Stuttering is not considered in the narrow sense of a one-sided, superficial understanding according to a didactic template, such as a deficiency of "one speech skill", or as a "speech defect", or even as a "spasmodic coordination neurosis" (Kussmaul), but in a broad sense in the fullness of the picture of the pathological personality of the patient with his internal and external experiences. Only with such a view will the true essence of stuttering be understood, it will be revealed to us as a disease of a fearful personality with an altered mental makeup.
The following states will be considered as permanent mental experiences:
1) Fear, as a system of images of fearful self-esteem, is the basis of the personality of a stutterer.
2) The presence of a common obsessive idea: "I'll stutter."
3) The presence of a fixed obsession in the form of a phobia of certain words.
4) The periodic occurrence of obsessive, convulsive, difficult words with any new excitement, such as: shyness, embarrassment, uncertainty, doubts, confusion, etc.
5) Obsessive states of shame that force one to hide stuttering as a subject of shame and humiliation (“phobia of stuttering itself”).
6) A state of anxious anticipation and uncertainty before an upcoming conversation, when the patient assumes that they will probably talk to him, or he himself will be forced to enter into a conversation, explanation.
7) Fear of unexpected questions, meetings, explanations.
8) Fear of unexpected questions, reports, dispatches, queues to receive tickets at the box office, etc.
9) A mood of suspicion, distrust, ill will in thoughts and imaginary pictures.
10) Depressed state and mood after failures and cases of stuttering, or, all the same, after unfulfilled, unfinished, postponed intentions, decisions, assignments, promises.
11) Various types of split personality, tendency towards introspection.
12) Phobia of people, as well as phobia of different life situations, responsible decisions.
13) Habitual motives and tricks of defensive behavior in the fight against illness. Various forms of fearful will.
14) State of melancholy and hypochondria.
In a stutterer, we call obsessive thoughts those that constantly, temporarily or for a moment, but powerfully fill the patient’s consciousness, do not allow any objections, are felt as a heavy burden, attracting to themselves, at that moment, all available affective attention.
According to their form of discovery and origin, the following seven species can be distinguished.
1) General vague obsession: “I’ll stutter,” when the exact conditions of time, place, and situation have not yet been determined, and when neither the content of the conversation nor the person with whom you will have to talk are known.
2) No less painful is another kind of obsession, which occurs immediately as soon as the stuttering patient must urgently go somewhere and personally carry out an assignment... no matter what the patient does, no matter how and where he is distracted - his brain is permeated every minute with obsessive thoughts about the expected failure.
3) The third form of obsession has as its object some difficult word and is expressed in the mind like this: “I will stutter on such and such a word”...
4) The fourth form of obsession, like the second, does not occur in all patients, but only in those who sometimes decide to enter into a fight with their obsession and go their own way against obvious danger, not listening to its advice and instructions. In another case, obsession appears in the form of other people's "voices", orders and always in a categorical, imperative form.
5) This form of obsession is expressed in the fear of discovering the very fact of stuttering; the patient is ashamed of stuttering, considering it a disgrace and humiliation.
6) Further obsession, no less painful than pathological shame for one’s stuttering, is presented in the form of fear of other people’s opinions or, all the same, fear of strangers and even familiar faces.
7) Obsessive thoughts can also include the effects on the patient’s imagination of various signs, superstitious observations and false judgments.
In the system of psychological treatment of stuttering, pathological speech itself with all its spasms, tricks and protective methods does not play the main or primary role (as in the didactic method), since it represents not only a secondary symptom, but also a phenomenon subordinated, generated and supported by a fearful state of mind and its various forms. Therefore, it is clear that with the implementation of only causal treatment, organized in a whole series of the indicated psychological measures (1909), stuttering is finally eliminated and normal speech is restored in the patient.
As is well known, in addition to causal treatment, there is also symptomatic treatment, when attention is paid to individual attacks of the disease and one or another method is used to weaken and remove them at the present moment and in the future. The psychological method completely ignores such a method as untenable, fruitless and even harmful. Indeed, to treat the symptoms of any mental illness means to mark time and even contribute to the intensification of the underlying suffering. We must not forget: a symptomatic phenomenon is part of the entire disease, and no matter how much it is treated, the latter remains unchanged. Furthermore, the significance of such an external symptom as convulsive speech is that it outwardly expresses the psychological cause hidden behind it, as an active motive. If we temporarily remove it by means of some method, trick, distraction, change of scenery, then we will not help the matter and will not benefit the patient, because the psychological structure of the convulsion remains the same, and it will recur again in the same form under appropriate conditions. Only causal treatment - i.e. action on the main psychological motive - can weaken and then destroy the convulsions forever. Such a measure fully corresponds to the indication: "to treat the sick person, and not just the speech."