Impact of Cultural Perspectives on Stuttering and the Implications in Therapy - Term Paper Example

?IMPACT OF CULTURE ON STUTTERING ETIOLOGY AND TREATMENT PERCEPTIONS: CHALLENGES INVOLVED IN DEALING WITH STUTTER CASES The acceptance towards stuttering has improved considerably within different societal contexts despite the lack of active researches or attempts in this direction (Vinacour and Weinstein, 2011). This is peculiar given that speech is considered the most valued and concerned aspect of human communication. However, cultural values still strongly influence the perspectives and impressions towards stuttering and consequently the treatment methodologies adapted. Scientific evidences point to a diverse range of possible etiologies leading to stutter. One set of studies shows that children when forced to write from their right hands when their preference is of the left become stutterers. This prevalence was found higher in children with the switch than children who were allowed to develop their own hand preference. The underlying philosophy is the stress that the left handed children are likely to experience to confirm writing with the right hand, thereby leading to development of the stutter, and not the motor process itself. For treatment purposes and concerns, the therapists are faced with the challenges of handling the treatment options through scientific processes, while still addressing the cultural and even religious concerns of the people when addressing cases of stutter. EASTERN CULTURES AND THEIR APPROACH TOWARDS STUTTERING The Chinese culture does not show progress when it comes to creating awareness about stuttering within its society, it’s possible causes and the professional help that can be sought to treat it. Mostly considered a social taboo, research indicates that the society blames the parents for not treating the child well, who in turn starts to stutter. The Chinese strongly believe in the preservation and proper speaking of their mother tongue, which is why they emphasize on correcting the stutter until the child overcomes the problem through constant correction and teaching them the language (Vinacour and Weinstein, 2011). On the other extremes, the belief that the will of god is involved in the person who stutters prevented treatment options to be sought in many cultures, such as Israel, Africa and some Asian cultures for a long time (Vinacour and Weinstein, 2011). Here the challenge to treat patients with stuttering can become a battle between the scientific rationale and the personal belief system of the patient and the patient’s family (Robinson and Crowe, 1998). Without a proper understanding of the cultural backgrounds and the patient perception and understanding of the condition by the speech therapists, the treatment may simply be rejected by the patient or the patient’s family. Japan displays a more scientific approach towards treatment of stuttering. Its focus on curing stuttering through therapy is evident from the 1950s, compared to China where the condition is still considered a bad omen or a cause of ridicule (Kenjo, 2005). Japanese have incorporated the speech therapy system for stutterers in their school systems, where they are given play time and isolated time with speech therapist to overcome their speech difficulty. In other cases, the use of group therapy has been found useful (Kenjo, 2005). But the actual reason belying the low rates of stutter in Japanese may also lie in its language structure and makeup. Certain language structures show predominance in stutter development where there is a higher number of word repetition in its speech. Chapter reference stuttering in Japanese CULTURAL CONSIDERATIONS IN AFRICAN CULTURE There is perhaps no greater challenge to address stuttering in any other region than in African countries. This is because of the near absence of any institutes to treat stutter and the societal ignorance on the phenomenon of stuttering (Nsabimana, 2013). This leads to extreme discrimination, mocking and humiliation experienced by those who stutter from the society. Researches also are lacking due to absence of research institutes focusing on this problem (Nsabimana, 2013). African American cultures place causes of stuttering in emotional traumas, babies left in the rain, Indian Karmas or even not informing the tribal ancestors about the birth of the child (Thomas, 2002). Deeper investigation and research by asking the traditional African healers revealed similar reasons; however, they also gave some anatomical causes to stuttering (Thomas, 2002). For example, stuttering due to failure to cut the membrane joining the tongue to the base, imitating an adult’s stuttering pattern, heredity, meningitis or other similar illnesses or by evil curses respectively. Grasshopper eating is also considered a cause of development of stutter (Thomas, 2002). Cameroon cultures of Upper Ngemba believe in the God of Tongues, who when offended causes the child to stutter. Similar in line are the concepts of witches and wizards, which destroy generations by making them stutterers through witchcraft (Thomas, 2002). Even in the African American cultures, many etiological myths exist. These vary from mother not eating proper food while feeding the child to the child being bitten by the dog. Even the ‘work of the devil’ is considered a possible etiology of stuttering (Robinson and Crowe, 1998). CULTURAL IMPLICATIONS IN THERAPY Before discussing the cultural implications in therapy, it is important to understand what are the outcomes expected of the therapy. The following four have been described as the goals of any therapy to treat stutter. 1. To create a fluent speaking skill with a normal or near normal sounding rate. 2. Creating a positive attitude towards communication and creating confidence among children 3. To improve the quality of life by improving social skills, and helping deal with daily hassles such as teasing and bullying particularly common in children and school going children. 4. Giving confidence to children to improve their stuttering by monitoring it themselves and taking active participation in this regard (Vinacour and Weinstein, 2011). One aspect of therapy option provided and widely debated is the possibility of engaging speech therapists who themselves suffered from stuttering in order to provide an example and role model for patients suffering from stuttering (Vinacour and Weinstein, 2011). The premise is to have a speech therapist that is able to understand the myriad of emotions stutterers feel, dealing with negative emotions and overcoming stutter without relapse. Evolution of the treatment modalities and research led to new methods of treatment, particularly at childhood age. These include one to one home setting therapies to group therapies to help children overcome stuttering (Vinacour and Weinstein, 2011). Herein lies the challenge about what the parents of the families of the children feel towards stuttering therapy and how willing they are to amalgamate cultural values with scientific methods of treatment. The parents therefore, govern the decisions of management of children with stutter. EXAMPLES OF CULTURAL THERAPIES IN GLOBAL CULTURES Ellis created a Rational Emotive Therapy based on views of older civilizations’ views, arguing the stuttering process to be triggered internally within the person rather than externally (Vinacour and Weinstein, 2011). Greeks for example, held the view that is was the person’s ability to view his or her surroundings that led to stuttering rather than environmental factors contributing to stuttering. This means that should the person overcome certain behaviors, he is likely to overcome stuttering as well. This method has been an underlying principle in many of the cultures and now has found its way in the medical therapy as well. This method helps the person to take a more proactive role towards his treatment and thus give him confidence (Vinacour and Weinstein, 2011). The example of Ellis’ methodology however, is much different from the other cultural influences that affect therapeutic measures within different societies (Vinacour and Weinstein, 2011). In the western models, the emphasis may be too much on making the patient clear about his or her condition. In this attempt, the therapist may focus too much on encouraging the person to talk in a particular manner, and overanalyzing his or her thinking pattern (Vinacour and Weinstein, 2011). This may even lead to a somewhat instructive model where the therapist guides the patient to speak in a particular manner. The therapist could start thinking for the patient rather than allowing the patient to express him or herself. This is in contrast with Eastern models, where there is effort to create a dialogue that is natural, uninterrupted and unlimited (Vinacour and Weinstein, 2011). More common in the Yoga and Buddhist therapies, the patients are encouraged to find their inner core of peace and wisdom, and use that as a channel to overcome stuttering. Buddhist and Eastern cultures however, believe in the treatment of the entire soul of the person. In this process, the therapists believe in identifying the reasons why a person is the way he or she is, and what are the possible causes leading up to stuttering. In such cultures, the stuttering is an outcome, rather than the disease itself. To treat stuttering, the person must be cured. Yoga and Buddhist therapies focus on the connection of the mind and body, whether through relaxation therapies, breathing exercises, meditation and focus intensive exercises. Through these methods, the patient is allowed to explore his or her mind and soul, find answers and then overcome the hurdles leading up to the stuttering. The therapists here therefore allow for time, meaning they allow silence and even welcome it as a part of normal communication process. The Eastern philosophy does not overwhelm the patient with information (Vinacour and Weinstein, 2011). It allows the patient to express him or herself, at her time, in his or her words, in order to provide confidence. This then leads to small changes in the therapy to improve the patient at his or her pace. The philosophy is therefore to explore and understand, not dictate the method of treatment (Vinacour and Weinstein, 2011) The Chinese culture as mentioned has very few facilities that are directed towards treatment of the stutter per se (Reese, Hoffman and Li, 1999). The cultural taboos prevent stutterers and families to seek treatment. Alongside, there is no governmental effort to educate the public about stuttering and its causes. This has led to creation of a set of negative ideas and biases against people who stutter, akin to left handed people. The stutterers are considered less intelligent, even stupid and are frequently overlooked for better healthier candidates in a highly competitive Chinese economy. Although there are not many treatments available for curing stuttering in the traditional Chinese medicine, there are pockets of people who claim to have found cures for stutter (Reese, Hoffman and Li, 1999). It seems that the social and economic challenges are so numerous and the resources of the families so limited that little concern is given to issues such as stutter (Reese, Hoffman and Li, 1999). Eastern cultures it seems have a more open attitude about stuttering. However, the societal responses to the stutterers are no different from the rest of the cultures. CULTURAL THERAPIES IN AFRICAN CONTEXT South African culture of healers, medicine, doctors and even witches and wizards believe that mystical and natural methods can be used to cure stuttering. They believe that the cause of stuttering is due to evil spirits, curses, or some neglect in the care of the baby. However, the healers also believe that active therapy of teaching children to avoid stutter and proper using of words and language helps overcome stuttering. This particular logic aligns itself with the concept of mindfulness, when the patient is engaged to consciously avoid a particular habit or idea (Boyle, 2011). Singing is among the most common rituals and methods recommended in the African cultures to help children overcome their stuttering. Singing is associated high higher self-consciousness, and anxiety is the predominant psychological concern that emerges among children who stutter (Boyle, 2011). Therefore, singing could be used to overcome anxiety, highlight another feature of the person which is his voice, and thereby give him enough confidence to overcome stuttering (Boyle, 2011). Other use of materials having perceived mystical powers of healing include use of snail shells, owl nest, water from a particular kind of jar for water carriage called Canaries, heat and relief of the tongue by cutting the lingua frenum respectively. Herbal treatments, feeding grasshoppers to adult stutterers are also some of the recommended treatments in African medicine. CONCLUSIONS The current therapy should and can be a good amalgamation of the culture as well as the scientific evidence. For example, applying the singing therapy of the African culture with that of mindfulness therapy, in isolation or group can help children overcome their stutter even in school environments. The method can help bring confidence to children and allow them to express themselves more openly thereby reducing inhibition, and common outcome of stuttering among children when communicating (Boyle, 2011). This is not only a proposed solution but also a dire need for multicultural countries and health systems catering to people from different cultural and ethnic diversities. As stuttering holds deep connotations and concerns for people from different cultures, it becomes imperative to be aware of their importance in their culture and address the issue in the right manner (Hall, nd). Gradual increase in the awareness of stuttering can help overcome some of the negative cultural taboos associated with stuttering, improve the acceptability of people with stutter in the society and give them equal opportunity to live happy, healthier and fulfilling lives. REFERENCES Boyle M P, 2011. Mindfulness Training in Stuttering Therapy: A Tutorial for Speech-Language Pathologists. Journal of Fluency Disorders 36(2011) 122-129. Hall F, nd. Multicultural Considerations in the Treatment of Stuttering. Kenjo M, 2005. Stuttering Research and Treatment Around the World: Japan. The ASHA Leader. Nsabimana D, 2013. Stuttering Treatment in Africa: Challenges and Strategies. The Netherland Association for People Who Stutter. Site last accessed on May 10th, 2013 from http://www.demosthenes.nl/wc2013/index.php/program/accepted-abstracts/taboo-breakers/276-dieudonne-nsabimana Reese S, Hoffman S and Li L S, 1999.The State of Stuttering in China. Site last accessed on May 10th, 2013 from http://www.mnsu.edu/comdis/isad2/papers/reese.html Robinson T.L. Jr. and Crowe , T .A (1998) Culture Based Considerations in Programming for Stuttering Intervention with African American Clients and Their Families, LSHSS, Volume 29, p. 172-179. Thomas A M, 2002.Ideas in Our Country, Culture, Family About What Causes Stuttering and What Should Be Done About It. Paper Submitted at the International Stuttering Awareness Day Online Conference, ISAD 2002. Vinacour R E and Weinstein N, 2011. A Dialogue Among Various Cultures and Its Manifestation in Stuttering Therapy. Journal of Fluency Disorders 36(2011), 174-185. Read More