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Full text of "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 






' • • ■ ' • • • 



.^ 








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 psyc ho-an alytic." 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) 



iliiliiiM tliilylil|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 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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