The taken-for-granted idea I want to explore today is that stuttering is something that can and should be measured. How do we know if a person stutters? How do we know what treatment to prescribe? How do we gauge the success of a treatment? Well, first and foremost by measuring and categorizing dysfluent speech. This is run-of-the-mill stuff for SLPs. But when we stop and think about it, measuring stuttering is an odd and fairly recent practice that reveals a lot about our assumptions of what speech, communication, and disability are.
Like many, I have gone to speech therapy and twitched as the SLP tapped out my syllables and dysfluencies on her counter. The tap quickly became background noise and forgotten: a regular part of therapy. Yet if counting stuttering has become natural for stutterers, it is far more so for SLPs. In fact, I will argue that measuring disabled speech is a central foundation of SLP as a discipline and industry.
What we now understand as SLP only emerged as a discipline at the beginning of the 20th century. While rhetoricians have been teaching proper elocution since Ancient Greece, and medicine—including an attention to speech “defects”—flourished during the Enlightenment, it was not until the 1920s that professional “speech correctionists” from backgrounds of education, medicine, and elocution came together to form various special interests groups such as the American Academy of Speech Correction (AASC), which eventually became the American Speech-Language-Hearing Association (Duchan 2012). From a historical perspective this timeline is fairly unsurprising. Many other social sciences, such as psychology and anthropology, were established within this period, a period defined by the rise of what is called “logical positivism.”
Positivism is the belief that for a claim to be meaningful it must be demonstrable (and verifiable) through evidence. If it can’t be measured and demonstrated, it is neither true nor false, but is rather meaningless or gibberish. Needless to say, positivism shaped the entire field of Western science. Einarsdottir and Ingham (2005) point out that “from a scientific point of view, it is necessary that the measurement, and therefore the diagnosis, of a disorder should have consistency if research on that disorder is to have progress” (260). Positivism fits fairly easily with “hard” sciences like chemistry and physics which were already firmly based in experimentation, observation, and evidence. However, how do you measure messy things like the human mind (psychology), culture (anthropology), or speech (linguistics / SLP) in a way that positivists will accept as credible? Social sciences have often responded (especially in the heyday of positivism) by contorting human activities such as emotion, politics, and communication into quantifiable data that does great violence to their complex nature. Despite or perhaps because of this effort, social or “soft” sciences have continually struggled to be recognized as “real” sciences.
The immediate problem for SLP was thus proving that what they do is scientific—i.e. credible and legitimate. Charles Van Riper hints at the early worry about the field: “Back then we had no texts, no tools. We recorded our clients’ speech on wax phonograph cylinders. Our sound waves were scratched on a smoked kymograph drum. Using tuning forks of different frequencies, we calibrated hearing loss by marks on the office carpet. We had no standardized tests.” (Van Riper, 1989, pp. 72-73; quoted in Duchan 2012). One of the first tasks of the AACS was accordingly to find a scientific grounding for speech correction: a means of quantifying disabled speech such that results can be verified and taken seriously within medical scientific communities.
Wendell Johnson was more or less the first SLP to come up with a standardized and widely recognized system of measuring stuttering—or, as SLPs call it, a “disfluency typology.” In the late 50s, Johnson devised a measurement system that used eight categories of stuttering (interjections, sound and syllable repetitions, word repetitions, phrase repetitions, incomplete phrases, broken words, and prolonged sounds). By measuring any sort of speech he was of course making a statement about what speech is: a phenomenon that can be reduced to its linguistic structure, set of phonemes, and accompanying motor functions. Other less measurable ways of understanding communication were thereby set aside as outcomes of, or incidental to, the demonstrable facts of syllable counts. Since then, the categories have shifted slightly—the more general metric “SLD” or “stuttering like disfluencies” is often used today (Einarsdottir and Ingham 2005, 262)—but the idea and practice of using syllable counters, syllable count sheets, and word count sheets to quantify, standardize, and understand stuttering behaviors has changed very little. Finding the best way to measure stuttering is an intensely debated topic within SLP, yet almost all within the field agree that it must be done (and in fact only argue so intensely about how to do it because they see it as a matter of such great importance). The Lidcombe program is an excellent example of the compulsion to quantify stuttering today, as the program goes so far as to export these practices into the home and the family—Lidcombe explicitly relies on parents measuring and charting the dysfluencies of their child.
My first point is this: the idea that stuttering is something that can be measured and represented on a count sheet is not a simple and obvious fact, but must be understood in its historical context as a way of thinking closely connected to the legitimacy of SLP as a scientific discipline. SLPs are often quick to point out that theirs, in unmistakably positivist terms, is an “evidence based practice.” While many individual SLPs do strain against the positivist roots of their discipline, for better or for worse the discipline itself is still married to the (elusive) goal of measuring stuttering, which presents real limits on the possibility of individual SLPs deviating from this method.
However, while SLPs are of course measuring something in their typological practices (motor functioning or deviations from linguistic structures), I do not think they are actually representing a deep fact about the reality of stuttering and speech production when they count out syllables and measure dysfluencies. We are of course supposed to believe that dysfluency counts are describing something scientific, objective, and therefore deeply true about the reality of my body when they quantify my speech (e.g. that I have “a stutter,” and this is a pathological medical condition). But I reject the positivist project upon which SLP is built (note that rejecting positivism is not the same as rejecting science). I believe that when these sorts of claims are made what is really happening is a circular confirmation of what has already been assumed as true. SLP starts with the assumption that stuttering is a medical and biological pathology that can therefore be measured, and then proceeds to prove this by measuring and quantifying stuttering. This is a strong but certainly not maverick claim to make on my part. Many others have staunchly resisted the positivist conquest of human affairs: the discipline of political science is a fascinating example. Even closer to home groups like Deaf pride, the anti-psychiatry movement and c/s/x, and queer activists remain highly skeptical of modern psychiatry/medicine’s discourse around and definition of their bodies and minds (cf. Price 2011). Note, I am not saying SLP isn’t a science nor an evidence based practice. Rather, the point is that “scientific” does not mean objective nor a description of how things “really are.”
I might accordingly ask: what is SLP as a discipline really accomplishing by grounding itself in measuring and quantifying dysfluent speech? SLP (a) gets to call itself a science with the rest of them and (b) is able to use this credibility (and the ensuing funding) to pathologize and treat our bodies. Again, this has very little to do with the intentions of individual SLPs who for the most part are simply wanting to help stutterers. The issue is that there is always something happening that exceeds individual intentions.
Picking up on (b), my second point is this: measuring stuttering is deeply connected to capitalism. We have argued before--here and here—that whatever else it is, SLP, along with all rehabilitative medicine, is also an industry that makes money by pathologizing and subsequently treating our bodies. Understanding the historical relation between SLP, positivism, and scientific legitimacy, we can be a little more specific about the capitalist aspect of SLP. We must consider (i) that scientific credibility enables the capitalization of rehabilitative fields like SLP. Nikolas Rose (2007) argues that as medicine was intensely capitalized in the latter half of the 20th century, “clinical practice was reshaped by the requirements of medical insurance, and criteria for reimbursement. Basic and applied biological research – in biotech companies and in universities – become bound up with the generation of intellectual property and shareholder value” (4-5). In this way, syllable sheets providing hard data are an economic tool by which SLPs get reimbursed by third-party payers for services rendered. The need to provide quantifiable outcomes to third parties continues to be a source of frustration for some SLPs who wish to provide more holistic therapy. The measurement of stuttering is thus not simply a diagnostic tool for prescribing (and reviewing) appropriate treatment, but is a type of guarantor that legitimizes and sanctions the “exploitation” of disabled speakers—the idea that their bodies must be normalized through (often costly) therapy to have value in society. Scientific credibility greases the wheels of the medical-industrial complex.
(ii) I believe it is also important to consider that measurement and quantification are central to capitalism itself. Capitalism works by maximizing profit margins: wringing the most value out of its workers and continually expanding its markets. Capitalism increasingly measures work to make production more efficient. Nike, for example, has the time it takes to produce the various parts of a shoe down to the hundredth of a second. On the other end of the process, companies quantify markets to increase profitability. Coca-Cola sets targets according to “Total Liquid Intake”: quantifying and then increasing their share of how much liquid humans ingest in a day worldwide. Insofar as speech and communication are increasingly central to capitalist production, quantifying speech and attempting to maximize communicative efficiency through SLP are every bit a capitalist project regardless of (and even in spite of) the intentions of individual SLPs.
In conclusion, I would like to suggest that quantifying and measuring speech (or treating it as something that can be quantified at all) should perhaps be rethought. Speech is not a string of sounds. Communication is not the exchange of meanings ferried between two brains by phonemes. Similarly, dysfluencies—no matter how meticulously counted—do not disrupt my ability to be with another through speech in a measurable and reductive way. Spoken communication is a rich, affective, aesthetic, intersubjective, and dynamic process. To contort it into a string of sounds that can be measured, dissected, and then labelled as dysfluent and pathological is a violence not only against my body but against the very nature of speech. My stutter is too wily to be reduced to a syllable count. It refuses to be caged. I refuse to make it an assembly line.