Embarrassment vs. Effectiveness
Embarrassment vs. Effectiveness
Last month I had an epiphany at the Texas Speech-Language Hearing association convention in Houston. For three days I demo'd my new SmartTalk iPhone app for Minimum Phonated Interval (MPI) stuttering therapy. More than 300 speech-language pathologists responded enthusiastically to the device. But no SLPs asked questions about MPI stuttering therapy, or what effects had been documented in a clinical trial. Instead the #1 question I was asked was "Is the app available for the iPad?"?
This question didn't make sense to me. The iPhone/iPod touch is wearable, so SmartTalk users can do stuttering therapy outside of speech clinics, and even in stressful situations. The iPad is portable but not wearable.
Then I realized that I was looking at the other side of a wall I've banged my head against for more than 15 years. In 1996 I was scheduled to present a workshop about technology for treating stuttering at the National Stuttering Association (NSA) convention. I arrived in the room early, straightened up the chairs, set up devices for people to try, and waited. No one came. After 20 minutes I walked around wondering where people were. Everyone was in a room listening to Gerald Maguire talk about his Risperdal clinical trial. I couldn't get in the room because it was jammed shoulder to shoulder.
When I read the clinical trial I wasn't impressed. The medication reduced stuttering 50% in low-stress speech clinics. Patients complained about side effects from weight gain to men growing breasts to a potentially fatal respiration disorder. In contrast, my altered auditory feedback (AAF) devices reduced stuttering 70% in stressful telephone calls to local businesses. And my devices don't have side effects.
Yet the idea of taking a pill to treat stuttering was more appealing to stutterers. In 2003 I ran into this wall again when SpeechEasy promoted their hearing aid-style AAF devices. Stutterers (and parents) liked the idea of a tiny, invisible hearing aid instantly curing their (or their child's) stuttering. As clinical trials were published finding that SpeechEasy devices have little or no effect on stuttering, and many SpeechEasy users complained about the devices' loud amplification of background noise, I found that customers didn't want to hear about clinical trials or hearing safety.
The Hollins Communication Research Institute has never published a clinical trial in a scientific journal showing that their intensive therapy program has an effect on stuttering. I did the program twice without effect on my speech. Yet thousands of stutterers travel to Virginia to spend two weeks in the program.
My epiphany in Houston was that stutterers care more about embarrassment than effectiveness. Taking a pill isn't embarrassing (unless you're man who grows breasts). Wearing a hidden hearing aid isn't embarrassing (unless you can't hear what people are saying). Going away for two weeks to do speech therapy in a town where no one knows you isn't embarrassing. And iPads are the height of cool so nothing you do with an iPad is embarrassing.
In contrast, the few stuttering therapies that have been proven effective require doing something embarrassing. You have to talk abnormally slowly, or wear a conspicuous device, or—worst of all—actually go out and open your mouth and talk to people.
I seem to have been born without the part of the brain that feels embarrassment. (My wife makes up for my deficit by being extra embarrassed by the things I do in public.) I've done stand-up comedy and acted in plays and dressed like this in a snowstorm:
My biggest breakthrough in fluency was in 1995 when I brought my company's new electromyographic (EMG) biofeedback device to the American Speech-Language Hearing Association (ASHA) convention. The device was the size of stereo receiver and required taping electrodes all over my face and throat, plus wearing large headphones and a microphone. For three and half days, ten hours a day, I demonstrated it to SLPs. I talked non-stop, with the device keeping my respiration, phonation, and articulation muscles relaxed. After the convention I couldn't stutter for a week. Eventually my stuttering returned but less severely than before, and I knew what to do to regain my fluent speech.
I sold two or three of those devices. No other stutterer was willing to do what I'd done to become fluent. Before developing the EMG biofeedback device I developed a delayed auditory feedback (DAF) telephone. I talked slowly but fluently on telephone calls. When telemarketers called I'd try to keep them on the phone as long as possible so that I could practice my slow, fluent speech. I've told hundreds of stutterers about this and not one has ever used prolonged speech with a telemarketer. One man even told me that he couldn't do that because he's a Christian!
I've never been more than mildly embarrassed about my stuttering. Not being embarrassed to do things that improve my speech may be the reason why I can now talk fluently when other people are still stuttering. Ironically, trying to avoid embarrassment is why those people continue to be embarrassed by their speech.
