Getting the words out

A man walks into a bookstore and asks, “D-d-do you have a t-travel section?” The clerk responds, “Y-yes, sir, against that wa-wall.” Angry, the customer asks, “Are y-you imitating me?” Says the clerk, “N-no, sir, never.”

As the man browses, a new customer asks, “Have you a cooking section, old boy?” Without stammering, the clerk replies, “Right this way, my good fellow.”

Furious, the first man scolds the clerk, “You w-were imitating m-me!”

“N-no, sir,” replies the clerk, “I was imitating him.”

In the annals of less-than-tasteful jokes, this one barely registers – except to persons who stutter. For them, such jokes – as common to their ears as they are corrosive to their spirits – are reminders that the verbal communication most of us take for granted is frequently beyond reach.

“People who stutter deal with enormous obstacles,” says psychiatrist Dr. Gerald Maguire. “They’re often viewed as less than intelligent and lacking in social skills. To protect themselves from ridicule, they may become socially anxious and introverted, which is often counter to their natural personalities.”

Maguire, who can’t recall a time when he didn’t stutter, experienced these challenges firsthand but refused, even as a child, to be bound by them. In grammar school, he discovered that speaking in cartoon voices, a la Porky Pig, would result in peers laughing with him, not at him. And he learned the value of a thesaurus, which gave him options for problem words.

He recalls, “One year, I was assigned a class presentation on my family – but, no matter how hard I tried, I couldn’t say the word ‘brother.’ My thesaurus defined ‘brother’ as a ‘male sibling,’ so I said I had four siblings – three boys and one girl – and aced the presentation.”

A compassionate home environment provided additional support. And Maguire, who excelled academically and had many friends (but admits that dating was difficult), says he used his speech impediment as a springboard, asking himself, “I have a stutter. Now – what more can I accomplish?”

Maguire, associate professor of clinical psychiatry and human behavior as well as senior associate dean of educational affairs in the UC Irvine School of Medicine, has accomplished much. Recently, his duties expanded even further: As director of UCI’s newly opened Center for the Medical Treatment of Stuttering, Maguire helms a team dedicated to research and care management. Currently the only facility in the world that seeks to optimize patient fluency through a comprehensive combination of speech therapy, counseling, medication and research, the center is a valuable resource for the approximately 3 million Americans who stutter.

Looking inward

Stuttering creates a peculiar inequality. Well-meaning people complete sentences for those who stutter. Snide jokes are suffixed with comments such as, “Where’s your sense of humor?” Attempts to advance oneself are often met with discouragement, something Maguire experienced in medical school when a coursework evaluation noted his stutter “makes people uncomfortable.”

And, in perhaps the cruelest irony, those who stutter are often denied the chance to respond with their greatest weapon – their intellect – because the words won’t quite come.

For much of the 20th century, stuttering was viewed within the scope of Freud’s repressed-need principle, which suggested the condition was a neurotic behavior that resulted from the denial of core physiological need. Contemporary medicine theorizes stuttering begins within the brain – that disruption of nerve impulses within the left cerebral hemisphere (which governs speech and motor actions), combined with genetic predisposition, cause stuttering.

“PET imaging has revealed irregularities in the brains of persons who stutter, including a surplus of dopamine – the catecholamine neurotransmitter within the brain that helps regulate movement. Medication developed expressly for this will prove crucial in future treatment protocols,” says Maguire, presently chief investigator in a study of Pagoclone (Indevus Pharmaceuticals), the first drug placed into clinical trials specifically to treat stuttering.

Early intervention is key. Clinicians find children who begin speech therapy as soon as stuttering appears (often as young as age three) show significant progress. Says Maguire, “Some children outgrow stuttering; others advance to where disfluency is no longer an issue. Adults who didn’t receive or respond to speech therapy as youths will always stutter but may demonstrate improvement with a combination of counseling and medication.”

Giving back

For Granville Kirkup, a successful Orange County businessman and Maguire’s patient since 1992, the center’s mission is personal. Says Kirkup, who has stuttered since childhood, “It’s why I became a business owner – I couldn’t manage job interviews. I decided that I’d run the company and hire people to make calls and deal with the public for me.”

In his native England and later the U.S., Kirkup built an impressive resume in numerous industries, including telecommunications and software development. Also noteworthy is his philanthropic inclination: In 1999, intrigued by Maguire’s investigative efforts, Kirkup gave UCI $250,000. And, in December 2006, Kirkup donated $1 million, a gift that will significantly benefit the center’s research goals.

“I believe Dr. Maguire is on the right track in making enormous strides in care,” Kirkup says. “Stuttering affects your whole life, so it’s imperative that people have a place to go. Under Dr. Maguire’s guidance, UCI will be known as a central location for the complete treatment of stuttering.”

Moving forward

Now 42, Maguire, the man who can’t recall a time when he didn’t stutter, considers his future. A frequent lecturer at symposia around the world and regular contributor to medical journals, he devotes much of his time to a less-sophisticated form of communication: responding to the hundreds of e-mails he receives weekly from people who stutter – who wonder if there might be help available for this medical condition that is so personally painful and, in many ways, still so misunderstood by the world.

“The center is a vital line of defense,” Maguire says. “In the coming years, we’ll see medication developed purposely for stuttering that provides much better response. We’ll also improve the research on genetic testing that will determine the hereditary profile, which will help direct treatment.”

He reflects a moment.

“I love to teach and to guide – and what influences me is that I understand how patients who stutter feel. I believe I can make a difference – and that should take care of the next 40 years.”

Facts about stuttering

• More than 3 million U.S. children, teens and adults suffer from a chronic stuttering disorder.
• Stuttering patterns are often unique to each individual, and treatment modalities are also unique to patients. However, most stuttering patterns are marked by repetitions of syllables, long silences and the contortion of a person’s face as they try to speak.
• Stuttering is believed to have a genetic component; it tends to run in families.
• Stuttering affects more men than women; approximately 4 to 1.
• About 75 percent of children who stutter outgrow the disorder without intervention.
• Some 20 percent of children go through a development stage when stuttering is severe enough to be a parental concern. Here, the best prevention tool is early intervention.
• “Person who stutters” is now the correct phrase, replacing “stutterer.”
• Famous folks who stuttered: Marilyn Monroe, James Earl Jones, Lewis Carroll, Carly Simon, Sir Isaac Newton, Winston Churchill, Tiger Woods, Bruce Willis, Sen. Joe Biden Jr., John Stossel, Bill Walton, John Updike.