoothly.

3. Open mouth in position '* Ah."

4. While opening take good breath easily from
abdomen.

5. When coldness in glottis is felt let breath return.

6. Start and get a good hold of first syllable.

7. Form words on continuous sigh " Ah . . ."

8. Speak slowly ; elongate the vowels.

9. No pressure, no effort, no hurry.

10. Emphasize final consonant of each clause only.

11. Completely exhaust the breath at the end of each
phrase.

12. Never hold the breath.

13. Before any difficulty say " Er . . ."

14. Keep up the continuity of the sound.

Any comment seems superfluous, since the rules
contain nothing that has not already been known for
years.

Fortunately, during the last decade those who have
sought a cure for stammering have gradually been led
into the right path and have started from a correct
basis — namely, that a stammerer is not, and never has
been, lacking in the faculty of carrying out all the

42 STAMMERING AND ITS CURE

" movements of speech " correctly. What does happen
is that he experiences a momentary hindrance by
hampering mental impressions. Thus, intelHgent in-
vestigators reject more and more conclusively all tire-
some exercises which aim at a systematic training of
the organs of speech, having at last begun to realize
that the stammerer can speak, provided that no psychic
influences interfere. Speech drill of any description is
seen by such investigators to be utterly superfluous.

There have been different ways and means applied to
remove the psychic obstacles which make stammer-
ing an obsession. The psychic therapeutics employed
for the removal of these inner hampering influences
may be divided into three categories, in which the first
and second are closely related :
■ 1. Actual hypnosis or trance.

|, 2. Verbal (non-comatose) suggestion, or commanding
suggestion, as it might be termed.

3. Educational method, with or without the addition
of auto-suggestions.

In the first case, the patient is put into a state which
excludes arbitrary actions and suspends consciousness
more or less, thus becoming a puppet, with no will of
his own, in the hands of his hypnotizer. In the second
case, an attempt is made (without noticeably influencing
consciousness and automatic functions) to shape the
patient's impressions, feelings, and actions after the
commands or persuasion of the suggester. In the third
case, an effort is made to influence the patient in an
educational way by a more definite appeal to his intel-
lect than to his faith in authority, and it is required
that the sufferer shall take an active share in the
cure. He must try to regulate his train of thought
and dispose his actions towards the endeavour to get

FROM THEORY TO PRACTICE 48

cured, and must bring his will into harmony with this
desideratum.

Hypnotic and non-comatose (hetero-) suggestions
have been known to improve stammering temporarily,
but the effect mostly wore off by degrees. In the end
these means, like so many others, failed in their object,
in spite of the great hopes raised by the promising
experiments made with hypnotic suggestions in Nancy,
Paris, and elsewhere. Of the factors which contribute
in hypnotic suggestion towards temporary improve-
ment, we shall have more to say later on.

With regard to educational therapeutics, we are glad
to be able to state that beneficial and lasting results
have been obtained, especially in cases where the
patients have faithfully co-operated by means of intel-
ligent auto-suggestions. Of those who fight in the
front rank for educational therapeutics we may mention
Dubois,'-J Roseribach,j2 Payot,50 and Levy.39

But even thus far it had not been realized that the
problem of " ^read." represented the essential point of
all forms of hysteria, phobias, and obsessions. The
phobias, including stammering, had hitherto been the
hieroglyphics of neurology; queer signs were observed,
yet no one was able to interpret them. It is especially
due to Freud that we are at last enabled to decipher
the cryptology of neurotic people. Freud's psycho-
analyticaPtreatment has during the last few years been
applied to the cure of stammering as well, and the
results have been so excellent that experts like Stekel,
A^ler (Vienna), Jung (Zurich), and others are thoroughly
convinced " that in future the therapeutics of stam-
mering can only be psycho-analytic." What this treat-
ment is, and on what extraordinary discoveries it is
based, we shall fully explain as we proceed.

44 STAMMERING AND ITS CURE

On looking back at the history of the attempts to
cure one of the most distressing afflictions that flesh
is heir to, we cannot fail to notice that each of the
different attempts, even the quite irrational ones, did,
at least in the beginning, show some results. Though
a large amount of self-delusion may have crept in, or
the old motto " Mundus vult decipi, ergo decipiatur "
may have been acted upon, a remnant of cures un-
doubtedly can claim reliability. We shall later have the
opportunity of showing in what manner this fact may
be explained.

/

CHAPTER III

MECHANISM OF SPEECH

nrN order to prove our contention that all forms of
I speech drill can be done away with and that stam-
mering can be treated solely by psychic means, we
will present the affliction in its various forms, and, in
order to facilitate matters, we will give illustrations
from its counterparts. In the first place, we will
picture the manner in which normal speech is brought
about — that is to say, how a child learns to speak.
Dr J. Wyllie, in his book entitled *' The Disorders of
Speech," speaks with regret of the small advantage
that is taken by *' the medical parent " of the oppor-
tunities he has of noticing " the phenomena presented
in the course of the development of speech in his own
child." This, however, he proceeds to say, " is a tedious
process, requiring much self-denial and patience," and
he mentions Charles Darwin and Professor W. Preyer
as ha\nng been amongst the few who have made these
observations with great perseverance and success. In
the second place, we will notice what processes in the
human organism are brought into play with each normal
act of speaking.

The use of articulate language demands movement
of the mouth; a person opens, closes, rounds, purses
up his lips, and so forth ; occasionally, when lips and
teeth part, the tongue becomes visible, now in tliis

45

46 STAMMERING AND ITS CURE

now in that position. When looking closely, one further
notices that the front portion of the throat takes part
in the process of speaking, and, finally, that the chest
works more noticeably than usual, expanding and con-
tracting more quickly, whereas in times of silence— in
normal sleep, for instance— the heaving and the lowering
of the thorax show about equal duration.

All those movements, the collective acting of which
causes vibrations of the air, we term articulate
language; all those movements of mouth, larynx,
and lungs are caused by the contracting of certain
muscles and the simultaneous expanding of their coun-
terparts within the organs mentioned. As everybody
knows, with the movement of any part of the body
a pair of muscles or parts of them are in mutual action
with one another. When a part of the body, owing to
the contraction of one muscle, has undergone a change
of its position, the same muscle is not able to regain
the original position, but a second muscle is required,
by contraction, to move that member of the body into
the opposite direction.

All muscles that we can move by an act of our will—
the muscles which close and open the mouth, for
instance— are connected by nerve-fibres with the central
station in man— the brain and spinal cord. When one
of these nerve-fibres is reached by a stimulus, the cor-
responding muscle reacts with a contraction. When,
therefore, during the act of speaking, now these, now
those parts of the mouth, throat, and chest move, such
movement is caused by contractions carried out by
this, then by that muscle ; these contractions, again, are
the results of irritations or stimuli of the will which
reach the different nerves.

In order to produce a single sound— e.g., " Ah ! "—

MECHANISM OF SPEECH 47

several contractions of muscles are required, and also
several nervous stimuli, which partly follow each other
and partly march side by side. A child (as will generally
be known) does not bring into the world the art of
enacting this multifarious play of nervous stimuli.
What he brings with him is, apart from the organs
required for speech, a certain predisposition for speak-
ing, which he owes to countless previous generations.
Thus, certain parts of the nerves are more sensitive
than others ; consequently they can be put into action
more easily. The art of speaking, however, has to be
gradually learned by the individual being, and the
practice of this art commences very early. The first
cry with which an infant, unpleasantly affected by the
sudden change of temperature, salutes its new environ-
ment, initiates this — always unconscious — practice.
Mostly to the annoyance of his nurse, but much to
the advantage of his cultivation of speech, frequent
outbursts of crying follow later on, induced either by
hunger or by any feelings of inconvenience or dislike.
The child whose ear soon opens and gradually awakens
takes in his own crying with his mind, and, by the
synchronism, presently notices the connexion between
the movements of the muscles he feels and the crying
he hears.

Those paroxysms of crying are, as already mentioned,
induced in the nervous channels by feelings of dislike.
These feelings live in those nerves which are termed
sensorial. From these sensorial nerves, those nerves
are stimulated by reflex action which are connected
with muscles, and more particularly those motor nerves
are influenced which, owing to heredity, are easily
accessible by nervous stimuli — viz., the nerves con-
nected with expiration, the vocal ligaments and the

48 STAMMERING AND ITS CURE

mouth, on the one hand, and the nerves moving arms
and legs, on the other. In other words, when feehngs
of dislike arise, the child cries and moves his arms and

legs about.

These muscular movements do not always show the
same intensity, the intermittent actions of the child,
when moving his arms and legs about and when crymg,
alternating with each other. This is evidently con-
nected, on the one hand, with the varying mtensity of
the feelings of dislike, and, on the other hand, with
conditions of exhaustion in the motor nerves. In the
same degree in which the feelings of dislike and the
strength of the nerves rise and fall during the paroxysm
of crying, the intensity of the crying voice alters.
Sometimes the crying increases spasmodically, and
assumes the timbre of wilfulness or obstmacy; only
a small amount of intention seems to be united with the
crying, so that, in this period, the child is already
acquiring the capability (by influences of his will) to
put in the background the reflex character of crying
after it is once started by feelings of dislike. These
moments, where feeling makes room for volition,
augment from day to day, especially when the infant
notices that the nurse responds and helps him. They
are of the greatest importance for the development of
speech : each of these acts of volition, each obstinate
cry which sharply interrupts the reflex crying, helps the
child to leave the latter period and to pass on to that of
arbitrary production of sound.

Progressing in his mental and physical development,
the child, according to the mood which is prevalent-
here, also, the feeling is the mother of the sound-soon
begins to crow or to yell, and, occasionally, even forms
a cultured sound m addition to the other " wild " ones.

MECHANISM OF SPEECH 49

At first the exercise is quite unintentional; in time,
however, the child hears the playful sounds, and, not
rarely, finds a delight both in his momentary products
and in the muscular movements inducing them. This
feeling of delight induces the baby to repeat such
sounds and to utter over and over again his "bbb," or his
*' ah-ba, ah-ba," or " ah-boo, ah-boo," and so on. These
repetitions, therefore, are no longer a mere product of
chance, but the child has been induced, owing to his
pleasure in the tones of his voice and his muscular
movements, to produce those sounds spontaneously by
the aid of the nerve-channels which had just been
stimulated. The repetitions are the second bridge
leading to the conscious production of sound.

Let us suppose baby is feeling very comfortable in
his cosy crib. The child's attention then lives quite
in the sphere of feeling, and — in moments of supreme
comfort — without intention he stirs those nerves and
muscles which, particularly " sensitized " by the prac-
tice of previous generations, produce tones of a con-
tented description, such as '* ah-boo," uttering the sounds
even perhaps a second and a third time. By degrees
the child becomes attentive to the melodious tones —
that is to say, his attention is now diverted from the
sphere of feeling to that of hearing. When, however,
the sound has died away, he returns, under the influence
of the warmth of the bed, into the sphere of feeling ;
again resounds the tone, and again baby pricks up his
ears, and so forth. When the child is somehow
reminded of this tone later on, the sense of comfort
need not fully reach that previous degree, the joyful
thought of the sound heightening contentment up to
the intensity required. So soon as this degree has been
reached, the feeling of comfort again induces that
4t

50 STAMMERING AND ITS CURE

sound. Thus the sphere of hearing, through the sphere
of feehng, is connected with those nerves which pro-
duce sounds of speech. As it is with the child, so we
find it with the adult. It is not necessary at all to
suppose that hearing seeks for other ways to the organs
of speech than those which are opened up by comfort.
As is the case with the baby, so later on in life a
comfortable frame of mind and a desire to talk are also
in a pronounced proportion to each other. When we
/ are in an extremely happy mood, only a very small
X inducement to talk is required to make us squanderers
/ of words; whereas, when we are down in the dumps,
1 it requires somewhat stronger interests to draw even
scanty remarks from us.

When we think of a sound, certain auditory nerves
(that is to say, their inmost fibres) at the same time move
in us in a fixed succession, connexion, and time; and
each sound, thought of quietly, induces, in the way
just mentioned, a group of irritations in the centre of
word-locomotion, again m a fixed succession, con-
nexion, and time. When, for instance, the child thmks
of that " ah-boo," the connexion between the two
centres immediately becomes outwardly noticeable, and
the child utters that " ah-boo," provided that the sphere
of feeling is sufficiently stimulated. In the ordinary
way both centres are separated from each other; we
mostly think silently. However, when the interest m
speaking increases, and the pleasure of speaking is not
restricted by more powerful factors, that separatmg
layer is broken through, by reflex action, as it were, and
the group of irritations corresponding with the silent
thoughts at once begins its action in the centre of word-
locomotion. As, at first, with a senseless word-image,
so, later on, with single sounds, syllables, and words,

MECHANISM OF SPEECH 51

a corresponding group of successive irritations is
associated in the motorium. According to individual
habit and momentary intention, these pairs of groups
are large or small. A complex of words flowing from
the mouth in succession, without a pause, seems to be
connected with a corresponding complex of thoughts,
so that we need only once think of such a structure of
thoughts to make it rattle out mechanically, like a
chain, in the motor apparatus, without our being con-
scious of all the details. In other words, while speaking
a sentence, we can already think of the next one, to
a certain extent. The more frequently a child, in
repeating the sounds, uses those junction-lines between
the word-image centre and the word-locomotion centre,
the more traversable they become; the more that layer
separating them seems to lose its resistance, the more
easily the feeling of comfort induces the action of the
organs of speech.

By the aid of those trained junction-lines between
the word-image centre and the word-locomotion centre,
the child ultimately begins to repeat also such sounds
and syllables which he has not spoken himself for the
first time, but has heard from his environment. We
will suppose that the mother has shown the child how
to pronounce the word "papa." At first, conducted by
the ear, in the word- (or sound-) image centre an im-
pression is induced in the shape of an irritation of
certain nerves, in a fixed succession and intensity. The
child likes — the word being of the nature of music to
him — to find pleasure in the same sound once more;
the imitative instinct begins to take rise, which induces
the baby to mimic the word " papa." Having already a
certain routine with the articulation of *' bbb " and

ah," he, after several failures, ultimately succeeds in

((

52 STAMMERING AND ITS CURE

producing " baba." That sound is, to a certain extent,
like '* papa," but is not quite correct yet. The child
himself perceives the difference very well, owing to
the control carried out by his ear. Further exercises,
strongly promoted and supported by his mother's com-
mendation, eventually produce the wished-for word
"papa." The joy at this achievement generally finds
its jubilant expression in frequent repetitions of the
acquired word.

In the same way, as with b and p and a and their
connexions in ba and pa, the baby gradually learns to
pronounce all vowels and consonants — that is to say,
more and more paths between the word-image centre
and the word-locomotion centre are formed. Having
thus, to a certain extent, learnt how to form all the
sounds which are used in the language of his environ-
ment—following the principle of imitating first those
sounds which appear easiest to him, and then the more
difficult ones— the child tries to consolidate his posses-
sion by vigorously practising, in a playing manner, the
innumerable associations of vowels and consonants,
which become syllables and then words.

Already, with the first awakening of the senses, the
auditory word-images begin to be connected with the
images of persons and the things signified by them;
so, for instance, the word-image " papa," heard by the
child, is associated with the image of the person thus
called. All these images of persons or things together
form a third centre, the so-called centye of ideas. It is
therefore at a very early age that connexions between
the word-image centre and this centre of ideas are
formed. The more frequently the nervous current (or,
psychologically speaking, the child's attention) travels
from one centre to the other, the firmer and more

MECHANISM OF SPEECH 53

fluent become those connexions, and the better he
understands what is meant by the word " papa," and
the word presents itself in his mind with increasing
facility when he thinks of his father.

When the child, on seeing his father, wishes to call
him, and therefore utters the word " papa," first the
word-image centre has to be stimulated, and only from
here — not immediately from the centre of ideas — the
centre of word-locomotion can be stimulated ; in other
words, a word has always first to be thought of silently
before it can be uttered.

Thus the child soon begins to combine ideas with
the words which he hears, and amongst the words
imitated by him frequently those are found to which
he attaches a meaning. This stage represents but first
steps. A moment comes, however, when, looking at
an object, the characterizing word occurs to the child
(for example, when looking at milk, this word enters
his mind ; or, inversely, when thinking silently of the
word, at once the impression of the corresponding liquid
is associated) ; not until this moment does speech begin
to become a means of thinking to the child. When,
from this moment, the child longs for the milk, he at
the same time (at first rarely, then more frequently)
thinks of the word *' milk "; from now the movements
of his arms more and more adopt the character of
gestures which are connected with the word thought of.

When ultimately the child occasionally succeeds in
uttering such a word simultaneously, he has reached a
still higher stage : speech has now become to him a
means of expression. According to the tone with which
he utters the word '* milk," it means either *' I want to
have milk," or "That is milk," and so forth. Before
long two words are pronounced one after the other,

54 STAMMERING AND ITS CURE

and thus, when two impressions are brought into re-
lation with each other, almost a sentence is evolved —
«« Milk hot." Verbs also enter into the circle of con-
ception, at first m the simplest form— " Have milk."
Later on they are— often, of course, in an ungram-
matical manner— conjugated too—" Baby eated." The
number of words spoken in one breath, by degrees,
grows, and finally the child also learns how to give
the words the grammatically correct position. All this
progress is made by first repeating the words like a
parrot, thus impressing word-images on his mind, and
afterwards forming the expression of his thoughts in-
dependently.

As it is a long, weary road of development and
training that a child has to travel before he masters
articulate language, to a certain extent, it is not to be
wondered at that not a few (temporarily) stumble on
the way. Some need plenty of time for a distance
which is traversed by others at a flying pace. The
desire to speak, the temperament, the fitness for educa-
tion varies with the individual, while the impulse of
speaking which the environment supphes, and last, but
not least, the physical disposition, all combine to
promote or retard the child's progress. Most children
understand more of the words spoken by their parents,
brothers, sisters, etc., than they are able to pronounce
themselves, and in many there exists the eager desire
to say things which they find still too difficult to utter ;
in short, I a disproportion often becomes apparent be-
tween conc^ptiQlL_and imitation, on the one hand, and
between the desire_to speak and the capacity to do so,
on the other. Especially important is the latter pomET
Very lively children are eager to say as much as possible in
the quickest time available, but their organs of speech are

MECHANISM OF SPEECH 55

not trained enough yet to follow such haste of thought;
they are then inclined to exert themselves, and to in-
crease the pressure on larynx and mouth. In this way
not only the speech nerves are irritated beyond measure,
but the children also feel the incapacity of their organs
of speech. This enters their consciousness, causing them
to dislike speaking, though this dislike appears only
very momentarily. Two influences, therefore, meet
here in an injurious way — a physiologic and psycho-
logic one ; their intensity gradually increases from one
action connected with speech to another, unless more
powerful physical and psychic proceedings counteract
them and remove their traces. In nearly all cases nature
succeeds, thanks to the inherited routine of previous
generations, in forcing its way through triumphantly,
and in balancing gradually that disproportion between
the desire to speak and the capacity to do so, but
slight reminiscences of nervous irritability (that is to
say, slight uneasiness in speaking, owing to intense
emotions, dislike of speaking, and embarrassment) be-
come still noticeable for some time to the physiologist
and psychologist.

On the whole, certain indications of the manner in
which a person has learned to speak are apparent to
the attentive and experienced observer by the way in
which that person expresses himself. We will now
turn to the adult. By a very simple instance we will
explain the proceedings which take place with an
ordinary speaker when uttering a sentence, and point
out those momenta which intervene either in a further-
ing or in a hampering way.

Supposing a person has to make some remarks on a
beverage set before him. First of all, he, of course, tries
to find out what is standing before him. He sees that

56 STAMMERING AND ITS CURE

it is a liquid ; by its colour and smell he supposes it to
be cocoa. Having tasted it, he finds that it is cocoa,
and that it contains plenty of sugar, and that it is hot ; he
feels now that he has burnt his mouth. By means of the
senses — viz., of the eyes, nose, taste, and feeling — stimuli
(according to the physiological conception), apper-
ceptions, impressions, and thoughts (according to psycho-
logical conception) are abundantly transferred to the
centre of ideas. Here the matter ends in the case of
a deaf and dumb person; he continues to work silently
with these impressions by putting them in reference to
each other. A normal individual, however, at the same
time employs the word-image centre. Each appercep-
tion— i.e., each irritation of the nerve-channels con-
nected with the four senses mentioned before — is
followed up by an irritation of the junction-lines
between them (the centre of ideas) and the word-image
centre; in other words, each observation is connected
with word-images spoken inwardly : " That is a liquid,"
" It is coloured like cocoa," *' It smells like cocoa," " It
tastes like cocoa," " It is very sweet," etc. It is, of
course, entirely dependent on the choice of the in-
dividual as to which of these sentences are to be uttered
— that is to say, in connexion with which of them the
centre of word-locomotion has to come into action.

Smaller or larger groups of thoughts are, as already
mentioned, associated with a smaller or a larger group
of stimuli for the motorium. Many a stimulus seems to
rush forth immediately and involuntarily. When the
person burns his mouth with the cocoa, either a cry
escapes him or the exclamation, " Hot ! " If he possess
a fair amount of self-control, he will use a whole
sentence : " This is hot 1 " " This stuff is hot ! " " This
cocoa is hot ! " In this case the temperature of the

MECHANISM OF SPEECH 57

cocoa evidently is the most important thing to him,
and this side of his apperceptions, therefore, pre-
dominates over the other.

Apparently, the thought of heat predominates, simply
because this quality obtrudes itself particularly strongly
upon the observer. That these sensorial nerve-channels
and, consequently also, motor-channels are irritated
depends : —

1. On the intensity with ivhich the object acts. If,
however, the same person has shortly before tasted a
liquid which is hotter still, but quite bitter, he notices
the heat much less than the sweetness of the cocoa.
Further, the direction which is chosen by the irrita-
tion in the sensorium and, consequently, also in the
motorium, of speech is dependent : —

2. On the momentary condition of senses and mind,
influenced by previous irritations and particularly by
the individual's state of health or frame of mind. For,
when we feel well, everything is impressed more easily
on our mind ; the nerve-channels seem to be more pass-
able ; everything is going like clockwork when we feel
very comfortable ; whilst, on the contrary, when we are \y
indisposed, we are as lazy in thinking as in speaking.
Analogous to the latter state of mind, which induces
feelings of dislike, though confined to a shorter time
(in comparison, however, acting much more intensely),
are certain emotions which burst forthjyiolently, such as
terror. Here we see distinctly (it should be mentioned,

by the way, that this phenomenon is not absent when
any strong feelings of dislike assert themselves) that
the organs maintaining the process of life — viz.,
stomach, lungs, heart, kidneys, etc. — play an important
part in these psychic proceedings. The irritation of
terror, coming on with great and sudden vehemence,

68 STAMMERING AND ITS CURE

would annihilate the nerve-channels struck by it, if this
irritation did not spread over the whole of the nervous
system by means of the brain centres, and were thus
lessened. Naturally, this irritation becomes especially
noticeable in the motorium. Under the influence of
terror, all muscles show the tendency to contract
suddenly, whereas the organs worked by them are
retarded in their movements, provided that the affected
nerves and their counterparts are equally irritable. If,
however, the irritability of the nerves differs from that
of their counterparts, the movement of the organs is
only retarded if the group of nerves chiefly active is
less irritable than its opponent, otherwise, a momentary
acceleration is the result. This applies both to the
voluntary muscles— e.g., those of the organs of speech
—and to the involuntary— e.g., the cardiac muscles.
We notice the shock of the Umbs, owing to the general
contraction of the muscles, and perceive that retardation
to simulate paralysis. This paralysing feeling is still
increased by the anelectrotonus simultaneously induced,
by which the influence of voluntary stimuli on the nerves
and muscles is weakened.

Fear, dread, anger (at least at the first moment) pro-
duce similar effects; in short, everything that causes
unpleasant sensations (even good news broken to us
suddenly) is in its effects, at first, decidedly dis-
agreeable. The emotions derive their special character
from the contents, intensity and duration of the per-
ceptive irritation inducing them. According to the
contents, this perception is particularly connected, now
with the organs of breathing, now with the organs of
the circulation of the blood, etc., by way of association,
so that, according to the contents of conception, this or
that organ is more affected. This influence is made

MECHANISM OF SPEECH 59

unpleasantly conspicuous in the motor nerves — e.g.,
those of the organs of speech. When dread is directed
to the organs of speech, these nerves are afflicted three-
fold : (1) By irritations of volition ; (2) by the irritation
of dread ; and (3) by attention. He who dreads the
pronunciation of certain words, or letters, concentrates
on these words particularly frequently and intensely,
thus irritating these parts of the word-image centre
especially strongly, with the result that, from here, the
centre of word-locomotion also receives extremely in-
tense stimuli ; it cannot, therefore, be wondered at that
the nerves succumb to this threefold irritation.

8. It further depends on attention which nerve-
channels are irritated (and to what extent) by an apper-
ception. The observer may perhaps just have been
engaged in matters which interest him to such a degree
that he has no inclination for anything else. The
pleasure his thoughts have experienced with that occu-
pation takes the visual point of his consciousness back
to it over and over again. To return to our illustration,
his attention for the liquid put before him is consider-
ably divided, and he will either take a long time in
finding out what he is tasting, or he will set to work
very superficially. In the latter case, the traces of his
action will not cause deep impressions on his memory,
and, further, he will be apt to make some mistakes in
speaking when relating his observations ; words which
are associated with things interesting him far more will
crowd forward automatically. Attention itself is not at
all times equally fixed even on objects which afford us
pleasure. The question why great individual differ-
ences are to be found in the capacity of concentrating
the attention on one subject, for a longer or a shorter
period, will be fully dealt with in Chapter VI.

60 STAMMERING AND ITS CURE

4. Of great importance is also the observer^ a degree
of culture. By a cliild, all those observations (that is a
liquid, that is sweet, etc.) are actually made singly and
step by step. The child is first compelled to seek after
words for some time ; he will apply circumlocutions
here and there, and ultimately will produce the sentence
word by word, sometimes even syllable by syllable.
With an adult, on the other hand, many associations
are already trained to work quite automatically, which
cannot be carried out by a child without laborious
reflection. Naturally, a certain amount of attention has
always to be bestowed on the act of speaking; it is,
however, directed to different sides of the process of
speaking during the various periods of a child's develop-
ment— namely :

(ft) In the period of imitating sounds — i.e., so long as
the child is not yet able to speak the different sounds
as well or as badly as his people do — the child, in the
first place, pays attention to the words spoken by other
persons ; attentively he repeats them silently ; tries to say
them and listen to his own word-productions, comparing
them with the words of other people. He pays atten-
tion to the movements of his own muscles only when
he intends imitating other people's movements of the
lips.

(b) In the last part of this period, in which words are
connected with thoughts, the child's attention is con-
centrated first on the thought and then on the linguistic
expression; he, first of all, listens to single words,
especially to the last ones of a sentence — their image
not being spoiled by other impressions at all, — and tries
to repeat them (echolalia); then he listens to the
adult's formation of sentences, and endeavours to
emulate him. The attention with regard to the cor-

MECHANISM OF SPEECH 61

rectness of sounds and the controlling action of the ear
(which, of course, never ceases entirely) is now con-
siderably inferior to his care in regard to the contents
and formation of the sentence.

(c) Finally, from the end of this period, where the
formation of the sentence develops more and more
mechanically, the speaker's attention is principally
bestowed on the contents of the sentence. An adult,
in the first place, thinks of what he is going to say, and
only in the second place of the grammatical form; but
he pays very little attention to hearing himself speak,
nor does it ever occur to him to watch how he 7noves his
mouthf etc. He speaks — and that is the result of many
years' practice, not to mention the congenital disposi-
tion— quite automatically, unless he choose to assume
affectation. This is the reason why most people have
not the remotest idea as to which muscles have to be
brought into action to form the different sounds — that
is to say, how they shape the mouth, etc. — when pro-
nouncing, for example, an a, d, /, g. Elocutionists and
many " speech-specialists " seem to put this fact down
to a lack of culture; here we cannot agree with them
at all, but, in conformity with one of the most eminent
authorities on defective speech,* we see in the fact
" that we do not know the construction of our speech-
mechanism at all, the best guarantee for the smooth per-
formance of the movements, for the correct and quick
working of speech. Owing to the will already find-
ing everything prepared and simply adapting the
trained mechanism to its purposes, it will achieve
the latter most easily. Just as the commander-
in-chief, in order to direct the 100,000 members of his

* Professor Dr Kussmaul, " Die Stoeruiigeu der Spraclie,"
1881.

C2 STAMMERING AND ITS CURE

well-organised and trained army in the proper way, has
to give his orders only in general outline, we merely
need, in order to carry out the most complicated move-
ments of our organs of speech, to have the wish to convey
a thought by this word or that sentence — and we
actually utter it; fortunately, we need not to care
further about the single actions required in the com-
munication between the countless inner telegraph-
stations. When our message is correctly worded and
handed in, and if the organism is in normal working
order, we can be certain of it reaching its destination."
We shall return to this point later on, when dealing
with the aetiology of stammering.

5. It is obvious that, for the intensity of the impres-
sions, the time during which the observation or irritation
lasts is also of great importance ; the same applies to
the frequency of that influence.

6. It is further not unimportant whether a long or
a short time has passed since the object was observed
last. It is evident that the traces of previous irrita-
tions by degrees disappear, if the nerve-channel has
not been stimulated recently. We forget what we
have not seen nor practised for some considerable time
— at least so far as " indifferent " recollections are
concerned. We may in an anticipatory way here
mention that impressions of memory which have been
repressed by a psychic effort do not undergo any
change, owing to the lapse of time.

Duration and frequency of the nervous irritation, the
observer's state of health, his education and the intensity
of his attention are, therefore, favourable to the act of
speaking and to the previous act of thinking.

The attitude of the nerves with regard to attention
teaches us also that smaller interruptions are welcome.

MECHANISM OF SPEECH 68

The curve of attention rises and falls — that is to say,
each more intense exertion of the ganglions is of itself
followed by a relaxation. It is not possible, with the
same eagerness, to listen to a speaker for hours ; if we
should compel ourselves to do so, we feel fidgety, which
shows that we do something unnatural. For this reason,
every speaker earns the thanks of his listeners, if, from
time to time, he either makes a pause or recapitulates
briefly, thus giving them the opportunity to rest, to a
certain extent. In fact, it is somewhat preferable to
listen to an orator who, speaking in a conversational
tone, seeks for suitable terms, without any signs of
hurry, than to one who rattles off his speech.

In the domain of the motor nerves the want of rest
becomes also noticeable by greater or smaller pauses in
the action of one and the same muscle (and of one and
the same nerve) setting in automatically. When one
muscle is contracted, the counterpart takes rest. We
find the same in the alternation of accented and unac-
cented syllables — i.e., of syllables which are pronounced
more strongly or less strongly ; and if this alternation,
this rhythm, please us, we find the explanation in the
feeling of comfort experienced by our nerves, owing to
this alternation between greater and smaller activity.
With each syllable, spoken more gently, the speech
nerves gather new strength ; such a manner of speaking,
consequently, causes us less work, and our organs of
speech appear to us more elastic and more able to
perform their work. This does not only apply to the
recital of poetry, but the emphasizing of accentuated
syllables in prose also affords us the same striking
facility in speaking. Again, the changing succession of
vowels and consonants allows pauses, now to the
articulatory organs, now to the vocal cords. Equally

64 STAMMERING AND ITS CURE

agreeable is the alternation between inspiration and
expiration to the muscles of the respiratory organs. In
the domain of the articulatory organs, lips, tongue, etc.,
can alternate with each other. When, however, we
have to form two equal sounds immediately in succes-
sion, the second one is somewhat harder to pronounce,
for the reason that, twice in the same way, exactly the
same organs are irritated without a pause ; consequently,
those languages in which a continual change between
vowels and consonants prevails, not only sound better,
for a permanency, but they can also be spoken more
easily, the different organs of speech coming into action
by turns. The pleasure in the alternation and the
facility in the action of speaking thus caused refers also
to the timbre. The speaker who keeps on using the
same pitch will not only lull his listeners to sleep,
owing to their nerves being actually overtired, but
speaking gives him much more trouble than when
changing his pitch frequently. This alteration of the
timbre is, in truth, based on nothing else than a change
of innervation, by means of which the nerves are given
the opportunity of resting, to some extent.

If of all these momenta favourable to the act of
speaking one or several are missing with an individual,
he will speak less well than somebody with whom this
is not the case. The absent-minded, badly educated
person, or one who feels out of sorts, may suffer from
feelings of apprehension, and be unable to fix his interest
on anything for some timc-^such an individual is bound
to speak badly. Spceeli/ is, considering the intimate
connexion between the cefitre of ideas and that of the
word-images, so closely interlaced with the inmost
being of man that it can be rightly called " a mirror of
the soul."

CHAPTER IV

THE PATHOLOGY OF STAMMERING

IN order to give a full insight into the nature and
origin of stammering, we must start from a collec-
tion of good evidence. To this end we will first
describe what a close observer notices, what he hears
and sees when in company with a stammerer; then
what the latter notices himself, especially what he feels
and thinks immediately before, during, and directly
after an attack of stammering. For the '* symptoma-
tology " we have copious material before us; for the
first part (observations of a spectator) the profound
studies of Ssikorski; for the second part (self -observa-
tions of a stammerer) the comprehensive statements of
Kussmaul, Denhardt, and others.

1. " An essential primary symptom," says Ssikorski,
" is a spasm noticeable in the domain of one or several
special mechanisms which together form the faculty of
speech as a symmetrical function. As a rule, the spasm
rises suddenly in the midst of free and normal speech,
momentarily disturbing the articulatory movements or
destroying their clearness and integrity.

*' (a) The duration of the spasm is mostly very short,

and is only measured by seconds ; nevertheless, a

paroxysm always forms a sharp interruption of speech,

disagreeable to the listener's attentive ear. When the

5 Q5

66 STAMMERING AND ITS CURE

spasm ceases, the articulation is continued with com-
plete regularity up to a renewed stoppage.

"(b) Affected by the spasm are : Either single muscles,
or, which is more frequently the case, physiologic
groups of muscles or entire associations of single groups,
in the shape of a co-ordinated act more or less com-
pound which, however, presents all the properties and
symptoms of an involuntary spasmodic movement.

"(c) As to the extension of the spasm, it is first con-
fined to those muscles which belong to one or another
component of the complicated speech mechanism; in
inveterate cases, and when the single paroxysms are
very intense, it goes beyond those boundaries, and also
seizes very many other muscles of the body.

" (d) The intensity or degree of the spasmodic muscu-
lar contractions varies considerably ; mostly the contrac-
tions are very intense, sometimes even extremely intense
and painful; frequently, however, only moderate, re-
minding one of the usual voluntary contractions of the
muscles during the act of speaking, which circumstance
induced some authors to suppose that these spasms are
voluntary, though intensified, normal contractions.

"(e) The point from which the spasm always starts is
formed, now by the muscles at the moment immediately
engaged in the movements (i.e., of the articulatory
organs), now by the muscles immediately engaged in
them (i.e., of the vocal apparatus and respiration). The
symptoms of the attack, and the succession of the
different phenomena, vary considerably, according to
the starting-point and the centre of the spasm, as it
were.

" (/) The motif or stimulus which induces the spasm
is formed by movements of speaking which either have
already started or are only intended, so that in some

PATHOLOGY 67

cases the mere intention to speak already brings on the
spasm.'*

Thus stammering is shown by Ssikorski to be a
sudden disturbance of the continuity of articulation
caused by a spasm which, in a part of the speech-
apparatus, appears as a physiologic entity.

2. These spasms — the primary phenomena — have to
be distinguished carefully from secondary ones ; it is
further necessary to ascertain the connexion and genetic
succession of both kinds, if we want to recognize the
pathological symptoms correctly.

3. It must be taken into account that stammering
manifests itself more or less differently in each case ;
certain symptoms disappear or become much less con-
spicuous, while others impress themselves on the
observer more strongly; others, again, appear to be
quite unusual, and some symptoms manifest themselves
only under extraordinary conditions.

4. Respiratory spasms must be particularly noticed
which comprise a complicated and manifold group of
phenomena — viz. :

I. Inspiratory Spasms *

The patient, previous to the pronunciation of a
word, sometimes in the middle of it, or even of
a syllable of it (always at the wrong time), suddenly
inhales, now more deeply, then more superficially,
and now more intensely, then more feebly — even if
the lungs are sufficiently filled with air.

On the basis of our own experiences we cannot agree
with Bonnet and Ssikorski, who classify these contrac-
tions of the diaphragm as involuntary. The patient

* Ssikorski, pp. 48-52.

68 STAMMERING AND ITS CURE

meets with resistance at the moment he attempts to
speak after inhahng ; involuntarily he repeats the move-
ment of inspiration, but hastily and shortly, feeling that
he has still air in his lungs ; again he tries to speak,
and again he fails; another dash — i.e., a renewed
inspiratory movement — though no air, to speak of, is
inhaled at all, nor can possibly be taken in ; the thorax,
filled to excess with air, expands ; nevertheless, another
attempt to inhale more air is made with the utmost
effort and excessive contraction of the diaphragm, so
that even the hypogastrium is drawn in. However, all
efforts are in vain; the patient attempts to speak once
more, but cannot produce a sound. Deep exhaustion,
in the end, forces the unfortunate sufferer to give up
further attempts for the time being. The primary
difficulty is here undoubtedly a *' spasmodic state " in
the articulatory region or in the larynx ; the lungs work
according to the patient's desire, but their movements
are merely preparations for the initial effort to break
a resistance felt in the larynx. The stammerer notices
this resistance either shortly before he begins to speak
or in the course of speaking, and spasmodic inspirations
occur accordingly. It is obvious that they cannot be
classified as " involuntary spasms " ; the only resem-
blance they have to a spasm is in the anxious haste
with which they are enacted, especially when the
inspiratory nerves are irritated by exaggerated effort
and dread of speaking.

II. Expiratory Spasms *

These " spasms " mostly show the same sudden-
ness and " jerky " violence as the ** inspiratory

* Ssikorski, pp. 67-7b.

PATHOLOGY 69

spasms," and disturb the continual flow of speech
by breaking into its regular succession of sounds.
The expiratory spasm, as a rule, does not show
itself at the outset, but comes on during the course
of speaking ; its entry is sharply marked by a sudden
increase of expiration, which, by no means, arises
from momentary want of articulatory power. The
contraction of the abdominal muscles is mostly
carried out so suddenly and strongly, that the
patient bends forward to a certain extent, while
the breath escapes with great tension, speed, and
noise ; in this way, the economy with which the
expiratory air is used, whilst speaking, is largely
and suddenly upset by the expiratory spasm; the
latter expels both the whole respiratory quantity
and the residual air. In severe cases of stammer-
ing the expiratory spasm is induced by the intention
to speak, and sets up at the first attempt to open
the mouth. The position in which the articulatory
parts are met by the spasm remains unchanged
during its whole duration; the expiratory spasm,
similar to a catalepsy, fetters the articulatory organs
in their momentary position, as it were, and the
succession of the articulatory movements is actually
stopped. The same applies to the vocal apparatus.
The aspirating sound is more or less of a whispering
nature, but never assumes a full or loud tone, the
adductor muscles of the glottis never succeeding
in entirely carrying out their function, owing to
the antagonism of their opponents. At the same
time, the adductors of the glottis are able to
approach the vocal cords so far that the expi-
ratory air cannot escape so freely as when the
stammerer does not make any attempts to speak.

70 STAMMERING AND ITS CURE

" Three spheres are in mutual connexion during
the expiratory spasm : The organs of articulation,
the vocal apparatus, and the expiratory organs ;
their movements arise, grow, and decrease simul-
taneously, thus showing the character of conjugate
movements."

These complicated symptoms are called " expiratory
spasms " by Ssikorski. This term might lead to mis-
conceptions ; one would be inclined to think that the
spasmodic expiration is the source, the centre, or the
most important momentum of the phenomenon. This,
however, is undoubtedly not the case ; but all three
spheres are seized by spasm at the same time. It
would certainly meet the case better to term these
symptoms as " general spasms of speech," or *' spasms
in the three spheres of speech." Here, again, the
** spasms " are, beyond all doubt, induced by psychic
obstacles. Just as in the fairy-tale of " The Sleeping
Beauty," by the magic power of the evil fairy, every
activity is hampered in an instant (the arm of the cook
who is going to box the scullion's ears is suddenly
paralysed in the midst of this movement, and so on),
the muscles of the vocal and articulatory apparatus
are, by an inner resistance, at once made captive.

What proportion does hurry bear to these muscular
contractions ? Hurry tries to obliterate entirely all
differences between sounds with quick and sounds with
slow muscular movements, by accelerating all simul-
taneous slower movements to such an extent that they
become similar to those which have to be carried out
quickly. Thus it damages the distinctness of pronun-
ciation and causes the swallowing of sounds, leading to
a contraction of sounds which, being unfamiliar lo the
tongue, are more difficult to pronounce (instead of

PATHOLOGY 71

"accusation," " axation," etc.). In short, it throws
obstacles in the way for the tongue, which cause it
to stumble. We call this faltering hoesitatio sthenica.
Strictly speaking, such hesitation is merely a stoppage
from awkwardness, from lack of readiness ; it is due to the
same awkwardness which makes us hesitate over pro-
nouncing an uncommon foreign word. Such stoppage
is no actual stammering yet; it only shows a certain
likeness to it, inasmuch as the speaker suddenly grows
dumb. This sudden silence strikes the observer so
much the more because hitherto the words had flown
from the speaker's mouth with great facility.

Haste and eagerness also promote the repetition of
words. This, however, does not necessarily appertain
to stammering — not, at any rate, in those cases in which
the repetition is voluntary, as, for instance, when the
speaker intends filling out a pause. But when this
repetition is unconsciously — that is, involuntarily — in-
duced, then it shows a morbid character, and can be
termed " stammering." Even ordinary speakers auto-
matically repeat the words last uttered, if they are in
doubt as to how to continue. They are more inclined
to be stopped by such doubts when they are impressed
by the importance of the listeners. The eager thinking
of what is to follow induces them to pay much less
heed to what is flowing from their lips at the moment.
The previous thoughts not being uttered are, however,
still so vivid, and the nerve-channels used for them are
still stimulated to such an extent, that those thoughts
automatically crowd forward again, and the nerve-
channels begin to work mechanically when stimulated
once more from outside. This applies especially to those
nerve-channels which had been irritated last — viz., those
which innervated the last thoughts and the last words.

72 STAMMERING AND ITS CURE

While speaking those words, they themselves hear
them, and those words irritate, from outside, exactly
the same nerve-channels the stimulating of which, for
the first time, had been caused by those words a moment
before. Their own words induce a reaction ; it is a
kind of " echo-speech."

The auditory stimulus of the word uttered by the
speaker last, and thus also heard by him last, recalls
that very word in the sound-image centre, in which it
was alive but a moment before, and from here the
motor is stimulated in the same manner as hitherto —
that is to say, the word is spoken once more ; again the
sensorium reacts on it, and again the centre of word-
locomotion is set going, and so forth. The process is
automatically repeated sometimes three, four, and even
five times. Now, having become attentive, the speaker
suppresses the automatic repetition by continuing ener-
getically to speak with deliberation. This procedure
is, therefore, based, on the one hand, on too great an
excitability of the sensorium, and, on the other hand,
on momentary inattentiveness. That the whole phe-
nomenon is originally induced in the sensorium and
not in the motorium — we call it repetitio resonans — is
proved by the fact that in the speech-muscles nothing
of a spasmodic nature is noticeable.

What we occasionally notice with ordinary speakers,
develops into a serious symptom in a stammerer, owing
to his neurotic disposition. However, here spasms are
missing, too. Ssikorski and others have tried to prove
that the cause of the ** repetitions " is to be found in
a spasmodic respiration. The respiratory movements
are supposed not to go together with articulation, thus
producing speech with syllables and words spasmodi-
cally repeated, but without inducing spasms in tongue

PATHOLOGY 73

and lips. Ssikorski seems to believe that the syllable
following the repetitions cannot be uttered, simply
because the necessary breath is missing; owing to the
respiratory spasms, only sufficient breath is produced
merely to allow the utterance of the previous syllable.
When, for instance, a stammerer pronounces the word
" analogy," the respiratory movement, according to
Ssikorski, suffices for " ana," but not for " logy " ; that
is why the sufferer repeats " Ana — ana — ana," inter-
rupting each " ana " by a spasmodic inspiration, which
does not admit of the pronunciation of the word being
finished. That Ssikorski explains the proceeding in
this way follows from all that he puts forward, which is
based on Sievers' phonetics — namely, that each syllable
requires an expiratory movement exactly measured.
However, nobody will be inclined to believe that an
equivalent quantity of breath which produces ** ana "
would not be sufficient to utter " logy." No doubt
Ssikorski has described the symptoms excellently, but
we cannot fall in with their interpretation.

The stammerer evidently hesitates to pronounce the
sounds following the repeated syllables; he does not
dare to produce the syllable *' lo " ; undoubtedly he
dreads to pronounce it. He starts and breaks off,
starts and breaks off again, and so forth. We admit
that this starting and breaking off displays an alterna-
tion between slight ex- and in-spirations ; however, he
is certainly not prevented from pronouncing the follow-
ing syllable " lo," because his breath is spasmodically
intermitted or would not suffice, but he retains his
breath because he thinks that he cannot pronounce the
syllable " lo " at the moment. The unfortunate stam-
merer's whole attention is anxiously focussed on that
syllable, while his speech-apparatus is automatically

74 STAMMERING AND ITS CURE

working, repeating the previous syllable without think-
ing : *' Ana— ana — ana." So long as these syllables are
following each other in very small equal intervals, like
the single strokes of a clock, we undoubtedly have to
deal with that echo-repetition ; when, however, the
repetitions show increasing hesitations, and do not
exactly resemble each other, we have to deal with con-
scious repetitions. Occasionally automatic repetitions
are followed up by conscious ones — namely, the sufferer
tries sometimes to delay the moment at which he has
to utter the dangerous syllable as much as possible by re-
peating the previous one (repetitio syUaharum asthenica).
Those who know this trick will discern this repetition
(due to dread) by the fact that a word or a syllable is, in
all its details, not the exact image of its predecessor,
but that the pitch changes, the last syllable being
elongated, and so on. The stammerer waits for the
favourable moment to jump over the next syllable by the
aid of the sound of the repeated word. Naturally, these
repetitions cannot be counted as actual stammering ;
they belong to those numerous helps which a stammerer
applies to combat his impediment. It is different with
the echo-repetitions ; these are only noticed subse-
quently by the stammerer — i.e., after they have occurred
once, twice, or even three times. Often they escape
his notice entirely, so that he is surprised at being
told by the listener that he has repeated a word or a
syllable. This is not to be wondered at, as the
stammerer's attention is already concentrated on the
following word, whether it usually causes him diffi-
culties, or whether it occupies a prominent place in
the sentence, v This looking ahead is particularly pro-
nounced when the sufferer has to read aloud ; anxiously
his eyes hurry on in advance to espy a possible enemy

PATHOLOGY 75

amongst the approaching words. But not only when
reading is his attention on the qui vive, but when speak-
ing also. This tendency to anticipate difficulties is the
chief feature in all forms of stammering, and has
become deeply rooted by the fact that the patient is
continually afraid of being taken unawares by inner
(psychic) obstacles frequently cropping up without the
slightest warning.

We will now turn to the main source of all paroxysms
of stammering — viz., dread. Characteristic with this
emotion is the patient's incapacity to keep his limbs
still — arms, legs, jaws, etc., move tremblingly to and fro.
To judge from appearances, the irritation caused by
dread influences the normal innervation to such an
extent that now this and now that group of muscles is
seized with slight thrills. By vigorously tightening
the muscles it is possible to assuage this trembling
somewhat, but it is not practicable to suppress it
entirely — nay, it seems as if each of these attempts
at suppression develops the small quick waves of
trembling into larger, slower billows. In so far as
these irritations of dread influence the motorium, they
resemble the influence of alarm. However, whereas the
latter approaches suddenly and intensely, and vanishes
as quickly as it appeared, dread dissolves in numerous,
small irritations rapidly succeeding each other, and
lasts for a longer time, upsetting both the motor and
sensorial nerves, and disturbing their functions.
Alarm resembles a powerful troop of horses rushing
forward like lightning ; the irritations of dread, on the
other hand, slink about in the territory of the nerves
like treacherous guerillas, sallying forth for some time,
now here, now there. The retardations (major and
minor) and acceleration last much longer than is the

76 STAMMERING AND ITS CURE

case with the irritation of alarm, as the single irrita-
tions continue their harmful game for some time, and
the influence of the will is consequently debilitated
by anelectrotonus for the same period. The waves
of dread, by the way, follow each other much more
quickly than the convulsions of the limbs may make
us presume. The convulsions only occur if a nerve
and its counterpart be not reached simultaneously by
an elevation of a wave or a depression between two
waves, but one by an elevation, the other by a de-
pression. Each wave corresponds to an irritation of
the nerve; when these irritations follow each other so
quickly that sixteen to eighteen in a second reach the
nerve, retardatio asthenica degenerates into hoesitatio
asthenica, or tetanus astheniciis.

Slighter degrees of dread are frequently found
with children — namely, embarrassment, confusion, and
similar asthenic emotions.

The irritability caused by dread can visit any nerve
connected with the process of speaking ; each nerve is
therefore able, under the influence of eagerness and
dread, to induce one of the accelerations (sthenica or
asthenica), and one of the retardations {minor or major)
of its organ. Therefore, with regard to accelerations and
retardations, twice as many forms of stammering can
appear as there are speech-nerves or speech-muscles ;
combinations are possible, too, which still augment the
number of varieties.

Ssikorski confirms our observations by saying : " The
phenomena of stammering are so diversified and com-
plicated that, in dealing with this neurosis, the question
involuntarily crowds into the mind whether these
phenomena represent one distinct malady or different
forms of illness combined in a group, owing to insufR-

PATHOLOGY 77

cient analysis of the symptoms. The outer form of the
malady is so polymorphous that (at the first glance) it
seems impossible to group the different cases and
to compare them with each other."

We will now continue our criticism on Ssikorski's
expositions. He calls those muscular contractions
"spasms." However, if they were actual spasms, they
would not cease at the same moment as the will to
speak is suspended ; further, if they were based on real
spasms, nobody would be able to imitate, for the pur-
pose of amusement, the paroxysms of stammering so
strikingly as is often done.

Ssikorski points out that there is no lack of articula-
tion ; the process actually commences ; the articulatory
organs, however, persevere exactly in the same position
in which they were taken unawares by the setting in of
the " expiratory spasm." " Strictly speaking," he adds,
*' it is merely a stoppage." He does not here mention
the word " spasm," and such it undoubtedly is not.
The sufferer, full of expectation, keeps the outer organs
in a correspondingly distressed position to that of the
vocal cords. He hears that the vowel will not sound.
As soon as the vocal cords approach each other, the
position of the articulatory organs changes also ; but
not exactly as would have been the case if speaking
had not been impeded. And this cannot be wondered
at if we consider the unfortunate stammerer's frame of
mind at the moment ! He is quite satisfied if he succeed
in uttering the word at all ; whether the word " hand " is
correctly articulated, or whether he says something more
like " h-ond," he hopes no one will blame him for it.

With the *' expiratory spasm " it is, therefore, only
the muscles of the vocal cords which are withdrawn
from the stammerer's free will; whereas the stopping

78 STAMMERING AND ITS CURE

of the articulatory organs,* as well as the intensifying
of the abdominal muscular pressure (the latter had
already been realized by Becquerel and Merkel) are
solely actions of the will. This phenomenon cannot
be termed " expiratory spasm " as matters stand.

III. Rhythmic Spasm of Respiration, t Combina-
tion OF Inspiratory and Expiratory Spasm

Before and during the act of speaking the breath
goes in and out several times without producing
sound. The intention to speak exists. Expiration
is interrupted, continued, followed up by inspiration,
then again an expiration, and so forth, without a
distinct norm. The spasms seem, to a certain
extent, to be subjected to the influence of the will.
The patient appears to be, for the moment, a help-
less and quite undetermined man. The respira-
tory phenomena are frequently the preliminary
symptoms of intense spasms. With the respiratory
spasm the listener mostly hears nothing but breath-
ing noises, instead of articulatory sounds ; it is
very seldom that sounds are actually produced
which are repeated as often as inspiration and
expiration take place. Continuous sounds, like
/ and s, can often be heard pretty distinctly, whilst
explosives, like p and t, are not frequently formed,
but are rather like the continuous sounds corre-
sponding to them.

This description alone proves that the " articulatory
spasms," as partly admitted by Ssikorski himself, are
voluntary actions. As a matter of fact, the patient
dreads uttering the next word in the sentence, and
actually serious *' spasms " mostly break out when
* He can move them at will. tSsikorski, pp. 78-87.

PATHOLOGY 79

he ventures to approach pronunciation; it is only with
more or less difficulty and indistinctness that he ulti-
mately squeezes out the word. That dread of speaking
makes him waver and hesitate ; he will begin ; the next
moment, however, he gives up his intention ; again he
plucks up courage, and again he loses heart, thus help-
lessly vacillating between resolution and dread, between
dread and resolution. This vacillation in his soul is
most clearly reflected in his respiration. The centre of
this form of stammering is undoubtedly not the respi-
ratory organs, but some part of the phonetic apparatus,
the innervation of which stands under the paralysing
influence of dread of speaking. The term " respiratory
spasms " has, therefore, to be avoided.

IV. Spasm of the Glottis *

With each endeavour to speak, a spasmodic
closure of the glottis takes place. The vocal
cords do not simply touch each other, as is the
case when formation of sound is normal, but they
join tightly together. In this way the expiratory
air finds the exit barricaded, and this barring of
the gate puts an end to the production of voice
and articulatory sounds for the whole duration of
the spasm. Thus an unexpected pause, a sudden
temporary dumbness, ensues in the midst of an
even, uninterrupted succession of sounds. The
pause does not only occur between two syllables,
but may occur also in the middle of a syllable, nay,
even during the production of single sounds, causing
the dismembering of syllables and sounds so fre-
quent with stammering. The duration of the spasm

* Ssikorski, pp. 89-105.

80 STAMMERING AND ITS CURE

varies sometimes considerably. Whilst the listener's
ear can very easily notice the spasm of the glottis,
it is less apparent to the eye. The lack of visible
changes keeps the inexperienced observer entirely
in the dark about the seat and cause of this dis-
turbance. In most cases the spasm is caused
during speaking; in severe cases, however, the
mere intention to speak is sufficient to close the
glottis. Very frequently the spasm is first caused
by the endeavour to pronounce a vowel or an h,
and, as a rule, the spasm precedes the vowel sound.
When the impediment is developed and deeply
rooted, the spasms even occur, if no contraction of
the glottis take place, according to the postulates
of articulation and vocalization. The glottis closes
so completely that not even the smallest fraction
of breath breaks forth; a mirror held in front of
the stammerer's mouth will convince anyone of
this fact. Only the adductors of the glottis are
contracted, the tensores of the vocal cords are
not. Owing to the eager action of the abdominal
muscular pressure, the air retained in the inner
aerial ducts is pushed against the larynx ; the latter
is thus moved upwards, sinking, however, as soon as
the abdominal pressure decreases. Consequently,
the muscles destined to fix the larynx either do not
resist at all, or only resist this shifting in an insuffi-
cient way. The closure of the glottis is, therefore,
the only active proceeding in the domain of the
muscles of larynx and throat. In the articulatory
region there is nothing of a spasmodic nature
noticeable. By the barring of the air and the tre-
mendous tension of the abdominal pressure — the
unfortunate sufferer endeavouring to burst open

PATHOLOGY 81

the lock by force and concentrating all his atten-
tion on this point — the blood in his face, eyes, and
jugular veins is accumulated, causing the symptom
of cyanosis. Many stammerers remain cool so far
that the listener can only estimate the inner struggle
from the sudden loss of voice and the cyanosis of
the face. Sometimes the patients are under the
impression that the spasm is subsiding; but when
they try to continue speaking the spasm increases
anew. The action of articulation does not cease.
If the individual, at the moment the spasm of the
glottis sets in, wishes to utter a u, his lips are
rounding and pointing for the M-tube; these move-
ments, however, are carried out slowly. The stam-
merer fairly often repeats them several times, and
each time the abdominal pressure is increased.
The hollow, short, and more or less indistinct
sound which occasionally escapes the glottis, just
before its closure, appears so much less like the
actual vowel sound, the sooner the glottis closes.
The articulatory organs, though on the way to the
correct position, are still far from it.

All these observations of Ssikorski are, up to the
smallest detail, extraordinarily correct, and the whole
description represents an excellent picture of this form
of stammering. The explanation of the phenomena is
also correct, to a certain extent, inasmuch as it discerns
the seat of the serious trouble in the muscles of the
glottis, and deduces the other phenomena from the
circumstance that the muscles of the adductors of
the glottis are excessively contracted.

However, he makes no reply to several important
questions, namely :

1. Why does the " spasm " set in before the beginning

a

82 STAMMERING AND ITS CURE

of the articulatory and expiratory movements which,
surely, are innervated with it at the same time ?

2.Why does the '* spasm " set in, in difficult cases,
even when the adductors of the glottis are not in action
at all at the moment?

3. Why does the " spasm " get the start of the
articulatory and expiratory organs now more, now less;
why does it not always run in advance equally ?

In the following chapter we shall show that our
conception of the phenomena is able to throw light on
all these questions. For the present we will only point
out that a " spasm " is entirely a misapplication, as the
closure of the glottis ceases instantaneously when the
stammerer gives up his intention to speak.

V. Vowel Spasm

Under this term Ssikorski * has classed two forms of
stammering which, in our opinion, are quite different
as to their derivation :

1. Compressed Breath Voice

The voice, in spite of the greatest effort, cannot
be brought into the correct position ; it is like
whispering — compressed and hollow, or it sounds
suppressed — as if it came from a longer distance
than from the larynx. Often abnormally deep, it
sometimes appears normal, to a certain extent,
though its production invariably makes the impres-
sion of an extremely troublesome and straining
process, as though the vocal muscles had to sur-
mount serious obstacles. All muscles of the throat
which govern the larynx, further, the muscles of the

* Ssikorski, pp. 105-119.

PATHOLOGY 83

hyoid bone, which, on their part, form the piinctum
fixum of the larynx, and finally the inner muscles
of the larynx, show extraordinarily violent contrac-
tions. Articulatory movements, though retarded,
alternate with each other.

2. Spasmodic Voice

The vocal apparatus perseveres in one and the
same position for an abnormally long time. The
result is an unusually long duration of the vowel
sounds, to be found mostly with children (between
three and five years of age) who just begin to
stammer. Articulation is completely interrupted,
the mouth channel stiffening in the vowel position.
Respiration is not disturbed.

The form of stammering described under Division 1
has its seat — here we agree with Ssikorski — in the
muscles of the larynx. The vocal cords will not
relinquish their position of rest. The muscles by which
they are kept in that position are contracted against
the speaker's will. Evidently, under the influence of
dread, one of the two retardations sets in, either major
or minor — preferably the latter. Whilst the glottis
should quickly grow narrower, this movement is ex-
tremely aggravated and retarded by the appearance
of dread. As a matter of fact, the adductors of the vocal
cords would not succeed in breaking the resistance of
their counterparts unless they were strongly supported
by all the muscles of the larynx which take part in the
production of sound. Nevertheless, the vocal cords
are only approximately brought into the corresponding
position. As all those organs are contracted to the
utmost, in order to force the glottal ligaments into a

84 STAMMERING AND ITS CURE

somewhat satisfactory position, the voice acquires an
unusual tone — compressed, hollow, dull, whispering.
When dread is very intense, the sufferer does not succeed
at all in narrowing the glottis ; the breath enters and
goes unhindered, and the stammerer is unable to get
hold of the vowel. If the case be easier, the patient
may succeed in forming h; occasionally a vowel is
joined which is comparatively clear, provided that the
stammerer only contracts sharply the adductors of the
glottis in order to overcome the abductor muscles of
the glottis. However, when he introduces the other
muscles into the struggle, the tone, thus formed
abnormally, soimds more or less imperfect, dull, and
hollow. We are inclined to think that this phenomenon
occurs of itself, when all organs engaged in voice pro-
duction are hampered in their movements — i.e., retar-
datio minor. Under the impression of dread, the whole
speech-mechanism naturally works clumsily, so that the
harmony of the movements is more or less disturbed.
Not only all organs of the larynx work incompletely
and laboriously, but also all movements of the articu-
latory apparatus are depressed, clumsy, and slow. The
sufferer feels as if hundredweights were attached to all
his organs of speech. No wonder that muscles and their
counterparts are, under the pressure of dread of speaking,
intensely tightened.

As to Division 2 — spasmodic voice — Ssikorski con-
siders the seat of this symptom to be also in the muscles
of the larynx. In our opinion, however, the larynx
works quite normally. The organs take up the right
position without exertion and without overstepping the
mark — that is to say, neither the abductor nor the
adductor of the glottis are morbidly stimulated in the
least. We agree, however, with what Ssikorski says

PATHOLOGY 85

with regard to articulation : " The articulatory mechan-
ism stiffens at the moment that it enters into the vowel
position." The little sufferer — it is mostly children
who are attacked by this form of stammering — does
not succeed in going from the articulatory position for o
in " Sophia " into that for ph. This transition causes
him difficulty; it seems as if it were unfavourable to
this particular child. From the position of rest, the
child would perhaps be able to enter into the p?i-position,
but he carmot manage the transition from the articula-
tion of o to that of ph. The counterpart of that muscle,
which should act in due course, is evidently irritable,
and works, under the influence of embarrassment, more
intensely than it ought to do, so that the required
movement can be carried out but slowly, if at all;
during that time the vowel sound continues to be pro-
duced quite clearly until the articulatory movement
again proceeds. At first a child suffers from the diffi-
culty of forming intelligible sounds through embarrass-
ment only ; later on, however, the suffering is increased
by dread of speaking and the fear of " bugbear " letters
and words making their appearance. This dread may lay
hold of the sufferer to such an extent that he is utterly
unable to proceed until the emotion has subsided.

The explanation which Ssikorski gives of the phe-
nomenon dealt with under the next head, is certainly
at fault.

VI. Intermittent Vowel Spasm *

Speech is, for a short time, interrupted by a
tremulous sound, similar to the bleating of a sheep
or a goat, or to a light spasmodic cough, or to other
noises the character of which cannot easily be

* Ssikorski, pp. 119-129.

86 STAMMERING AND ITS CURE

described in words ; sometimes the patient is for
several minutes unable to utter a single word, and
only produces a long series of inarticulate sounds
(compared by Ssikorski with the " mute voice ").
The sounds have nothing in common with the
vowel which has to be pronounced. The cavity of
the mouth has now this, now that shape. The
patient at that moment does not articulate at all.
In this way the spasm we are speaking of distin-
guishes itself from all other spasms of stammering.
The " mute voice " is, with this form of stammer-
ing, the result of a series of spasmodic shuttings
and openings of the larynx which are entirely
involuntary and operate in quick turns. The other
form — the tremulous voice — is induced by the
vocalization undergoing some modifications with
each tremolo ; each time the arytenoid cartilages
move backwards, to a certain extent, while the
epiglottis moves forward a little, and the aperture
of the larynx widens. Each stammerer has his
favourite sound. There are two categories : (1) Loud
sounds or noises ; the vocal cords, in this case,
are nearly in position for speech. (2) Whispering
voice ; here the vocal cords are absolutely in
correct position, the muscles of the throat, which
are engaged in the act of speaking or whispering,
alone being contracted.

Now, if these phenomena may be called " spasms,"
we are entitled to say that anyone suffers from " inter-
mittent vowel spasm " who at the moment, immediately
before or whilst speaking, clears his throat or inter-
lards his speech with a frequent " er . . ." We do
not think that Ssikorski himself would maintain this
point when pushed to such an extent. He must not

PATHOLOGY 87

speak, then, of an *' intermittent vowel spasm " ; for
expedients which are occasionally used by ordinary
speakers to get over any unevenness of their speech are
simply used in an aggravated manner by a stammerer.
When unable to continue speaking, particularly when
the vocal cords refuse to react on stimuli coming from
the word-image centre, he, after cautiously opening the
glottis to a small extent, makes a breath of air pass it,
with the result that a humming or a bleating, etc., is
produced ; or he allows the vocal cords to go back to
the position for whispering, and then sends a breath of
air through them. Undoubtedly, it is not his intention
to speak at that moment, as he does not articulate at
all ; he only wishes to make his refractory vocal cords
ready for speech, like a musician who tunes his instru-
ment before the concert begins. He does not innervate
the muscles of the larynx from the word-image centre,
but from the motorium; he, at first, keeps them in the
position in which they refuse to obey, and then, test-
ing them cautiously, he allows them to leave this con-
strained position more or less, with the intention of
sending a breath of air through. However, when he
tries once more to play the vocal instrument which
he has thus tested — that is to say, when he wants to
stimulate the muscles from the word-image centre
(from the a, e, i, o, ?i-image), his nerves work just as
incorrectly as before ; he is again unable to form these
vowels, except he be either less eager or less " funky "
than previously.

In short, this form of difficulty which, according to
Ssikorski, is based on '* spasm," is from the beginning
to the end a purely arbitrary act of the stammerer,
caused by refractoriness of the vocal organs brought
about by psychic resistances.

88 STAMMERING AND ITS CURE

VII. Spasm of the Soft Palate *

Preliminary: The opening which combines the
channel of the mouth with that of the nose is, during
the process of speaking, mostly shut by the soft
palate. It is only opened with the so-called nasal
letters m and n; with m the lips are closed at the
same time, whereas with n they are opened; a
closure of the mouth-channel, however, is brought
about by the tongue being tightly placed against
the teeth. Both sounds do not obtain their full
character until these closures open, except if they
follow directly upon a vowel.

1. The sounds, which have come in their turn,
suddenly intermit, and the patient, in accordance
with the temporary position of his lips and tongue,
utters spasmodically such sounds as ** pm-pm-pm,"
*' tn-tn-tn," or " kn-kn-kn." The main substance of
this symptom is evidently caused by the posterior
nares closing and reopening, thus causing a series
of explosions of the soft palate. Here also, as was
the case with the " intermittent vowel spasm,"
articulation is interrupted, and instead, the posi-
tion for p, t, or k (this closure is not spasmodic) is
formed, sometimes with and sometimes without
voice. Now the glottis is in position for speech,
now it is opened ; in the latter case the noise
produced reminds one of sneezing, snoring, etc.

2. As in the latter case the nasal channel closes
and uncloses, so also in the following case ; here,
however, this movement occurs only once, whereas
it is repeated several times with the " pm-pm-pm "
sounds. A child, for example, has to say " shady,"

*Ssikorski, pp. 138-142.

PATHOLOGY 89

but says instead " sh-n-ady " ; instead of "effort,"
'*effm-ort" ; instead of "clover," *'clovm-er; instead
ol *' Lissa," " Lissn-a " ; instead of *' sanus," *' sn-
anus." The closure of the nasal channel, caused
by the consonant or vowel, is followed up by the
opposite effect, so that an m or an n resounds ; as
a matter of fact, the nasal channel ought to have
remained closed.

In both cases we notice that articulation — as is the
case with the " intermittent vowel spasm " — is inter-
rupted, and, instead of the sounds to be uttered, some-
times quite strange and odd ones are produced. This
indicates that the patient, at the moment, does not
want to speak at all. The openings of the nasal
channel, to which both the repeated " pm-pm-pm," etc.,
and the m or n happening but once are due, are move-
ments carried out consciously, to clear away an obstacle
whilst speaking. This is particularly striking with the
examples specially given. The inner resistances evi-
dently do not allow the stammerer now to enter into
the vowel, now to get out of it, and the combination of
vowels with the letters /, v, s causes him difficulties.
He tries to overcome them by opening the nasal channel ;
the m or n thus produced naturally induces the low
resonance of the vocal cords, and facilitates the pro-
nunciation of the following vowel, and, on the other
hand, the m sounding but slightly leads again out of
the vocalization gradually.

Vin. Spasm of the Closure of the Lips *

The spasm of the nmsctilns orbicularis oris will be
recognised as being one of the most frequent
symptoms of stammering; it can mostly be dis-
*Ssikorski, pp. 143-151,

90 STAMMERING AND ITS CURE

tinguished without difficulty by the closing an(? the
pressing together of the lips ; sometimes the lips
even take on the shape of a tube, which if quite
visible to the observer. In most cases the degree
of closure is considerable. The spasm is confined
to the muscle which closes the mouth. The dis-
turbances brought about by such spasm first of all
concern all sounds in the formation of which the
lips take a principal part (h, p, m, f, v). In accord-
ance with the intensity of the spasm three cases
can be distinguished :

1. Occlusio spasmodica: a very violent attack;
the lips remain closed for a shorter or a longer
period; articulation is interrupted, thereby causing
an abnormally long soundless pause, " momentary
dumbness." The spasm, as a rule, lasts several
seconds (with b, p, m); at any rate, it is consider-
ably longer than intervals occurring when speaking
normally. If the spasm arise when intonating the
sounds V and /, the latter either intermit entirely,
or they are changed to a very short aspiration
preceding the closure of the lips. In most severe
cases the spasm is not only induced by labials, but
also by other letters, such as d, t, c. The mere
intention to speak is often sufficient to produce
the spasm of the lips. Together with the increased
tension of the muscle closing the aperture of the
lips, energetic expirations take place which are
more intense than those in connexion with the
respiratory spasms. The vocal, and particularly
the respiratory, apparatus remain intact.

2. Explosio spasmodica : a less intense attack ; the
aperture is forced open when the tension of the
breath has reached a certain degree. Like an

PATHOLOGY 91

explosion the breath escapes, thus producing a b
or a p. Since part of the expired air is wasted and
the retained air has lost its elasticity, the spasm of
the lips, unless it has come to an end, once more
gets the upper hand, compelling the lips to shut
again. Immediately the tension of the expiratory
air increases again, forcing the lips asunder, and
so forth. Thus a series of repetitions of the same
letters, following each other in more or less quick
succession, is produced, which continues to express
itself until the spasm has subsided. Possibly the
action of the counterparts also plays a role. The
weaker the spasm, the more frequent the explosions.

3. Spiratio spasmodica: a still slighter attack;
the utterance of the continual sounds m, /, v.

The lips do not quite close, but persevere spas-
modically in the position previously adopted. The
intonated sound continues with unconquerable
power as long as the spasm itself continues. The
sounds thus produced are not clear by a long way.

During the spasm, the sufferer makes more or
less pronounced movements which are intended to
form the transition into the next formation of
sound. If his disposition be very intense, the
spasm of the lips occurs with each articulatory
movement in which the lips take part, even when
pronouncing a vowel. For example, the patient
wants to say ** comet." When he attempts to
form c, the lips close and open after the spasm has
subsided, so that a p is heard before the word,
" p-comet "; instead of "Odes^sa," "0-b-b-b-dessa."
The o is followed up by the lips closing, opening,
again closing, opening, and so forth. The syllables
" dessa " do not join until the spasm has ceased.

92 STAMMERING AND ITS CURE

Here, again, Ssikorski made the mistake of putting
down these phenomena to *' spasms," while they are
really due to haste and dread, frequently intensified by
anticipation. When an impulse of the wiU is trans-
ferred to an irritable nerve, haste and dread have an
accelerating influence. Owing to this influence, the
lips are pressed together too tightly for 6 or p to be
articulated {acceleratio sthenica or asthenica cum produc-
tione motuum).

When, however, in order to open the 6 or p lock, the
will innervates the muscles which open the mouth,
dread has the effect of retarding the movement (re-
tardatio asthenica major cum ahbreviatione motmim).
When emotion is intense the mouth remains entirely
shut — nay, with each increase of excitement or dread it
may be shut more tightly than ever — but, in any case,
the lips will open comparatively slowly.

The lips, by the way, are rigid in very severe cases
only; in somewhat slighter forms of excitement and
dread a tremblmg movement is noticeable in the lips,
which has been compared by Gutzmann with the
mumbling of rabbits. This trembling of the lips alone
is sufficient to disclose the cause of this form of stam-
mering, as it involuntarily reminds us of the trembling
of our limbs when dread overtakes us. In fact, we have
before us a retardatio, even a hoesitatio asthenica, which
is a product of dread. The attention becomes riveted
on articulation, and directs the waves of dread to the
organs of speech, just as the writer, who is afflicted
with writer's cramp, has all his attention concentrated
on his movements, and his excitement produces tremor
in the irritable nerves of his hand. Now the sphincters,
now their counterparts, are seized by the emotional in-
fluences. The will attempts to come to the rescue, but

PATHOLOGY 93

is weakeued by anelectrotonus and inner resistances
(psychic conflicts play an important part with writer's
cramp), and all efforts are of no avail.

The question may be asked, however : Is there no
possibility of assisting the will to gain the victory in
spite of dread being at work ? Judge for yourself.

The series of ganglions and nerves which stimulate
the contractor is irritated by dread as intensely as that
which innervates the detractor. The more the irrita-
tion of dread increases, the more tightly both muscles
contract. Now, should it not be possible to force one
series of ganglions and nerves, by stimuli of the will,
to work so that the counterpart is detracted, in spite of
all opposition of dread ? If only the stimulus of the will
could take effect I The acoustic nerves send stimulus
after stimulus to the equally contracted fighting parties,
but, imfortunately, none of these reinforcements can
reach them. The upper parts of those nerve-channels,
especially those in which the motor ganglions are
situated, are visited by anelectrotonus, and are practi-
cally impassable to stimuli of the will, owing to the
continually trembling and quickly alternating currents
of dread, which cause retardatio and even hcesitatio
{tetanus) in both series of ganglions. It is only occa-
sionally that a single stimulus, when dread is less,
sneaks to its party, helping it to obtain an insignificant
success ; however, when dread is more intense, no
stimulus of the will can wedge its way through. The
single particles of the nerves are somewhat separated
by the currents of dread, so that no stimulus of the
will can leap over these gaps which, though very small
indeed, are too wide for it. The upper parts of the
nerves, when seized by anelectrotonus, conduct no
stimuli of the will.

94 STAMMERING AND ITS CURE

What would happen if the stimuli of the will, owing
to such strong pressure of volition as even to be painful,
should succeed in crossing those gaps ? If all organs,
equally excitable, are also equally attacked by the re-
tardation of dread, they continue to work equally,
though very slowly. If, however, the organs are un-
equally irritable, the increase of the pressure of
volition would be of no avail. If, for example, the
articulatory organs are more irritable than the vocal
organs — the former being seized by violent, the latter
by weaker, retardation — such an increase of the pressure
of volition would suit the articulatory organs, but would
be far too strong for the vocal organs. The vocal cords
would, therefore, close tightly, and speaking would be
quite impossible.

If there are such abnormal conditions in the gang-
lions and the more frequently used nerve-channels,
the patient is helpless for the moment. Even if the
pitiable stammerer, before the critical moment, had re-
peated the bugbear words to himself a thousand times,
and even if these repetitions had been done with
physiological consciousness, when dread sets in all these
exercises are absolutely futile.

The only thing that sometimes helps him is a change
of innervation, such as a different pronunciation of the
words, a change of the timbre, raising or lowering of
the voice — in short, anything that is connected with
the quality of sound. The question might be raised :
Does this altered innervation arrive at the muscle at
all, or is it also kept back by the dread anelectrotonus ?
Now, this change of innervation, of course, proceeds
from the sound-image centre ; another pronunciation
of the words, an alteration of the timbre, etc., has first
to be thought of silently by the stammerer. The more

PATHOLOGY 95

the altered pronunciation differs from the customary,
the more it attracts the sufferer's attention; he, there-
fore, does momentarily forget his incapacity to speak.
His dread is not directed to his next movements of
speech, thanks to the helpful stimulus of the novelty;
the anelectrotonus and, with it, the irritability of the
nerves subside, with the result that the stimuli of the
will can now arrive at their destination without
hindrance. This is the reason why elocutionists and
" speech specialists " temporarily obtain striking results
with their methods, which frequently deviate consider-
ably from the customary manner of speaking.

The *' spasm of the upper lip, nether lip, and of the
corners of the mouth," are such rare forms of stam-
mering that we need not discuss them; they influence
speaking but very little. More frequent, however, is —

IX. TnE Spasmodic Opening of the Moutk
(Os Quadratum)

which manifests itself in two forms :

1. The jaws are closed, only the teeth are bare.
The muscles which open the mouth are intensely
contracted, while the countenance becomes strange and
woeful; the opening of the mouth is drawn asunder
as though by a strange power, and the stammerer
appears more helpless than is the case with other
paroxysms of stammering. The muscles which raise
the upper lip and the corners of the mouth con-
tract violently, giving the mouth a quadrangular form,
reminding one of an animal showing its teeth. This
spasm is mostly tonic, and often keeps the mouth in
this singular position for some seconds. On this
general spasmodic basis, as it were, single spasmodic

96 STAMMERING AND ITS CURE

waves make their appearance in the shape of clonic
convulsions in single muscles, or bundles of muscles.
The picture thus becomes extremely multicoloured, the
single muscles and their groups seeming to wrestle with
each other.

2. In addition, the mouth is widely opened, while the
lower jaw sinks down.

Articulation is mostly rendered impossible by the
spasm; undefinable sounds of a vocal character are
sometimes produced.

The OS quadrat um is invariably the result of dread,
which suddenly attacks the stammerer at the moment
he has opened his mouth — that is to say, while speak-
ing. The musculus orhicularis oris does not succeed in
closing the mouth, until a very great effort has been
made.

Finally, as to the " spasms of the tongue," practically
the same causes and effects as we have alleged concern-
ing the " spasm " of the lips apply here also. With
the " spasm of the protrusive tongue " the latter is
extended, grows stiff in this position, extending more
or less beyond the rows of the teeth, and protruding
outside, to a greater or lesser degree. Whether this
form of stammering is independent or is merely an out-
come of the throat being choked, we should not like to
decide. In several cases under our observation the
phenomenon seemed to represent a special form of
stammering by itself, while in a few other cases we were
under the impression that it was merely a conscious
movement, by means of which the patients believed
themselves to be able to "clear the throat." The
paroxysms of stammering often resemble voluntary con-
tractions to such an extent that the patient alone can
enlighten the observer as to whether a contraction is

PATHOLOGY 97

conscious or is unconscious, and merely the automatic
outcome of dread and psychic resistances. The same
applies even more strongly to the so-called co-move-
ments. These can be explained correctly by none but
the stammerer himself. He alone can know whether
this or that movement of an arm or leg, this or that
facial contortion, is intended to help him in his desperate
struggle with his refractory muscles, or whether they
are induced by inner resistances, on the one hand, and
the enormous pressure of volition, on the other, by the
aid of which he tries to force his disobedient organs of
speech to work. In some cases even the patient him-
self is not able satisfactorily to explain the origin of
those co-movements.

Some movements are undoubtedly apt to aid speech,
such as gestures of the right arm. The movements of
speech, as well as those of the right arm, are innervated
from the left side of the brain. Movements of the
right arm facilitate speaking, as speaking, on the other
hand, involuntarily furthers movements of the right
arm. Very likely the same applies to the stamping of
the right foot, by which energetic, angry words are
sometimes accompanied. Intense innervation of one
sphere aids and furthers, by irradiation, an innervation
of the sphere adjoining in the brain.

We will renounce the practically futile discussion of
the co-movements. We may mention, however, that
Gutzmann,* in a way worthy of acknowledgment, has
given a tabulated classification of some co-movements,
from which we will here quote one interesting case :

" The patient was a railway official, and had stam-
mered, in a slight degree, from boyhood. After a rail-
way accident his impediment began to increase in a

* Gutzmann, " Lectures," pp. 116-119.
7

98 STAMMERING AND ITS CURE

remarkable way. Before long the man was scarcely
able to speak at all. At each attempt to speak he in-
voluntarily wriggled about, and was only able now and
then to squeeze out a syllable or a word by a vigorous
jump forwards. Nobody — not even his own relatives —
at first thought of putting his strange behaviour down
to stammering. He was supposed to have lost his
reason, and was ultimately taken to the lunatic asylum
of the Royal Charite in Berlin. It was not until after
several weeks' treatment here that Professor Westphal
diagnosed the suffering as an extremely severe form of
stammering. As generally known, the impediment
considerably increases when the patient is in a state of
psychic emotion. Now, when Professor Westphal in-
troduced this man to his students with the words,
* Now, gentlemen, I will show you a highly interesting
case . . .% the wretched man, by his being characterized
as ' a highly interesting case,' became so intensely
excited that, at the attempt to insist on the Professor
not applying the term * case ' to his person, he jumped
about in the room with his fists clenched, without being
able to utter a single word."

We will now briefly recapitulate the results of these
investigations.

In the centre of stammering stands dread of speaking,
which, as momentum of inhibition, hampers the auto-
matic process of the function. When dread causes
the sensorium, particularly the word-image centre, to
vibrate — which is especially the case when the stam-
merer's attention is directed to letters and words — the
emotion easily transfers itself to those motor channels
which have become more or less irritable through
constant stimuli from the sensorium. The voluntary
movements of these motor nerves are, consequently,

PATHOLOGY 99

intensely influenced by dread. If the nerve and its coun-
terpart are equally irritable, both of them are equally
influenced by dread, and retardatio minor is the result.
As the proportion of forces working in both of them is
now altered, the active nerve cannot innervate as quickly
and with such result on the usual stimuli of the will
as in times of calm. The organ stimulated by it moves
more slowly and does not gain its end until the number
of the stimuli of volition is increased. The tremor
causes us to suppose that dread liberates single irrita-
tions in the motorium which follow each other very
rapidly. If a motor nerve is struck in one second by
sixteen stimuli of that description, the retardatio is
turned into tetanus. This influence of dread is still
intensified by psychic (largely unconscious) conflicts,
which counteract the stimuli of the will. Thus it is
still more possible that this retardatio riiinor, when
dread and psychic resistances are intense, is turned into
hcesitatio or tetanus.

It is easily conceivable that the spacial momentum
is also apt to aggravate the disturbances caused by the
disastrous influences of dread and psychic conflicts.
The organs of speech move within comparatively narrow
compasses. How small is the cavity of the mouth, how
small the larynx, how minute the glottis ! Any abbrevi-
atio motuum, and certainly any productio motmirrif
is bound to be accompanied by the worst consequences
to these diminutive organs ; when the glottis closes
but a trifle too much, and also, when it falls short
a little of the normal closure, speech is absolutely
impossible.

We may, en passant, repeat here that writer's cramp
is due to the same influences as those to which
stammering is attributed — viz., psychic conflicts and

100 STAMMERING AND ITS CURE

dread. That exactly the same inner resistances which
interfere with the normal innervation of speech are at
work in the case of a person suffering from writer's
cramp is proved by the fact that — as stated by
Naumann* — those stammerers who, at the same time,
suffer from writer's cramp are not able to write the very
words over which their organs of speech break down.

Anything that augments psychic conflicts and irrita-
bility also enlarges the basis of stammering, and, conse-
quently, the intensity and frequency of the paroxysms.
Everything that causes dread, haste, and eagerness has
the same effect. In this psychic domain only a
stammerer can be quite at home. It is impossible for
a non-stammerer to find his way about in this labyrinth,
unless he be guided by the sufferer after each attack.

The number of the momenta which increase or
decrease the stammerer's dread is legion. We can only
pick out the principal ones :

1. Beginning of a sentence. The stammerer sees the
whole of the long sentence before him. He will be
obliged to say all that ! The more he advances while
speaking or reading, the more his task and his dread
diminish. This is one of the reasons why stammering
is particularly conspicuous at the beginning of a
sentence. A further difficulty is to bring the organs out
of their position of rest. As a rule, it is easier to get
from one word to another than to start speaking. The
main reason is that, at the beginning of a sentence, the
acoustic help of the previous word is missing.

2. Sounds, syllables, and words at which the patient
has already stammered frequently increase his dread,
if he notice them beforehand. When speaking, and

*A. Naumann, *' Der Schreibkrampf," Graz, 1892.

PATHOLOGY 101

especially when reading, he anxiously looks ahead, until
he espies such a *' bugbear." Then his gvjne-'al dread
of speaking increases, sometimes causing him to get , ,
stuck long before he comes to the terrifying word;' ' '■ '
Nearly every stammerer has his own particular and
personal bugbear letters and words.

3. Each stammerer makes use of certain expedients
which he has devised to help him over an attack. Some
of these shifts would appear to an ordinary speaker
almost insane, or, at any rate, very odd and inappro-
priate ; for example —

(a) Many of the co-movements.

(b) The writing down of the words to be spoken, so
that, in case of need, the stammerer may be able to
show the note in a shop, booking-office, etc.

(c) The pointing at the objects he wishes to
designate.

(d) The altering of the arrangement of words in a
sentence.

(e) The substitution of an " easy " word instead of a
" difficult " one.

(/) The insertion of redundant words and phrases,
such as : " but," " then," *' namely," " you know,"
** I mean to say," etc.

If these expedients can be applied in the moment of
danger, dread will diminish, otherwise it will increase.

4. Strong psychic impressions direct attention to
other spheres of the senses, so that the domain of the
auditory and speech nerves becomes, to a certain extent,
free of dread ; for instance, travelling in a strange
country sometimes has a marked and salutary effect.

5. Being in pleasant company and the use in modera-
tion of alcoholic beverages favourably counteracts
dread ; on the other hand, the presence of persons

102 STAMMERING AND ITS CURE

standing in any authoritative relation to the stammerer,
especially when they watch him, unnerves him, and
may bring about an attack.

. r6. The existence of accessory circumstances, which
would not be noticed at all by a non-stammerer, acts
differently upon different individuals, frightening one
and calming another, the influence being dependent on
the experiences the sufferer has previously undergone
in similar circumstances.

7. The recollection of occasions in which he has
spoken well diminishes dread, whereas the thought of
occurrences at which he has broken down increases
it. Brooding over breakdowns and picturing the conse-
quences of the affliction to himself has a most detri-
mental effect also.

8. The thought that the observer does not know of
the infirmity sometimes represses dread ; in the same
manner a feeling of mental superiority over others,
which enables the stammerer to use authority in speak-
ing, has a salutary effect.

CHAPTER V

.ETIOLOGY

THE function of the brain called " speech " is a
psychic manifestation, which is the intermediary
between man and his environment. Without
speech man would be, to all intents and purposes, in
the world, but not of it, except in so far as he could
communicate with his brother man by means of gestures,
by pictures, or by natural expressions of fear, of joy, or
of pain, in cries common to man and beast. With such
limitations, it is hardly conceivable that progress along
the road of civilization would have made any advance.
The communication of ideas from man to man (the
object of all language) must find a ready and convenient
vehicle, and man himself created, as the outcome of his
brain and his vocal organs, that means of communica-
tion which we term " speech."

At the root of speech lie the emotions, the impulses
of love, of hate, of joy, of fear, which existed in the
savage breast in the same degree as they exist to-day
in that of the most typical product of the civilization
of all the ages.

The love which the prehistoric mother and child felt
for each other would find its expression in the same
raetliods as would maternal and filial love at the present
time : —

103

104 STAMMERING AND ITS CURE

1. By acts denoting love and affection, however
uncouth.

2. By affectionate speech, however immature; the
former being gradually replaced by the latter.

Speech is secondary to emotion, but is the most
important outlet for the emotions to the properly
balanced brain. If this means to express emotion be
wanting, an abnormal psychic condition is set up, and
it is interesting to notice in this connexion that a
marked tendency to retire from the world usually
asserts itself when a person is afflicted in such a way
as to make communication with his fellows impossible
or even difficult.

At the root of the emotions lies the desire for pleasure,
whether it be pleasure derived from self-gratification or
from altruism, as when " the first mother warmed her
loneliness at her infant's love." * In each and all a
desire for self -gratification is a factor with which we
have to reckon; in a child it is the dominating principle.
All his efforts at speech are made in order to open up
new sources of pleasure; even his expression, first by
actions and then in speech, of love for those around
him, reflects sensations of pleasure and comfort upon
himself, because it is a vent for the natural emotion
which surges up within him. Could he, all through
his life, give expression to every feeling, whether of
love, of joy, of truth; had he no secrets to keep, no
antagonisms to encounter, no obstacles to pleasure to
face, fear and dread would have no existence for him,
and stammering and other " phobias " would cease to
be the possible enemy lurking beside every cradle.

It has been said that " to be able to express one's
ideas with some amount of accuracy is one of the

* Drumuioud, " Ascent of Man," p. 372.

AETIOLOGY 105

luxuries of life." From the earliest years, speech being
used, as we said before, in order to open up new sources
for pleasure, any impediment of speech becomes an
obstacle to pleasure. [^How does this dire affliction first
come about? Civilization makes demands upon even
the smallest child; restricted actions, restricted speech
are necessary adjuncts in the training of a well-brought-
up child : " You must not do this," " You must not say
so-and-so." In fact, secretiveness is unconsciously
forced upon the child who is brought down into the
drawing-room, and fear is developed with every effort
on the part of the mother to show her child off to best
advantage — fear of strange faces, fear of being unable
to do or to say something which will be demanded, fear
of saying something which should not be said, which,
at least in the neurotic child, amounts to dread. Later
on, dread is apt to attack speech itself. The child
begins to be afraid of not being able to speak calmly
without being blocked; in fact, all who understand the
subject recognize dread as the centre and cause of
stammering. Thus it will be seen that the impediment
is a psychic betrayal, an unconscious complex forcing
its way between syllables and words. The affliction is
caused by inner resistances, which hamper free utterance,
and not by wrong articulation, incorrect breathing, faulty /
vocalization, etc.

The neurosis which forms the basis of the impedi-
ment invariably starts in childhood, assuming mostly
the shape of a pure dread-neurosis. The latter is,
unfortunately, but little recognized and little studied.
A child who suddenly becomes afraid of the dark and
of being alone, will be regarded by an expert as in
danger of developing neurosis. Of course, all small
children are instinctively afraid of the dark. This fear

i

lOG STAMMERING AND ITS CURE

is, as Professor Freud 27 points out, the very root of all
feelings of dread : " Dread of children is originally
concomitant with their missing the beloved person;
that is why they meet any stranger with dread; they
are afraid of the dark because they cannot see the
beloved person in it, but are easily calmed down when
they can take the person by the hand." This applies
to all children, both to the healthy and to the nervous.

One day, however, one notices that, without a per-
ceptible cause, the child manifests a certain irritability
and a kind of exaggerated timorousness. A child who
hitherto quietly remained in a dark room now refuses
to be left alone or to enter a dark room. He begins
to feel shame and to ask numerous and extraordinary
questions, such as : "Why are the trees green ? " " Why
hasn't a man four legs ? " and so it goes on ceaselessly.
At the bottom of all these incessant questions there is
one which has begun to occupy the child's mind. He
has come into contact with the sexual problem and feels
a libidinous emotion from his unconscious, which is
experienced by him as dread. And the one question
which occupies the foolishly brought-up child would
have to be worded : " Where do children come from } "
Other signs of cerebral irritation appear also, such as
a strange restlessness, absent-mindedness, and a lack
of concentration, in cases where the child has already
taken up school-work.

Such a child commences to be restless in his sleep
and to suffer from night teirors. Sleeplessness is fre-
quently the first and sometimes the only symptom of
infantile dread-neurosis. Some children have dreams
of bogies, giants, dogs, wild animals, etc., and start up
with a fright; others utter confused words in their
sleep.

ETIOLOGY 107

An analysis of the child's dreams and a minute
investigation into his hallucinations will always furnish
the same material — viz., an erotic emotion induced by
a parent, nurse, servant, a playmate, or by an accident.
Ghastly tales of the bogy may perhaps play a certain
part, too. But we have reason to think they merely
serve as momenta of secondary importance, or they may
offer an object for the dread already in operation. The
same applies to the overdrawn consequences of a sudden
fright (by a cat or a dog, or by a noise, a strange man,
etc.). Here the soil from which neurosis sprang into
existence was already prepared by erotic emotion, and
what took place was merely a wrong association of the
shock with that emotion.

We are aware of the fact that most medical men are
of opinion that colds, constipation, indigestion, adenoid
vegetations, etc., are the cause of night terrors. On the
other hand, children's doctors of great experience and
capable of subtle observation state that in most cases
of " pavor nocturnus " no disturbance of the digestive
organs nor any morbid condition of the respiratory and
circulatory organs is noticeable, and that adenoid growths
are missing also.

A hereditary disposition is, in some cases, undeniably
productive of these conditions, children of nervous
parents being the most likely to be attacked. However,
the connexion is almost entirely different from what
the adherents of the theory of heredity believe it to be.
A close investigation into the environment in which
nervous children grow up will, in many cases, show that
there is a special manner in which these little ones are
infected with nervousness by their parents.

It is a general experience that the bringing up of
children, when accompanied by exaggerated fondness

1^

108 STAMMERING AND ITS CURE

of parents, induces a corresponding need for the mani-
festation of affection on the part of the child, a need
which craves for satisfaction. So long as such a child
is small, that need is fully complied with. The parents,
and particularly the mother, are so overjoyed at their
child's proof of love that, in order to reward him, they
overwhelm him still more with caresses. Thus the
measure of affection increases instead of decreasing by
degrees. The child has to go to school. For the first
time in his life he has to face the will of a stranger who
demands work, but no love nor caresses. How easily
may conflicts be produced in such a situation ! Having
experienced no obstacles so far in transferring his
erotic tendencies on to the people with whom he came
in contact, he now realizes that the teacher does not
meet him in a similar way; the child gets alarmed at a
strict word and perhaps begins to cry; school soon
becomes distasteful to him, and he does not like to
learn. He has a desire to change school and to have
other teachers. If this wish be acceded to, the same state
of affairs will very likely begin again before long.

The great dangers of the manifestation of foolish
fondness for a child are only known to very few parents.
These dangers, which are, unfortunately, liable to in-
fluence the whole life more or less, consist in libidinous
sensations being prematurely aroused. We forget un-
pleasant experiences only too easily ; that is why most
adults have no recollection of the erotic events of their
early youth. Parents in particular often show great
proficiency in forgetting events of this description, a
forgetfulness which nearly verges on a pathologic state —
viz., hysterical amnesia.

That the sexual enlightenment of a child has become
an important problem of vital consequence is proved by

ETIOLOGY 109

the numerous books which are intended to solve it.
Open scientific explanations, according to the child's
age, should, we are now told, take the place of
mysterious experiences derived from turbid channels.
Very well ! But we must not imagine that the child's
erotic understanding has not yet been awakened pre-
vious to those explanations. To think this is a grave
blunder. The sexual life of a child does not begin, as
we are told in old books, with puberty, but actually
from the day of birth. Havelock Ellis,26 Freud,2T
and many other experts have proved this fact beyond
doubt.

People imagine a small child who cannot yet talk to
be unsusceptible of erotic impressions. Whence do
they derive their information? The child's brain is a
photographic plate which eagerly fixes impressions —
no matter whether they are comprehensible to the child
or not — impressions which may " constellate " his life to
a considerable extent. As a matter of fact, erotic
emotions can, later on, be induced only by associations
leading to those first infantile impressions. If only
people would not act so exceedingly naively in these
matters ! It would not then happen that children
sometimes sleep in their parents' bedroom up to their
tenth year in order that these anxious people may watch
the breathing of the cherished being. The parents do
not like to think of the possibility that the children can
there receive impressions which are extremely harmful
to them. Many an obstinate case of insomnia in tender
age and of nightly attacks of dread has thus been caused.

We have, therefore, to start from the premise that all
children are capable of erotic emotions, and that these
emotions are liable to do their nervous systems harm.
It is logical and is verified by experience that the child's

110 STAMMERING AND ITS CURE

prospects of becoming a healthy individual with strong
nerves are the greater the later his conscious libidinous
life begins. Among those factors which are able pre-
maturely to arouse erotic feelings, exaggerated tenderness
has to be reckoned with. There is scarcely any psycho-
logic difference between the tenderness of a lover and
that of a mother : both of them kiss, caress, fondle,
pet, embrace, hug and stroke. It is obvious that the
stimuli of the peripheral nerves conduct the irritations
to the same central organs in both cases.

Thus the child receives his first erotic sensations
from the persons under whose care he is, and, no
matter how we put it, the fact remains that the mother,
father, nurse, or nursemaid is the child's first love —
that is to say, his first erotic love. This, however,
must not be interpreted as if we would condemn tender
dealing with children. On the contrary, a certain
amount of tenderness is absolutely necessary to further
their normal development ; but it must not become too
great, as they are then prematurely brought into a state
of erotic over-excitement. When the child grows older
and becomes acquainted with educational restraints and
demands, strong inhibitions are brought into play to
subdue the power of instincts. As a reaction against
the premature erotic emotions, a strange process sets
in, which has been termed by Freud " repression "
(Verdraengung). The child either succeeds in effecting
this repression so well that he forgets his early ex-
periences, or he fails to do so, in which case his erotic
craving will increase year by year. In this way the child
is thrown into serious psychic conflicts, which tend to
prepare the ground for neurosis.

That exaggerated fondness often induces children to
obtain libidinous feelings in an auto-erotic manner may

iETIOLOGY 111

be mentioned by way of parenthesis ; it is here neither
necessary nor possible to enter into details. Most men
do realize that the experiences of childhood influence
their whole life. It only shows how tragic are the con-
ditions of human aspirations, that exaggerated love of
parents may ruin a child's health, and that the roses
strewn on his way by his parents may wither, and leave
their thorns in evidence sooner or later.

In most cases stammering begins when the child
feels under the obligation to hide from his parents
an action or a " discovery " of a libidinous nature.
Children show us the human psychic reactions in a
clear, undisguised manner, and maintain a correct
attitude against secrets, which adults would do well to
emulate. They are not able to keep a secret, as it
appears to them an unbearable burden. When they
happen to have a secret from their parents (because,
owing to instinctive shyness, they are too timid to speak
to them about everything), they begin to alter their
conduct towards their parents, and become mostly not
only reserved, but also more fractious and difficult to
manage.

Stammering, in however slight a form, will probably
set in, in cases where the child is disposed to stammer,
on the very day on which he gets hold of exciting
knowledge which must be kept secret. If, however,
his nervous system possess strong resistive power, the
psychic struggle with the " foreign matter " may go on
for a few months, or even years, before deleterious
results are manifested. Several of our patients have
been able to remember that their first stumbles occurred
on the same day on which some upsetting knowledge
came into their possession, or some event, demanding
secrecy on their part, took place. Such cases help us

112 STAMMERING AND ITS CURE

to trace with accuracy the psychic conflicts which inter-
fere with normal innervation — conflicts which are now
recognized as the " first cause " of the affliction which
we are considering. Where the impediment did not
make its appearance until some time after the stimu-
lating cause had taken place, the locating of that cause
is, of course, far more complicated. At the same time,
those cases in which stammering sets in immediately
after an accident, a fright, or some infantile disease, are
particularly misleading. The impediment has made its
appearance, and very naturally the anxious parents and
the sympathetic medical man cast about for a cause
which shall bear the onus of the defect. We will state
here that, in our opinion, such momenta as shock,
fright, or disease never produce permanent impedi-
ments of speech. It may happen, however, that psychic
conflicts, which had already been going on for a long
period, have now, through a temporary weakness of
the nervous system, a favourable opportunity of forcing
their way into innervation. In nearly all such cases
as this, it is equally imperative to trace the original
source of the psychic conflict before any complete
eradication of the defect can be accomplished. Amongst
other things, imitation is frequently supposed to have
brought about the affliction. Here, again, let it be
stated that mere imitation of a stammerer, even if done
wilfully and continuously, is insufficient to produce the
impediment. If, however, the imitator has already
suffered from the same complexes as the stammerer,
and was thus in a condition to appropriate the
symptoms of the latter, the case is different, and be-
comes one which may be regarded as due to the
phenomenon of hysterical identification. " Identifica-
tion," says Professor Freud, " is a momentum of the

.ETIOLOGY 113

greatest importance for the mechanism of hysterical
symptoms." Identification, it must be remembered, is
much more than the capacity which hysterical people
are known to possess of producing an exact imitation
of the symptoms of others, which have particularly
impressed themselves upon their attention ; it is much
more than sympathy, which is so exaggerated in
hysterical persons as to cause them actually to repro-
duce those symptoms.

Identification is a complicated psychic act which
travels along the road marked by imitation and sym-
pathy, and may be said to correspond to an unconscious
conclusion on the part of the imitator, which we will
suppose to be worded thus : " If that stammerer can
have such attacks from such causes " (strict treatment
at school, and so on), *' I, also, can get such paroxysms
of stammering, since I have the same causes " (com-
plexes). " The identification is, therefore, not simply
imitation, but an appropriation on a basis of the same
aetiological claim; it expresses a * just as . . .' and
refers to a joint psychic factor which remains in the
patient's unconscious " (Freud).

Psychic conflicts which are liable to interfere with
normal innervation of speech do not start, as a rule,
imtil the child is about three and a half years old.
Only in exceptional cases of delicacy of constitution or
of marked hereditary tendencies, a child may show the
first signs of an impediment shortly before reaching
the third year. We are not referring here to that tem-
porary stuttering which is frequently noticeable for a
few weeks or even months in quite young children
when endeavouring to master the elements of speech,
but to actual stammering, which has been set up by
the psychic conflicts already described.
8

114 STAMMERING AND ITS CURE

These conflicts soon produce other conditions : a
child who has experienced them will show strong
resistances ; particularly will he resist members of his
own family; he becomes difficult to influence, shows
signs of dread and embarrassment, and exhibits sus-
picious traits. From this moment introversion of his
libido * sets in — that is to say, his erotic emotions,
having lost more or less the usual channels (the channels
they hitherto frequented or used), cannot fail to be
piled up, with the result that a portion of the libido has
to be repressed. A superfluity of libido in the child's
soul (conscious) and in repression (unconscious) results
in the formation of an emotional complex, which repre-
sents the expansion of a gasometer, as it were. It must
be borne in mind that the soul can only bear a certain
amount of libido, its possibilities in this direction corre-
sponding to individual capacity, any surplus having to
go into repression.

When the emotional complex has begun to be formed,
the child may develop the impediment of stammering.
This, however, is not possible before the emotional
influences of the complex have overcome the natural
resistances of his nervous system. The complex is apt
to attack the weakest spot first (locus minoris resist entix).
In most cases a child will merely develop a phobia
of dogs or of horses, etc. If, however, the speech nerves
are weakened, owing to heredity, to a shock, or to
diseases like whooping-cough or diptheria, the complex
will use these weakened nerves as channels for its floods
of emotions, and an impediment of speech is the result.

Introversion — that is to say, piling up of libido —
always produces two results, viz., (1) An increased

* Libido is understood to comi^rise love in the first place, and,
in addition (owing to partial sublimation), energy and aspirations,

ETIOLOGY 115

play of imagination, and (2) a condition of expectant
attention coupled with dread ; the result of this
combination being that any impression which enters
the mind is endowed with an overcharge of expres-
sion. A requirement to undertake anything new
always necessitates the overcoming of inhibitions, as
the " application of interest " (with which is con-
nected the transference of more or less numerous
fancies) is at once demanded of us. We act the thing
in our imagination, and, when we have to carry it out,
we transfer the whole material of fancies to the person
we may have to deal with.

A stammerer, owing, as we said before, to the intro-
version of his libido, suffers from increased play of
imagination, and, in proportion, experiences more in-
tense obstacles and inhibitions, when the transfer has
to be made, and dread sets in; hence he invariably
breaks down when endeavouring to deliver an important
message, when giving evidence in a court of law, and so
on. None but a stammerer can fully realise what this
condition of expectant attention, this " being on tenter-
hooks " all day long, means to the sufferer !

Any "expectant attention" may become "dread ";
there is no special limitation. A certain amount of
dread is in every expectation. Let us illustrate this
psychological fact by a comparison.

A girl has arranged to meet her lover at their trysting-
place at a stated hour each evening. He has been
there regularly for weeks ; to-day, however, he is not at
the rendezvous, though it is ten minutes past the
arranged time ! She feels that he is inconsiderate, and
vexation shows itself on her countenance; after waiting
another ten minutes anger sets in ; yet another ten
minutes pass without his appearance. Now her imagina-

116 STAMMERING AND ITS CURE

tion begins to play : either an accident has happened,
or, worse still, he is faithless I Dread begins to paralyse
every limb, and even his appearance at last, with a
perfectly good excuse, does not immediately overcome
the psychic effects of the episode.

The moment at which expectation may change into
dread varies in each individual case. If, for instance,
the girl in our illustration be neurotic, dread will set
in perhaps after the first five minutes of unrealized
expectation.

To make the phenomenon of dread still more lucid, we
will compare it with the sensation of fear. Let us con-
sider fear as a feeling of dislike, founded on a reasonable
cause, which has placed itself in the service of the
instinct of self-preservation. Fear has always a definite
and a more or less tangible object; we are reasonbly
afraid of fire or of water which have overstepped their
proper bounds, of ferocious animals which are not
under restraint, or of brutal men. On the other hand,
we experience dread when we are face to face with the
*' unknown." Dread is the neurotic counterpart of
fear. What fear is to the physical, dread is to the
psychic sphere in man ; therefore dread is by no means
an amplification of fear. Or, let us say, dread is not
fear in a comparative or positive degree. The super-
lative degree of fear is terror, fear being a chronic and
terror an acute state, and both are manifestations of the
life-instinct. Moebius 46 even classifies fear as the most
important manifestation of the life-instinct : " When in
morbid states life-instinct declines, longing for death
supervenes, and it is as though fallow dawn lays itself
on everything that otherwise appeared bright and
pleasing."

Dread is also a manifestation of life-instinct, but with

ETIOLOGY 117

one difference : fear is a comparatively healthy mani-
festation of normal conditions, which has a beneficent
object, whereas dread is an unhealthy symptom, a
manifestation of abnormally suppressed instincts and
a product of so-called repression.

Which instinct is from early childhood mostly ex-
posed to suppression and repression? Is it not the
sexual instinct? Dread is the manometer which indi-
cates the degree of this repression. The sexual instinct
never gains prevalence by itself, as, generally speaking,
the various instincts always make their appearance
accompanied by their counterparts. Thus sexual in-
stinct is always accompanied by life-instinct and its
counterpart, death-instinct. Nay, the sexual instinct
is, in the meaning of the masses, directly associated
with life-instinct, which is evidenced in their desire to
" live a life of enjoyment." Any obstacle to the appli-
cation of libido means partial death, and finds its
expression in presentiments and weariness of life, which
are phenomena frequently met with in neurotic people.

It is no mere poetic sentiment that makes love and
death intimately connected. When the poet does con-
nect them, he acts on the instinct, or it may be on the
knowledge of psychologic facts, which are " the scaffold-
ing of which poetry is the house." How often in
poetry or in prose are our sympathies called out by the
death of a lover who has lost his loved one; by the
death of the aged husband or wife within a few days of
his or her companion of so many years. We must,
however, introduce the less poetical but frequent cases,
where thoughts of suicide follow on such losses.

The more strongly life-instinct is developed, the more
intensely will the individual be subject to feelings of
fear. However, not until life-instinct, coupled with

118 STAMMERING AND ITS CURE

sexual instinct, is represed, will dread appear. Thus
dread is the reaction against the pressing forward
of death-instinct, caused by the repression of sexual
instinct. It is entirely due to Professor Freud that
modern psychology now knows that dread is always
caused by repression of libido.

Even a very temporary introversion of hbido is able
to produce strong feelings of unpleasantness. To take
a case which is well known : when a child leaves home
for some time to stay with relatives or friends, he finds
it for the first few days difficult to transfer his love on
to his new environment. The result is that the child,
being unable to use the accustomed channels for his
affections, is bound to pile up his libido, which accumu-
lation, after it has reached a certain expansion, is
experienced by him in the shape of home-sickness. If
the accumulation of libido goes on for some time, the
introversion may even produce a phobia there and then
— at least in a child of a rather neurotic disposition.
It is, for example, not a rare occurrence that a child
develops stammering shortly after he has gone to
school, as, on the one hand, he is obliged to dissever
his libido from his first beloved ones, while, on the
other hand, he finds it difficult to transfer his affections
on to his new and perhaps stricter surroundings. ^ The
latter difficulty is so much greater if the master at
school happens to be a stern disciplinarian.

Before we proceed to outline the further consequences
of introversion, we will give some details about the
nature of repression. Dr. Stekel 6i points out that our
culture is built on ground reclaimed by great efforts
from beneath turbid expanses of water, which had first
to be repressed by the erection of powerful dams, so to
speak. Culture which has been won at the cost of

iETIOLOGY IIU

repression is, therefore, obstruction; even though it be
well organized and to all appearances beneficent, it is
still obstruction.

What applies to mankind as a whole applies also to
the single individual. Repression enables us to lead
the life of civilized beings who aim at putting all the
ethical and social demands of their time to good account.
It also enables us to cultivate those higher aspirations
and ideals which distinguish us from savages. From
this point of view and thus described repression seems to
have none but beneficent influences, and would appear
to be a desirable factor in both individual and corporate
life.

Far from this, repression without the aid of conscious-
ness is often a primary cause of psycho-nervous disease,
and may be said to represent the compressed condition
of gases, rocks, etc., beneath the outwardly unmoved
surface of the earth, which may at any moment find
their vent by way of earthquake or volcano. What
lies hidden imder the calm exterior of consciousness
can, when stirred, agitate the entire human frame;
hence repression is not freedom, but it is a bondage
from which all who suffer will thankfully learn how to
escape.

Repressed thoughts, wishes, and emotions can never
be successfully got rid of, unless they can first be traced
up to their most subtle associations, and to do this we
must avoid mixing up the mere forgetting of indifferent
impressions with repression itself. Repression presup-
poses an emotion, a feeling of dislike associated with
strong emotional tone, while an indifferent impression
is not so associated ; therefore an indifferent impression
may be forgotten and may leave no ulterior harmful
result. Forgetting that is based on repression is a

120 STAMMERING AND ITS CURE

definite psychic act; but such repression rarely suc-
ceeds completely, and the entire and absolute forgetting
of an incident, an impulse, or a fancy, can seldom be
proved to have taken place. The more intense the
emotion accompanying an incident, the more difficult
will it be to repress the remembrance of it; and unsuc-
cessful repression, in which the emotion has not been re-
moved, but merely shifted, is a fruitful cause of neurotic
ailments. The symptoms of the latter are invariably a
compromise between emotion and repression.

The influence of repression in causing obsessions and
phobias is dealt with by Professor Freud somewhat as
follows : When a person who is predisposed to neurosis
has to shunt an incompatible impression, it becomes
separated from its emotion : this emotion remains in
the psychic sphere. The impression thus weakened
becomes a remainder in his mind, and is denuded of all
associations ; the emotion, however, being set free,
attaches itself to other not incompatible impressions,
and these, owing to the faulty alhance, are turned into
obsessions.

As already mentioned, any erotic emotion combined
with repressed hbido turns into dread. '* Wherever
libido as such does not become conscious ; where it is
masked ; where it is felt painfully, and therefore pushed
away from consciousness, it is manifested as dread. It
is the task of psycho-therapeutics to unmask dread as
an erotic emotion, and to remove it completely by
sending back libido from the patient's unconscious into
his consciousness " (Stekel).

We have digressed at some length from the actual
subject of this treatise, but not without need, if we
are successfully to explain the rational treatment of
stammering.

iETIOLOGY 121

1\ will be remembered that dread and excessive play
of tile imagination are consequent upon introversion of
libido, and that they bear an important relation to the
affliction of stammering; but there are two more
factors which aggravate the sufferer's struggle very
considerably — namely, over-sensitiveness and a feeling
of inferiority.

The neurotic state of a stammerer is betrayed by his
psychic over-sensitiveness, a trait which nearly all
neurotic people share with him. When questioned on
this point, the patient generally admits that he is
" touchy," and that he is easily offended by a word or
even a look ; or if the patient will not admit this failing,
his relatives are quite conscious of it, and conscious, too,
of their efforts to avoid hurting these sensitive feelings.
The patient has sometimes to give in to the overv/helm-
ing mass of evidence that can be arrayed against him,
and to admit the defect.

The manifestations of this over-sensitiveness are
rather interesting, and make themselves felt promptly
whenever the patient finds himself in a situation where
he appears to be subjected to, or is even likely to be
subjected to, neglect or to want of consideration. A
stammerer's accounts of the accumulations of dis-
paragement and humiliation to which he is exposed are
striking and surprising indeed to the lay mind, but the
psychologist knows that a considerable percentage of
these patients will sometimes positively seek out such
situations, and will even lay themselves open to smacks
in the face, so to speak, while the sufferer's excessive
play of imagination is responsible for most of the rest
of his catalogue. These tendencies arise from the un-
conscious, and, together with other impulses, bring
about a feature of neurosis known as " hypochondria ";

122 STAMMERING AND ITS CURE

the patient then becomes, on his own showing, a person
who is hurt, pursued, depreciated, and for whom ihere
is nothing but suffering, calamity, and ill-luck in store.
A lack of joy in life, continual expectation of mis-
fortunes and slights, distrust of his own powers and of
other people's intentions, soon destroy the social tissue
that connects him with his environment. This want of
contact soon becomes only too evident in the patient's
features and general attitude towards society, especially
when his inability to overcome a painful impression or
to avoid bearing resentment asserts itself. A sulky
obstinacy and a stubborn adherence to his own opinion
are further characteristics in some cases, and, where
these are in evidence, they tend to make the sufferer by
no means a pleasant companion.

Second to over-sensitiveness, which we have exempli-
fied, is the sense of inferiority, which all stammerers
suffer from, and which is '(though not in all cases)
partly based on an inherited disposition. We are often
told by stammerers that they have been delicate children,
or we are informed by their relatives that they have
been particularly awkward and clumsy in their child-
hood, so much so as to incur constant censure and
reproof. Far from treating such clumsiness as a fault,
it should be recognized as an indication of the fact that
severe struggles are proceeding in the child's soul when
he endeavours to fit his actions into such forms as
civilization and domestication require — requirements
which, to his particular organism, may be full of
difficulty.

Reminiscences of this childish clumsiness may often
be found in adult stammerers, though, owing to the
phenomenon of psychic compensation (of which we
shall say more later on), it is sometimes transformed

iETIOLOGY 123

into artistic skill of a high order. Frequently a psychic
awkwardness remains which contrasts vividly with the
eminent cleverness often found in stammerers, and it
may be so marked as to give an appearance of mental
inferiority where such does not exist. Generally, how-
ever, a state of perplexity, embarrassment, and timidity
has set in long before the commencement of the
neurosis, while the development of self-reliance remains
immature, and the need to lean upon, and to display
affection towards those about him, grows into such
boundlessness that the child's demand cannot possibly
be complied with. Thus it happens that the sensitive-
ness which was already apparent is immensely increased
and becomes an over-sensitiveness, which is constantly
giving rise to entanglements and conflicts.

Imagine the thoughts that may arise (for the sake of
illustration) in the mind of a step-child who has a
neurotic temperament. He expects slights and neglect-
ful treatment perhaps day by day, so that estrangement
and a propensity to distrust even the most well-
intentioned overtures of the step-parent set in. How
shall he assert his superiority to the children of that
step-parent ? Oh, that he were prettier, stronger, taller,
and cleverer than they I

It goes without saying that the continual ambition
to be all these things forms a powerful psychic stimulus,
and may assist such a child to obtain an over-valuation
and to develop characteristics which would otherwise
have been latent or non-existent. Side by side with
positive developments such as we have described here,
there may, however, be many negative ones — impulses
of hatred, envy, meanness, which are foreign to the
average child's soul, and the child's mind and imagination
are impregnated with impulses which, because they are

124 STAMMERING AND ITS CURE

blameworthy and would render him liable to exposure
and to punishment, he keeps closely veiled from his
environment. To maintain this disguise, a continual
conflict exists in his soul, of which silence, to those who
can analyse these things, is an index of the fact that
psychic impulses have become effective, impulses which
he does not want to be noticed. We have, of course,
given a rare case as an example, and must leave it to our
readers to apply the principle to more ordinary ones.

It is not possible within the scope of so short a treatise
as this to show more fully how such conflicts gradually
accumulate and form (to a large extent) the *' psychic
superstructure " of neurosis. We will only add that
any feeling of inferiority is invariably accompanied with
feelings of ardent desire, longing, and ambition, since
any feeling consists of two counterparts, which have to
be balanced. A feeling of inferiority is thus bound to
produce a counterpart with a huge plus ( + ). This
psychologic law explains the fact that stammerers are
usually very ambitious people, and accounts for the
fact that many of them eagerly wish to become pubUc
speakers.

Dr Adler l points out quite correctly that physical
inferiority very frequently produces psychic over-valua-
tion to such an extent as to characterize and stimulate
the whole of the mind. It is well known, for example,
that hunchbacks are, in their own imaginatiwi, " great "
persons. Further, it is no mere chance that people of
small build, like Casar, Charles XII., and Napoleon,
were possessed of insatiable aspirations. Inferior organs,
owing to the intense stimuli proceeding from the
" psychic superstructure," not seldom supply the basis
for a choice of vocation or for special inclinations and
favourite pursuits. Moses and Demosthenes, a stam-

iETIOLOGY 125

merer and a lisper respectively, became renowned public
speakers and leaders. Contemporaries of Camille
Demoulin, who in private life was a painful stammerer,
tell us that his speech (in public) " flowed on like
molten gold." Mozart's and Bruckner's ears had a
degenerate disposition. Beethoven and Robert Franz
are examples of the same type, but the disposition was
so serious that both composers, later on, lost their
hearing altogether. The hallucinations in Schumann's
psychosis indicate over-compensations in the " psychic
superstructure " of his ears; at the same time, however,
as is the case with any hallucination, they indicate the
ill-success of a psychic subjugation and of a psycho-
physical accord. Clara Schumann reports of her child-
hood : " The nurse " (who looked after her) " was by
no means loquacious, and this might have been the
reason why I did not begin to speak even the first
words until my fourth or fifth year, and was also unable
to understand much at that time." In another place
she goes on : *' As I heard so little conversation, nor
felt inclined myself to talk, my parents frequently com-
plained, especially when I began to talk, that I was
hard of hearing ; and this apparent defect had not quite
disappeared in my eighth year, though it had improved
the more I began to speak myself and the more I noticed
what happened round about me." A remark of her
father is interesting : " This is the opening accord of
an artist's life, which, in its further development, and
by the abundance of pure harmony which it diffused,
became not only a bearer of delight of a rare kind for
innumerable people, but was also destined to become a
model of accomplished and clarified harmony of art
and life. Strange that it should begin with a harsh
dissonance,"

126 STAMMERING AND ITS CURE

These are the results of a successful over-compensa-
tion. What happens, however, when the compensa-
tion is unsuccessful — that is to say, when the psychic
stimulus arising from physical need (heredity, temporary
disease, shock, etc.) — meets with complexes which impede
the compensative work half-way ? Out of this psycho-
physical relation a condition of high psychic tension is
bound to be evolved, and the person thus affected
becomes imequal to any further demands. When,
therefore, owing to disease, shock, or fright, additional
claims are made upon the constitution, they cannot be
complied with normally, and stammering or some other
phobia will set in.

The psycho-motor superstructure of the organs of
speech fights a continual battle with the influences of
the emotional complex, and, consequent upon successive
victories or defeats, stammerers experience ups and
downs, good days and bad days. It is obvious that,
when the sufferer's nervous system is weakened by a
temporary bodily unfitness or by worry, the hostile
influences of the complex are felt more intensely.

A phenomenon connected with stammering (and
other neurotic ailments) is frequently noticed — namely,
that in some cases the first two or three hours in the
morning are particularly trying to anyone suffering from
the defect we are considering. This is accounted for
by the fact that resistance on the part of the fore-con-
sciousness decreases during sleep, with the result that
the emotional complex sends its energy (mostly in the
shape of dreams) into fore-consciousness producing dis-
turbing influences, from which some patients find it
difficult to get free until they have been awake for a
considerable time.

Let us now turn, by means of a simple diagram, to a

iETIOLOGY 127

consideration of the manner in which the emotional
complex interferes with the normal innervation of
speech.

Let a represent the contents of consciousness and b
the emotional complex ; d may represent the source of
libido (instinct of life) which supplies both a and h with
energy. The intention to speak (in a) meets, on its
way to the centre of innervation, in c with an inhibition
coming from the complex, with the result that libido
quickly increases. The stammerer now begins to work
himself up in order to overcome the obstacle. The
energy in b, however, has also increased, and with it
the obstacle in c. If the
emotional complex be com-
paratively small, the sufferer
is, as a rule, able, after a
momentary struggle, to over-
come the inhibition in c; if,
however, the complex be
great, he has to make several
intense efforts to overcome
the barrier, or may have to
give up the struggle altogether. If no actual inhibition
be experienced at all, the patient will, during the act
of speaking, feel either hampering dread or goading
excitement.

Stammering is at the outset, and often for a good
many months, or even years, absolutely unconscious on
the part of the sufferer. The child's environment, how-
ever, soon begins to distress him, and laughter, scolding,
and threatening open up before his mind the saddest
prospects for the future. Through this attitude of those
around him the stammerer contracts more and more
dread of speaking. The movements, first weak and un-

128 STAMMERING AND ITS CURE

consciously inco-ordinate, are considerably increased by
dread, and the respirations, owing to dread, also become
frequent and irregular. The paroxysms of stammering
increase accordingly, and the parents seek some one
who will instruct him in " exercises." He is induced
to repeat the words over which he stumbled ; his parents
find ** difficult " letters and words, and point them out
to him, with the advice to practise them over and over
again. Thus dread of special bugbear words and letters
is artificially inoculated into the stammering child, and
he begins to watch the words he has to speak or is
speaking. So far, all abnormal respiratory and speech
movements had been entirely involuntary; henceforth,
owing to the attitude of the environment, voluntary
ones are added also.

So long as stammering is unconscious, the child
notices that his manner of talking differs from that of
his father or mother, and he may think that it is merely
peculiar to a small child; he does not, however, con-
sider it a defect, nor does he worry about it in the least.
But after he has been repeatedly rebuked or teased, it
gradually dawns upon him that his speech is defective,
and he feels annoyed at it. Continual distress does
not, as a rule, set in until the child has gone to school
for some time, and has felt the impediment keenly,
when competing with his schoolmates. From this
moment the mental impression, " I can't talk," coupled
with the most disagreeable feeling of nervous tension
and oppression which soon associates itself with any
serious paroxysm of stammering, increases more and
more, and the child begins to avoid speaking as much
as possible. By degrees " funk " is increased up to the
power of an asthenic emotion, owing to the fact that
the patient has to contend more and more with thoughts

.ETIOLOGY 129

of being degraded in the eyes of others, of painful
situations, and of making a fool of himself at any
moment. When only one of those hateful thoughts
springs up in his consciousness — when, for instance, the
features of the person, to whom he is speaking, by chance
assume apparent compassion — at once a whole host of
hampering thoughts rise hastily from the depth of the
unconscious in which they are lurking, as it were, in
order to frighten and to torture the unfortunate patient.
When haste, embarrassment, or dread are particularly
intense — being, for example, consequent upon the pre-
sence of extremely influential or authoritative persons —
even the speech nerves of ordinary speakers may break
down. " Such may stammer in exactly the same way
as a stammerer does," the only difference between the
two classes being that ordinary speakers, owing to well-
grounded confidence in their powers of speech, only
succumb to intense psychic influences, while stammerers
quickly display signs of their affliction when quite in-
significant emotions operate upon them. Besides,
dread of speaking is missing with a non-stammerer,
and the feeling of confidence increases with him from
year to year, helping him over any possible unevenness.
Between both categories we find various transitions, in
accordance with the intensity of the emotional complex
and the power of the nervous resistance. Further,
with an inveterate stammerer, we can discern different
degrees in the intensity of the single paroxysms of
stammering, the degrees being dependent on the patient's
state of health on the one hand, and on the intensity
of psychic emotion, on the other. An adult sufferer, for
instance, stammers, as a rule, much less when speaking
to a child than when speaking to an adult, as the
presence of a child does not embarass him so much,
9

130 STAMMERING AND ITS CURE

and therefore psychic emotion is less intense. A stam-
merer probably experiences fewer difficulties at the end
of his holidays than at their beginning, as his nervous
system has temporarily improved. Differences between
persistent and occasional stammering can only be under-
stood by sharply distinguishing between the nervous
basis and the psychic stimuli.

Professor Freud SO has proved that even slight stam-
mering or stuttering, due to the temporary embarrass-
ment of an ordinary speaker, is invariably caused by
inner conflicts which are betrayed by the disturbance
of speech. The same applies, by the way, to any auto-
matic mistake in speaking, writing, or reading, and still
further to symptomatic and accidental actions, etc.,
inasmuch as all errors of this description (in an educated
person, of course) are caused by unconscious motives
influencing innervation. Many phenomena which border
on the miraculous or support superstition can — as Freud
has cleverly substantiated — be entirely explained by
fathoming the unconscious psychic functions.

No psychic action is accidental. It is only to
people who are not on good terms with themselves that
frequent mistakes happen. People who are full of
presentiments, fear, and anxieties are often unlucky !
Thanks to Professor Freud, we are now able both to
realize the psycho-pathologic significance of those small
functional disturbances and to analyse them minutely.
He has enabled us to penetrate deeply into the secrets
of the human soul, and to recognize the illimitable, un-
ceasing activity of our unconscious, which becomes
apparent even in connexion with unimportant matters.

The same strange psychic mechanism which causes
small mistakes and faulty innervations produces all
psycho-neurotic symptoms, particularly hysteria, obses-

AETIOLOGY 131

sions, and phobias (including stammering). This fact
affords a reasonable basis for the statement frequently
met with — namely, that the line of demarcation between
nervous norm and abnormality is difficult to define, and
that every one is, to some extent, nervous. In slight
cases of " nervousness " we find symptoms of trifling
importance located in the least important psychic
actions, while every action that can claim higher
psychic value takes place free of disturbance. On the
other hand, we have to deal with more or less serious
cases of neurosis, where the symptoms are lodged in
such a way that they affect the most important indi-
vidual and social actions, and are thus able to interfere
with professional work and sociability. " The character
which both the slightest and severest cases have in
common is to be found in the reduction of the phenomena
to incompletely suppressed psychic material, which,
though pushed away from consciousness, has not been
deprived of the capacity of manifesting itself " (Freud).

In the next chapter we will show how, owing to the
influences of the emotional complex, a new pathologic
personality is by degrees created, whose inclinations,
opinions, and decisions mostly tend in the direction of
the morbid will. The normal ego-centre is partly con-
sumed by the "second personality " which forms an
autonomous state in a state, and is forced into the role
of a secondary (subdued) complex.

The emotional complex has always the tendency to
separate the individual from his environment. This
phenomenon is due to the fact that the complex is
invariably composed of conflicts and "secrets " which
build up a more or less high wall of resistances, by
which the individual is dissociated from his fellow-
men. He who has to guard psychic secrets slinks

182 STAMMERING AND ITS CURE

about timidly, is lonely, reserved, and excluded from
many pleasures of life.

All stammerers suffer from a multitude of psychic
conflicts. A sufferer is, of course, inclined to say to
himself : "I only stammer, otherwise I am quite normal
in every way." However, he entirely overlooks the fact
that his impediment is solely the outcome of a ichole
system of inner obstacles. This is verified by observa-
tions which we have had occasion to make in severe
cases — namely, that, besides impeded speech, various
forms of phobias (particularly agoraphobia and claus-
trophobia) and hampered innervation in connexion with
walking, piano-playing, etc., can also be found.

As stated before, wherever hysterical symptoms make
their appearance, they have always one psychologic
object — namely, to separate the sufferer from the world.
So long as he does not come in contact with other
human beings, he does not, as a rule, experience the
slightest inhibition. This is the reason why even the
worst stammerer can speak and read quite fluently when
by himself. Whether the sufferer finds the greatest
difficulties when speaking to members of his own family,
or to strangers, entirely depends on the nature of his
individual conflicts. In all cases the impediment regu-
larly represents a projection of the patient's indi\adual
conflicts on to his environment. Any paroxysm of
stammering betrays a conflict, and is like a signal
of distress which is hoisted, where a complex is
embedded.

It is a very important psychologic fact that our social
tissue is extremely strong, and that we only feel com-
pletely happy in human society. When communication
with our neighbour is interrupted for any length of time,
introversion of libido and its consequent conversion into

ETIOLOGY 183

dread sets in. A stammerer is in the worst possible
position in regard to this social tissue, inasmuch as he
is wounded in that most important of all his manifesta-
tions and requirements — namely, speech. Any form of
stammering contains great resistances against social
relations, and, therefore, results in isolation.

It is the task of a rational treatment to remove all
psychic obstacles which separate the patient from his
environment. To this end it is imperative to restore
the connexion of the dissevered emotional complex
with the ego-centre. The moment this " reconcilia-
tion " has taken place, all interferences with normal
innervation of speech cease, and the sufferer can enjoy
again unrestricted freedom of utterance.

RESUME

1. Stammering, like all phobias and obsessions, is
caused by a psychic complex which is endowed with
extremely intense emotions and inhibitions, and, there-
fore, possesses so impelling a power that it forces the
patient to be more or less under its influence.

2. The physical and psychic symptoms of defective
speech are merely projections of the conflicts piled up
in the emotional complex. All paroxysms of stammer-
ing are produced by an energy supplied by repressed
libido.

3. A rational treatment has to aim at removing all
psychic inhibitions which interfere with normal inner-
vation of speech, by reconciling the hostile complex
with the ego-centre.

CHAPTER VI

GENERAL INFLUENCES OF THE EMOTIONAL
COMPLEX ON THE MIND

IN the previous chapter we have been able to give
but a few rough outlines as to the main effects
of the emotional complex on the mind of a
stammerer. As the matter is of the greatest import-
ance to a proper understanding of hysterical ailments,
phobias, and obsessions, it will be as well to treat the
general influences of the complex more fully. In so
doing, we largely follow the exposition of Dr Jung
(Zurich) as contained in his book, " Ueber die Psycho-
logic der Dementia praecox."

The essential foundation of our personality is affec-
tivity.* Thinking and acting is merely a symptom of
affectivity, as it were.f The elements of psychic life —

* Professor Bleuler (Zurich) suggests the term "affectivity " for
feeling, heart, or emotion, a term " which is meant to signify the
emotions in the proper sense, but also the slight feelings or
emotional tones of liking or dislike in connexion with any events."
In English the word " affectability " appears to be the only one
that, in any way, conveys this meaning. Without further apology
we will, however, follow Professor Bleuler's example and coin
the word " affectivity," which more nearly expresses his German
" Affektivitaet."

tBleuler says: "Thus affectiTJty, much more than reflection,
is the stimulating element in all our actions and omissions. We
act very likely solely under the influence of feelings of liking and
dislike ; logical considerations derive their strength only from the
emotions connected with them."

Andre (Jodfcrnaux savs : " L'^tat affectif est le fait dominatcur,

184

THE EMOTIONAL COMPLEX 185

namely, sensations, impressions, and feelings — are given
to our consciousness in the shape of certain units which
might be compared with the molecules of chemistry.
Let us give an example :

I meet an old friend in the street ; this induces a
picture in my mind, a functional unit (" molecule ")
consisting of three components — namely, sensation,
intellectual component (impression, recollections, judg-
ments, etc.), and emotional tone. These three com-
ponents are combined to one solid association, so that,
whenever a recollection of that friend springs up, these
pertinent elements come up with it more or less.

Let us suppose that this person has on one occasion,
owing to indiscreet gossip, caused me a considerable
amount of trouble, the consequences of which I have had
to feel for a long time. This incident comprises a great
quantity of associations (as innumerable as there would
be in a body built up by molecules); many persons,
things, and events are contained therein. The func-
tional unit " my friend " is, in this unit, but a figure
amongst many. The whole mass of recollections has a
certain emotional tone — namely, a vivid feeling of anger.
Each molecule takes part in this emotional tone, so
that, as a rule, even when it appears either by itself or
in other associations, it carries along with it this
characteristic, and it is so much more pronounced the
more distinctly its reference to the great unit is
recognizable.

The instance shows how the molecule (sensation, etc.)

les idees n'en sont que les sujettes. La logique des raisonne-
mcnts n'est que la cause apparente de ces voltefaces de la pens6e.
Au-dessous des lois froides et rationelles de I'association des id^es,
il y en a d'autres bien plus conformes aux n<^cessit^s profondes de
rexistenro. C'est la la lopique du sentiment " (" Le Sentiment et
la Pcnsoc ct lours Principaux Aspects Pliysiologiques ").

136 STAMMERING AND ITS CURE

takes part in the emotional tone of the whole mass
of impressions * which we describe as the "emotional
complex." In this sense the complex is a higher
psychic unit. If we analyse our psychic material (e.g.,
by means of an experiment of associations), we find that
practically each association belongs to one or another
complex. Though it is not always possible to prove
in practice that the single associations belong to
different complexes, one fact is above all doubt —
namely, that each association is connected with the
ego-complex. The ego-complex is, in a normal man,
the highest psychic court of appeal; we understand
this complex to be the bulk of impressions con-
nected with our ego which are accompanied by the
powerful and always living emotional tone of our own
body.

The emotional tone is a state which is accompanied
by bodily innervations. The ego is the psychologic
expression of the firmly associated union of all bodily
common feelings. One's own personality is, therefore,
the firmest and strongest complex, and maintains itself
(health provided) through all psychologic storms. This
is the reason why impressions which immediately con-
cern our own personality are always the most stable
and interesting ; in other words, they have the strongest
tone of concentration.!

* The sinp:le impressions are combined with each other accord-
ing to the different laws of association (similarity, co-existence,
etc.). It is, however, by an emotion that they are sorted ancl
grouped to higher nnions.

t Concentration is, according to Bleuler, an emotional state.
" Concentration, as well as all our actions, is always directed by an
emotion "; further, " concentration is one side of affectivity, which
thereby does not do anything else but what we already know of it
— viz., that it prepares a way to certain associations, and hampers
others,"

THE EMOTIONAL COMPLEX 137

We will now consider —

1. TuE Acute Influence of an Emotional Complex

Reality takes care that the quietly working mechanism
of ego-centric impressions is frequently interrupted by
impressions of a strong emotional tone. A situation
causing danger pushes the ordinary play of impressions
aside, thrusting in their place a complex of other
impressions of the strongest emotional tone. The new
complex pushes all other associations into the back-
ground, it being momentarily the most distinct, as it
entirely hampers all other impressions for the time being ;
out of all directly ego-centric impressions it only allows to
continue what suits its situation, and it can, under certain
circumstances, momentarily suppress even the strongest
counter-impressions up to entire unconsciousness. It
has now the strongest tone of attention (concentration).
It is worth noting that modem psychologists do not say,
we concentrate our attention on something ; but, the
state of concentration is enforced by the impression.

Whence does the complex derive its hampering or
furthering power ?

We have seen that the ego-complex, thanks to its
direct connexion with the bodily common sensations, is
the most stable complex, and is endowed with the most
associations. The perception of a menacing situation
causes terror : terror is an emotion, and, therefore, is
followed by physical conditions, a complicated harmony
of muscular contractions and nervous stimuli. The
perception has found a way to the bodily innervation,
and has thereby immediately enabled its associational
complex to get the upper hand. Owing to the terror,
numerous bodily common sensations are altered, with
the result that most sensations which determine the

188 STAMMERING AND ITS CURE

usual ego are changed. Correspondingly, the usual
ego loses its tone of attention (or its furthering and
hampering influence on other associations). It has to
yield to other common sensations of the new complex ;
it, however, does (normally) not entirely submerge, but
leaves behind an emotional ego,* since even very
intense emotions are not able to transform all common
sensations upon which the ego is founded. As daily
experience shows, the emotional ego is a weak complex
which, as to impelling power, stands considerably back
against the emotional complex.

If the menacing situation be quickly solved, the com-
plex soon loses its tone of attention, since the common
sensations gradually resume their usual character.
Nevertheless, the emotion continues to vibrate for some
time in its bodily, and therefore also in its psychic,
components : the knees tremble, the face is coloured or
pale, the heart continues palpitating; one can scarcely
recover " from the fright." From time to time, first in
short and later on in longer intervals, the alarming
picture returns and, laden with new associations, excites
waves of emotional reminiscences. This perseverance
of the emotion is, in addition to the great intensity of
the feehng, a cause of the bulk of pertinent associations
increasing proportionally. That is why comprehensive
complexes always have a strong emotional tone, while,
inversely, strong emotions invariably leave very com-

* Jung qualifies by the term " emotional ego " the modification
of tlie ego-complex proceeding from the entering of a complex
witii a strong emotional tone. Many other wishes, interests, and
feelings have to yield to the new complex in so far as they are
opposed to the latter. When under the influence of strong
emotions, the ego is reduced to the most necessary stimuli. This
fact is illustrated by scenes of n shipwreck or a conflagration
of a theatre, where in a twinkling all culture falls off, leaving
scarcely more than the " mood of tiger," which, the poet tells us,
few can entirely escape from exhibiting on occasions.

THE EMOTIONAL COMPLEX 139

prehensive complexes behind. This is based on the
fact that, on the one hand, great complexes comprise
numerous innervations of the body, and, on the other,
intense emotions, owing to their generally strong and
persevering irritation of the body, are able to impel
very many associations.

Emotions sometimes produce after-effects for an
indefinite time (disturbances of the stomach or heart,
insomnia, tremor, etc.). They, however, die away by
degrees, the complex-impressions vanishing from con-
sciousness, and it is only in dreams that more or less
disguised indications make their appearance from time
to time. Complex-impressions can frequently be traced
by characteristic disturbances which are manifestable in
associations. However, their gradual extinction is con-
nected with a general psychologic peculiarity — namely,
their readiness to spring up again in approximately full
intensity, when similar, though much weaker, irritations
are induced. For example, a child who had been bitten
by a dog cries out in great fright, even when he only
sees a dog from a distance; when we have lately
received ill tidings, we open any succeeding telegrams
with shaking hands, and so forth. These influences of
an emotional complex which, under certain circum-
stances, extend over a long period, lead us to the
contemplation of the —

2. Chronic Influences of a Complex

Here we have to distinguish —

(a) Complex-influences extending over a very long
period, which were caused by an emotion, in some cases
occurring but once.

(b) Complex-influences which are made lasting by
the emotion being continually stirred up.

140 STAMMERING AND ITS CURE

There are impressions which are active for a lifetime.
The lasting effects of powerful religious impressions or
of stirring events are well known. The impressions are,
as a rule, particularly intense in early youth, and it is
the task of education to impress durable complexes upon
the child. The durability of a complex is guaranteed
by a constantly living emotional tone. When the
emotional tone dies away, the complex also dies. The
continual existence of an emotional complex naturally
has the same impelling effect on our psychic activity as
an acute emotion has ; what agrees with the complex is
taken up, while everything else is excluded or, at least,
inhibited.

We find the best examples in the different views on
religion and politics which exist. There is no argument
so weak as not to be made use of by the members of
different denominations if the argument only be pro,
whereas even the strongest and most convincing argu-
ments contra cannot gain ground ; they simply receive
no attention, for emotional inhibitions are much stronger
than logic. How frequently we notice that a single
disagreeable impression produces in many people an
imjjerturbably wrong judgment to which no logic, be it
ever so keen and correct, is equal, and we call that
person biassed.

The second group of chronic complex-influences,
where the emotional tone is continually maintained by
actual stimuli, furnishes the best examples of complex-
incentives. The latter are not always obvious, but often
become apparent as subtle influences -upon thoughts
and actions hidden under symbolism. Professor Freud
lays down the conception of a symptomatic action as a
special case of impulsion. As already mentioned in the
previous chapter, Freud shows in his " Psychopathologie

THE EMOTIONAL COMPLEX 141

des Alltagslebens " how disturbances of our actions
(forgetting, mistakes in speaking, reading, etc.) are due
to complex-thoughts interfering with and influencing
the normal mechanism. In the midst of a diverting
occupation we sometimes catch ourselves humming or
whistling a tune ; the words of the tune, which are, as
a rule, not easily remembered, are a stimulus of the
complex. We are perhaps persecuted by an obsession,
a tune, or a word, which forces itself on our tongue
over and over again ; these are also complex-stimuli. Or
we draw figures on paper or on a table ; these again
can be traced as cryptologic signs projected by the
complex.

We will show later on that Freud points out the
same influence with regard to dreams. Dr. Jung 3i has
produced in his works plenty of experimental demon-
strations which prove that complexes disturb and even
upset associations in a characteristic manner which is
determined by law (striking wording of the reaction,
prolonged time, or even falling off of the reaction,
forgetting of " critical reactions," etc.). These observa-
tions offer valuable hints for the complex-theory. In
choosing his " stimulus-words," Jung has taken pains to
apply only commonly used words of colloquial language
in order to avoid intellectual difficulties. One might,
therefore, expect that an educated person should react
on them '* smoothly." As a matter of fact, this is not
the case. In connexion with the simplest words
hesitations and other disturbances occur which can be
put down solely to the fact that a complex has been
irritated by the " stimulus-word."

Why is it that an impression which is closely con-
nected with a complex cannot be produced " smoothly" ?
The momentum of inhibition has, first of all, to be put

142 STAMMERING AND ITS CURE

down to emotional retardation. As stated before,
emotional complexes are mostly in a condition of
repression; the repression can be so intense that a
hysterical amnesia exists for the complex — that is to
say, the patient (or even a non-neurotic person) is
under the impression that a thought or an important
connexion is emerging, but an indistinct hesitation
keeps the production back. The patient has the feel-
ing that he is going to say something, but it has slipped
away. What slipped away was the complex thought.
Sometimes a reaction is produced which unconsciously
contains the complex thought; the patient is, however,
blind to it, and only the psychological expert can shed
light upon the matter.

The repressing resistance further shows a striking
effect, when one tries to reproduce the original re-
actions, after a few minutes have elapsed. Then one
frequently notices that the " critical " reactions either
cannot easily be remembered or cannot be recalled at
all. These facts prove that the complex holds an ex-
ceptional position compared with the more indifferent
psychic material. Indifferent reactions are produced
" smoothly " and within a short time ; they are, there-
fore, at the optional disposal of the ego-complex at any
moment. The complex reactions, on the other hand,
show quite different features : they only come with
reluctance; they often withdraw from the ego-complex
at the moment they arise; they are strangely formed,
being frequently products of embarrassment of which
the ego-complex is unaware and does not know the
sequence; often they are quickly buried in amnesia
afterwards, in contradistinction to indifferent reactions,
which possess a great stability, so that they can be re-
produced in the same manner after months or even

THE EMOTIONAL COMPLEX 143

years. The complex associations are, therefore, much
less at the command of the ego-complex than the in-
different ones. From this one has to draw the conclu-
sion that the emotional complex occupies a relatively
autonomous position against the ego-complex; it is a
vassal who does not humble himself unconditionally
under the authority of the ego-complex.

Experience shows that, the stronger the emotional
tone of a complex is, the stronger and more frequent
are the disturbances of the experiment. A person who
has a complex which is connected with intense emotion
is, therefore, much less able to react " smoothly " (not
only when experimenting with associations, but also on
all stimuli of everyday life), but is continually impeded
and disturbed by the uncontrollable influences of the
complex. His self-control (that is to say, the control
of his moods, thoughts, words, and actions) suffers in
proportion to the intensity of the complex. The de-
liberateness of his acting is gradually more and more
replaced by unintentional mistakes, faults, and in-
calcul abilities, for which he often cannot give any
reason himself. A person with a strong emotional
complex is, therefore, bound to show intense dis-
turbances in his associations, as a considerable number
of apparently innocent " stimulus-words " excite the
complex.

We will now proceed to bring some of these theories
to a practical application.

In order to enable us to form some idea as to the
extent of the emotional complex, we, as a rule, take
100 associations with each stammerer who places himself
under our treatment. Following Dr. Jung's si example,
we simply induce the patient to tell us the first associa-
tion which occurs to him on being given a " stimulus-

144 STAMMERING AND ITS CURE

word." We write that association (the " reaction ")
down, and also note the time it takes the patient to
produce the " reaction," making the necessary allow-
ance for stammering. Thus we get, to a certain extent,
an image of the stammerer's daily psychologic life, since
words are abbreviated actions. Each " stimulus-word "
automatically produces in the patient's mind a scene
or a situation, though it very seldom becomes quite
conscious. If no emotional complex be connected with
the " stimulus-word," the " reaction " is logical, and is
given promptly (on an average, within two seconds).
In the contrary case, there is more or less hesitation,
and the illogical " reaction " invariably discloses the
patient's conflict, and his inability to adapt himself
to his environment ; in the latter case, the " reaction "
always expresses : " If I (the patient) were in such
situation, I should do what is not suited to the circum-
stances."

To illustrate the considerable differences which exist
between a so-called normal individual and two different
types of stammerers, we give three diagrams on the
opposite page, representing the associations obtained
in each case (of equal intellectual standard) with the
same series of *' stimulus-words." It will be noticed
that the differences are enormous, though even a
" normal " person is never without a certain amount
of complex-influences due to that " piece of hysteria
each human being carries about with him." It is
obvious that a person who displays obstacles, as shown
in case No. 3, is out of contact with his environment to
such an extent as to show his psychic resistances any
moment. Further details will be found in Chapter IX.

As these diagrams show, thoughts and actions are
continually disturbed by a strong complex, in some cases

lil

t)

iliiliiiMtliilylil|iii

20 30 40 50 eo 70

::1

111

i

•tVdVTo 2'0 30 40 50 eo 70 ffQ 00 II

NO. 1. — ASSOCIATIONS OF A " NORMAL " PERSON.

2 4-68 10

20 VO 4 0 5t> 60 70 80 90 100

NO. 2. — ASSOCIATIONS OF A SLIGHT STAMMERER.

NO. 3. — ASSOCIATIONS OF A VERY SEVERE STAMMERER.

(N.B. — Tlie arrowb indiiate that in these instances no associations
were forthcoming within thirty seconds.)
10

146 STAMMERING AND ITS CURE

even to such an extent that the patient's general con-
nexions with the world around him are strangely distorted,
both in great and in small things. The ego-complex
is, as it were, not the whole person any more, but there
exists a " second personality " beside it, which tries to
have more or less its own way, thus disturbing and
impeding the development and progress of the ego-
complex. Owing to these influences, a " contraction
of the visual field " (Professor Janet, Paris) is produced,
with the result that the stammerer considers many
things, if not everything, from the point of view of his
complex.

We can easily imagine how the mind is influenced
when the intensity of the complex increases. A striking
example is furnished by the well-known state of being
in love. A lover is obsessed by his complex, all his
interest depending on this complex and on things which
harmonize with it. Practically every word and every
object reminds him of his sweetheart; the most trifling
things, if they are in some way coimected with the
complex, are guarded as invaluable treasures; the
whole environment, generally speaking, is looked upon
only sub specie amoris. What does not fit in with the
complex is of no further moment to the lover; all other
interests go down to freezing-point, which naturally
results in a standstill and a temporary desolation of the
personality. Nothing but what combines with the com-
plex induces emotions and is elaborated in his mind.
All thoughts and actions travel in the direction of the
complex; what cannot be pressed into this direction
is either rejected or done with superficiality and a
certain amount of thoughtlessness. When indifferent
transactions have to be carried out, the strangest pro-
ducts of compromise sometimes hapj^ens; mistakes

THE EMOTIONAL COMPLEX 147

in writing, caused by the love-complex, creep into
business letters, and, when talking, errors arousing
suspicion also take place. The series of objective
thoughts is frequently interrupted by the complex
breaking in, thus creating long intervals which are
filled by episodes connected with the complex.

This well-known example clearly illustrates the in-
fluence of a strong complex on a normal mind. We
see from it how all psychic energy entirely turns to-
wards the complex, at the expense of all the other
psychic material, which stands over for a while unused.
The mind is denuded, to a greater or lesser degree,
of all stimuli that do not fall in with the complex.
Even the emotional tone becomes inadequate; mere
nothings, like small ribbons, withered flowers, slips of
paper, locks of hair, etc., are treated with the greatest
attention imaginable, while questions of vital impor-
tance are perhaps settled with a smile of indifference.
On the other hand, the slightest remark which con-
cerns the complex, only from afar, immediately excites
a violent outbreak of delight, anger, or pain, which may
even adopt quite unproportioned dimensions.

If we were not in a position to place ourselves,
by means of personal knowledge, in the soul of an
enamoured normal person, his behaviour would appear
to us as being hysterical. With hysterical ailments and
phobias like stammering, where the sensitiveness of
the complex reaches much higher degrees than with
*' normal " people, those means are nearly missing
altogether, and many people — unless they have " gone
through the mill " themselves — find it naturally ex-
tremely difficult, if not impossible, quite to enter into
the hysterical emotions, and particularly into the feelings
of a stammerer.

148 STAMMERING AND ITS CURE

As already mentioned before, the complex must have
its way, or, in other words, the energy contained therein
must be invested somehow. Since, in many cases, the
erotic complex cannot use the normal channels, its
energy has to use by-roads. During the age of puberty
we find more or less abnormal libidinous fancies, fre-
quently alternating with religious - fantastic phases.
Later on, the erotic energy is often transferred to
daring sports, particular hobbies, etc. It is especially
the artistic talents which gain considerably by this trans-
ference. A very frequent transference (that is to say,
covering up of the complex) is brought about by insert-
ing a contrasting mood. We often find this phenom-
enon with people who have to banish a distressing
care, and frequently the best punsters and the best
humorists, whose jokes are spiced with a grain of bitter-
ness, are among such. Again, others hide their pain
under a forced, spasmodic cheerfulness, which, how-
ever, owing to its noise and artificiality, does not repre-
sent mirth.

These transferences and " sublimations " are able to
produce real double-natures, which have at all times
called forth new ideas in psychologically thinking
writers (for example, Shakespeare, Goethe, and, at the
present day, Bahr, Gorki, and others). " Double-
nature " is not merely a term coined by literary men,
but is a scientific fact which interests students of psy-
chology and psychiatry over and over again, but not
until it presents itself in the form of double-conscious-
ness, due to complexes being entirely split off.

It happens sometimes that the transference becomes
stable by degrees, and serves as a substitute for the
original character, at least on the surface. Every one
knows persons who, by superficial observers, are con-

THE EMOTIONAL COMPLEX 149

sidered to be very amusing and entertaining people.
Inwardly, however (perhaps in private life outwardly),
they are peevish grumblers, who keep an old wound open.
Their real nature often breaks suddenly through the
artificial covering, the assumed gaiety disappears all at
once, and one seems to be in front of quite a different
man. A single word, a gesture that struck the wound,
displays the complex which lurks at the bottom of the
soul. The psychologic expert should think of all these
imponderables of psychic emotions and moods before he
approaches the complicated souls of patients who suffer
from neurotic ailments.

In conclusion, we will still mention a characteristic
effect of the complex — namely, the inclination for con-
trasting associations. As Professor Bleulerio has proved
in detail, any clear-sighted psychic activity must be
accompanied by contrasts, a requirement which is abso-
lutely necessary for correct co-ordination and modera-
tion. As experience shows, any resolution creates
contrasts as next associations. Under normal conditions
the contrasts never hinder, but they further considera-
tion, and are useful for action. When, however, for
some reason or other, energy suffers, the individual
easily becomes the victim of a conflict between positive
and negative, inasmuch as the emotional tone of the
resolution is not sufficient to overcome and repel the
contrasts. This can be observed especially frequently
in all cases where a strong emotional complex absorbs
the pluck of the individual ; his energy being decreased,
the attention for things not associated with the complex
becomes superficial ; association being deprived of a
firm direction, a " flat type " is induced, on the one
hand, while the contrasts cannot be repelled further.
Each case of stammering shows plainly that it is merely

150 STAMMERING AND ITS CURE

a matter of psychic conflicts and emotional contrasts
due to complex-influences, against which the sufferer is,
as a rule, absolutely powerless.

It lies in the interest of the normal individual to
become free from an enslaving complex which hinders
the appropriate development of the personality — i.e.,
the adaptation to environment. Time sometimes assists
the individual in getting rid of it. In other cases, as
we have pointed out, transferences have to come to
aid; the individual hangs on to something new — if
possible, to something that strongly contrasts with the
complex. When the repression of the complex has
taken place, an intense complex sensitiveness still exists
for some considerable time — that is to say, the complex
is apt again to break forth at the slightest provocation.

If, however, the repression of the emotional complex
has only been brought about by the forming of com-
promises, as in nearly all cases of stammering, a lasting
inferiority results, allowing the patient but a limited
adaptation to his environment. In cases where the
complex has remained practically unaltered (which is,
of course, not possible without serious damage being
done to the ego-complex and its functions), the mental
development of the individual is more or less hampered.
Thus it happens that, although the majority of stam-
merers come, at least, up to the intellect of an average
ordinary speaker, we now and then meet with some
who decidedly betray a mental inferiority.

Here we are obliged to leave the subject, lack of
space, unfortunately, forbidding us to enter into further
details.

CHAPTER VII

CONSCIOUSNESS AND THE UNCONSCIOUS

IN the previous chapters we have repeatedly referred
to unconscious psychic functions or to unconscious
processes which influence the psychic functions.
As these phenomena, though met with continually in
connexion with psychologic observation, are frequently
ignored or misunderstood, it appears to be essential to
give some general outlines of the relationship between
consciousness and the unconscious.

Many psychologists, even up to the present day, take
the point of view that what is psychic is conscious, and
that the nature of psychic phenomena lies in their being
conscious.* These scientists quite forget " that no line
of demarcation can be drawn between consciousness
and the unconscious, strange though it may sound,
and that exactly the same functional formations and
mechanisms found in consciousness can also be proved
to exist outside it, and from this position can influence
the mind as well as the analogous conscious processes
can do. In this sense there are unconscious sensations,
perceptions, conclusions, feelings, apprehensions, and
hopes which distinguish themselves from the corre-

* Tliis demarcation, as Professor Bleuler points out, is as one-
sided as if, when describing the life of amphibia, a naturalist were
to confine himself to observing these animals on the dry land,
whilst ignoring their life in the water.

151

152 STAMMERING AND ITS CURE

spending conscious phenomena solely by the quality of
consciousness being missing. The demarcation is,
therefore, quite artificial, giving little or no opportunity
for observation, and those who entirely deny the
existence of these functions render the explanation of
the conscious processes impossible, simply because the
unconscious mechanisms, at any moment, not only
modify, but directly impel the working of the conscious
processes " (Bleuler).

It has frequently come under our observation that
persons who contest the existence of an unconscious
personality in themselves and others had not derived
their conclusions from convincing premises or any
premises at all. They have never observed the effect
of a post-hypnotic suggestion, and are greatly surprised
at quite ordinary facts, which our analyses of (not
hypnotized) neurotic patients show to be quite incon-
trovertible. That " the unconscious " is something
which the individual actually does not knoxc — not some-
thing of which he had not happened to think at the
moment — has never occurred to them. Neither have
they ever tried to convince themselves (as they can
easily do) of unconscious thoughts in their own psychic
life by analysing one of their dreams, and amazement
and perplexity at the results overwhelm them when,
with our assistance, this is done.

It is our task to show briefly that there are un-
conscious psychic phenomena, and in what different
ways they manifest themselves. We are, of course,
able to outline a few instances only ; a psychology of
the unconscious which claims completeness would have
to fill volumes. En passant we may point out that a
study of the psychology of the unconscious is particu-
larly interesting, inasmuch as it allows, without conflict

THE UNCONSCIOUS 153

of opinions, the explanation of all phenomena of hypno-
tism, spiritualism, dissociation of personality, hysterical
conditions, etc., divesting them of the characteristics of
marvellousness and mystery which are still attached to
them by many people.

It is understood that all physical occurrences taking
place automatically, after clockwork style, do not
possess conscious qualities. The term " unconscious,"
however, is not applied, and rightly so, to occurrences
of that description, but only to processes in the mind
which are lacking consciousness, though they are equal
in every way to the corresponding conscious processes.
We infer these processes either from their effects or, in
some cases, from subsequent conscious recollection.

A person absorbed by some problem is walking in the
street, following the right way, and passing many
people. Though of all mental impressions but a very
small fraction become conscious, his steps are neverthe-
less guided by them. That these are not simply reflex
actions can be seen, as Professor Bleuler* points out,
from the following facts : —

The taking and pursuing of the right direction when
walking, the going out of the way, etc., is originally a
psychic act which, in many cases, has become uncon-
scious (automatic), and, as a rule, quite gradually, with-
out the person being able to tell exactly at what moment
or with what action consciousness completely passed
away. After becoming automatic, the action cannot
possibly be different in principle from the original con-
scious one, for the simple reason that it can become
more or less conscious again at any moment.

The destination and the choice of the route to be
taken is mostly arranged in the mind previous to setting

* Bloulcr, " Bewusstscin und Assoziation." Zurich, lf>06.

154 STAMMERING AND ITS CURE

out on the walk. A reflex action cannot voluntarily be
directed in this manner; a reflex, in contradistinction
to psychic functions, is not " plastic." Thus it happens
that, by way of exception, the unconscious makes mis-
takes exactly in the same way as consciousness does.
It may, for example, instead of an intended unusual
way, choose another that had been frequently practised,
or it may pass by an adjacent street (the destination),
if its appearance, owing to obstructions, be altered, and
so forth.

In such cases serviceable unconscious alterations of
the original plan are sometimes made also; if, for some
reason or other, a street be not conveniently traversable,
another is chosen, without the person becoming con-
scious of it. Such unconscious action of choice has its
analogies only in conscious psychic activity, but not in
reflex.

All that had been perceived by the senses, later on
emerge as a memory-image ; it often happens that a
sentence spoken, a word read in passing, the striking of
a clock, etc., does not enter consciousness until some
time afterwards. Even after a long time an accidental
event, a dream, or a hypnotic suggestion can consciously
cause a memory-image, received unconsciously, to
appear.

All unconscious feelings and perceptions can be
turned suddenly into conscious ones. Amongst the
passers-by for whom, as a rule, the pedestrian makes
way automatically, is a friend or a person of unusual
appearance ; a noise is particularly intense ; danger is
threatening from something; a clumsy person passes
him awkwardly. In all these cases consciousness is
suddenly added to the unconscious action, without any
other change being noticeable.

THE UNCONSCIOUS 155

As any unconscious mental impression or its memory-
image can become conscious by any casual event, so
also can conscious actions become unconscious. It will
suffice to refer to playing the piano, or to correctly
emphasized reading aloud, whilst the player or reader
is thinking of something else, and to similar complicated
actions which have become automatic by practice; all
functions of this description can be entirely or partially
conscious any moment, and can immediately afterwards
be carried out unconsciously again.

From *' impressions " which can rarely be analysed,
people often draw far-reaching conclusions, of which they
know nothing but the results. People who have not the
slightest knowledge of graphology sometimes diagnose
an impostor from his handwriting without their know-
ing the reasons for it ; children frequently give a correct
and striking opinion about new acquaintances; again,
others now and then take a dislike to persons at the
first sight — an antipathy which often turns out later on
to be well founded. Many cases of so-called clair-
voyance can be explained by the same unconscious
mechanism.

Unconscious motives very frequently play a part in
conscious considerations also. Many of one's own
decisions caimot be sufficiently explained from con-
scious impulses, and he who analyses himself con-
scientiously will often find the decisive momentum in a
motive which was quite unconscious at the time of
consideration and decision. Without admitting and
analysing unconscious motives, it is not possible to get
to the bottom of one's neighbour's actions.

Self-observation on occasions which require a ready
answer or quick action will be found to be of much
interest. The conscious self is, in such cases, entirely

156 STAMMERING AND ITS CURE

incapable of instituting minute reflections. Feelings
govern our decisions. With the term " feelings," two
quite different things are (in this case) comprised —
namely, real emotions (anger, fear, etc.), on the one
hand, and intellectual motives and considerations, not
clearly thought out, on the other. The latter must be
thought more distinctly in the unconscious, as other-
wise our actions would be correct by chance only; this,
however, is not the case, since the acting person, when
trying to account for it, is often astonished at realizing
how correctly he has been guided by his " feeling " or
" instinct." Instinct, again, is merely the experience
of our unconscious (Bleuler).

As unconscious motives frequently impel conscious
action, so the reverse takes place also. One often re-
solves on actions which, later on, are carried out quite
unconsciously, and such *' focussing " can be lasting or
even definitive, without requiring any special practice.
The author's daughter had, up to her twelfth year, two
warts on her right hand, which she continually irritated
by scratching and sucking. On being told that warts
are maintained by paying attention to them, she made
up her mind entirely to ignore hers in future. About
eight months afterwards she was reminded of the warts
accidentally, only to find that they had disappeared ;
during the interval she had not thought of the warts,
nor of her resolution in respect of them, a single time.
A friend who suffered very frequently from toothache
was told that he would not suffer any more if in future
he made a point of drying his hands first when wash-
ing himself in the morning. After following out this
advice consciously for a few days, he noticed several
months afterwards that he had continued drying his
hands first without having bestowed any further thought

THE UNCONSCIOUS 157

on it. It had been sufficient so far to focus this action
but once. The toothache, by the way, had also left
him during that period — a phenomenon which is, of
course, merely due to auto-suggestion.

In these cases, we have before us a conscious in-
fluencing of processes which we are in the habit of
numbering amongst the psychic, and which undoubtedly
do not belong to the reflex movements, but to the
plastic functions. The curative motive persevered,
but, after the focussing, it became quite unconscious,
and so remained for a long time.

Bleuler points out that such focussing also takes
place in connexion with centripetal processes. One
has, for instance, the intention to look out for a special
plant when taking a country walk. After a short time
the matter is forgotten; the moment, however, that
one accidentally notices that plant, the attention is at
once concentrated on it, whereas all other conscious
occurrences are momentarily suspended. One runs
over the pages of a book in order to find a name;
interesting matter in the book catches the attention,
and the purpose of the perusal is forgotten for an hour
perhaps ; but as soon as the name which was to have
been hunted for catches one's eyes, it is immediately
observed and brought into the connexion originally
intended. In such cases the focussing refers to what
is termed, in regard to consciousness, " concentration."
There is an " unconscious focussing of concentra-
tion."

There is also a continual unconscious concentration ;
for example, when one continually goes out of the way
in a crowded street and chooses the easiest way, or
when one unconsciously searches the hedges for a
special plant, and so forth.

158 STAMMERING AND ITS CURE

Hypnosis offers particular opportunities of experi-
menting with unconscious processes. When to a
hypnotized person the order is given to pay a visit two
hours after waking up, he (in most cases) will carry
this order out with normal consciousness; the motive
of his action, however, is absolutely unconscious, he
believing himself to have other reasons. If the post-
hypnotic call be required after ten days, the days are
unconsciously counted, and the visit is made on the
fixed day. If the hypnotic suggestion be this, " When
I shuffle three times with my feet, you will cough," the
order is carried out, even if the hypnotized person,
when awake again, has entirely forgotten the sugges-
tion, and even if the hypnotizer delay the third
shuffling for several days. Thus it will be seen that
the shuffling must have been counted unconsciously.

Even without hypnosis, very complicated mental
operations can be carried out quite unconsciously. An
experiment made by Barkworth, a member of the
Society for Psychical Research, is very interesting in
this connexion. He was able, during an animated
debate, to add up long series of numbers without
diverting his mind in the least from the debate. By
some American scholars devoted to research — Speir,
Armstrong, and Child — interesting statistics on un-
conscious cerebration have been made. Hereby they
found that with this action, which is performed in the
unconscious mind, most people have a distinct notion
of an effort made. When some one, for instance, on
being unable to remember a name, does not try to trace
it on purpose, in the hope that it will occur to him
later on, here, according to those statistics, very fre-
quently the feeling of a certain effort was caused. The
quoted phenomena show that there is in man not only

THE UNCONSCIOUS 159

an unconscious intelligence, but also an unconscious
memory.

There are persons who are in the habit of beating a
tattoo on the table, or of carrying out similar move-
ments, when absorbed in thoughts. When they, by
chance, hold a pencil and put it on paper, they scribble
many things without noticing them. In this way
letters and words are automatically written down by
some people. This automatic writing is evidently
directed by a certain intelligence, as otherwise reason-
able words could not possibly be written down. This
intelligence must naturally lie in the person himself,
although he does not write with conscious intention.
The intelligence is unconscious; it works, however, in
a similar way as when consciously carrying out actions
and movements. Spiritualists are of opinion that this
automatic writing is enacted by a foreign force-
namely, a spirit. There is, however, no necessity to
put this phenomenon down to the help of a " kind
spirit," as the comprehensive investigations of F. Meyers,
P. Janet, Patrick, Flournoy, and others have proved.

A simple hypnotic experiment can demonstrate that
no metaphysical influences are required in connexion
with automatic writing. A person is hypnotized and is
awakened after passing through different scenes induced
by suggestion. On being asked what had happened
during hypnosis, he will answer that he cannot remember
anything. Even when pressed hard to try to recall
what he saw whilst in the hypnotic state, he will again
declare that he is utterly unable to recollect even the
slightest incident. However, when asked to write down
automatically the events of the hypnosis, he will put
down everything that had been suggested to him. It
is obvious that he would be unable to do this if the

160 STAMMERING AND ITS CURE

events of the hypnosis had been extinguished from his
mind. As the automatic writing shows, the recollection
lay dormant all the while in his unconscious.

When experimenting with automatic writing, one
frequently observes that the unconscious has the
tendency to invert syllables, words, or even sentences in
different ways. Such complications are not only un-
known to conscious thinking, but also require an amount
of intricate mental work which very few people would
be able to carry out consciously. This tendency in
our " unconscious cerebration " is particularly prominent
in dreams, and is regularly made use of in those cases
in which the dream finds it impossible to express its
thoughts in a clearer or more direct way. We will give
details about the psychic mechanism of dreams in a
later chapter.

In passing we may mention that the unconscious also
plays an important part in the production of jokes. As
Freud 28 has cleverly shown, the making of a jest
requires that " a conscious thought is left to imconscious
elaboration for a moment, and its result is instan-
taneously seized by conscious perception." The personal
qualification to crack jokes is merely dependent on the
facility with which conscious attention is dropped and
exchanged for the unconscious. A joke displays, by the
way, the same features as a dream — namely, certain
transformations, condensation, and transference. The
fact that the unconscious presents an important factor
in the production of jests explains the phenomenon that
the mediums of spiritualists show the tendency to pro-
duce anagrams, jokes, and puns.

Especially striking is the influence of the unconscious
with all hysterical symptoms, phobias, and obsessions.
Even if we only consider the ceremonials to which

THE UNCONSCIOUS IGl

many neurotic people are subject, and which consist in
small actions or restrictions that are very scrupulously
carried out in connexion with certain performances of
everyday life, then we find that these " formalities "
appear to be entirely void of importance, and the person
who is subject to them has the same impression; yet
he is mostly unable to suppress them, as any deviation
from the ceremonial is punished by intolerable dread,
which immediately enforces the omitted action being
carried out later on. *' As insignificant as the cere-
monial actions themselves are the actions, which are
adorned, aggravated, and also delayed by the formalities ;
for example, dressing and undressing, going to bed, etc.
One can describe the performance of a ceremonial by
substituting a series of unwritten laws, as it were. With
reference to a bed ceremonial, for instance, a chair must
be placed in a special position in front of the bed, and
the clothes must lie on it folded up in a certain order;
the person must make sure that the sheet is laid quite
evenly and properly pushed underneath on the side ; the
pillows must be placed in a special fashion, and his body
must be in an accurate position ; not until then is he
allowed to fall to sleep. In slight cases the ceremonial
largely resembles the exaggeration of an accustomed
and justified order. However, the special scrupulousness
of the performance and the dread experienced at its
omission qualify the formality as ' ceremony.' Dis-
turbances of it do, as a rule, disagree with the neurotic
individual ; publicity, or the presence of other people
during the action, is nearly always excluded."*

Any obsession or phobia, no matter whether it be of a
slight or a very severe form, has as premise that the

* Freud, *' Samnilung kleiner Schriftcn z. Neurosenlehre,"
2. Folgc, III., 1909.
11

162 STAMMERING AND ITS CURE

individual who is subject to it does not know its signifi-
cance. It is only by means of psycho-analytical thera-
peutics that the underlying unconscious motives can be
found out and removed. Since all hysterical ailments,
including phobias and obsessions, are due to unconscious
motives and fancies, it is obvious that the latter, owing
to psychic repression, cannot, of their own accord,
enter into consciousness, nor can they be influenced by
conscious thinking. Thus it happens that, even in
slight forms of hysteria, the dissociated complex brings
about a split of the soul-mind, so to speak, in two
relatively independent parts which, as we have shown
in a previous chapter, display intense antagonistic
tendencies causing the mind to represent a house divided
against itself. The repressed complex is that demon by
whom, in bygone times, hysterical people were supposed
to be possessed. That a spirit that is strange to his
consciousness sways the patient is quite correct ; it is not,
however, a strange spirit, but a part of his own spirit.

The phenomenon of multiple personalities in one and
the same individual is, in a way, analogous, though in
these cases both complexes possess conscious quality.
However, the dissociation of an entire personality,
generally speaking, does not differ from the split of the
unconscious, as unconscious complexes can turn into
secondary personalities by absorbing a considerable part
of the original personality. To illustrate the phenomenon,
we will refer to Azam's Felida, which case is well known
to every psychologist. A young girl had suddenly
forgotten most of the former occurrences in her life;
from an earnest person she had turned into a witty,
merry, and frolicsome one. After some time her original
state had set in again, and both states kept on changing
with each other in irregular intervals throughout the

THE UNCONSCIOUS 103

rest of her life. In her original state she had no recol-
lections whatever of the experiences which she had in
her second state, whereas, in the latter state, she
remembered perfectly the events of her normal existence.

Even more than two (in one case as many as eleven
have been observed) distinct personalities can change
with each other in the same individual. The memory
acts in such cases differently; the abnormal conscious-
ness with its experiences is, as a rule, unknown to the
normal, whereas the abnormal state can mostly (though
not always) utilize the recollections of the latter; the
patients sometimes live as two or more personalities
which are completely separated with regard to contents
and time. However, such different personalities can
sometimes exist side by side, not only exhibiting them-
selves one after the other; in fact, it seems very likely
that, in each of us, groups of psychic elements lead
a more or less independent existence.

There is every likelihood that the selecting and
grouping of the elements of memory which constitute
the different personalities is brought about by the
decisive influence of emotions. We have already seen
in the previous chapter that, whenever logic is governed
by an unconscious motive, this influence is invariably
caused by an emotion (wish, fear, instinct, etc.) which
is more or less conscious, but is started by an unconscious
motive. This fact is due to the circumstance that
emotions have the capacity, on the one hand, to hamper
all antagonistic associations, and, on the other, to pro-
mote the familiar ones, and thus to govern reason,
where all motives are conscious (Bleuler).

When we take the power of the emotions into
consideration, their influence on the dissociation of
a personality becomes more easily comprehensible.

164 STAMMERING AND ITS CURE

These phenomena are not at all strange, as they have
numerous prototypes in non-neurotic individuals. When,
for example, a child is subjected to an examination, he
is quite a different being to what he appears when his
knowledge can be got at incidentally by judicious con-
versation. Under examination the child is timid and
embarrassed, and he answers the questions with the
distressed expression and strange accentuation of a
child who says his lesson. It is, to a certain extent,
the same with a stammerer; a difference between the
child and the stammerer, however, lies in the fact that,
with the latter, a more pronounced separation of the
two states exists, owing to the influence of the emotions
being morbidly increased. The transition from one
state to the other is a gradual one in the case of a
" normal " individual, whereas it is frequently quite
sudden in a stammerer. The latter's emotional com-
plex is associated with but a small part of his personality,
while, with a normal individual, the greater part of his
ego is conjoined to both states. That is why amnesia
is a rare exception with a normal person, whereas it is
the rule with a stammerer or any other person suffering
from a neurotic ailment.

It happens sometimes that partial personalities become
more complete and obtain consciousness by absorbing
the most important elements of the ego ; they are then
the " second person," in the sense of Azam's observa-
tion, of certain states of trance, etc. Consequently, there
exists no difference in principle between unconscious
complexes and those second personalities that are en-
dowed with consciousness. When an unconscious
complex associates more and more the elements of
the ordinary ego, without joining the ego-complex, it
is eventually turned into a second personality /Bleuler).

THE UNCONSCIOUS 165

It is also due to the influence of unconscious com-
plexes that the phenomena of dreams appear strange
and obscure, and give the impression that confusion
reigns and illogical connexions occur. The inhibiting
and guiding power of the mind seems to be entirely
lost, and the associations pursue a course which is care-
fully avoided in the state of being awake. We shall show
later on that the grotesqueness which appears in dreams
is removed at once when properly analysed. It will
suffice for the moment to say that the apparent absurdity
of dreams is caused, primarily, by the fact that during
sleep the ego is composed of other partial complexes,
which naturally alter the normal personality to a con-
siderable extent. One often finds it extremely difficult
to remember dreams after some time, because from the
" awake " ego there are but few associations which
allow the dream to become conscious as a revived
image of recollection. If the dreamer wake up slowly,
the dream-complex finds sufficient time to form more
associations with the normal ego, with the result that
he can recollect the dream more easily than when
awaking suddenly. When dreaming, other motives
seem to direct the associations than when the person
is awake, where certain dominating impulses govern
conscious consideration. In dreams reason withdraws
to some extent, the associations being more or less
governed by feelings and emotions.

It will be as well to add a few remarks about the
relationship between consciousness and memory. The
reviving of traces of memory has been, for a long time,
supposed to be brought about by way of associations.
For instance, the impressions, the functions of which
form the idea *' bee," are in connexion with those
which represent the idea of " sting," *' honey," etc.

166 STAMMERING AND ITS CURE

The stimuli travel from one idea to the other, thus
realizing the association. As we have seen in the early
part of this chapter, this procedure also takes place in
the unconscious. The fact of a memory-image being
revived does not, therefore, necessitate the memory-
image becoming conscious. The stimulated image
becomes conscious only when, at the same time, it
forms an associative connexion with the ego.

Association is a process which dominates the whole
of the mind. That processes outside the ego-complex
can go on exactly like those within it is proved by
the various instances quoted above ; that they are not
associated with the contents of consciousness is obvious,
and it is also self-evident that everything that goes on
in " consciousness " is associated with the impressions
which form the personality — the ego — for the time being.
" What part, therefore, is left to consciousness, which
had been hitherto considered to be all-powerful and to
cover everything else ? No other but that of being a
sensorial organ for the apperception of psychic qualities "
(Freud).

We have made a point of avoiding the differentiation
of active and passive mind, which terms are preferably
applied in modern literature on "mental " therapeutics,
as they seem to be used with the object to equalize
*' psychic " and "conscious."

It is an indispensable preliminary condition for any
correct insight into psychic processes that the common
over-valuation of the quality of consciousness be given
up. '* The unconscious has to be accepted as a general
basis of psychic life. The unconscious is the larger
circle, which comprises the smaller of consciousness;
all that is conscious has an unconscious basis, whereas
the unconscious may stand still at that stage and yet

THE UNCONSCIOUS 167

claim the full value of a psychic act. The unconscious
is, strictly speaking, what is really psychic, and is,
in its inner nature, as unknown to us as the real of
the external world, and is given to us by the data of con-
sciousness as incompletely as the outer world is given
by the impressions of our sensorial organs " (Freud).

We speak here of the restricted conception of the
unconscious — namely, of the unconscious of neurosis,
as it were. Its meaning can only be comprehended by
realizing the way in which its contents have been
pushed away from conscious psychic elaboration. The
patient is unable to produce his imconscious psychic
impulses without experiencing a considerable resistance,
some force preventing them from becoming conscious
under ordinary conditions. The existence of this force
can be distinctly noticed when, in spite of it, the
attempt is made to introduce a patient's unconscious
impulses into his consciousness. On this phenomenon
of a " resistance " Freud's conception of the psychic
occurrences in neurotic ailments is based. The same
forces, which now offer opposition to the unconscious,
forgotten material being made conscious, must formerly
have caused its being forgotten, and must have pushed
the pathogenous events away from consciousness. As
pointed out in a previous chapter, Freud termed this
dynamic phenomenon '* repression," and considered it
as proved by the undeniable existence of the resistance.
The act of repression, though a normal psychic process,
can, owing to the predominance of the unconscious,
easily meet with ill success, inasmuch as the repressed
impulses continue to exist in the unconscious, and are
liable to send a disguised substitute into consciousness :
stammering or any other neurotic symptom.

Those primary impulses which succumbed to repres-

168 STAMMERING AND ITS CURE

sion — i.e., the unconscious in the psycho-analytical
sense — which feed the energies of both neurosis and
dreams, must be strictly distinguished from that
unconscious previously alluded to, which combines
automatic and half -forgotten processes. The " psycho-
analytical " unconscious contains nothing but repressed
impulses, in the largest sense of the word, and those
psychic formations which present themselves as descen-
dants of these impulses. Not imtil one has dived into
the depths of the psychic structure of neuroses is it
possible to comprehend the whole vital strength and
indestructibleness of this unconscious. Its power
becomes particularly apparent in dreams incessantly
flowing forth, and, in case of disease, in the continual
production of the neurosis.

Under these circumstances, it is obvious that the
study of the unconscious (psychic) functions is quite
indispensable to psychopathology, the symptoms of
which are directly governed by these functions very
frequently. When treating stammering, for example,
it can invariably be found that the emotion (" dread
of speaking ") connected with the affliction is due to
stimuli which are contained in the impressions of
the unconscious only, and he who undertakes to free
stammerers of those tantalizing emotions must needs
know how to analyze their unconscious. Then it will
be found that not only the stammerer's dread, but also
his obsessional thought, " I can't speak," are by no
means mere products of his imagination, but are well
grounded. Only by pursuing the intricate paths of the
repressed emotions is it possible to dethrone the haunt-
ing obsession, and thus to remove all those agonizing
symptoms which have persecuted the sufferer with
unwearying tenacity for years.

CHAPTER VIII

THERAPEUTICS

IT will be remembered that in Chapter II we de-
scribed the various attempts to cure stammering,
and we found that, for many decades, the methods
applied had the common basis of an attempted cure,
by means of breathing, vocal, and articulatory exercises.
Up to quite recent years the desideratum has been
to teach the sufferer hoiv to speak — a superfluous effort,
for we know quite well that stammerers experience
no difficulty in speaking under certain circumstances.
Far from decrying those who vainly try to free stam-
merers from their disabilities by these means, we know
that they deserve a meed of praise for undertaking a task
which, if fulfilled conscientiously, makes greater demands
upon them than upon any other educator. During
the hours which they devote daily to their patients,
they have to treat each one individually and in indirect
ways ; they have to evoke and to support the patient's
confidence by carefully weighed words, and the effects
are wellnigh bewildering. Stammerers, previously un-
able to utter a word without difficulty, may in an in-
credibly short period speak fluently, and the effects
of the tuition we have described seem nothing short
of marvellous. But will they last ? No ! We know
that the educator, however well-meaning, has missed
the whole point, and that the chief enigma has still to

169

170 STAMMERING AND ITS CURE

be solved— namely, how is the permanent removal of
the complex-influences which make stammering an
obsession to be effected ?

All methods and speech drill hitherto taught in
institutions are solely based on confidence (hetero- and
auto— suggestion) ; for all speech specialists will admit
that their methods alone do not effect a cure.

Whether a patient says the sentence. " Barking dogs
don't bite," with Blume thus :

" e-B-harking e-d-hogs e-d-hont e-b-hite " ;

or with Denhardt (inhaling and elongating the first
syllable) :

" Ba — rkingdogsdontbite " ;

or with Beasley (dropping the jaw, inhaling deeply at
the same time, keeping up the continuity of sound, and
paying special attention to the final consonants) :

" Barking dogs dont bite " ;

or with Colombat (emphazing the vowels, beating time
with a foot) :

" Bdr-kmg dogs ddnt bite " ;

or with Yearsly (emphasizing the vowels, very strong
expiration, beating time with thumb and forefinger) :

" Bdrk- ?ngd- dgsd- dntb- ?te " ;

all such efforts are equally futile. So long as confidence
lasts, and the new innervation is still a novelty, one
method is as effective as the other. The moment,
however, confidence breaks down and the novelty of
the new innervation wears off, one is as useless as the
other, one method being as unable as the other to
banish dread of speaking. When dread makes its

THERAPEUTICS 171

appearance, then, owing to retardatio and tetanus, it is
practically impossible to innervate the organs of speech
properly. And even if the sufferer has for weeks practised,
with the greatest conscientiousness, " Babe, Bebe, Bibe,
Bobe, Bube " (with Beasley), when dread crops up the
organs of speech are nearly paralysed and the word
*' Barking " refuses to come forth. And if ht has (with
Colorabat or Yearsly) trained the articulator> and
vocal organs for weeks, and has emphasized the vowels,
when dread appears his organs are rigid and stiff.
Speech drill of that description (even if based on the
best physiological principles) helps the patient only so
long as he has confidence in it.

Lewis, Yearsly, and others (like Colombat and
Serres d'Alais of much earlier date), are of opinion that
their exercises favourably influence the muscles and
nerve centres, in consequence of their invigorating
effect on the physique. However, we would point out
that this continual referring the stammerer to the for-
mation of the different letters and sounds demonstrates
ad ocidos the intricacy of the whole speech apparatus
by dismembering it in its different parts ; whereas the
sufferer should use it as a whole, remaining as uncon-
scious about its details as the large percentage of
ordinary speakers who use the apparatus so fluently,
simply because they hardly know anything about it —
nay, they do not even think of it. In fact, we may say
in this direction that '* where ignorance is bliss, 'tis
folly to be wise." All the mechanisms work so much
the more reliably the less one concentrates upon them
and the less one knows of them.

It is an utterly mistaken idea to suppose that any
explanation of the speech mechanism, or any speech
drill, will permanently enable the patient to suppress

172 STAMMERING AND ITS CURE

the momentum of inhibition, which is invariably? caused
by unconscious psychic stimuU. Against these the
stammerer is entirely powerless, and the exercises
cannot give him the required power. In speech nerves
which, owing to complex-influences, are kept in a state
of irritation, dread is bound to work, as it does with
a stammerer. The educator alone, who actually eradi-
cates dread of speaking, prevents all paroxysms of stam-
mering, and thus cures the affliction.

Dread is, in nearly all cases, but temporarily removed
by the methods we have described, the duration of
freedom largely depending on the character of the
sufferer, on the one hand, and the educational skill of the
instructor, on the other. If the patient's dread and
irritability be but slight, and his affliction not of long
standing, there is some hope that, given great confi-
dence in the method, the influences of the emotional
complex are counteracted to such an extent that the
patient may be proof against a relapse for some con-
siderable time. But the weaker the patient's confi-
dence, on the one hand, and the more intense the
impeding influences of his emotional complex^ on the
other, the greater the probability that the stammering
will return after he has left the institution. If, for
example, the " cured " stammerer is conscious of having
applied the method carefully when a paroxysm of stam-
mering occurred, without being able to guard against
the breakdown (and how easily can this happen !), this
experience must inevitably influence the patient detri-
mentally. His confidence begins to desert him, dread
makes its reappearance, and the occurrence of further
paroxysms is practically certain. From day to day
the frequency of the attacks and also their intensity
increases, and dread being on the scene again, all

THERAPEUTICS 173

methods are of little or no avail whatever; retardatio
and, more especially, tetanus, at the moment of danger
frustrates the execution of the prescriptions. If the
stammerer were able, at the moment of intense dread,
to move his organs at will, the prescriptions would be
very welcome indeed. Elongating the first vowel,
speaking in a low voice, keeping up the continuity of
sound, etc., these facilitate the keeping open of the
glottis; speaking aloud {locutio alta) and emphasizing
the vowels have also a favourable influence, inasmuch
as the more energetic the vibrations of the vocal cords
and the more vigorous the expiration the less is the
glottis able to close easily. Rhythmic speaking serves
the same purpose, in that it regulates the opening and
closing of the glottis at certain intervals. We admit
that these expedients give assistance when a little
unevenness is caused by a slight degree of nervousness.
However, when dread has reached a certain intensity,
they immediately break down ; the organs become
extremely clumsy, rigid, and immovable — retardatio and
tetanus 1

Any physiological method, no matter how " infal-
lible " it is claimed to be by its originator, aims at the
same end — namely, that of inducing the patient to
practise the movements involved in speech consciously.
The method certainly does influence the stammerer's
psyche by creating faith in the system; he is sup-
posed to say to himself : " As I have already prac-
tised these vowels and consonants so frequently, they
will be sounded correctly when I form them again in
the same manner during conversation ; I only need to
inhale and to speak * on rule.' " This thought is in-
tended to encourage the patient, and to enable him
to enter into the act of speaking with self-reliance and

174 STAMMERING AND ITS CURE

assurance. Unfortunately, confidence evoked in this
way is, as a rule, very short-lived, and the patient,
especially if he be young, is unable to inspire himself
again with the confidence which he has lost, For even
if he know ever so well how b is to be formed, for
example, this knowledge will be of no avail to him
if complex-influences, for the time being, absolutely
prevent him from carrying out the necesary move-
ments.

Some originators of physiological methods point out
\ that their second aim is to suppress the co-movements
noticeable in many cases of stammering. In most
patients co-movements are only found in connexion
with the articulatory muscles; particularly frequent
are trembling of the nostrils, frowning, spasmodic
snapping of the lower jaw, etc. The pressure of
volition which, owing to inner (unconscious) resistances,
partly irradiates to nerves not directly connected with
speech, causes these to begin to work also. Experience
shows that the co-movements only occur when the
pressure of volition works on the speech nerves too
intensely. The moment the patient does not feel the
momentum of inhibition, and hence is not compelled to
apply a surplus of pressure, no co-movements appear.
Consequently, all the patient has to do is to allow the
pressure of volition to act on speech nerves with normal
intensity, and the co-movements will immediately dis-
appear of themselves. But what can be termed
*' normal intensity"? When psychic impeding in-
fluences are in question, there exists no normal
standard of intensity. Any surplus of pressure, how-
ever, is bound, according to the nature of the central
organs, to produce an irradiation of the impulse of
volition. When the originators of certain physio-

THERAPEUTICS 175

logical systems combat the co-movements, they fight
either against laws of Nature or against the impulse
of volition. It would certainly be far more rational
for them to endeavour to do away with the intense
psychic resistances ! Then the nerves will act in such
a manner that the surplus pressure of volition is never
required, and, when such is avoided, the co-movements
are bound to leave the patient of themselves. How-
ever, so long as the impeding complex-influences are
in existence, all combating the co-movements is futile ;
for when the combat aims at decreasing the pressure of
will, the latter, when dread makes its appearance at the
same time, becomes too weak, and speech is impos-
sible. With retard, minor, and hsesitatio (tetanus), a
weaker pressure of will cannot possibly cope, let alone
the fact that even a strong innervation often fails to
overcome the intense psychic resistances.

The chief point, however, on which many originators
of physiological methods lay stress, is that the stam-""!
merer has to undergo a systematic drill, in order to
enable him in future to carry out the articulatory
movements as superficially as possible, and to sub-
ordinate them to phonation. This point of view is,
however, absolutely erroneous and contradictory to all ^
experience. Every adult stammerer will admit that he
got hung up hundreds and hundreds of times, simply
because he either thought of a letter (or a syllable) or of
the necessary movement of his organs of speech. This
thought, this watching of details, already produces dread
in advance, and it is obvious that speech drill tends to
support this disastrous inclination, instead of removing
the deeply rooted " dread " tendency in stammerers.
We need scarcely mention that we have had a large
number of sufferers under treatment, who had been

176 STAMMERING AND ITS CURE

made considerably worse by previously undergoing
mechanical treatment.

Another task which speech drill undertakes is " by
improving the physique to restore the natural bravery
of the human being." We ask : Can any elocutionary
methods (even when coupled with physical exercises)
possibly remove intense dread and the irritability of
the speech nerves caused by psychic stimuli } Are the
enormous inner resistances and the nervous irritability
to be cured by keeping on irritating these nerves
systematically ?

Has ever greater nonsense with regard to the treat-
ment of neurotic people been unearthed and publicly
advocated ? We might just as well affirm that it would
be necessary for a man who has contracted neuras-
thenia, owing to mental overwork, to continue hard
mental work systematically ! Or we might just as well
maintain that, to cure a person who has over-exerted
single nerve-channels, it would be essential for him to
go on exerting those parts of his nervous system
methodically !

Indeed, our words involuntarily become sarcastic when
we think of this nonsense, and of the tiresome work and
loss of time and energy it has involved. However, as all
institutions, with the sole exception of some conducted
by hypnotists, apply speech drill, we cannot engage too
enthusiastically in fighting against those expedients.

Even the arguments of some specialists — namely,
that the elocutionary exercises aim at producing new
speech centres — cannot justify their retaining these
exercises. Tiresome drill, to be carried out for months
or years, is not required for the production of new
speech centres, which can be attained in an instant —
uamely, by change of innervation induced from the

THERAPEUTICS 177

sound-image centre, and with the assistance of the ear.
Every one carries out such a change of innervation who
either imitates another person's manner of speaking or
suddenly begins to pronounce each syllable clearly and
distinctly, whereas previously he had never paid the
slightest attention to the aesthetic side of his speaking.
Such a stammerer immediately speaks without difficulty,
especially when musical.

Therefore, let us away with these superfluous and
frequently detrimental elocutionary exercises, the in-
fluence of which can, at best, be equal only to that of a
temporary suggestion. " Suggestion " certainly can be
so intense as to bring about a temporary cure, but this
result is by no means due to speech drill, but largely to
the helpful influence of the environment of the establish-
ment in which the drill is applied.

The latter fact is easily accounted for by the psycho-
neurotic nature of the affliction. As pointed out before,
any psycho-neurotic ailment has the tendency to isolate
the patient from the world, or, in other words, the
complex prevents the sufferer from transferring the
repressed energies to his environment, thus making
psychologic adaptation impossible. Thanks to the
psychologic law, " A common complex is no complex,"
some stammerers, when amongst fellow-sufferers, are
soon able — while at the institution — to adopt the same
mental attitude as is theirs when alone. And lo ! all
dread and nervousness vanish, and the patients imagine
themselves " cured " by a marvellous system. Un-
fortunately, a short time after they have left the
establishment and have returned to their old associa-
tions, the emotional complex, which, of course, had not
been directly attacked at all, again begins to get the
upper hand, and relapse sets in.
12

178 STAMMERING AND ITS CURE

As the psychic phenomenon of " transference " is a
mechanism that is characteristic of neuroses and their
pathological symptoms, it will be as well to give here a
few details * referring to its curative influence. It has
been proved by hundreds of cases treated by psycho-
analysis that in every human being, and particularly in
, every neurotic person, the loving, bashful, timid child
\y" continues to exist, and that all loving, hating, and
dreading occurring later on represents but transferences,
or — to apply a term of Professor Freud's — " new
editions " of currents of feeling which had been culti-
vated in early childhood (before the completion of the
fourth year) and subsequently repressed.

It is a well-known fact amongst capable observers
and experimentalists that sympathy and respect con-
siderably influence the bringing about of suggestive
susceptibility. However, what was hitherto not known
and could only be found out by means of psycho-
analysis is, firstly, that unconscious affects (emotions)
play the chief part in the bringing about of any sug-
gestive impression; and, secondly, that they represent
manifestations of libidinous impulses which were largely
transferred from the relation '* child-parent " on to that
of " patient-suggester."

Referring to hypnotism in particular, it had already
been known, as stated before, that sympathy or anti-
pathy between hypnotist and medium (patient) largely
influences the success of the experiment. But the fact
was undiscovered that the feelings of " sympathy " and
*' antipathy " are highly compounded psychic forma-
tions, which can be resolved by Freud's method hito
their elements.

* For further details see Dr. S. Ferenczi, " lutrojection und
Ucbertragunjj," Vienna, iy09.

THERAPEUTICS 179

Whether a person can be hypnotized and influenced
by hetero-suggestions depends on the possibility of
" transference," or, to put it more plainly, on his positive
(though unconscious) libidinous relation to the hypno-
tist; the transference, however, has, like any other
affection, its root in the repressed parental complex.
Proofs for the correctness of this conception can be
easily found by taking into consideration the practical
experiences in connexion with suggestibility and
hypnosis.

It is striking how considerably the proportion of suc-
cessful hypnoses varies with the different experts. One
is successful in 86 only, another in 80 to 90, or even in
96 out of 100 cases. All experienced hypnotists agree
that hypnosis is facilitated, to a large extent, by the
imposing appearance of the experimenter. It is
generally recognized that self-assurance in demeanour,
the report of previous successes, differences in the
social position, education, etc., considerably contribute
towards the suggestion being successful.

To induce hypnosis, the suggestions must be given
so decidedly and firmly that any contradiction on the
part of the patient is to appear quite impossible. For
another form of hypnosis the requisites are — a darkened
room, absolute stillness, and kindly mild persuasion
induced by a monotonous and slightly melodious tone ;
soft stroking of hair, forehead, and hands are often
used as assisting measures.

Generally speaking, it can be stated that the suggester
has two ways and means at his disposal to hypnotize
and influence people by suggestions — namely, dread
and love. The hypnotist with the imposing counte-
nance, who gives his commands firmly, has surely a
striking likeness to the picture of the strict, powerful

180 STAMMERING AND ITS CURE

father, as it may have impressed itself on the child's
mind, and to believe in, to obey, and to emulate whom
is perhaps the highest ambition of any normal human
being. And as to the smoothly stroking hand, the
agreeable, monotonous words productive of sleep, are
they not a new edition of scenes which were enacted at
the child's bedside between him and the tender mother
as she sang a lullaby or told a fairy tale ?

No great stress need be laid on the distinction
between paternal and maternal hypnosis, quite apart
from the fact that father and mother often enough
exchange their respective roles. It suffices to point out
that the conditions of hypnosis are apt to induce the
patient to take himself, consciously or unconsciously,
back to the realm of childhood, and to awaken in
him latent reminiscences of that period of childlike
obedience.

Even the soporific means, which are supposed to act
by such outward stimuli as the holding of a shining
object before the patient, or the placing of a ticking
watch to his ear, are the same which succeeded, for the
first time, in riveting baby's attention, and are, there-
fore, very effective means with which to waken infantile
recollections and feelings.

All these considerations make it evident that any

"^ successful hetero-suggestion (with or without hypnosis)
requires as premise that the suggester shall be a match
for the patient — that is to say, that he shall be able to
awaken in the latter the same feelings of affection or of
fear which the child had towards his parents, and the
same convictions of infallibility with which he regarded
them.

To avoid misconceptions, it must be pointed out that

^ the susceptibility for suggestions — i.e, the disposition

THERAPEUTICS 181

to blind faith and obedience — is here understood to be
not only genetically connected with analogous psychic
pecuharities of childhood, but that, in our opinion,
through hypnosis and suggestion, *' the child slumbering
in the adult's unconscious " (Freud) is awakened, as it
were. The existence of this second personality not
only reveals itself during hypnosis ; it also manifests
itself at night in all our dreams, which, as we know —
thanks to Freud's ingenious discoveries — invariably
have their main root in infantile reminiscences, and
even in daytime the psyche is caught now and then at
infantile tendencies. In our inmost soul we are, and
we continue to be, children all our lives.

If we wish to put this information to good account,
we must naturally alter our traditional ideas about our
ability to forget. Analytical experience convinces every
one that a " forgetting," a " vanishing," in mental life,
without leaving a trace behind, is as impossible as the
destruction of energy or matter is supposed to be in the
physical world. Psychic occurrences possess a very
great persistency, and can be reawakened or recon-
structed as unchanged complexes, even after having
been ** forgotten " for decades.

When comparing the symptoms of psycho-neuroses
with the phenomena of hypnosis and suggestion, the
investigator will always notice that the hypnotist cannot
possibly show anything else but what is produced by
neurosis spontaneously — viz., the same psychic and
paralytic phenomena. The analogy between hypnosis
and neurosis goes so far that one cannot help adopting
the conviction of their complete identity, considering
that, in both states, unconscious complexes impel the
phenomena, and (amongst these complexes), in both
cases, the infantile and erotic ones (particularly those

U

182 STAMMERING AND ITS CURE

which refer to the j^arents) play the most important
part.

What applies to hypnotism also applies to non-
comatose hetero-suggestions. Hetero-suggestion is un-
able to bring about results in a patient unless his latent
tendency for blind faith and indiscriminating obedience
be unconsciously transferred to the person giving the
suggestion. To illustrate that such transference is
often directly made a conditio sine qua non by many
speech specialists, we will quote a part of the printed
instructions which are handed to every stammerer
(curious as it may seem) when entering a well-known
English establishment for the cure of defective speech :

*' There must be a unanimity of feeling between
teacher and pupil; this is most important, and at the
same time a critical point. The teacher, desirous of
considering the interests and welfare of his pupil, and
careful lest he should offend, is liable, unless thoroughly
experienced, to allow him to indulge in liberties, which,
if persisted in, would result in grave consequences, as,
should the teacher find it imperative to remonstrate,
his remarks might cause a separtion of friendship.
The secret of successful tuition is : insist upon good
behaviour and obedience, be tactful, make your pupil
realize that his teacher is his friend, that his faults
increase your sympathy for him, and that whatever
remarks you may have to make in correcting his
deviations from your instructions, they are solely
actuated for his benefit. Be kind, but firm; once let
the pupil lose confidence as to your ability in the cure
of his impediment, or feel your incapacity as an in-
structor and disciplinarian, and you have an incurable
subject."

Unfortunately, neither the teacher nor the pupil is

THERAPEUTICS 183

always able to enforce the transference, since the in-
fantile (unconscious) premises naturally vary more or
less in each case. There is a considerable percentage
of patients who, owing to infantile impressions, cannot
help feeling disinclined to take everything for granted,
especially those who have tried before to find a cure for
their impediment and have experienced the usual relapse.
We cannot think any the worse of them for being on
the outlook for inconsequences in the teacher's declara-
tions and for showing passive resistance, to a certain
extent. If they happen to feel that the teacher is incon-
sistent, or if they discover inconsequences in his method
— and how easily is this possible with mechanical systems I
— they are irrevocably turned into " incurable subjects."
However, the ultimate fate of those pupils who have
been able to transfer their faith to the instructor does
not substantially differ from that of the " incurable
subjects." They do not know that the fluent speech,
which some of them enjoy when leaving the instructor's
establishment, is but an artificial product brought about
by the helpful influences of the environment, on the one
hand, and by confidence in the teacher and his system,
on the other. These momenta act like a wall built
round the patient's ego, which is thus protected from
the upsetting stimuli of the emotional complex, for the
time being. The moment the patient returns home
and has to face all his old associations and erroneous
conceptions, he has to rely entirely on confidence, and,
as general experience proves, at least nine out of ten
will soon find that they had built their house '* upon the
sand." As soon as the " cured " stammerer, in spite of
careful application of the method, finds himself stam-
mering again, his confidence in the method receives a
very severe shock, and, from this moment, his suffering,

184 STAMMERING AND ITS CURE

which was, of course, artificially subdued, breaks forth
anew. The more complete the stammerer's previous
confidence in the instructor and in the method, the
worse is he influenced by the subsequent stage of
despondency and despair.

By far the largest percentage of persons thus " cured "
are bound to suffer a relapse, since the real cause of the
trouble — namely, the emotional complex — has not been
dealt with in the least. The outcome of the complex —
namely, dread and impeding psychic resistances — will,
of necessity, appear on the scene again, as the shaken
confidence is no longer able to keep the patient's ego
free from the sway of the pathogenous complex.

Let confidence once be broken down, the pitiable
stammerer, dependent on himself (being away from the
establishment), is utterly unable — even if he would
practise daily for hours — to inspire himself again with
confidence in the method. Without confidence, the
mechanical methods (and we feel it our duty to point it
out once more) are of no avail whatsoever, as they are
entirely dependent upon faith. A stammerer should
carefully guard himself against such " cures," where
faith and confidence are required, and which inevitably
end in a relapse.

To avoid misconceptions, we would point out that we
are, of course, well aware of the fact that *' suggestion '*
is an extremely helpful agent in the effective treatment
of quite a number of diseases. However, when ail-
ments are concerned which are merely caused by uncon-
scious psychic stimuli due to complex influences, hetero-
suggestions (hypnosis and non-comatose suggestion)
are of little avail to the patient, neurotic dread being
far too strong to allow them to counteract effectively.
If dread be very slight and the patient's powers of con-

THERAPEUTICS 185

centration good, it is possible to bring about a complete
and lasting cure in a small percentage of cases by means
of auto-suggestions, which necessitate the sufferer
working out his own salvation, as it were; but speech
drill must be strictly avoided.

After Dr. Liebault (late of the University of Nancy)
had worked out the theoretical basis as regards the
curative influence of auto-suggestions, it was Dr. Levy,
of Nancy ,39 who founded the first practical system of
their application. Liebault has explained the influence
of auto-suggestion in a fundamental manner, quite in
contradistinction to the empiric procedure in vogue till
then. He says : " It is my full conviction that an art
exists which will make the mind influence the body,
and this not only with other people, but also with one's
own self. To be cured does not require the agency of
a hypnotist, a trick, a cabalistic formula, or a fetish ; in
short, no striking apparatus of any kind is needed, but
solely the concentration of attention on the idea * to be
all right again.' Everyone has the faculty in himself to
bring about such intense and sure results by it as by no
other curative. Not that it is my intention to deny the
significance and benefit of medicaments — as a matter
of fact, it is my wish to enrich the therapy, not to
impoverish it — but a simple negation of the disease is
always felt beneficially by the organism, and is fre-
quently sufficient by itself to produce good results.
For mental pharmacology is anything but quackery.
One need only concentrate one's thoughts, with in-
tensity, on being cured, and one is already in possession
of a healing art by the application of which anyone
will bring about good results."

Here is not the place to give details about the
systematic application of auto-suggestions, and we

186 STAMMERING AND ITS CURE

^ refer those interested in the subject to Dr. Levy's ex-
• cellent book entitled, " L'Education Rationelle de la
Volonte " (published by Alcan, Paris, 1906). { We would
only point out that the effect of auto-suggestions largely
depends on two factors — namely, on the patient's
powers of concentration and his capacity for arousing
and cultivating a feeling of self-reliance, which auto-
matically drives the suggestion home with irresistible
power. If, owing to intense counteracting influences,
impelled by the emotional complex, the patient's powers
of concentration are weak, it is utterly impossible for
him to form any new associations of thought which are
able to outweigh those influences. As the complex-
influences are of considerable intensity in a large
majority of stammering cases, it is obvious that the
application of auto-suggestion is, unfortunately, only
useful to a very limited number of sufferers.

The advantage of auto-suggestions compared with
hetero-suggestions lies in the fact that they do not
appeal, as the latter do, to faith, but largely to the
patient's intellect, and, at the same time, they enable
him to cultivate an independent, clear-sighted activity
of his will. A cure effected in that way is, as a rule,
lasting, unless the patient lose confidence in the logic
of facts and in his own observations.

In order to enable the patient to live up to his auto-
suggestions, on the one hand, and to counteract the
influences of the emotional complex, on the other, it is,
according to our experience, to the last extent advisable
to cultivate a saturated jeeling of mental ease. By
so doing, the psychologic axiom is utilized — namely,
when a man practises one and the same feeling over
and over again, this feeling will in time dominate the
man.

THERAPEUTICS 187

To this end it is imperative that the patient avoid
any too great pressure of vohtion, and that he speak in
the easiest, let us say the most phlegmatic, way possible.
Whilst speaking, he must also endeavour to keep up the
saturated feeling of ease, and manifest it in the act of
speaking itself. We refer to the ease which presents the
sentence piece by piece, exactly like some public speaker
who, quite phlegmatically and comfortably, unfolds his
subject little by litle, just as it occurs to him. Thus
the question, answer, narrative, or speech gets the char-
acter of something unaffected and unstudied, with a
peculiarly modulated cadence as it is stimulated by
the ease of the moment, a manner of speaking which
impresses the listener much more favourably than
the rattling off of long, studied periods.

The patient should not be afraid of ever bemg too
much at ease. As any ordinary speaker has his peculi-
arities, nobody will mind letting the patient have his —
only let it be the most natural one imaginable.

Further, what the patient is going to say should
appear to him so indifferent and insignificant in pro-
portion to his endeavour to induce the phlegmatic feel-
ing that he should be inclined to pay very little attention
to the form and construction of his words. The im-
portant thing for him is the maintenance of personal
ease, and what he is going to say should be of secondary
consideration. The patient should work with the greatest
determination towards the attainment of ease, of which
it is impossible for him to obtain an overplus.

The stammerer who, following our directions, applies
the lever to the right point with all his energy — that is
to say, who forces and educates himself to that per-
meating feeling of ease — will be able, in a comparatively
short time, to speak without stammering, always pro-

188 STAMMERING AND ITS CURE

vided that the counteracting complex-influences are not
intense. If these influences be but slight, the phleg-
matic feeling is before long so strong as to allow the
patient to check the advance of dread. The watching
of " bugbear letters " will subside as well, since, owing
to the pervading feeling of ease, there is no crowding of
thoughts, but the latter move on step by step, thus
making anticipation impossible.

The more the patient cultivates that phlegmatic feel-
ing, the more chains of associations he forms, which
ultimately are able to counteract entirely and to " cover
up " the emotional complex. He should take care
never to utter a thought unless the feeling of comfort
cause it to flow over his lips, as it were; on no con-
dition should he apply any effort when pronouncing a
word; all his energy, as pointed out before, should be
concentrated upon the inducing of the comfortable feel-
ing of ease. The sufferer, in order eventually to be
reminded of it automatically, should always keep this
thought in mind : " When my feeling of ease is intense
enough, the thought flows over my lips of itself." This
should also form the main theme of his regular auto-
suggestions, to be applied twice daily.

If, however, the patient now and then omit to think
of this suggestion, and the anti-suggestion, " I can't
talk," take possession of him, causing him to come to
grief, he should remember the fact that it is not possible
in a few weeks firmly to establish a new train of thought
under adverse circumstances. Any dwelling on the
breakdown would merely augment the power of the
complex-influences.

As mentioned before, this auto-suggestive treatment,
combined with the cultivation of absorbing mental ease,
is, unfortunately, completely effective only in a small

THERAPEUTICS 189

percentage of cases. In inveterate and severe cases the
patients are, as a rule, utterly unable to cultivate that
feeling of ease and to make their auto-suggestions so
strong as to counteract the emotional and impeding
influences of the complex.

It goes without saying that a treatment which merely
effects a cure by covering the complex up cannot be
considered as ideal from every point of view, inasmuch
as the energies contained in the complex are thus
entirely lost for the patient. This would be practically
immaterial in slight cases, where the complex has but a
small extension. In severe cases, however, it would be
a regrettable mistake to imprison the substantial com-
plex, as the patient would then never be able to develop
all his faculties properly.

In order to illustrate that fact, we will make a com-
parison. The mind is like a country which possesses
an army of, say, 100,000 men. In this army 5,000 of
the troops become rebellious, and to check the rebels
the commander-in-chief has to put 7,000 to 10,000
soldiers in the field. The army is now diminished by
12,000 to 15,000 men, who are engaged in the interior
and cannot be made use of for purposes of defence
when occasion requires.

By suggestions the " rebels " are often strengthened,
while, on the other hand, part of the army has continu-
ally to be kept under arms, and cannot be employed for
external tasks. In this way nothing is gained for the
patient's personality in its entirety. The only ideal
treatment is the psycho-analytical one, which alone
reconciles the *' rebels " and leads them back to the
main body of the army.

In the following chapter we will endeavour to show
in detail how psycho-analysis has to be applied.

CHAPTER IX

THERAPEUTICS (coniinued)

IT has been justly pointed out by Dr. Loewenfeld 41
that, strictly speaking, any therapy is psycho-
therapy; but the technics which have hitherto
been applied for the effecting of cures have been partly
confined to persuasion, partly to promises working by
suggestion — i.e., by strengthening the patient's assurance
that his affliction would soon be removed — partly, also,
to direct hypnosis. In fact, while the psychic causes
of the disease were previously not realized, or, at the
most, were only superficially entered into, psycho-
analytical therapy searches for the root of the ailment.
Psycho-analysis has nothing in common with any other
psycho-therapeutics ; it ignores hypnosis or any form
of suggestion, and merely uses the patient's thoughts
and dreams as means by which to lay bare his uncon-
scious.

The advantages of psycho-analysis compared with
suggestive therapy are brought out in the following
quotation by Professor Freud : " Between the suggestive
technics and the analytical technique exist the greatest
contrast possible- -that contrast which the great Leon-
ardo da Vinci, for the arts, has framed in the formulae
per via di porre and per via di levare. The art of painting,
says Da Vinci, works per via di porre — that is, it puts
small heaps of colour where they previously were uot —

190

THERAPEUTICS 191

namely, on the imcoloured canvas. Sculpture, on the
other hand, proceeds per via di levare — namely, it takes
off from the stone as much as still covers the surface of
the statue contained therein. Quite in a similar way
the suggestive technics try to work per via di porre ;
they do not care about origin, dynamics, and significa-
tion of the pathologic symptoms, but add something —
viz., the suggestion — which, they expect, will be strong
enough to prevent the pathogenous idea from manifest-
ing itself. The analytical therapy, on the other hand,
does not aim at putting on, or introducing something
new, but it aims at taking off and clearing the ground ;
and to this end it attends to the genesis of the patho-
logical symptoms and the psychic connexion of the
pathogenous idea, the removal of which is its aim. I
was early obliged to give up the suggestive technics,
including hypnosis, as I despaired of making the sugges-
tion so intense and durable as would be necessary for a
permanent cure. In all severe cases I saw the sugges-
tion, laid on, peel off again, and the disease, or a sub-
stitute of it, make its reappearance. Besides, I reproach
those technics with veiling our insight into the play of
the psychic forces."

Analytical treatment is, unfortunately, very difficult,
and requires a considerable amount of practice and
experience before it can be applied effectively. We
will quote Freud once more : " The mistake seems to
be largely spread amongst my colleagues that the tech-
nique of investigating the causes of the disease and the
removal of the symptoms by that investigation is easy
and self-evident. . . . However, the psychic instru-
ment is by no means easy to play I am here induced
to think of the discourse of a world-renowned neurotic
man who, of course, has never been under medical

192 STAMMERING AND ITS CURE

treatment, but who has merely existed in a poet's
imagination. I am referring to Prince Hamlet of Den-
mark. The King has sent the two courtiers, Rosen-
crantz and Guildenstem, to him, in order to sound him
and to wring the secret of his depression from him.
Hamlet keeps them off; then he takes a flute and asks
one of his tormentors to play on it, remarking that it is
as easy as lying. The courtier refuses, pointing out
that he knows no touch of it. As he cannot be induced
to try to play the flute, Hamlet ultimately bursts forth :
* Why, look you now, how unworthy a thing you
make of me. You would play upon me ; you would
seem to know my stops ; you would pluck out the heart
of my mystery; you would sound me from my lowest
note to the top of my compass; and there is much
music, excellent voice, in this little organ, yet cannot
you make it speak. Why do you think that I am
easier to be played on than a pipe? Call me what
instrument you will, though you can fret me, you cannot
play upon me.' "

Now let us turn from these quotations from the
works of this, the greatest of psycho-analysts, to a prac-
tical application of his marvellous theories.

In carrying out the psycho-analytical treatment it is
advisable for the patient either to lie down on a couch
or to sit in an easy chair. Thus the patient, freed from all
muscular activity, can concentrate the necessary atten-
tion on a certain train of thought ; if under the influence
of strong emotions, he is also at liberty to pace the room
to and fro, or to carry out certain symptomatic actions,
which often turn out to be very significant for the com-
prehension of one or the other symptom.

At the beginning of the treatment it is imperative
to point out to the patient that the only thing which

THERAPEUTICS 193

psycho-analysis absolutely requires of him is concentra-
tion and sincerity. He is expected to say everything
that passes through his mind, even if he be of opinion
that certain thoughts which occur to him are immaterial
or do not refer to the subject. It is absolutely neces-
sary for him to avoid all criticism and to leave it to the
psycho-analyst to decide whether the thoughts pro-
duced are of significance for the understanding of his
affliction or not. It is incumbent upon the patient
to communicate those thoughts also which an inner
resistance endeavours to persuade him to conceal.

The patient put at complete ease, and well aware of
the necessity for concentration and for perfect sincerity,
is now asked to give a detailed account of his life and
environment, particular attention being paid to the time
previous to the beginning of his stammering. When
the patient gives the account, many lapses of memory
show themselves, incidents have been actually forgotten,
temporal relations have been confused, or casual con-
nexions have been disjoined, so that apparently inex-
plicable effects are produced. There is, of course, no
account of any neurotic disease without an amnesia of
some sort at the outset. When pressing the narrator
to suply those lapses of memory by intense concentra-
tion, one notices that the thoughts just about to emerge
are pushed back by the inner (critical) resistances, until
he eventually feels a direct dislike (pain) when the
required recollection actually appears. Freud rightly
concluded from that experience that the amnesias are
the result of the process which he has described as
"repression."* The psychic forces which have brought
about this repression are to be felt in the re.s/.sfance

* See chap, v., pp. 110 et seq. For further details see also Dr. E.
Hitschniann " Freud's Neurosenlehre," Leipzig, 1911.
13

194 STAMMERING AND ITS CURE

which arises against the incidents being recalled. To
find and to solve these resistances is the most important
part of therapeutic work.

When we notice, at the beginning of the treatment,
that a patient's resistances are so intense that he
finds it impossible to produce anything which he has
a tendency to repress, we usually apply the system of
unveiling unconscious ideas, as elaborated by Dr. Jung,
of the University of Zurich. The process is carried on
in this way : the patient is challenged by a *' stimulus-
word," * and he must reply with the first association
which comes to his lips. The association word is called
the *' reaction."

The system starts from the premise that words are
abbreviated actions or representations, and it works in
a similar way as when an Indian magician is able to
make the situation, conveyed by some stimulus-word,
arise before the mental vision of his audience. If no
emotional complex is touched by the stimulus-word,
the reaction is produced without hesitation, and is in
logical sequence. If a complex be stimulated, the re-
action either requires more than the average time, and
thus expresses : " I am undecided as to what to say " ;
or the reaction is illogical, and expresses : " If I were in
such a situation, I should do what is not adapted for
it." The system, therefore, allows us, first of all, to
test how far the patient is able to adapt himself to his
environment, and, at the same time, to find out from
what repressed complexes (in rough outlines) he is
suffering.

As soon as the patient feels at ease and answers
readily, we take a stop-watch (indicating fifths of a
second) and proceed to call off the stimulus-words.

* See chap, vi., pp. ItS et seq.

THERAPEUTICS

105

Like Juiig, we use, as a rule, a set of one hundred
stimulus-words. The moment we call off " head," we
set the watch going; as the patient answers, we stop
it. In this manner the whole list of one hundred words
is run through. This done, we go over the list once
more, inducing the patient to answer just as before, but
to give the same association, if he can recall it.

The following is part of an actual record on a case of
stammering :

Stimulus-word.

Reaction.

Time.*

Reproduction.

I.

head

hair

v6

+

^

green

lawn

V2

+

3-

death

fear

3 "4

burial

4-

long

short

1-4

+

5-

boat

to row

ro

+

6.

to pay

much

2-8

+

7-

window

pane

1-6

+

8.

lake

water

2 "4

boat

9-

kind

animal

1-8

+

lO.

father

son

5*2

+

* Time in seconds (that time only is noted which it took the
patient to think of an association; the surplus of time now and then
required by stammering has been deducted). + indicates that
the association was remembered.

In such a record we look for associations which show
one or more indications of distracted attention, invariably
due to complex-influences. Dr. Jung gives the following
list of the symptoms of unconscious complexes :

1. Unusually long time caused by the interference of
a strong emotional tone.

2. Strange (illogical) reaction; mistakes, or no re-
action at all.

3. Stereotyped repetition of a stimulus-word.

4. Forgetfulness.

196 STAMMERING AND ITS CURE

5. Persistence of the disturbance for following asso-
ciations. •

6. Translation into a foreign language ; a quotation,
or a vigorous expression.

As further complex-indicators which can frequently
be noticed we may mention :

7. Surprise at a stimulus- word.

8. Laughing at a reaction (the patient is often com-
pelled to laugh when his unconscious has been hit.)

9. Superficiality of the association.

All these symptoms show that emotional complexes
bring their impeding influences to bear strongly even
on the associations of ideas, and we know from our
experiences that exactly the same impeding influences
produce stammering. Though it is usually understood
that the association of ideas is under a man's free
option, and that he can say what he wants to say, he
cannot do so ; he is compelled to say what his com-
plex suggests. His reactions, therefore, are by no
means free ideas, but merely symptomatic actions
(Freud), which are directed by a psychic factor which
acts as a second personality. The emotional complex
thus produces effects which continually and success-
fully compete with the intentions of the ego-complex ;
they stimulate reactions, in spite of the antagonistic
attitude of the ego-complex, and send up associations
for the meaning of which the ego-complex often has no
explanation.

All our thoughts and actions which appear to be
conscious in their essential parts are, in reality, com-
posed of smaller particles, which are determined, in
a very subtle manner, by innumerable momenta lying
entirely outside consciousness. The process of associa-
tion appears to be the work of our consciousness, carried

THERAPEUTICS 197

out at its own discretion, free will, and attention; as
a matter of fact, however, consciousness is but the
puppet which dances on the stage, behind which is
hidden an automatic mechanism.

To return to our description of psycho-analytical
methods. After finishing the whole record of one hundred
words, it is necessary to find the probable mean which
the patient took in producing the associations. Con-
sidering that an excessively long hiatus frequently occurs,
the application of the arithmetic mean is not practicable,
as the high figures caused by the hiatuses would influence
the average in an absolutely mistaken manner. This
drawback is avoided by applying the probable mean,
which is found by arranging all figures according to
their value, and by simply taking the middle figure. In
the record quoted the probable mean (taking into account
the whole list of one hundred words) is 1-8 seconds.
Any reaction which required more time than 1-8 seconds
shows complex influences (in our case the associations
to the words "death," "to pay," *' lake," and "father").

Then the patient was asked what he thought of for
"death." He said that, owing to his affliction, he had
often suffered from intense depression, which some-
times even took the shape of pronounced weariness of
life. If it were not for his aged parents and for religious
considerations, he would have blown out his brains
some years ago. (How intense the " suicide complex "
was, is evident by the fact that he was absolutely unable
to remember his first association, " fear.")

The word " to pay " brought up old unpleasant recol-
lections in connexion with money matters at home.

For the word " lake " the association was also for-
gotten. On being asked how he accounted for the two
complex-indicators (long reaction time and forgetful-

198 STAMMERING AND ITS CURE

ness), he answered, after some thought, that he vaguely
remembered having had an accident with a boat on a
lake near Keswick when scarcely three years old.

In connexion with " father," he produced an abun-
dance of infantile recollections. His mother used to
spoil him, while his father tried to counteract this
influence by fits of excessive strictness. He used to
stand in such awe of his father that he identified him
later on with the giants about whom he read in fairy
tales. (It would take too much space to quote all asso-
ciations to " father " produced by the patient. Need-
less to say, he found it practically impossible, as time
went on, to speak to his father at all without stam-
mering.)

These few instances may suffice to show that any
experiences of an emotional nature, especially those of
early childhood, remain in the person's mind as a com-
plex, which mixes itself up with the most ordinary
affairs of life. Every person, of course, has one or
several complexes which, in some way or other, manifest
themselves in his associations. The whole memory
material is grouped around these complexes, which, as
we have pointed out before, entirely impel a man's
thoughts and actions, and, therefore, his associations
also. Owing to this fact, a complete record of a patient's
associations invariably allows us to find out the main
outlines of his complexes, and thus renders us able to
overcome a certain amount of his unconscious resis-
tances.

It goes without saying that the patient is often
utterly unable to explain immediately why there are
strong indications of complex-influences in connexion
with some words. In a case of this description we ask
him to say a series of words (" free associations ") just

THERAPEUTICS 199

as they occur to him incidentally, so to speak, whereby,
relying on the rigorous determinism which underlies all
psychic events, we expect him to call out words that
are connected with the searched-for repressed occur-
rences. When the patient then gives us his *' free
associations," one out of three possibilities will happen
— viz. :

1. The patient may give a series of words referring
merely to his present environment ; for example, '* death
— life — to eat — table — chair — carpet." (Such a series
of external associations would be useless, and indicates
the patient's endeavour to distract his attention from
himself.)

2. Or he may give an " identical series," such as
" death — coffin — grave — funeral — clergyman." This
form of association, again, shows the patient's resis-
ances, inasmuch as he tries to shut off unconscious
influences by intellectual (conscious) concentration.

3. By avoiding conscious concentration, the hidden
complex-influences are allowed to exercise the control
over the associations. To this end it is imperative
on the patient to react in a subjective manner on the
stimulus-word, the complex being unable, without affect
(emotion), to take the guidance.

It is self-evident that no analysis of the stimulus-
word can be made, unless the personal relation be found.
When the word has aroused an affect, the patient is
bound to give a series of words which refer to his com-
plex. When analysing these words, the patient is fre-
quently unable to explain immediately the disguised
meaning of some of them. In such a case one has to
wait ; the required explanation, as a rule, presents itself
in the course of the next few days, quite by accident, as
it were.

200 STAMMERING AND ITS CURE

In this way it is possible, by means of associations,
to obtain the outlines of the patient's complexes, and
at the same time, to overcome his first resistances.
However, much more is required to get accession to all
those repressed conflicts on which dread of speaking
and the momentum of inhibition (" I can't ") are based.
To gain this end, Freud has developed a most ingenious
system of interpretation, which enables the psycho-
analyst to find out the repressed thoughts and emotions
from the chaos of thoughts and recollections produced
by the patient. Without Freud's devices the psycholo-
gist would not only be unable to undermine the sufferer's
immense psychic resistances, but he would soon lose
himself in the labyrinth of thoughts, and ultimately get
hopelessly astray.

The objectives of Freud's method of interpretation
are not only the patient's flashes of thought, but also
his dreams, which open up the most direct accession to
the knowledge of his unconscious; further, his unin-
tentional, quasi-desultory actions, and his blunders in
functions of everyday life, give matter for considera-
tion. The method consists of a series of rules built
upon profound experience, which enable the analyst to
construct the unconscious material out of the thoughts
produced by the patient; it further contains instruc-
tions as to the procedure, when the thoughts refuse to
come, and advice for dealing with the most important
typical resistances which usually occur in the course of
such treatment.

Though, at the first glance, it looks very much as if
one could safely rely on the patient's flow of thoughts
and carry out this system of interpretation accordingly,
any practical attempt, be it ever so short, shows that
the analytical work is very frequently interrupted by

THERAPEUTICS 201

tht resistances which contend against giving vent to the
repiessions. The removal of those resistances is the
main task of the analytical technique, and, when this is
achieved, the material required for the disclosing of the
emotional complex results of itself. The psycho-analyst
must be prepared for these resistances, which are clothed
in a great variety of forms, and invariably lead to pauses
in the patient's train of thought. The pauses have
certain typical symptoms which are easily diagnosed
by an experienced psychologist. The flow of thought
can, for example, be interrupted by a feeling of intense
antipathy or sympathy between patient and analyst,
which the former tries to hide. In a similar way im-
patience on the part of the sufferer, owing to the com-
paratively long duration of the treatment (the pecuniary
side of the matter troubling him), acts as an interrup-
tion. The resistance is further evidenced, in frequent
cases, by the patient's dreams, which either discontinue
altogether or which flow in such abundance as to render
it impossible to deal with them properly within the
compass of the daily treatment. The experienced
psycho-analyist will acquaint the patient with the
momentary resistances from time to time, and the
analysis will thus be achieved at a quicker rate, because
by the removal of a resistance the accession to new
unconscious material is accomplished, this resistance
having acted as an obstruction to that repressed material.
As mentioned before, besides the patient's thoughts
and symptomatic actions, his dreams are of the greatest
importance, since they provide the best material with
which to penetrate into the unconscious mental life.
In fact, the experimentalist who does not understand
the symbolic language of the dream and its origin will
in vain endeavour to understand the psychic structure

202 STAMMERING AND ITS CURE

of phobias and obsessions, or to carry out a completely
successful psycho-analysis. Dream analysis, in jpite
of its vital importance from a therapeutic poiat of
view, is a subject little studied or understood up to
the present; we will, therefore, give a few outlines of
the structure, etc., of dreams, though the following
description can at best serve but as an introduction to
the study of Professor Freud's *' Traumdeutung " : 31

*' It is commonly believed in scientific circles that
the mental processes of which dreams are composed
arise, without any direct physical antecedent, as the
result of irregular excitation of various elements in
the cerebral cortex by physiological precesses occurring
during sleep. This, it is maintained, accounts for the
confused and bizarre nature of the mental product,
and any apparently logical connexion and order that
frequently appear, to some extent, in dreams are ex-
plained by the supposition that the mental processes
in question are represented in cortical elements that
stand in close anatomical or physiological relation to
one another, and so are simultaneously stimulated by
the peripheral stimuli. Hence, any problem as to the
psychical origin of the mental processes, still more as
to the meaning of the dream as a whole, is by the nature
of things excluded as being non-existent, and any inves-
tigation along such lines is condemned as savouring of
antiquated superstitions about the ' reading of dreams,'
unworthy of educated people. To this attitude Freud,
as must every consistent philosopher, stands in sharp
opposition. He contends that dream processes, like all
other mental processes, have their psychical history,
that, in spite of their peculiar attributes, they have a
legitimate and comprehensible place in the sequence of
mental life, and that their origin can be psychologically

THERAPEUTICS 208

traced with as much certainty and precision as those of
any other mental processes.

*' It is, at all events, striking that up to the present no
investigator in any country, who has taken the trouble
to learn the technique of the psycho-analytic method,
has reached any conclusions that fail to confirm Freud's
in all particulars, although at least fifty thousand dreams
have been investigated by this method ; this fact in itself
speaks for the finished state in which Freud gave his
theory to the world." *

Freud was led to the scientific investigation of the
subject of dreams by the fact that neurotic patients
who were undergoing his psycho-analytical treatment
spontaneously related to him dreams which occupied
much of their attention during the day. On close
examination of the dreams he found that, almost with-
out exception, they were intimately connected with the
momenta causing the ailment, and also that they always
contained infantile roots. The unconscious, which forms
the basis of any neurosis, is certainly disguised in dreams,
but it can be deciphered. By the discovery of this fact
Freud found what he himself calls the royal road to the
patient's unconscious. The same mechanisms are found
in neurotic symptoms as in dreams — that is to say, what
plays a part in the one will be found in the other. For
example, the incomprehensibility, which is a feature
of the dream, is also a feature of neurotic symptoms,
incomprehensibility in both cases replacing erotic
material which had become unconscious, owing to
repression.

But there are other actual dream-instigators, in
addition to the infantile and erotic stimuli already

* " Freud's Theory of Dreams," by Ernest Jones (AT.D. Lond.),
" American Journal of Psychology," April, 1910,

204 STAMMERING AND ITS CURE

noticed, among which are the ignored incidents of the
previous day with their numerous, though apparently
unimportant, details, which, on superficial considera-
tion, frequently seem to govern the scene of the dream.
Somatic sensations and external stimuli must not be
overrated as dream-instigators; they may stimulate the
dream, but they are, like other recent occurrences,
employed merely in order to disguise unconscious wishes.

To make the influence of dream-instigators clear, we
will, by means of a simple diagram, illustrate the process.

Let a represent the contents of consciousness and
b the unconscious ; d may represent a recollection or

an experience of the previous
^^_^_^^^ day, which was able to form

y^ ^N. associations with forgotten (re-

/ e \/ — ^ pressed) memories contained in
I vJr-~— - — ^^^^^ the complexes e and /; c may
\ f"*¥? — /^ >y represent the " endo - psychic
\^^^^ y\ censor" — i.e., the psychic resis-

^^ * tance that keeps mental pro-

cesses unconscious. A dream
can only be stimulated by a recent experience (d), ii the
latter be able to form associations with repressed wishes
accumulated in the complexes e and /. Since conscious-
ness sleeps, it is naturally unable to supply the energy
required for the " dream-making." To use Freud's
comparison : " Let us imagine that a thought of the
previous day plays the part of a contractor for the
dream; but the contractor who has the idea and the
desire to realize it, cannot possibly get to work without
capital; he wants a capitalist to defray the expenses,
and this capitalist who furnishes the psychic expense
for the dream is always a wish of the unconscious.
The dream-thoughts thus instigated have to undergo

{

THERAPEUTICS 205

a series of changes (explained later on), before they are
allowed by the endo-psychic censor (c) to enter con-
sciousness as the *' manifest content " of the dream.
According to our diagram, two dreams would be pro-
duced, as both complexes e and /, like cinematographs,
would project their respective dream-thoughts into
consciousness.

Generally speaking, dreams may be classified into the
following three categories — viz. :

1. Dreams which are, at the same time, sensible and
intelligible; such especially are the dreams of children.

2. Dreams which are connected and have an evident
meaning — a meaning, however, the contents of which
are curious and surprising, and cannot be fitted into the
rest of our waking life.

3. The most frequent type of dreams — those where
the mental processes seem disconnected, confused, and
senseless.

After studying intensely his own dreams and those
of neurotic patients. Professor Freud discovered the
very important fact that a dream invariably represents
the dramatic fulfilment of a wish, an infantile wish
being mostly combined with an actual one. The wish
character can be easily realized in some dreams. Though
it is not obvious in the majority of adult's dreams. The
dreams of a healthy child, however, present, as realized,
the naive and simple wishes which had been aroused
during the daytime and had remained unfulfilled.
Numerous other dreams, especially dreams where dread
and apprehension play a part, at the first glance seem
to be an argument against the wish theory, and are fre-
quently used as an objection to its generalization.

Freud will, however, be found quite capable of meet-
ing such objections. He proves that the dread dream,

206 STAMMERING AND ITS CURE

after interpretation, shows itself also as the representa-
tion of a repressed erotic wish, the disguise of which
failed. When analysing a dread dream, it can always
be found that the dread felt in the dream is only seem-
ingly explained by the contents of the dream ; as a mat-
ter of fact, it is only " soldered on " (as Freud expresses
it) to the representation accompanying it, and originates
from another source. It is, therefore, not a new side of
the dream problem which becomes manifest in dread
dreams, but it is the actual conception of neurotic dread
which has to be dealt with. The dread dream belongs to
the problem of dread, which we have already discussed
in connexion with the aetiology of stammering.

It must not be imagined that the interpretation of
patient's dreams and the fitting of them into the psychic
puzzle, so to speak, is an easy matter. What the
patient remembers in the morning is mostly a highly
phantastic, sometimes paradoxical, formation of thoughts
which, even where it seems to be logically joined to-
gether, does not disclose the real sense of the dream.
But if Freud's method be applied to any component
part of a dream, however senseless it may appear on
the surface, mental processes are reached which are of
high personal significance to the dreamer. Freud
terms the mental processes thus reached the " dream-
thoughts " ; they constitute the " latent content " of the
dream in contradistinction to the " manifest content,"
which is the dream as related by the patient. It is
absolutely essential to keep these two groups of mental
processes strictly distinct, for on the appreciation of the
difference between them rests the whole explanation of
the puzzling riddle of dreams. The " latent content "
is a logical and integral part of the patient's mental life,
and contains none of the incongruous absurdities and

THERAPEUTICS 207

other peculiar features that characterize the " manifest
content " of most dreams.

One must not be misled by the dream being, in one
point, or in several points, connected with occurrences
or impressions of the previous day. These connexions
are but superficial, and have but loose, insignificant
relations to the complexes which actually formed the
dream. As pointed out before, the real basis of the
dream is formed by experiences and wishes of early
cliildhood which had been repressed, and hence com-
pletely forgotten, but the existence of which can often
be objectively confirmed. Those early memories some-
times occur with startling fidelity even in the " manifest
content " ; in the '* latent content," however, such for-
gotten memories appear far more frequently, and Freud
is of opinion that the " latent content " of every dream
is very likely connected with mental processes that
extend back to early childhood.

The distortion of the dream-thoughts into the dream
as it is remembered, takes place according to certain
well-determined psychological laws, and for very precise
reasons. The essential part of Freud's theory on
dreams resides in his tracing the cause of this distortion
to a "psychic censor " — i.e., a repressing action of con-
sciousness in the service of the ego, which even works
during sleep and does not allow those repressed im-
pulses to pass in full clearness. He arrived at this con-
ception from the analysis of various psycho-neurotic
symptoms, which he found to be constructed on a plan
entirely analogous to that of dreams. Owing to the
censorial obstruction — i.e., that kind of moral check
which is still more alert in the waking state — not only
the latent dream-thoughts arc compelled to put on a
more or less complicated disguise, but, at the same

208 STAMMERING AND ITS CURE

time, the emerging of painful emotions which would be
connected with the unconscious becoming distinctly
conscious, is, as a rule, also avoided.

To understand the real meaning of the dream, it is
necessary to translate its " manifest content " into the
" latent content," just as a hieroglyphic script does not
yield its meaning until it has been interpreted. Here
the question arises : What are the psychic processes by
which the carefully interpreted dream-thoughts have
been transferred to the apparently incomprehensible
dream.'' When one is studying this many-sided and
peculiar '* dream-work," one is struck by the character-
istic feature that the dream-thoughts, found by analysis,
greatly surpass in extent the remembered content.
This circumstance indicates an extensive condensation
of the dream-thoughts. Each of the elements in the
manifest content does not originate from a single ele-
ment of the latent dream-thoughts, but represents the
fusion of several of them; on the other hand, one
dream-thought is, as a rule, represented by more than
one dream element. The condensation is shown in
several ways ; for example, a figure in a dream may be
constituted by the fusion of the memories of two or
three different actual persons, gathering up some
traits common to different persons and neglecting the
ones not common to them, thus forming what Freud
term a "collective person." The same process fre-
quently affects scenery, rooms, and even names, so that
neologisms may be formed.

Besides condensation, a second process gives rise to
another misconception about the psychic value of
dreams, and adds to their incomprehensibility. While
the interpretation discloses the ingenious train of
thought underlying the dream in proper order and with

THERAPEUTICS 209

its corresponding emotional tone, subordinate and in-
significant elements in the dream are nearly always
endowed with disproportionately intense emotional tone.
This displacement, as it is called, of psychic intensity
from important to subordinate elements contributes, to
a large extent, to hide the sense of the dream, and to
render unrecognizable the connexion of the manifest
content with the dream-thoughts.

Besides condensation and displacement, two most
significant and most characteristic assets for the dream-
making, the regard for dramatization, like the arts of
painting and sculpture, further compels the dream to
employ special expedients to indicate mental processes
that cannot be directly portrayed. Just as a painter
has indirectly to convey abstract ideas by adopting
certain technical devices, so a dramatist has to select
and modify his material, in order to make it conform
to the restrictions of his art. In a dream the mental
processes are dramatized in such a manner that the
past and future are unrolled before our eyes in a present
action; a wish, for instance, which refers to the future
is seen realized in a present situation.

The dream-thoughts that have become unrecognizable
and incomprehensible by that regard to dramatization
and the '* distortion " exercised in the service of the
endopsychic censor, are ultimately subjected to a final
rearrangement ; the latter is (in different dreams) carried
out more or less carefully, with the purpose of giving
the originally ingenious dream-thought, which has been
made senseless by the dream-making, the outward ap-
pearance, at any rate, of sense and connexion. This
accomplishment of the dream-making, termed secondary
elaboraiiun, represents a concession to conscious think-
ing, on the one hand, while it again serves censorial
14

210 STAMMERING AND ITS CURE

purposes, on the other. The secondary elaboration
particularly affects parts of the dream that have been
insufficiently distorted during the dream-making. Its
action continues after waking, so that the memory of a
dream becomes more altered the greater the period
which has elapsed since it was experienced.

A second most significant fact (besides the " wish "
character of the dream) was discovered — namely, the
fundamental law that the majority of the dreams of
adults treat of sexual material, and give expression to
erotic wishes. It goes without saying that an opinion
on this point can only be formed by not registering
merely the manifest content, but by penetrating into
the latent dream-thoughts. The explanation for the
frequency of erotic material in dreams is to be found in
the circumstance that no other instinct has suffered so
much suppression since infancy as the sexual instinct,
with its numerous components. The essential content
of a dream is, therefore, formed by the fulfilment of an
erotic wish. However, Freud has never thought of
maintaining that this feature of the dream be exclu-
sive; on the contrary, as his comprehensive work on
** Die Traumdeutung " shows, he has pointed out that
quite a number of dreams contain either egotistic or
ambitious wishes.

The statement that the majority of dreams of adults
discloses an erotic content appears at first to be un-
proved, since the language and the pictures of a dream
rarely take up sexual scenes, but are, mostly in a harm*
less or even in a poetical manner, composed of animated
pictures taken from family, nature, travelling, etc.,
which correspond with the dreamer's actual family and
other life. Further, as an instinct is in question, of
which everyone is more or less ashamed, and with which

THERAPEUTICS 211

he does not like to see himself affected so broadly,
naturally it was this part of the dream interpretation
which aroused general contradiction. However, Freud
has proved that the subject of sexuality does not crop
up in dreams without disguise, but is represented in a
typical, recurring, and symbolical way of expression,
analogous to metaphorical speech. The layman who is
informed of this fact for the first time might easily con-
tract the impression that it is extremely arbitrary to take
quite harmless and apparently commonplace pictures,
objects, actions, words, etc., in an erotic sense. But
the psychologist who has become familiar with the lan-
guage of neuroses, the roots of which are concealed by
repression, can be easily convinced that both the dream
and the expression of the neurosis cannot possibly dis-
close their real sense without adopting a mask.

Where the manifest content of a dream becomes
strikingly harmless or confused (and such a dream is fre-
quently connected with dread), one can safely suspect
something which is the product of a particularly intense
repression. It is the censorial influence of conscious-
ness which compels the dream to make use of the dis-
guising language of symbols in order to render the
representation possible. In passing, we will mention
that the use of symbols is not a peculiarity of dreams
only, but it can be found in folk-lore, myths, fables,
and puns, often more completely than in dreams. It is
to be expected that the scientific proofs for the large
extension and popular psychological basis of symbols
will soon be fully produced by the contributions of
mythologists and philologists, and that they will thus
lose their paradoxical appearance.

The psychologist who does not understand the
symbolic language of dreams will never be able to in-

212 STAMMERING AND ITS CURE

terpret a dream completely or to carry out a psycho-
analysis successfully. Symbolism is the first and most
important technical resource for the psycho-analytical
interpretation of dreams ; to master the knowledge of
symbolism is, therefore, indispensable for the psycho-
analyst, as symbolism, in each case, is bound to be
unconscious, and hence no associations occur to the
patient. It is entirely the task of the analyst to apply
this knowledge, and especially must he do so in cases
where an element of the dream (owing to the patient
being unable to give any explanations) arouses sus-
picion that it is a symbol.

Though the intimate knowledge of symbolism enables
the physician or psycho-analyst positively to lay bare
the deepest stratum of the unconscious dream-thoughts,
the finding of those thoughts which arose from actual
conflicts is not practicable without minute interpreta-
tion, by the aid of the patient's free associations. It
is by this means only that it is possible to insert the
interpreted dream into the whole of the psychic con-
catenation. This actual analytical work, in the first
place, brings a material to light which, in the strict
sense of the word, is not unconscious, but must perhaps
be termed " fore-conscious," inasmuch as it can be
made conscious without special difficulties.

The technique of dream interpretation, therefore, does
not start from the symbolism, but from the dreamer's
own thoughts and spontaneous associations. To in-
terpret a dream, it is essential to split up the dream-
text (which should be written down by the patient
immediately after waking) into single pieces, called the
dream-elements, without paying heed to any external
connexion (secondary elaboration). When the patient
from each of these elements now gives himself up,

THERAPEUTICS 218

without criticism, to his train of thought (free associa-
tions), he will soon produce a quantity of thoughts and
recollections, all of which are not only intimately con-
nected with the content of the dream, but also present
a continuous sensible whole. These associations — no
matter whether they are free ones or are called forth
by stimulus-words — frequently show superficial con-
nexions by means of unison, ambiguity, temporal
coincidence without inner meaning — in short, by means
of all those ways of association as they are used in
jests, puns, etc. However, the significance of these
associations becomes more plausible when one is
familiar with the fact that, whenever a psychic element
is connected with another one by a superficial associa-
tion, there must also exist a correct and deep-seated
connexion between the two which, underlying the
resistance of the endopsychic censor, has to hide behind
that superficial one. The beginner, who first finds it
difficult to accept this rule, will also hear without convic-
tion that occasionally a part of a dream does not yield
its sense until single elements are inverted with regard
to either space or time. Inversion is one of the most
favourite means of dream-making which is so capable
of many-sided application; it is, however, particularly
valuable in the service of the censor, inasmuch as it
brings about a degree of *' distortion " which at first
positively cripples the understanding of the dream.
Some patients seem to employ this distorting mechanism
to an inordinate extent, and many a dream can be in-
terpreted only by inverting it altogether.

Those who intend taking up the scientific interpreta-
tion of dreams must repeatedly study most thoroughly
Freud's " Traumdeutung " itself. We can here give
but a few more practical hints. For instance, every-

214 STAMMERING AND ITS CURE

thing that appears in the dream as actual words has to
be traced back to a discourse which the patient has
either overheard or in which he has taken part himself ;
this analysis invariably proves that the dream most
arbitrarily combines but fragments of the actual dis-
courses. A trick of the censor is also the forgetting of
dreams, or part of them, which it is desirable to with-
hold from analysis. This often happens at the begin-
ning of the treatment so completely that the patient
does not bring any dreams, maintaining that he does
not dream at all. This tendency of the censor, though
in a weakened form, shows itself in the forgetting of
part of a dream which, when supplied afterwards, has
to be valued as being particularly full of rich informa-
tion, for this later supplement invariably corresponds
with those dream-thoughts that have undergone the
most intense repression. A kind of miscarried " for-
getting " shows itself in the fact that some parts of the
dream are characterized as *' confused " or " indistinct.'*
These parts are also especially important, and mostly
want to hide something important which has displayed
itself from out the unconscious. "When interpreting a
dream, it is essential to bear in mind that the dreams
of one night, or sometimes even of a series of nights,
have an intimate connexion as to their contents, and
the dreams of one night particularly should always be
considered as a whole.

The beginner cannot be induced, without difficulty,
to acknowledge the fact that his task is not always
accomplished when he has succeeded in discovering a
complete interpretation of a dream, and has found it
to be sensible and coherent, containing all the elements
of the dream-content. He must learn that it is possible
that the same dream has another meaning (either part

THERAPEUTICS 215

or the whole of a dream may be ** over-determined "),
which escaped his attention. The question as to
whether each dream can be interpreted has, from a
practical point of view, to be answered in the negative.
One must not forget that the analyst, when interpreting,
has the psychic powers against him, which cause the
comprehensive distortion of the dream. However, one
is nearly always able to overcome the patient's inner re-
sistances to such an extent as to gain a certain insight
into the meaning of the dream.

Though each individual has entirely individual dreams,
there is a certain number, which we will call " typical
dreams," which have been dreamt by nearly every one,
and which probably have the same meaning in every
case. These typical dreams are especially interesting,
as they may have the same origin with all men, and are
therefore particularly useful for throwing light on the
sources of dreams. Such dreams are, for example, the
dream of a beloved relative (parent, brother, sister, etc.)
having died ; of a situation in which the dreamer finds
himself scantily dressed; or of passing through narrow
rooms. To the class of typical dreams further belong
those which have for their subject burglars, the act of
flying, or a house (or part of it) being on fire. As it
would take up too much space here to explain and
substantiate the interpretation of symbolism in dreams
and of typical dreams just quoted, we must again refer
the reader to Freud's " Traumdeutung," which contains
most of the details required.

Before concluding this very imperfect sketch on the
analysis of dreams, we would point out the important
fact established by many years of close research, that
a dream never proceeds from trifles, but only from the
mental processes that are of great personal interest

216 STAMMERING AND ITS CURE

and of the greatest moment to the dreamer. The
dream-thoughts are invariably ego-centric, and nobody
can dream about matters that concern others, however
deep his interest in relatives or friends may be, but
only about matters that concern himself.

The analysis of dreams is of incalculable value for
the cure of stammering, not only because it affords the
easiest access to the exploration of the patient's un-
conscious in general, but especially because it allows
us to disentangle with minuteness both his dread of
speaking and the momentum of inhibition (" I can't ").
A considerable percentage of stammerers experience
intense dread when called upon to speak, though they
have never had a severe breakdown, being always able
to get through by a liberal application of substitutes
and one or two other little helps. Though, in those
cases, the intense dread seems to be unfounded, yet the
stammerer finds himself utterly unable to remove it by
logical arguments. Psycho-analysis, however, proves
in each case that the '* funk " is only too well grounded,
but has formed, owing to the structure of the patient's
repressions, a wrong connexion with speech. In dreams,
as well as in neurotic ailments, the affect (dread in
particular) is always right, at least as to its quality;
its intensity may be increased by the displacement of
neurotic concentration. Hence dread dreams represent
an ideal means for the exploration and removal of dread
of speaking, and we lay great stress on the careful
analysis of dreams containing an intense affect. We
may mention, by the way, that dread is frequently
converted into anger, a conversion which is often met
in the infantile form of dread neurosis. Children who
easily fly into a passion suffer from a surplus of dread.

As to the momentum of inhibition to which stam-

THERAPEUTICS 217

mering is due, dreams again afford the most direct
means of finding out those psychic conflicts on which
the " impediment " is based. The dream has different
ways by which to indicate those conflicts, one of the
most striking ones being the sensation of an action or
of a movement being hampered. The analysis invariably
discloses that the momentum of inhibition is induced
by the endopsychic censor checking a repressed, but
in the dream a revived, erotic wish, which conflict
may be expressed as " I would like to, . . . but I ought
not to." The sensation of being impeded can be illus-
trated in the dream by any action that the dreamer
intends to carry out at the moment the conflict sets in.
Thus the impediment may be felt in connexion with
walking or running, the dreamer having the impression
either that he cannot cover the ground or that hundred-
weights are attached to his feet, and it may also be felt
in speaking (stammering), playing, etc.

Needless to say, psychic conflicts of that description
are at the bottom of all phobias, and sometimes produce
even two or three different symptoms in one and the
same individual. As a matter of fact, we have had
several stammerers under treatment who, at the same
time, suffered from claustrophobia or temporary inhibi-
tions in connexion with walking or playing the piano,
not to mention various obsessions. This fact alone
goes to prove that a thorough psycho-analysis is the
only means of removing all psycho-neurotic impediments
entirely, and that speech drill cannot possibly eradicate
those unconscious conflicts which cause stammering.

The above few remarks may suffice to show of what
vital importance the scientific interpretation of dreams
is for a successful psycho-analysis.

Further assistance for the exploration into the patient's

;?/>^

218 STAMMERING AND' ITS CURE

unconscious psychic life is offered by the so-called symp-
tomatic actions. The latter comprise those actions which
are carried out by a person " automatically, uncon-
sciously, without paying any attention,'* so to speak;
when asked, he would dispute their having any signifi-
cance, and declare them to be indifferent and accidental.
Closer investigation, however, displays that such actions,
of which consciousness is not aware, lend expression
to unconscious thoughts and impulses, and hence are
valuable, and offer information as admitted utterances
of the unconscious. Beside many possibilities of indi-
vidual and sjjecific symptomatic actions,* certain typical
forms play, as a rule, a part in every psycho-analysis.
For example, a resistance on the part of the patient is
indicated by his being late for the hour of treatment.
Important also, under the head of symptomatic actions,
are the patient's first statements, both at the very
beginning of the treatment and at the commencement
of each hour of treatment. As he gives the psycho-
analyst information by means of symptomatic actions
in a similarly indirect way, the next dream also may
produce the sought-for material in a disguised allusion.
In addition to those analytical means of paramount
importance quoted above, we may mention a few rules
of interpretation which were arrived at by Freud in an
empirical way. They refer especially to the manner in
which the patient reacts on certain instructions or
explanations of the physician or psycho-analyst, which
disclose unconscious processes. Amongst these reactions
of the patient's, the so-called "-unconscious yes " has to
be particularly noticed; by this Freud understands such
ideas of the patient as contain something corresponding

♦Striking examples are contained in Freud's " Psychopatho-
logie des Alltagslebens," Berlin, 1907.

THERAPEUTICS 219

to what the analyst has discerned, but not confirming
his statement directly. A further indirect confirmation
of the fact that the analyst has succeeded in disclosing
the disguised unconscious to conscious perception is
a characteristic laugh on the part of the patient, which
even occurs when it is by no means justified by the
contents of the matter disclosed. Other forms of
affirmation cannot be submitted by the unconscious ;
there is no unconscious ** no " at all. From this point
of view, the " no " with which the patient answers,
after the repressed thought has been, for the first time,
submitted to his conscious perception, has mostly to
be taken as a ** yes " from the repression. When this
" no " is not taken as the expression of an impartial
judgment (of which the patient is naturally not capable),
but is passed over and the analysis continued, the first
proofs soon appear, which show that, in such a case,
*' no " means ** yes " ! Another rule which has been
developed from the technique of psycho-analysis main-
tains that an inner, yet still hidden, connexion becomes
manifest by the temporal proximity of the patient's
ideas. A further experience teaches that, when a repre-
sentation is left undecided, no account is to be taken
of the patient's view, but the report is to be taken in
the positive sense. When a representation wavers
between two versions, it is advisable to consider the
first version correct, the second as a product of repres-
sion.

Though the above sketch on the technique of the
psycho-analytical treatment is unavoidably incomplete
and somewhat unarranged, owing to the comprehen-
siveness of the matter, it may suffice to show how the
psycho-analyst penetrates into the patient's mental life,
and we may add the following practical remarks :

220 STAMMERING AND ITS CURE

It is essential for the analyst to be as passive as
possible; the more passive he is during the treatment
the more quickly are the patient's resistances overcome,
and the more rapidly the cure effected. The analyst's
disposition has to be equable throughout. The patient
frequently identifies him with those persons of whom
he is obliged to think so often ; owing to this identifica-
tion (transference), one day the patient shows friend-
ship and sympathy for him, another day he exhibits
hatred or distrust. Whichever it be, the psycho-analyst
must endeavour to impress the patient with the feeling
that he thoroughly understands his affliction, and has
but one desire — that of helping him. The atmosphere
of help should surround the patient during the whole of
the cure.

The task that has to be performed by the psycho-
analytical treatment can be expressed in different
formulas : (1) It can be said that the task of the cure is
to remove the amnesias. When all gaps of memory
are filled, all intelligible effects of the patient's psychic
life are cleared up, the continuance, or even a new
formation of the suffering, is made absolutely impos-
sible. (2) Or it may be put in this way : all repres-
sions have to be undone; the psychic condition is
then the same as that in which all amnesias are filled.
(3) Or the task may be described thus : to render the
unconscious accessible to consciousness, which is
achieved by overcoming the resistances. This reaches
further than the other formulas; this is educational
work — in fact, the psycho-analytical treatment can,
generally speaking, be considered as an after-education
for the subduing of the injurious residuums of child-
hood. It would be an ideal state where all residuums
were removed; but this cannot exist even in the most

THERAPEUTICS 221

normal person. The treatment, however, is perfectly
able to accomplish the complete removal both of the
patient's impediment and of his psychic resistances
against his environment.

We have described the methods to be carried out in
psycho-analytical treatment, but it is not every man
who can be a psycho-analyst. The technique cannot
be easily learned or applied, and with ever so much
knowledge, pains, and patience, the psycho-analyst can
only proceed just so far as his own complexes and inner
resistances allow him. Therefore self -analysis, deepen-
ing as he gathers experience with his patients, is re-
quired, and his achievements in consequence of this
self-analysis must ever be the test of his capacities for
treating patients analytically. Even when this test is
applied successfully, it still remains for the man, who
makes it his life-task to search for neurotic dread and
repressions, to be chaste in life, modest in thought, and
earnest by nature. Only with such a disposition is it
possible to speak about many things that a false moral
hypocrisy would condemn.

We all suffer from the repressions caused by the false
modesty of our guardians in early years, who hid the
truth in an ignorant or a cowardly way, and we suffer
from neurotic diseases in consequence. Let repressions
be removed, and one sees during the treatment how
relieved is the patient to be freed from the distress they
caused him. Not only his agonizing impediment is
cured, but he can return to full enjoyment of life, the
gruesome spectre of dread being removed never to
appear again.

To blame Nature for the existence of stammering or
other neurotic ailments is supremely unjust. Nature

222 STAMMERING AND ITS CURE

has nothing to do with neurosis. If the laws of Nature
be adhered to, disease will not exist. For all diseases
are, in their essence, nothing but the result of natural
laws not being broken with impunity. Civilization and
culture are by no means an unmixed blessing, since we
may lay on them the burden of many an outraged law.

Prevention is always better than cure; but it is use-
less to regret the past. Disease in the form of tantaliz-
ing dread confronts us. Thanks to the unwearying
labours of the students of psycho-analysis, we can meet
it with weapons which have hitherto been practically
unknown, but which are so effective that conquest is
certain.

BIBLIOGRAPHY

1 Adliji : Studie uber Minderwertigkeit von Organen, 1907.

2 d'Alais : Memoire des Hopitaux du Midi, 1829; Arch. Gen.

de M6d., 3mc s^rie, vol. iii., 1888.

3 Angermann : Das Stottern, sein Wesen und seine Heilung,

1853.

4 Arnott : Elements of Physics or Natural Philosophy, 1830.

5 B.uiTii : Neuere Ansichten iiber Stottern, Stammehi und

Horstummheit, 1904.

6 Beksel : Belehrung iiber die Entstehung, Verhiitung und

Heilung des Stotterns, 1843.
^ Bell : Philosophical Transactions II. ; Arch. G^n. de Med.
2me serie, vol. i., 1832.

8 Benedict: Elektrotherapie, 1868.

9 Bergen : De Balbutientibus, 1756.

10 Bleuler : AfEektivitat, Suggestibilitat, Paranoia, 1906.

11 Bleuler, Freud, and Jung : Jahrbuch fiir psychoanalytische

und psychopathologische Forschungen, 1909 and 1910.

12 Blume : Neueste Heilmethode des Stotteriibels, 1843.

13 Bonnet: Gazette Med. de Paris, 1841.

14 Bradley: "On the Failure of Movement in Dream," Mind,

July, 1894.

15 Br.\id : London Medical Gazette, 1841.

16 Breuer and J'reud: Studien iiber Hysteric, 2nd ed., 1909.

17 De Chegoin : Journal G^ndral de Medicine, de Chirurgie et

de Pharmacie, vol. cxi., 1830.

18 Coen : Das Stottern, Stammeln, Lispeln und alle iibrigcn

Sprachfehler, 1883.

19 CoiiN : Pathologic und Therapie der Spracbanomalien, 1889.

223

224 STAMMERING AND ITS CURE

20 CoLOMBAT : Traits de Tous les Vices de la Parole et en Parti-

culier du B^gaiement, 1840.

21 CoRMACK : A Treatise on the Cause and Cure of Hesitation of

Speech or Stammering, 1828.

22 Deleau: Arch. Gen. de M6d., vol. xix., 1829.

23 Denhardt : Das Stottern, eine Psychose, 1890.

24 Dieffenbach : Die Heilung des Stotterns durch eine chirur-

gische Operation, 184-1.

25 Dubois : Les Psj^chonevroses et leur Traitement Moral, 1905.

26 Ellis : Analysis of the Sexual Impulse, 1903.

27 Freud : Drei Abhandlungen zur Sexualtheorie, 1905.

28 Freud : Der Witz und seine Beziehung zum Unbewussten, 1905.

29 Freud : Sammlung kleiner Schriften zur Neurosenlehre, 2 vols.,

1906 and 1909.

30 Freud : Psychopathologie des AUtagslebens, 1907.

31 Freud: Die Traumdeutung, 2nd ed., 1909,

32 GuiLLADME : Du Begaiement et de son Traitement, 1872.

33 Itard : Journal Universel des Sciences Med., vol. vii., 1817.

34 Jung : Diagnostische Assoziationsstudien, 2 vols., 1906 and 1910.

35 Jung : Uber die Psychologic der Dementia praecox, 1907.

36 Klencke : Die Storungen des menschlichen Stimm- und

Sprechapparates, 1844.

37 KussMAUL : Die Storungen der Sprache, 1885.

38 KusTNER : De Lingua Sana et JEgra, 1716.

39 Levy : L'Education Rationnelle de la Volonte, 1894.

40 LiCHTiNGER : Medizinische Zeitung, No. 34, 1844.

41 LoWENFELD : Lclirbuch der gcsammten Psychotherapie, 1897.

42 Malebouche : Precis sur les Causes du Begaiement et les

Moyens de le Gu^rir, 1841.

43 Marshal-Hall : On the Derangement and Diseases of the

Nervous System, 1841.

44 Mercurialis : De Puerorum Morbis. Frankofurti, 1584.

45 Merkel : Physiologic der menschlichen Sprache, 1866.

46 MoBius : Die Hoffnungslosigkeit aller Psychologic, 1906.

47 Moll: Der Hypnotismus, 1907.

48 MiJLLER : Handbuch der Physiologie des Menschen, 1840.

49 Or£ : Nouveau Dictionnaire de M^d. et de Chir. Pratiques,

vol. iv., 1866.

50 Payot : L'Educatiou de la Volontd, 1894.

BIBLIOGRAPHY 225

51 PtTtRSON AND JuNG : " Psycho-physical Investigations with

the Galvanometer and Pneumograph," Brain, July, 1907.

52 RosENBACH : Nervose Zustande und ihre psychische Behand-

lung, 1903.

53 Rosenthal : Diagnostik und Therapie der Nervenkrankheiten,

1870.

54 Ruff : Das Stottern, seine Ursachen und seine Heilung, 1885.

55 Rui.LiER : B^gaiement in " Dictionnaire des Sciences M6d.,"

vol. iii. Bruxelles, 1828.

56 Sauvage : Nosologie M^thodique, 1771.

57 ScHR-ANK : Das Stotteriibel, eine Cortikalerkrankung des

Grosshirns, 1877.

58 ScHiXTHESS : Das Stammeln und Stottern, 1830.

59 Du SoiT: Gazette M6d., 2me s6rie, vol. viii., 1840.

60 SsiKORSKi : About Stammering (original in Russian), 1894.

61 Stekel : Nervose Angstzustande und ihre Behandlung, 1908.

62 Thome : Pathologie und Therapie des Stotterns, 1867.

63 Troemer : Wiener klinische therap. Wochenschrift, No. 8, 1905.

64 VoisiN : Du B6gaiement, ses Causes, ses Differents Degres,

1821

65 Wyllie : The Disorders of Speech, 1894.

66 Yearsly : On the Cure of Stammering by Surgical Opera-

tions, 1841.

15

INDEX

Abbreviatio motuum, 99

Abdomen, 28, 30

Abdominal muscular pressure,

78, 80 et seq.
Absent-mindedness, 64, 106
Acceleration, 75 et seq.
Actions, 42, 143; automatic, 151

et seq., 168; symptomatic, 130,

140 et seq., 192, 196, 200, 218
Adaptation, psychologic, 144,

177, 194
Adenoid vegetations, 107
Adler, 43, 124
Adults, 55 et seq.
Adynamia, 8
Affectation, 61
Affection nei-veiise, 7
Affectivity, 134 et seq.
After-education, 220
Agoraphobia, 132
Alais, Serres d', 7, 9, 25 et seq.,

171
Alarm, influence of, 75
Alcibiades, 2
Alcoholic beverages, 101
Altruism, 104

Alveoli of the upper teeth, 24
Ambitions, 123 et seq.
Amnesia, 108, 142, 164, 193, 220
Amussat, 19

Anagrams, production of, 160
Anelectrotonous, 58, 76, 93 et seq.
Anger, 58, 135, 147, 156, 216
Angermann, 7
Antagonism, 69
Anticipation, 74, 75, 92, 101,

188; and see Watching
Antipathy, 178, 201
Apperception, 56 et seq,, 137, 166

Apprehension, 64, 151

Aristotle, 3, 4

Armstrong, 158

Arnolt, 26, 27

Arnott, 6

Articulation, 31 et seq., 66 et

seq., 171
Articulatory muscles, 8, 63, 68

et seq., 94, 174
Articulatory spasms, 78, 79
Aspirations, 119, 124
Associations, 58, 60, 119, 135

et seq., 165 ct seq. ; record of,

194 et seq.; free, 199,212
Attention, 33, 49, 52, 59 et seq.,

73, 81, 92 et seq., 115, 137 et

seq., 157, 185, 192, 197
Auditory nerves, 50
Authority, 102, 129
Auto-suggestions, 22, 42, 43,

170, 185 et seq.
Awkwardness, 123
Azam, 162, 164

Bad days, 126

Bahr, 148

Balbus Bla^sus, 4

Balbuties accidentalis, 4

Balbuties naluralis, 4

Bark worth, 158

Barth, 15

Battos, 2

Beasley, 41, 170, 171

Becquerel, 29, 30, 78

Beesel, 6

Beethoven, 125

Bel, Charles, 8, 26, 29

Belladonna, 35

Benedict, 8

227

228

STAMMERING AND ITS CURE

Bergen, 5 ]

Bleuler, 134, 136, 149, 151 et \
seq.

Blume, 9, 26, 28 et seq., 170

Boards of Education, 40

Bonnet, 10, 67

Braid, 5, 19

Brain, 9, 11, 14, 46 et seq.; dis-
orders of, 8

Bravery, 176

Breathing exercises, 28, 81, 38
et seq., 169; and see Respira-
tion

Brooding over breakdowns, 102

Broster, 24

Bruckner, 125

Bugbear letters (or words), 85,
94, 101, 128

Caesar, 124

Calm, 99; and see Ease
Cardiac muscles, 58
Catalepsy, 69
Catullus, 4

Censor, endo-psychic, 204 et seq.
Central organ, 4, 9, 174
Centre of ideas, 52 et seq.
Centre of speech, 11, 12, 15
Cerebral influence, 7
Cerebral irritation, 106
Cerebral stammering, 8
Cerebration, unconscious, 158,
160

Ceremonials, 160, 161

Charlatanism, 39

Charles XII., 124

Chegoin, Hervez de, 5, 18

Chervin, 35, 36

Chest, 30, 36, 68 et seq.

Child, 158

Childhood, realm of, 180; ex-
periences of, 198, 207; resid-
uums of, 220

Children, 47 et seg.; dealing
with, 110,

Chloroform, 38

Choreatic stammering, 9

Cicero, 4

Circumlocutions, 60

Civilization, 103, 105, 122, 222

Clairvoyance, 155

Claustrophobia, 132
Classification of impediments of

speech, 8 et seq.
Cleverness, 128
Clonic spasms, 6, 7
Coen, 11 et seq., 36 et seq.
Co-operation, 43
Co-ordination, 8, 14, 149
Cold sponges, 4
Colds, 107
Colombat, 9, 28, 25 et seq., 170,

171
Comfort, feeling of, 49 et seq., 63
Communication of ideas, 103
Co-movements, 97, 98, 101, 174
Company, pleasant, 101
Complexes, 105, 112 et seq., 129,
164 et seq. ; influences of, 133
et seq., 170 et seq., 195 et seq.
Compressed breath voice, 82, 83
Concentration, 59, 136 et seq.,
171, 184, 193; lack of, 106,
186; unconscious, 157
Condensation, 160; of dream-
thoughts, 208
Confidence, 35, 129, 169 et seq.;

lack of, 11, 14
Conflicts, see Psychic conflicts

Confusion, 76, 165; in dreams,
214

Conjugate movements, 70

Consciousness, 42, 55, 119, 135,
151 et seq., 204 ; a puppet, 197

Consideration, lack of, 121 et seq

Constipation, 107

Contents of sentences, 61

Contortions, 32, 97

Contrasts, 149, 150

Convulsions of the limbs, 76

Cormack, 6, 25 et seq., 36

Cortex, cerebral, 202

Criticism, avoidance of, 193

Croton oil, 88

Crying, 47 et seq.

Culture, degree of, 60

Cyanosis, 81

Darwin, 45
Deaf and dumb, 56
Death instinct, 117, 118
Deep chest voice, 27, 28

INDEX

229

Defective breathing, Qoetseq.;
and see Respiration

Deleau, 10

Delicacy of constitution, 118;
and see Neurotic disposition

Delius, 4

Demi-baths, 37

Demosthenes, 2, 124

DemouHn, 125

Denhardt, 14, 81, 40, 65, ITO

Desire for pleasure, 104

Despondency, 184

Determination, 187

Determinism, 199, 215

Diagrams, 127, 145, 204

Diaphragm, 38, 67 et aeq.

Didactic methods, 22 et seq., 85

Dieffenbach, 6, 10, 18 et seq.

Diet, 17

Diphtheria, 114

Disease, 112; negation of, 185

Dislike, feeling of, 55, 57, 116,
119

Displacement of dream - ele-
ments, 200; of neurotic con-
centration, 216

Domestication, 122

Double-nature, 148

Doubts, 14

Dramatization, regard for, 209

Dread, 14, 15, 43, 58 et seq., 68 et
seq., 105 et seq., 129, 161, 168,
170 et seq., 200, 205 et sefj.

Dread neurosis, 105, 216

Dreams, 106, 189, 141, 152, 154,
160, 165, 168, 181, 200 et seq.;
analysis of, 202-217 ; forgetting
of 214; language of, 210 et
seq. : latent content of, 206
et seq. ; manifest content of,
205 et seq. ; typical, 215 ; wish-
character of, 205, 210

Drummond, 104

Dubois, 43

Dumb-bells, 33

Dupuytren, 23, 26

Dynamics, 191

Eagerness, 14, 54, 68, 71, 76. 100
Ear, controlling action of, 61,
177

Ease, feeling of mental, 186 et

seq.
Echolalia, 60
Echo-speech, 72, 74
Educational method, 42, 48, 169

cf seq.
Ego-centre (complex), 133 et

seq., 164, 166, 196
Ego, emotional, 138
Elaboration, conscious psychic,

167; secondary, 209 et seq.
Electricity, 37 et seq.
Ellis, 109

Elocutionists, 61, 95, 176
Elongation of vowels, 26, 31 et

seq., 170, 173
Embarrassment, 11, 55, 76, 85,

123, 129, 142, 164
Embrocations, 17, 38
Emotion, 11, 33, 55 et seq., 85,

92, 98, 103, 107 et seq., 128,

168, 168, 178, 216
Energy, 35, 147
Environment, 51 et seq., 122,

127, 132 etseg., 144, 150, 177
Envy, 123
Epilepsy, 18
Erotic sensations, see Libidinous

sensations
Events, pathogenous, 167; per-
sistency of psychic, 181
Examination, 164
Exertion, 63
Exhaustion, 21, 68
Expectant attention, 115 et seq. ;

and see Attention
Expedients, 101, 176
Expiratory spasm, 68 et seq.
Explosio spasmodica, 90, 91
Explosives, 13, 78
Expression, overcharge of, 115;

speech a means of, 53 et seq.
Extremities, 13

Facial muscles, 6, 8
Faith, 42, 173, 181 et seq.
Faheltn notes, 37
Fancies, 115; unconscious, 162
Father, influence of, 179, 180,
198

230

STAMMERING AND ITS CURE

Fear, 58, 103, 105 et seq., 156;

of the dark, 105 et seq., 163
Feelings, 42, 47 et seq., 135, 151,

154 et seq., 180
Female sex, greater immunity

of, 14
Fencing, 34
Ferenczi, 178 et seq.
Ferrum, 37
Flournoy, 159

Fore-consciousness, 126, 212
Forefinger (time-beating), 34
Forgetting, 119 et seq., 141, 181,

214
Fork, 22 et seq.
Formalities, 161
Franz, Robert, 125
Freud, 43, 109, 113, 120, 130,

140, 141, 160, 166 et seq., 178,

181, 190 et seq.
Fright, 112
Froriep, 10
Frowning, 174
Functions, plastic, 154 et seq.

Galen, 3

Ganglions, 93, 94

Gerdts, 38

Gesticulation, 31

Gestures, 53, 97, 103

Glottis, 69; spasm of, 79 et seq.,

99, 173
Godfernaux, 134, 135
Goethe, 148
Gorki, 148

Grammatical form, 54, 61
Graphology, 155
Grumblers, 149
Guersant, 20
Guillaume, 8
Gutzmann, 40, 97

Hahn, 4

Hallucinations, 107, 125

Hamlet, 192

Harmony, disturbed, 9, 10, 84

Haste, see Hurry

Hatred, 123, 178', 220

Health, state of, 57, 62, 129

Hearing, 49 et seq.

Heart, 57, 189

Heredity, 47, 107, 113

Hesitation, 71, 76, 93, 99, 141,
175

Hetero-suggestion, 31, 42, 48,
170, 179 et seq.

Hippocrates, 3

Hitschmann, 193

Hobbies, 148

Home-sickness, 118

Humiliation, 121 et seq.

Humorists, 148

Hunchbacks, 124

Hunger, 47

Hurry, 70 et seq., 100, 129

Hydrophobia, 7

Hyoid bone, 83

Hypnotic suggestions, 42, 43,
152, 158 et seq., 178 et seq.,
190

Hypnotists, 178 et seq.; quali-
ties of, 179

Hj'pochondria, 121 et seq.

Hypocrisy, false moral, 221

Hypogastrium, 68

Hypoglossus, 38

Hysteria, 43, 160 et seq.

Identification, 112, 113, 220
Images of persons and things,

52
Imagination, increased play of,

115, 121
Imitation, 35, 54, 60, 112, 177
Impediments, 143
Impressions, 42, 53, et seq., 101,

109, 135 et seq., 155, 178, 183
Inarticulate sounds, 86 et seq.
Inattentivcness, 72
Incapacity, 55

Incongruity, mechanical, 10
Indigestion, 107
Indistinctness, 79
Inferiority, feeling of, 121 et

seq., 150
Inhibitions, 115, 127, 132, 137 et

seq., 217
Inner resistance, see Psychic

resistances
Innervation, 8 el seq., 37, 64 et

seq., 97, 112 el seq., 127, 130,

133, 136, et seq., 170 et seq.

INDEX

231

Inoculation, 38
Insomnia, 106, 109, 139
Inspiratory spasms, 67, 68
Instigators of dreams, 203, 204
Instincts, imitative, 51, et seq. ;

erotic, 110, 156, 163
Insufficiency of biool, 11, 12
Intelligence, unconscious, 159
hitemperies frigida, 17
Interest, application of, 115
Intermittent vowel spasm, 85

et seq.
Intonation, 27
Introversion, 114, et seq.
Interruptions, 62, 63
Inversion of dream-elements,

213
Irradiation, 97, 174
Irritability, 55, 85, 1T6
Itard, 6, 7, 22, 23
Iodide of potassium, 35

Janet P., 146, 159

Jokes, production of, 160

Jones, 202, 203

Jourdant, 29

Jung, 43, 134 et seq., 194 et seq.

Katenkamp, 35

Kidneys, 57

Klencke, 8, 26, 34, 37 et seq.

Kustner, 5

Kussmaul, 8, 37, 61, 65

Labials, 90

Lalophobia, 7

Langenbeck, 38

Larynx, 6, 22, 26, 36, 46, 55, 80

et seq., 99
Laws, unwritten, 161
Lecture posee, 22
Leigh, ^Iadame, 5, 23 et seq., 36
Lesion, 11
Levy, 43, 185
Lewis, 171

Libidinous sensations, 108 ct seq.
Libido, 114 et seq.
l,irhtinger, 7
Li(5bault, 185
Life-instinct, 116 et seq.
Ligament of the tongue, 5, 18

Lips, 13, 25, 32, 45, 89, et seq.,

spasm of 96
Lisping, 2

Listener, 63, 64, 71, 74, 78
Locus minoris resistentiw, 114
Loewenfeldt, 190
Logic, feeling stronger than,

140, 144, 163
Loneliness, 132

Love, being in, 146, 147; in-
fluence on suggestions, 179
ct seq.

Lungs, 46, 57, 68 et seq.

Malebouche, 5, 24, 29, 30
Malformations, 5, 6
Manifestation of affection, 108 •
Marshal-Hall, 7, 8
Maximus, Valerius, 4
Meanness, 123
Medicinal means, 35, 37
Meraorv-image, 154 et seq., 165,

166
Memory, lapses of, 193; of

dreams, 210
Mercurialis, Hieronymus, 4, 17,

18, 22, 37
Merkel, 10, 13, 78
Meyers, F., 159
Mind, frame of, 57, 77; active

and passive, 166
Misapplication of breath, 6
Modesty, false, 221
Model, 35
Moebius, 116

Momentary dumbness, 90
Momentum of inhibition, 15, 98,

141, 172, 174, 200, 216
Moods, 50; control of, 143
Moral influence, 35
Morgagni, 4

Moses, 1, 124

Motives, unconscious, 155 et

seq., intellectual, 156
Motor nerves, 47, 63
Motorium, 51, 56 ct seq., 75

et seq.
Mouth, 31 et seq., 45 ct seq.,

61, 92, 96; roof of, 13
Movements of the arms, 20
Mozart, 125

232

STAMMERING AND ITS CURE

Muscular contractions, 70 et seq.
Musculus orbicularis oris, 89

et seq.
Muthonome, 27
Muller, 6, 27

Napoleon, 124

Nasal channel, 88, 89

Naumann, 100

Nerve-tibres, 46; (centres), 171

Nerves, acoustic, 93

Nervous disorders, 35, 181

Nervous stimuli, 47

Neurasthenia, 176

Neurosis, 105 et seq., 131, 167,

168, 178, 216
Neurotic disposition, 72, 123
Night terrors, 106, 107
Non-coraatose suggestion, 42, 43
Nostrils, trembling of, 174

Obedience, 180, 181
Observation, 60, 62, 152
Obsession, 14, 42, 43, 120, 130,

160 et seq., 202, 217
Obstacles, 71
Obstinacy, 48, 122
Occlusio spasmodica 90
Opium, 35, 37
Or^, 10
Organ of Broca, see Centre of

speech
Os quadratum, 95, 96
Otto, 27

Over-compensation, 125, 126
Over-sensitiveness, 121 et seq.,

147
Over-valuation, 123, 124

Palate, 5, 27, 88

Paroxysms of stammering, 14,

65 et seq., 100, 113, 128, 132,

171 et seq.
Pathological symptoms, 67 et

seq., 191, 207
Patrick, 159
Pavor nocinrnvs, fee Night

terrors
Payot, 43

Pedagogic methotls, 22 et seq.
Peppermint oil, 38

Perseverance of emotions, 138
Personality, 136 ; dissociation

of, 131, 146, 153, 162 et seq.,

181
Persuasion, 179, 190
Petroleum, 88
PhiHpps, 18
Phobias, 43, 104, 114, 120, 131,

160 et seq., 202, 217
Phonic inspiration, 34
Phonophobia, 7
Physiologic influences, 55
Physique, improving the, 176
Piano-playing, 132, 155, 217
Pluck, 149, 176
Presentiments, 130
Pressure of volition, 94, 97, 174
Preyer, 45

Pro'diictio motmim, 99
Pronunciation, distinctness of,

70 et seq.
Psychic compensation, 122 et

seq.
Psychic conflicts, 99, 100, 108,
110 et seq., 130, 182, 150, 200,

217
Psychic disposition, 10
Psychic life, elements of, 134

et seq.
Psychic resistances, 33, 42, 68

et seq., 105 et seq., 131, 133,

167, 174 et seq., 183, 193

et seq.
Psychic stimuli, 14, 31, 130.

172, 176
Psychic superstructure. 124 et

seq.
Psycho-anal vst, qualities of,

220, 221
Psjcho-analytical treatment, 43,

162, 178, 189 et seq.; com-
pared with suggestive therapy,

190, 191 ; the task of, 220
Psychoneurosis, 14, 119, 130, 181
Puberty, 109
Pulmonary air, 13
Purgatives, 17

Quinine, 87

Reactions, 142, 144, 194 et seq.

INDEX

288

Reading, 155; mistakes in, 130.

141
Reciting, 22, 28, 68
Recollections, 135; indiflferent,

62; infantile, 1«0, 181
Rectified alcohol. 38
Redundant words, insertion of,

101
Reflection. 60

Reflex .actions, 7, 47, 153 et seq.
Refractoriness of the vocal

organs, 87
Relapse, 26, 30 et seq., 172 ei

acq., 183 et seq.
Relaxation, 21, 63
Repression, 110, 117 et seq.,

142, 162, 193, 203, 210 et seq.
Repetitio, resonans, 72
Repetitio sijllabarum asthenica,

74.
Residual air, 69
Resistances, see Psychic re-
sistances
Respect, 178
Respiration, 6, 7, 12, 13, 24, et

seq., 64, 66 et seq., 128, 173
R^suni^, 133
Restlessness, 106
Retardation, 58, 75 et seq., 93,

94, 99, 143, 171, 173
Rhythm, 63, 173
Rhythmic spasm of respiration,

78, 79
Ribs, 31
Romberg, 20, 37
Roscnbach, 43
Rosenthal, 8, 38
Ruff. 11
Rullier, 9, 10, 23

Sandow, L., 14

Santorini, 4

Sauvage, 5

Schmalz, .38

School, influence of, 108, 113,

119, 128
Schrank, 13

Schulthess, 6, 17, 18, 22, 87
Schumann, 125
Scolding, 12T
Scrofula, 35

Secretiveness, 105, 131

Self-analysis, 221

Self-control, 56, 148

Self-gratification, 104

Self-preservation, instinct of, 116

Self-reliance, 35, 123, 173, 186

Senses, 56 et seq., 154

Sensorial nerves. 47, 57

Sexual enlightenment, 108 et seq.

Sexual instinct, 117, 210

Shakespeare, 148

Shame, 106

Shock, 11, 58, 107, 112, 126

Shouting, 34

Sievers, 73

Silence period, 27 et seq.

Sincerity, 193

Singing tone 23

Sleeplessness, see Insomnia

Social tissue, 122, 132

Soit, Du, 6

Sound-image centre, 51 et seq.,

72, 94, 177
Spasmodic voice, 83 et seq.
Spasm of the closure of the lips,

89 et seq.
Spasm of the glottis, 27
Spasm of the soft palate, 88, 89
Spasms, 6 et seq., 27, 65 et seq.
Speaking, predisposition for, 47,

55; act of, 45 et seq., 127, 173,

177
Speech drill, 18, 28 et seq., 45,

169 et seq., 217
Speed, 69 et seq.
Speir, 158

Spinal cord, 7, 8, 12, 46
Spinal stammering, 8
Spiratio spasmodica, 91
Spiritualism, 153, 159 et seq.
Sports, 148

vSsikorski, 14, 65, et seq.
Stammering, beginning of. 111

et seq.
Stamping of the foot, 97
Stekel, 15, 43, 120
Stimulus words, 141, 148, et seq.

194 et seq., 213
Stomach, 57, 139
Stoppage, 66, 71, 77
.Stuttering, temporary, 113

234

STAMMERING AND ITS CURE

Subjects, •' incurable," 182, 183
Sublimation of libido, 114, 148
Substitution, 10], 216
SuflEusion of blood, 11
Sujrgester, 42, 178 et seq.
Suggestibility, 179 et seq.
Suggestion, see Auto-, Hetero-,

and Hypnotic suggestions
Suicide complex, 197
Superiority, 102
Surgical methods, 10, 18 et seq.,

39
Susceptibility, suggestive, 178

et seq.
Swallowing of sounds, 70 et seq.
Swimming, 34
Symbolism, 140, 211 et seq.
Sympathy, 113, 178, 201, 220
Symptomatology, 65

Talents, artistic, 148

Teacher, 35, 40, 108, 182 et seq.

Teasing, 128

Technique, psj'cho - analytical ,
191, 201 et seq.

Teeth, 13, 32, 34, 45

Temperament, 54

Tension, nervous, 69 et seq., 128

Terror, 57 et seq., 137

Tetanic stammering, 9

Tetanus, 6, 7, 13, 76, 93, 99,
171, 173

Thinking, 50 et seq., 71 ; rapi-
dity of, 11; speech a means
of, 53 et seq. ; control of, 143

Thom6, 11

Thorax, see Chest

Thoughtlessness, 146, 147

Throat, 6, 38, 46, 96

Thumb, 34

Tidings, ill, 139

Timbre, alteration of, 64, 94

Time-beating methods, 23, 26 et
seq., 33 et seq.

Tongue, 5, 6, 10, 22 et seq., 45;
spasm of, 96

Tonic spasm, 95

Tonsils, 6

Trance, 42, 164

Transference (psychic), 108, 115,
148, 160, 177 et seq., 220

Transformation in jokes, 160
Tremor, 92, 99, 189
Tricks, 74
Troemer, 15

Unconscious, the, 113, 120, 129
et seq., 151 et seq., 200 et
seq.; of neurosis, 167, 168

Uneasiness, 11

Uvula, 5, 6

Vinci, Leonardo da, 190, 191
Violette, 31

Visual field, contraction of, 146
Vocal cords, 36, 63, 77 et seq.,

173
Vocal gymnastics, 33 et seq.,

170 et seq.
Vocalization, 32, 34, 69 et seq.
Vocation, choice of, 124, 125
Voice production, 7, 30 et seq.,

48 et seq., 83
Voisin, 9

Vowel initial sound, 29, 31
Vowel spasm, 82 et seq.

Watching, 61 et seq., 128, 175,
188 ; and see Anticipation

Westphal, 98

AVhispering voice, 69, 82 ct seq.

Whooping cough, 18, 114

" Wild " sounds, 48

Wilfulness, 48

Will (volition), to speak, 48, 77,
83, 90, 127; disturbance of,
15, 143 et seq.; impulses of, 7,
10, 13, 120, (unconscious) 167,
(hbidinous) 178 et seq.; stimuli
of, 46, 66, 93 et seq., 202

Wishes, unconscious, 204 et seq.

Word-image centre, 50 et seq.,
87, 98

Word-locomotion centre, 50 et
seq., 72

Writer's cramp, 92, 93, 99, 100

Writing, mistakes in, 130, 147;
automatic, 159, 160

Wyllie, 45

Wyneken, 14, 35

Ycarslev, 170, 171
Yearslv, 5, 19

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