More Foucauldian than indended Let me start off by recognizing that speech therapy is an incredibly complicated issue. We want to make space here for those who desire speech therapy while at the same time being able to stand back and question some taken-for-granted assumptions. So I have a couple of disclaimers up front. First, these are simply some thoughts on speech-language pathology, not final nor sedimented beliefs. I am very much still working through this issue. Second, as the amazing disability writer and activist Eli Clare pointed out to Zach and I a couple months ago, speech therapy enables people with “severe” communicative disabilities to access education and (thus) other social opportunities that would be denied them otherwise. Because of these complexities, it is not our intention to dismiss speech therapy outright. However, we are nevertheless concerned with the way in which speech-language pathologists, even at their best, exert subtle yet very real power over people who stutter.
As the name suggests, speech-language pathology or speech therapy “pathologizes” our voices. In other words, these practices begin with the assumption that our voices are abnormal or deviant, and then medically intervene, either to increase our fluency or to offer therapeutic and emotional supports. With this in mind, I would suggest that speech therapy has three effects:
(1) Entering into a client/therapist relationship produces a specific kind of identity for the stutterer (in academic terms, it is a form of “subjection”). I enter into a relationship where I become someone who is pathologized. This is a relationship where a therapist has the authority to speak the “truth” about my body and my disability, which includes the seemingly obvious fact of my physiological/medical condition. At the same time, entering into this relationship limits the kinds of responses and control I can have over my body. Individual speech-language pathologists seek to use this authority in positive ways, and I want to stress that the vast majority of speech pathologists I have encountered in my life have been incredibly wonderful and well-intentioned people. However, this is not about individual intentions. As I have mentioned in another blog post, I just don’t think the medical, physiological difficulty of producing sounds is the best way to understand what stuttering is and what makes it a so-called “impediment.” Because pathologization is built into the client/therapist relationship—because my stutter is defined upfront as a medical issue that the therapist is given authority to help with—the option of deciding for myself that there is nothing wrong with my voice is severely limited.
(2) The client/therapist relationship is “depoliticizing.” That is, speech pathology assumes, and convinces stutterers, that what stuttering is (when we get right down to it) is an individual and biological thing. This process of medicalization covers over the ways that the very idea of normal and abnormal speech is produced by cultural values and expectations—and of course, by speech pathology itself. Because of this depoliticization, the stutterer is left with the belief that ultimately (a) stuttering is something that only I can manage (whether it be through fluency reduction or reducing avoidance, fear, etc.), (b) being able to communicate is primarily my responsibility, and (c) these are not political and social, but individual psychological and physiological issues. Speech pathology can thus distract us from getting at the root causes of our oppression.
(3) Speech pathology is a massive industry that makes money off of our bodies. Or, more specifically, it makes money off of pathologizing our bodies and reinforcing the idea that we, rather than society, are the ones who ultimately need to change. On an individual level this isn’t such a big deal. We pay people to provide us with services all of the time. However, stepping back a little and looking at the big picture, the speech pathology industry rests entirely on the assumption that our bodies require intervention. Besides traditional speech pathology, this industry includes pharmaceuticals, technology such as Speech Easy, psychology, neuroscience, and genetics. Contemporary speech-language pathology cannot therefore be separated from capitalism—or what has been termed “late capitalism.” There is big money being made by exploiting our bodies.
In my own life, I have found speech therapy both helpful and unhelpful. Even while it treated my voice as broken and needing to be fixed, it encouraged me to speak up in ways I had previously avoided, and I am grateful for that. Whether or not to participate in speech therapy is a personal decision, and if you choose to engage in it you are very welcome here. Our hope is simply that as a community of stutterers we can begin a critical conversation about the pathologization of our voices.
-Josh
As the name suggests, speech-language pathology or speech therapy “pathologizes” our voices. In other words, these practices begin with the assumption that our voices are abnormal or deviant, and then medically intervene, either to increase our fluency or to offer therapeutic and emotional supports. With this in mind, I would suggest that speech therapy has three effects:
(1) Entering into a client/therapist relationship produces a specific kind of identity for the stutterer (in academic terms, it is a form of “subjection”). I enter into a relationship where I become someone who is pathologized. This is a relationship where a therapist has the authority to speak the “truth” about my body and my disability, which includes the seemingly obvious fact of my physiological/medical condition. At the same time, entering into this relationship limits the kinds of responses and control I can have over my body. Individual speech-language pathologists seek to use this authority in positive ways, and I want to stress that the vast majority of speech pathologists I have encountered in my life have been incredibly wonderful and well-intentioned people. However, this is not about individual intentions. As I have mentioned in another blog post, I just don’t think the medical, physiological difficulty of producing sounds is the best way to understand what stuttering is and what makes it a so-called “impediment.” Because pathologization is built into the client/therapist relationship—because my stutter is defined upfront as a medical issue that the therapist is given authority to help with—the option of deciding for myself that there is nothing wrong with my voice is severely limited.
(2) The client/therapist relationship is “depoliticizing.” That is, speech pathology assumes, and convinces stutterers, that what stuttering is (when we get right down to it) is an individual and biological thing. This process of medicalization covers over the ways that the very idea of normal and abnormal speech is produced by cultural values and expectations—and of course, by speech pathology itself. Because of this depoliticization, the stutterer is left with the belief that ultimately (a) stuttering is something that only I can manage (whether it be through fluency reduction or reducing avoidance, fear, etc.), (b) being able to communicate is primarily my responsibility, and (c) these are not political and social, but individual psychological and physiological issues. Speech pathology can thus distract us from getting at the root causes of our oppression.
(3) Speech pathology is a massive industry that makes money off of our bodies. Or, more specifically, it makes money off of pathologizing our bodies and reinforcing the idea that we, rather than society, are the ones who ultimately need to change. On an individual level this isn’t such a big deal. We pay people to provide us with services all of the time. However, stepping back a little and looking at the big picture, the speech pathology industry rests entirely on the assumption that our bodies require intervention. Besides traditional speech pathology, this industry includes pharmaceuticals, technology such as Speech Easy, psychology, neuroscience, and genetics. Contemporary speech-language pathology cannot therefore be separated from capitalism—or what has been termed “late capitalism.” There is big money being made by exploiting our bodies.
In my own life, I have found speech therapy both helpful and unhelpful. Even while it treated my voice as broken and needing to be fixed, it encouraged me to speak up in ways I had previously avoided, and I am grateful for that. Whether or not to participate in speech therapy is a personal decision, and if you choose to engage in it you are very welcome here. Our hope is simply that as a community of stutterers we can begin a critical conversation about the pathologization of our voices.
-Josh
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