Friday, June 09, 2006

Will power vs pill power

I met up with Carl and Lloyd on Wednesday afternoon at the Metropolitan in New York, and we went to a near-by cafe. It was good to hear that they both enjoy reading my blog.

The discussion was also an interesting one. I was sitting opposite the two, and both are currently in treatment for their stuttering. Carl has done the McGuire course, which is a behavioural theory with coastal breathing being a core technique, and Lloyd took part in the Pagoclone study and is now in an one year open-label extension. Carl, a tidier and more intellectual version of Frank Zappa :-), spoke about how the course has changed his outlook, and about the intense experience that he felt when realising that he could control his stuttering more and the importance of will power. He got a bit over excited about the paradox of completely believing that this is the right way to become more fluent and not being dogmatic that this should help everyone else. I think it is fair to say than neither myself, Lloyd, nor himself did fully understand what he meant! I am sure he will give us a more collected summary of his thoughts here. Carl said that he was a mild to medium severe stutterer, but that he is pretty fluent at the moment. And I have to agree with him. Apart from some coastal breathing, he spoke completely naturally.

Lloyd spoke about his experiences on Pagoclone, and one thing is clear: Pagoclone is no wonder drug. He still has clear blocks and prolongations. On the other hand, I did feel that his stuttering symptoms were clearly visible but of low intensity, a bit like people doing van Ripper. He did not seem to struggle a lot and seemed patiently going through the blocks and prolongations. Now I dont know how he spoke before the trials. Lloyd said that he felt in greater control of his speech, but only after taking the high dose. He also said that family members thought he spoke better on the phone. So his stuttering seemed to have gotten easier, but no cure. I forgot to ask him whether he wants to write a post about his experience, but will do so. He also mentioned that his recordings were probably more positive due to them being taken in a calm room with a nice female speech therapist!

We also discussed whether a combination of a behavioural therapy and medication would be useful. And whether medication can improve to such a degree that it makes stutterers fluent. Intuitively, meeting the two has made me think that medication is probably most suited for more severe stutterer to give them break and allow for more behavioural work. Finally, we talked about relapse, which is the real test for any behavioural therapy.

P.S. Just want to say that these are individual cases not necessary a reflection of a wider population.

2 comments:

Carl Joakim Gagnon said...

Tom,

I'm glad to see you're back to blogging. And thanks for the comparison to Frank Zappa.

As for the paradox of choosing a behavioural therapy as right for you, but at the same time not telling other stutterers that this is the only approach that can help them -- well, it _is_ an exciting and difficult one (more so than it first seems, I think).

Anyway, there is nothing magical about costal breathing or the specific techniques taught at the McGuire Program. They're old hat. The question in all behavioural programs, as you know, come down to motivation. But the really important thing to realize about motivation is that it is not simply something that some people HAVE and others HAVE NOT. If you're not motivated to use speaking techinques, it's not because you're an unmotivated person. It's because you can't grasp the reason you should do so _with sufficient vividness_! Remember, you are being told to put yourself through emotional bludgeoning, doing things you really do not want to do: for you to do them, you need much more than an abstract idea that you "should" do them. And getting that vivid sense is NOT -- stutterers know this, in spite of all those self-help books out there -- primarily a matter of will-power.

Compare it to a roller-coaster ride. You can't have the experience of a ride just by standing next to it and telling yourself you have the experience. It's not in your power. What is in your power is buying a ticket to a ride.

Likewise, what is in your power is signing on to a course that takes you away from your ordinary life for a few days, allows you to reach a solid level of fluency, and, as long as the course has _SOLID follow-up support_, allows you to attack your feared situations aggressively and with PLENTY more practice in the street and other places than you think you need. And, as a matter of fact, I think McGuire is probably the best place to get this right now.

Carl Joakim

Anonymous said...

Tom,

Can you please bring me in contact with Carl? I leave in the NY area too.

Thanks,
George