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to be very marked in the cases of stammerers between the ages of twelve and twenty, records showing that most of the suicides of stammerers are persons between those ages.

The intense mental strain, the extreme nervous condition, the continual worry and fear cannot fail, sooner or later, to have its effect upon the mind. This is clear to any stammerer, who is familiar with the mental condition brought about by the first few hours of one of his periods of recurrence. Another case where the mental strain is extremely great is that of the synonym stammerer —the mentally alert individual who, in order to prevent the outward appearance of stammering, is continually searching for synonyms or less difficult words to take the place of those which he cannot speak. This continual searching for synonyms results in a nervous tension that is sure to tell on the mental faculties sooner or later, and I have found, in examining many thousands of cases, that the synonym stammerer is usually in a more highly nervous state than any other type.

MENTAL STRAIN EVENTUALLY TELLS: The effect of stuttering or stammering on the sufferer’s concentration is very marked. The sufferer notes an inability to concentrate his mind on any subject for any length of time, finds it impossible to pursue an education with any degree of success or to follow any business which requires close attention and careful work.

The power-of-will is also affected and the stammerer notes an inability to put through the things which he starts and which require the exercise of will power to bring to a successful conclusion.

A diagnosis of insanity is sometimes made in the case of a stammerer in the advanced stages of his malady, while in other instances the mental aberration takes the form of a hallucination of some sort, as in the case of the boy who was of the belief that he was continually being followed.

But regardless of what form is taken by the mental disorder resulting from stammering, such cases are almost invariably found to have long since passed into the incurable stage, although positive statements as to the individual’s condition should not be made, as a rule, without a thorough diagnosis having first been made.

CHAPTER VIII THE EFFECTS ON THE BODY

The effect of stammering or stuttering upon the physical structure is problematical. In some cases examined, a noticeable lack of vitality has been found, together with an almost total loss of active appetite, a marked inclination toward insomnia and a generally debilitated condition resulting from the nervous strain and continued fear brought on by the speech disorder.

In other cases, it has been found that the health was but little affected and that there was no marked departure from normal.

The physical condition of the stammerer is the result of many factors. If plenty of fresh air and exercise is supplied, and the mind is well-employed so that the worry over the trouble does not disturb the stammerer, then the chances for being in a normal physical condition are good.

On the other hand, the boy of studious disposition, who is somewhat of a bookworm, keeps close to the house and does not play with other children of his age, will probably find time for much introspection, and on this account, as well as on account of the lack of fresh air and exercise, will probably be in a physical condition that of itself demands careful attention.

It has been found in examinations of stammerers and stutterers, however, that they are usually of below normal chest expansion and that the health, while not particularly bad, is subject to a great improvement as a result of the proper treatment for stammering.

Charles Kingsley, the noted English divine and writer, and himself a stammerer many years ago, has the following to say regarding the effect of stammering on the body: “Continual depression of spirit wears out body as well as mind. The lungs never act rightly, never oxygenate the blood sufficiently. The vital energy continually directed to the organs of speech and there used up in the miserable spasm of mis-articulation cannot feed the rest of the body; and the man too often becomes thin, pale, flaccid, with contracted chest, loose ribs and bad digestion. I have seen a boy of twelve stunted, thin as a ghost and with every sign of approaching consumption. I have seen that boy a few months after being cured, upright, ruddy, stout, eating heartily and beginning to grow faster than he had ever grown in his life. I never knew a single case in which the health did not begin to improve then and there.”

CHAPTER IX DEFECTIVE SPEECH IN CHILDREN

(1) THE PRE-SPEAKING PERIOD

 

From the standpoint of speech development, the life of any person between the time of birth and the age of twenty-one years, may be divided into four periods as follows:

From Birth to Age 2—PRE-SPEAKING PERIOD. Age 2 to Age 6—FORMATIVE-SETTING PERIOD Age 6 to Age 11—SPEECH-SETTING PERIOD Age 11 to Age 20—ADOLESCENT PERIOD

This chapter will deal only with the first period of the child’s speech-development, beginning with birth and taking the child up to his second year. The speech disorders of the later periods will be taken up in the three following chapters.

THE PRE-SPEAKING PERIOD: This is the period between the time of birth and the age of 2, and takes the child up to the time of the first spoken word. This does not mean, of course, that no child speaks before the age of 2, for many children have made their first trials at speaking at as early an age as 15 months, and many begin to talk by the time they are a year and a half old. At the age of two, however, not only the precocious child but the child of slower-than-average development should be able to talk in at least brief, disjointed monosyllables.

Before taking up the possibility of a child exhibiting symptoms of defective speech with the first utterance, let us familiarize ourselves with the fundamentals underlying the production of the first spoken words.

The mother, who for months, perhaps, has been listening with eager interest and fond anticipation for her child’s first word to be spoken, has little comprehension of the vast amount of education and training which the infant has absorbed in order to perfect this first small utterance. Months have been spent in listening to others, in taking in sounds and recalling them, in impressing them upon the memory by constant repetition, until finally after a year and a half, or more, perhaps, the circuit is completed and the first word is put down as history.

ASSOCIATION OF IDEAS: It must be remembered that perfect coordination of speech is the result of many mental images, not of one. In saying the word “salt,” for instance, you have a graphic mental picture of what salt looks like; a second picture of what the word sounds like; a “motor-memory” picture of the successive muscle movements necessary to the formation of the word; another picture that recalls the taste of salt, and still another that recalls the movements of the hand necessary to write the word.

These pictures all hinging upon the word “salt” were gradually acquired from the time you began to observe. You tasted salt. You saw it at the same time you tasted it. There you see was an association of two ideas. Thereafter, when you saw salt, you not only recognized it by sight, but your brain recalled the taste of salt, without the necessity of your really tasting it. Or, on the other hand, if you had shut your eyes and someone had put salt on your tongue, the taste in that case would have recalled to your mind the graphic picture of the appearance of salt.

As you grew older and learned to speak, your vocal organs imitated the sound of the word “salt” as you heard it expressed by others and thus you learned to speak that word. At that stage, your brain was capable of calling up three mental pictures—an auditory picture, or a picture of the sound of the word; a graphic or visual picture, or a picture of the appearance of salt and a third, which we have called a motor-memory picture, which represents the muscular movements necessary to speak the word. A little later on, after you had gone to school and learned to write, you added to these pictures a fourth, the movements of the hand necessary to write the word “salt.”

At the sight of the mother, a child may, for instance, be heard to say the word “Mom” while at the sight of the pet dog whose name is “Dot,” be heard to say “Dot” in his childish way.

Here we have the first example in this child of the association of ideas. The child has heard, repeatedly, the word “Mama” used in conjunction with the appearance of the smiling face of his mother. Thus has the child acquired the habit of associating the word “Mama” with that face—and the sight of the countenance after a time recalls the sound of the associated word. Thus a visual image of the mother transmitted to the child through the medium of the eye, links up a train of thought that finally results in the child’s attempt to say “Mama.”

To take another example of the association of ideas or the coordination of mental images necessary to the production of speech, let us suppose, for instance, that the child has been in the habit of petting the dog and hearing him called by name “Dot” at the same time. Now, if the dog be placed out of the child’s sight and yet in a position where the hand of the child can reach and pet him in a familiar way, this sense of touch, like the sense of sight, will set up a train of thought that results in the child making his childish attempt to speak the name of the dog “Dot.”

In other words the excitation of any sensory organs sets up a series of sensory impulses which are transmitted along the sensory nerve fibres to the brain, where they are referred to the cerebellum or filing case, locating a set of associated impulses which travel outward from the motor area of the brain and result in the actions, or series of actions, which are necessary to produce a word.

It will make the action of the brain clearer if the reader will remember the sensory nerve fibres as those carrying messages only TO the brain, while the motor nerve fibres carry messages only FROM the brain.

To make still clearer this association of ideas so necessary to the production of speech, suppose this same child hears the word “Dot” spoken in his presence. He will, in all probability, begin to repeat the word, and to search diligently for his pet dog. Thus it will be seen that in this case the sound of the dog’s name has stirred up a train of mental images, one of these being a visual image of the dog himself, causing the child to look about in search for him.

HOW WE LEARN TO TALK: We learn to talk, therefore, purely by observation and imitation. Observation is here used in a broad sense and means not only SEEING but SENSING, such as sensing by smelling, touching or tasting. The child imitates the sounds he hears and if these sounds emanate from those afflicted with defective utterance, then it follows that the initial utterance of the child will be likewise defective.

SOURCE OF THE FIRST WORD: The first spoken word of the child usually finds its source in some name or word repeatedly spoken in the child’s presence. It is not usual that this first word is marked by a defective utterance and if

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