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What “The King’s Speech” Teaches Us About Stuttering

The film “The King’s Speech” won the Academy Award for Best Picture [on Sunday night.] The movie has come in for some criticism for its depiction of the political machinations surrounding the abdication of Edward VIII  and Britain’s appeasement of Hitler. The British-born writer Christopher Hitchens, unsparing and deliciously eloquent as always, puts the politics of  George VI in a far less favorable light than the movie does.      

But ”The King’s Speech” has won almost universal praise for its portrayal of the reluctant monarch’s stuttering, a speech pattern that includes involuntary repetition of sounds and syllables and “speech blocks” that cause prolonged pauses. Many young  children who stutter grow out of the problem, but perhaps as many as one in every 100 adults are affected by the condition, 80 percent of whom are men. Stuttering clusters in families, so researchers have been searching for inherited genes that might cause the condition. Last year, in The New England Journal of Medicine, NIH researchers reported some success with results showing an association between three mutated genes and stuttering, although those mutations are probably responsible for a very small minority of cases. 

It’s been said that ”The King’s Speech” will do for stuttering what “Rain Man” did for autism: Plant a sympathetic view of a disability in the public consciousness. One danger of such a quick infusion of awareness, however, is that it can harden into a fixed, if largely favorable, stereotype. We are finding out — or are being reminded — about all the famous people who have stuttered (many of them writers). First-person accounts are popping up all over the place because of the film. The best I’ve come across is by Philip French, a British film critic, who describes vividly what it was like to listen to the radio broadcasts of the real King George VI, wondering if he would make it to the end “like a drunken waiter crossing a polished floor bearing a tray laden with wine glasses.”

French writes about the special anxiety in his family: 

In my household, however, there was an additional source of unease — a special elephant in the corner of the room or, more accurately, a little Dumbo at the festive table, namely myself. I can recall no social experience prior to the king at Christmas 1937 and thus I can’t remember a time when I too didn’t stammer. Increasingly as the years passed, I became conscious of my family and our guests at that special annual occasion pretending not to look in my direction and clearly wondering exactly how they should react in my discomfiting presence.

In the movie, the Australian speech therapist Lionel Logue, played by Geoffrey Rush, has his royal client, played by Colin Firth, sing, swear (the swearing is the reason for the film’s R rating), and perform various strange vocal exercises. Despite their quarrels and class differences, the strong bond between the two men (at one level, the movie is a Masterpiece Theater-style bromance) is also presented as being crucial  to the king’s heroic, and eventually successful, efforts to control his stutter.  

After I saw the movie, and as a part of the runup to Sunday night’s show, I began to do a little research into stuttering. And after making some inquiries, last week I ended up emailing and then talking to Alex Johnson. Johnson is provost and vice president for academic affairs and a professor of communication science and disorders at the MGH Institute of Health Professions in Boston, an organization that trains speech therapists as well as nurses and other health professionals. Diagnosis and treatment of stuttering has been a focus of Johnson’s clinical career.

Certainly look beyond this blog post if you’re seeking expertise. But I’ll pass along a few of the things I learned from my conversation with Johnson, his blog post on “The King’s Speech,” a piece about Logue by Caroline Bowen, an Australian speech-language therapist who is an expert on Logue, and a  few other scattered sources:

  • One semantic issue can be put to rest right off the bat: Johnson told me that stuttering and stammering are interchangeable. The only difference is that the British prefer stammer over stutter.  
  • Johnson and others familiar with stuttering are quick to point out the contrast between “The King’s Speech” and other depictions of stuttering. Here’s a portion of Johnson’s blog post:

This movie is so unique in its accurate representation of the stuttering experience. I have, over the years collected episodes of television shows, cartoons (Porky Pig?), popular movies (, and some novels that have included persons who stutter as characters. People who stutter are most often portrayed in these media as cognitively challenged, mentally unhealthy, shy, dangerous, or as the object of ridicule.  How difficult a road this has been for people who stutter.

  • Lionel Logue, the speech therapist played by Rush, was trained as an elocutionist, a now-extinct profession devoted to proper vocalization and public speaking. (Interesting fact from a quickie Google search: Alexander Graham Bell’s father was a prominent elocutionist.) In his native Australia, Logue was something of a celebrity, and his recitals were well attended. Like Logue, many early speech therapists and speech “correctionists” had been elocutionists, and understandably, they applied elocutionist techniques to speech therapy. So, for example,  in the movie, Logue has his star pupil repeat tongue twisters, a common exercise taught by elocutionists. 
  • Apparently, Logue never gave a full account of the techniques he used with the king.  Still, once you make allowances for the need to streamline messy history into a story (the screenplay for the movei also won an Oscar), most of what we see is probably a fairly good reflection of Logue’s techniques, according to Caroline Bowen. In her estimation, the two aspects that don’t ring true are the use of swearing to increase fluency (what a shame — it’s a hilarious scene) and His Royal Highness agreeing to let Logue call him by his nickname, Bertie.
  • Logue is shown using singing a lot in the royal therapy sessions. Johnson says that contemporary speech therapy for stutterers wouldn’t typically include singing but that therapists do use techniques that tap into the fluency that most stutterers experience when they sing and take into account the timing and rhythm of speech.
  • In one of the movie’s early scenes, Logue shows the then-Duke of York that he can speak without stuttering if he doesn’t hear his own voice as he speaks. Johnson told me that this scene bears some resemblance to “delayed auditory feedback” techniques that have been part of mainstream stuttering therapy for decades. Modern electronics have made it possible for people who stutter to wear auditory feedback devices that look like hearing aids. They cost about $4,000 to $5,000 according to a recent article in The Washington Post. Johnson said that some models help people who stutter by not delaying when they hear their own voice but also by slightly altering the pitch. 
  • Johnson told me that  stuttering therapy today falls into two broad categories: Efforts aimed at modifying the behavior of speaking and those that focus on eliminating the fear of speaking. ”The King’s Speech” is moving partly because Logue is portrayed as being such a master at easing fear: The mere commoner, and an Australian to boot, who calms the king. In the final scene of the movie, George VI,  facing the dreaded microphone, reads his speech more to Logue than to the radio audience.

- Peter Wehrwein, Editor, Harvard Health Letter

*This blog post was originally published at Harvard Health Blog*

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

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Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

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