Tuesday, July 27, 2010

More on Mind/Body Connection

Disfluency is a combination of brain disfunction and mind involvement. The usual standard for judging stuttering severity is the number of disfluencies experienced over a given tIme period when reading, for example, a given amount of text. But the severity of stuttering gives no indication of the extent of brain involvement in the episode given that the mind and the context also come into play. In the ideal, we would like to rank the brain involvement on a scale from 1 to 10, where 1 is the least severe and 10 is the most severe. Similarly, the mind involvement can also be ranked on a 1 to 10 scale. So the most severe episode of stuttering would have a score of 20, while the least severe would be scored a 2. An individual may have intense brain involvement with a score of 10, yet not be very reactive and have a mind involvement score of 1, for a total of 11. Another person may have a mild brain involvement with a score of 1, yet be very reactive with a mind involvement score of 10, again for a total of 11. In both cases, the severity of stuttering may be the same, but the underlying causes would be different. And each of these cases may respond differently to treatment. For example, the person with greater mind involvement might respond better to psychologically based therapies while those with substantial brain involvement would show better improvement with drug therapies.

Unfortunately, it would be very difficult to disentangle the brain involvement from the mind involvement on a priori grounds. A clinician might be able to infer the relative amounts of involvement only after observing treatment results.

Wednesday, July 21, 2010

Stuttering, the Mind, and the Body

There are many ailments that start as a problem with some part of the body but are made worse when the mind comes into play. Knee or back pain may have its roots in some physical problem with one's bones, ligaments, or tendons and this may cause some discomfort or pain. But in some individuals, the mind comes into play and this discomfort or pain becomes intensified. Another example is erectile disfunction, which may initially have some physiological roots, start out as relatively mild, but through repeated embarrassing failures end up as a more intense problem. This phenomenon is called the mind/body connection.

It turns out that stuttering has a strong mind/body connection for most people with this problem. It is currently believed that in the great majority of cases stuttering starts in a preschool child because of a malfunction in the motor neuron section of the brain. At this point in time the child is relatively unaware of the problem, but by the time he reaches school age, parents reacting negatively and teasing schoolmates make him acutely aware. What happens at this point is that the mind comes into play  resulting in secondary stuttering characteristics such as blocking, twitching, etc. So the initial fluency problem is intensified by the action of the mind. This mind/body connection (the body part involved being the brain) can be depicted in the diagram below:

Starting from the left, some root cause--in the case of stuttering an abnormality in the brain--leads to a physical problem, namely stuttering.  This physical problem results, at some point, in anxiety which may vary depending upon the context in which the stutterer finds himself (e.g., speaking before an audience).  This anxiety then feeds back into the physical problem, perhaps making the stuttering worse.  So the physical problem is in some sense the product of a body problem (in this case the brain) and a mind problem (in this case the awareness and the anxiety associated with stuttering.

Saturday, July 17, 2010


This blog is dedicated  to exploring stuttering and its connection to both the mind and the body.  Future posts will provide information about the current understanding of the causes of stuttering, e the role of the brain in stuttering, as well as the role of the mind.  The mind is distinguished from the brain in that the brain is the physical mass that exists in your skull, while the mind is a manifestation of the brain (e.g., consciousness and self-awareness).  In addition, future posts will deal with the role of drugs in treating stuttering, drug trials, and their interpretation.

Many of the readers of this blog had high hopes for the recent pagoclone drug trials, but recently the pharmaceutical company, Indevus, announced the termination of these trials.  There could be many reasons for this termination, one of which is that the drug did not perform statistically better than a placebo (i.e., a sugar pill).  Another possibility is that the drug did not live up to other "success criteria" set up for it.  For example, a user of the drug may develop a tolerance for a given dosage (this is common for tranquilizers) and that dosage may subsequently become ineffective for improving fluency.

At any rate, a number of test subjects in the pagoclone trials have reported extended fluency improvements  while on pagaclone and decreased fluency while on the placebos.  So we can await future announcements from the drug company as to the reasons that the trials have stopped.

So tune in for future posts on this blog.  I'm sure that you will find them to be educational and informative.