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Stammering is a disorder in the rate of speech delivery. It appears in the communication patterns of children aged between two and five and is characterized by repetitions or blockages that lead to ruptures in the rhythm and melody of speech. Three out of four children are destined to overcome it before adolescence. Stammering is a universal complaint and has been documented in the most ancient cultures.

Sigmund Freud associated this type of disorder with hysteria, but classified it separately as a fixation neurosis (on an organ [of speech]). Otto Fenichel located this functional speech disorder in the group of pregenital conversion neuroses. The patient's mental structure was the same as that of an obsessive, whereas the symptomatology was of the conversion type. Speech had acquired an unconscious significance related either to its verbal content or to the general meaning of the function of "speaking" itself, as in severe cases of stammering in which the speech act represents a reprehensible drive.

Bernard Barrau draws attention to the frequent presence of situations of oral violence in these cases, and fantasies of "forcible introduction," whether in relation to forced food or its metaphorical equivalents (the voice and speech of the mother). Ivan Fonagy stresses the fact that speech is capable of absorbing narcissistic, oral, anal, or genital libido, and reports observations of parallel strategies in the anal and glottal sphincter (stammering when establishing sphincter control), and upward transfers of anal libdinal cathexis (one of Charlotte Balkany's patients identified resonant air with air emitted by the anal sphincter). René Diatkine points to the absence of a psychic structure specific to stammering subjects, whose symptom, as a disorder in verbal communication, modifies their relational system, particularly the balance between narcissistic- and object-cathexes.

Annie Anzieu traces the elements in the neurotic dynamics of stammering subjects. An anal-sadistic relation is often established between the (grasping and abusive) mother and the child, with the child fixating on a dual, merging relation with the mother, excluding all connections to a third object, unless it takes part in the mother-child whole. Stammerers thus have difficulty in engaging oedipal problems. Supervisions must be redoubled in order to integrate oedipal prohibtions into the ego, because what enters the body or comes out of it assumes a new erotic meaning. The speech act permanently alludes to castration anxiety. This relational mode leads to the persistence of what Melanie Klein calls the paranoid-schizoid position. Indeed the stammerer is persecuted by a particularly demanding father and mother. All verbal emissions are problematic. Like feces, words are experienced as aggressive objects whose true intentions may be to wound or kill. They become the concrete symbols of interiorized aggressive objects. These paranoid characteristics entail a considerable obsessional element as well. Stammerers exhaust their discourse to the point of fragmentation; they remain haunted by the specific words they should be saying. Obsessional cathexis of discourse can be understood in the process of neurotic construction as a superegoic symptom in relation to the hysterical symptom stammering constitutes. The phonetic dysfunction and suffering caused by verbal emission are a form of hysterical conversion, a conversion that lends genital significance to an originally anal-sadistic symptom. The stammerer expresses the conflict he has always experienced through his symptom; the subject hides behind it. The act of speaking conceals what is said. The psychotherapy or psychoanalysis of stammerers always evinces these hysterical, obsessional, and paranoid contents in a more or less typical fashion depending on the moment in treatment and patient in question. For Nicole Fabre, stammering is an archaic difficulty shot through with oral aggressivity and anal sadism, from which the subject has not yet been able to break free in order to fully accede to oedipal triangulation.

Although psychoanalytic treament is rarely indicated initially, especially with children, this approach does provide an understanding of the disorder that does not exclude its meaning from the outset.

The etiology of stammering is unknown. Constitutional factors interact with environmental ones in addition to factors linked to the personal dynamics of the child in varying proportions depending on the subject in question, thus illustrating the uniqueness of the trouble each stammerer faces.

CHRISTIAN PAYAN

See also: Tics.