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The Medical Model of Speech: Mapping out the limitations of an outdated framework

12/8/2014

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In the discussions that we at Did I Stutter have had with many in the Speech Language Pathology world, there is often a fundamental misunderstanding. One could almost say that we are operating with an entirely different paradigm.

To help clear up some of the confusion, we would like to introduce the distinction between what is called the “medical model” and the “social” or “cultural model” in the disability studies world. A medical model represents an attitude toward difference in which any type of biological deviation from what is expected (and understood as “normal”) becomes a form of pathology or deficiency. The medical model treats disability as a deficiency existing at the level of an individual person. Managing disability within the medical model is thus achieved almost entirely by seeking cures or rehabilitation within the individual body and person. 

 Speech pathologists and those within the medical model view stuttering and other dysfluencies as the main difference between the lives of “normal” speakers and those who cannot pass as normal. The medical paradigm views difference as disorder, often affirming a view of life that starts with birth, climaxes at marriage and ends in death. In such a view, stuttering is disruptive because it hinders attempts at normalized socialization and economic productivity. Stutterers are less than ideal citizens.

We at Did I Stutter subscribe to what is called a cultural model of speech. We view differences in speech not as causes of problems, but as a sign of unusual embodiment that, when identified by society, leads to the devaluation of the speech disabled individual. The cultural model argues that bodies are tremendously varied, but only some forms of variation are marked as abnormal and deficient (for example, red hair is a genetic mutation, but no one talks about the “risk” of having a red haired child in the way that we routinely talk about the “risk” of having a child with Down syndrome). The cultural model of disability refuses to assume that any bodily variation—be it hair color or disability—is somehow naturally deficient or bad. Rather, it is primarily social and cultural barriers discriminating against disabled bodies in a thousand ways that turn the ‘difference’ of disability into a deficiency.


 Of course, experiencing disability produces challenges that other bodies may not have—we often have physical pain, and our bodies can move (or not move) in ways that can at times be frustrating. The cultural model of disability does not deny this. However, it also believes that pain and frustration are in part shaped by a world which is designed for certain sorts of bodies while failing to accommodate others. The point is that disability is never an individual issue, but must always be understood in a social context. The medical and individual model of disability is far too simplistic to understand everything that disability is.

 A cultural view of stuttering might think that social attitudes toward deviance and appearance weigh heavier in the treatment of stutterers than the sound of the voice itself. A cultural view might be curious to look at the treatment of dysfluent individuals in non-western cultures, wondering if the stigma attributed to stutterers is associated with an idealistic attitude held toward efficiency. Finally, a cultural view of speech might encourage individuals to think about how they learn to speak and what “good speech” even means. Furthermore, it would contend that our learning about “good speech” has a heavy influence on our experience; if an individual experiences pain when they stammer, that pain is inseparable from the faces made by our conversation partners and the way their reactions condition our thinking about dysfluency.

While medical professionals may seek to identify causal biological issues, those interested in the social or cultural models of disability are deeply involved in considering how the social and representational environment affects the condition of dysfluent people.

It is important that a social or cultural model does not entirely exclude medicine or speech therapy, but that we use it to ask critical questions about how some of the assumptions of a curative model of speech might injure dysfluent individuals. 



-Josh

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Good Communication

10/28/2014

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After years of fluency-shaping speech therapy, I finally found a different approach when I learned about desensitization and stuttering acceptance. It was a huge relief to learn that there was another option for people who stutter: one that didn't necessarily involve fluency. The idea that I could be content with the way I talked while still stuttering was never an option to me before, and it honestly changed my life. Since then, I've managed to overcome a lot of the frustration that I used to feel every time my speech wouldn't cooperate.

There's so much I value about desensitization, but lately I've been thinking about the inevitable risks we face in self-help and speech therapy, even when the goal is self-acceptance. For me, the notion that people who stutter can be good communicators was incredibly exciting. I continue to feel empowered when I list all the options I have while speaking: even if I'm not fluent, I can make "good" eye contact, listen well, express excitement about whatever I'm talking about, and communicate openness about my stutter. But the idea of a "good communicator" seems risky, and it's become important for me to remind myself not to overvalue "good communication." I worry that this phrase promotes a normalized idea of speech: one that makes room for stuttering, but only if it's surrounded by other qualities of good communication, some of which may be out of reach for many speakers.

So how can we push back that inevitable narrative of speech therapy--and disability-- that values overcoming? How can people who stutter keep from aspiring toward some model of speaking, without looking at the forces that shape the idea of "good communication?" I love many things about the idea that good communication doesn't mean fluency, but it's easy for this notion to go from being empowering to being another way that we tell ourselves that our speech is inadequate. Instead of failing at being fluent, I was failing at communicating well, failing at adequately owning my stutter, or failing at maintaining eye contact.

That's why it's so important for all people who stutter to become educated about disability theory: to consider the forces that normalize speech, and that require us to appropriately handle our stutter-- whether that means concealing it, regulating it with fluency-shaping techniques, or treating it with the proper amount of levity and openness. Without this dimension added to speech therapy or to self-help, the techniques we learn for "good communication" are just another form of easy onset. Both work toward standard speech without considering the forces that reject and stigmatize "bad communication"-- or disabled communication.

I'm still in speech therapy, and I still want to do all the things I wrote about above: stutter more easily, maintain eye contact, communicate openness. A lot of speech therapy, for me, is about fighting back against the techniques-- and shame-- I learned during fluency-shaping speech therapy. But, at the same time, I want to love my speech at all times: when I'm stuttering, when I'm blocking, when I'm using filler words, when I'm avoiding certain sounds. These habits may have come from a history of anti-stuttering therapy, but they're still a part of my voice, and a part of me. I went from hating myself when I stuttered to hating myself when I wasn't being a "good communicator": different scenarios, but the feelings that come afterward are eerily similar.

In both cases, I was failing the expectations of my listener: being awkward, vulnerable, visibly embarrassed, and, above all, unable to make them comfortable-- whether by achieving fluency, maintaining eye contact, or "communicating well." Is there a way to let go of the idea that people who stutter have an obligation to make their listener comfortable? To make these techniques an option, without making them an obligation? Along with openness, and easy stuttering, and eye contact, I want to look closer at "bad communication" and how it works-- because, even though it's "messy" (as Zach puts it in his blog post from September), it still communicates.

-Emma

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