By Sandy Cohen
More than a half-century before Joe Biden entered the White House as president and shined a spotlight on stuttering, a UCLA researcher was laying the foundations for therapies that still are employed today to help people with the speech disorder.
AS A CHILD, PRESIDENT JOE BIDEN STUTTERED SO SEVERELY THAT HIS MOTHER WOULD GIVE HIM A PEP TALK EACH DAY BEFORE HE LEFT FOR SCHOOL, WHERE HE FACED RELENTLESS BULLYING. “REMEMBER, NOBODY IS BETTER THAN YOU, JOEY,” SHE WOULD SAY. “REMEMBER, YOU ARE A GOOD PERSON, JOEY.”
Even the teachers made fun of how he said his name, repeating his initials like a scratched record: J-J-J-Joey B-B-B-Biden. “I remember to this day how stuttering felt,” he shared during a speech in 2016 at the American Institute for Stuttering. “How dehumanizing. How embarrassing. How much it put into question — in my own mind, as well — my capabilities.”
Biden served in the Senate for 32 years before he was willing to publicly acknowledge his speech disorder. He finally addressed it in 2004, before an audience at the National Stuttering Association. “I’ve avoided coming to speak to you,” he told them. “Although all those who know me knew that I stuttered, I was reluctant to be nationally identified with it, because there are still people assigning rationales for why we stutter in the first place that are so insidious.”
Lack of intelligence. Lack of confidence. Weakness. Disability. Those are the characteristics that many people attribute to those who stutter, he said. “I was afraid that if people knew I stuttered, they would have thought something was wrong with me,” Biden says. “I, too, thought I was handicapped.”
Overcoming that shame and fear associated with stuttering is at the heart of most therapies employed today to treat the speech disorder in adolescents and adults. The foundations of that approach were laid at UCLA in the 1950s by a pioneering psychologist, Joseph Sheehan, PhD.
Like Biden, Dr. Sheehan stuttered as a child. His difficulty speaking belied his love of socializing and his playful sense of humor. It kept him from pursuing a career in chemistry — his first love — because he could not keep a job. After he found help from a therapist at UCLA in the 1940s, he went back to school to earn a doctorate in clinical psychology and devoted his career to understanding and treating what is known as childhood-onset fluency disorder.
Dr. Sheehan joined the UCLA faculty in 1949, and he spent the next 34 years conducting groundbreaking research and speech-saving therapies for people who stutter. Perhaps Dr. Sheehan’s greatest insight — still cited by speech therapists today — is the iceberg analogy he developed to explain the challenges of stuttering, which affects more than 3 million people in the United States and 70 million worldwide.
“The stuttering behaviors, and what we are able to observe on the surface, are really just 10-to-15% of what stuttering really is,” says Nicole Schussel, MS, a pediatric speech-language pathologist at UCLA Health. “Below the surface, we may see fear, shame, guilt, anxiety, isolation, denial, hopelessness — all of the things that really impact and exacerbate stuttering.”
Or, as Dr. Sheehan put it: “All those other feelings that we have when we try to speak a simple sentence and can’t.”
The 1950s were a golden age of research and treatment for stuttering in the U.S. Dr. Sheehan was part of a community of psychologists — predating the field of speech pathology — working to understand stuttering, its origins and how it might be overcome. Among Dr. Sheehan’s contemporaries were Oliver Bloodstein, who published the Handbook on Stuttering in 1959, and Charles Van Riper, who grew up with a severe stutter, gained international renown for his work on the disorder and is credited as a pioneer of speech pathology.
Scientists today still don’t fully understand stuttering, which has neurological, psychological, physical and genetic elements. But Dr. Sheehan and his fellow trailblazers were among the first to develop workable, promising therapies that could restore spoken expression to those who suffered in stilted silence.
Stuttering typically emerges in children around age 3 as their vocabulary is developing. Most children naturally outgrow stuttering behaviors, Schussel says, which are more common in boys than girls. Kids who begin stuttering before age 3½ are most likely to outgrow it, she says, while those who start later or stutter for longer than six-to-12 months are at greater risk of continuing. Having a relative who stutters is also considered a risk factor. Biden says he had an uncle who stuttered throughout his life.
Continuing to stutter into adolescence and adulthood is what creates the kinds of conditions Dr. Sheehan described in his iceberg analogy: the shame, guilt and fear associated with speaking. This generates what he described as an “approach-avoidance conflict,” a desire to speak that is hampered by a simultaneous desire to remain silent for fear of fumbling during speech. People who stutter also suffer a conflict of self-concept, Dr. Sheehan wrote. Because those who stutter also experience periods of fluency, there’s a tendency to embrace the self who speaks fluently and reject the self who stutters, he said.
He described stuttering as “a disorder of the social presentation of the self.”
“Basically, stuttering is not a speech disorder, but a conflict revolving around self and role — an identity problem,” Dr. Sheehan said.
“Your fear of stuttering is based largely on your shame and hatred of the way you speak,” he wrote in an essay, “Message to a Stutterer.” “The fear is also based on playing the phony role, pretending you do not stutter. You can do something about this fear if you have the courage. … You can learn to go ahead and speak anyway, to go forward in the face of fear. In short, you can be yourself.” Dr. Sheehan was joined in his work by his wife Vivian Sheehan, a speech pathologist. Together, they conducted group therapy sessions at UCLA to help people who stutter shed their fears and learn to speak more comfortably. The Sheehans encouraged their patients to accept themselves and how they speak, regardless of how it sounds. They advised clients to stutter openly and to maintain eye contact no matter what, even during blocks and halting speech.
Their work was so groundbreaking that Dr. Sheehan was a guest on such television talk shows of the day hosted by Art Linkletter, Merv Griffin and Dinah Shore, as well as That’s Incredible, bringing with him a group of regulars from his clinic to demonstrate his methods. He and his wife even brought clients into their home to reinforce their therapeutic approach. “My dad would use us kids as somebody for stutterers to introduce themselves too,” recalls Marian Sheehan, the eldest of the Sheehans’ three children and a speech pathologist who specializes in autism.
“We were instructed to maintain eye contact with the person while they are stuttering, and they had to say their name first. And I was fine with it. We waited patiently for them to get through the block.” The Sheehans counseled that stutterers should even tell others up-front that they stutter, so they’re less tempted to try to hide their speech issues with camouflaging tactics, such as word substitutions, errant “ums” and “uhs” or pretending to forget what they wanted to say.
“If you bring your iceberg up out of the water, it can melt,” Vivian Sheehan would say. Videos of these sessions are alternately heartbreaking and triumphant. For many people who stutter, saying their own name is one of the hardest things to do smoothly. Clinic participants, seated in a circle, look intently at a speaker as he struggles to simply say “Peter is my name.” They all maintain eye contact. Peter is at first silent, then tentative. When he finally introduces himself, his face softens and his shoulders relax.
“Your name is so personal to you. It’s representative of you,” Schussel says. “I’ve had adults who stutter tell me they’ve introduced themselves with a completely different name, because they were so afraid of stuttering. There’s just so much fear, anxiety and shame around speaking.”
VIVIAN SHEEHAN CONTINUED DR. SHEEHAN’S GROUNDBREAKING THERAPY for another two decades after his death from pancreatic cancer in 1983, first at UCLA and later at the Sheehan Stuttering Clinic in Santa Monica. By the time filmmaker Allan Holzman found her, he was desperate. His stutter emerged at age 6 and, as a teenager and young man, he did everything he could think of to overcome it. He tried therapy. He ran for class president. He enrolled in a Dale Carnegie public-speaking course.
He took acting classes. He changed jobs and moved to different cities, each time attempting to reinvent himself and outrun his speech disorder.
“I was in the habit of changing my life every three years, but failing at changing my stuttering. And when you move and fail, you fail really deeply, because it’s such a disappointment and you put so much into the dream of losing your stutter,” says Holzman, now 73. “I was burnt out on all the tricks to lose your stuttering. I wanted to be natural and real and not stutter.”
He’d read about the Sheehans’ approach and wondered if it might work for him. At the time, Holzman was a burgeoning filmmaker living in Los Angeles. Because he often froze up on the phone, he asked his wife to contact Vivian Sheehan on his behalf. Sheehan refused the call. “She said, ‘He has to call me himself,’” Holzman recalls, “which was a very Vivian thing to do: Make the stutterer talk.”
Holzman went on to spend a year as Sheehan’s patient — “or student, as she liked to call it” — and 10 more as a role model for other clinic participants. He also made two documentaries about the Sheehans’ work: a portrait of Dr. Sheehan’s contributions at UCLA titled for Dr. Sheehan’s essay, Message to a Stutterer, and No Words to Say, an intimate look at Vivian Sheehan’s stuttering clinics. Both films reveal the painful struggles those who stutter encounter anytime they want to speak: the mental tightrope walk around potentially troublesome sounds, the frantic search for substitute words, the paralyzing fear of a silent block that leaves a meaningful thought unexpressed.
Because the Sheehans advocated that those who stutter accept this fact about themselves and address it openly with others, Holzman recalls that one of his earliest assignments in therapy was to talk about his stuttering with his parents. “Of course, your reaction is, ‘My parents know I stutter,’” he says. “But at that point, I had only talked to them three times about it.” Holzman was then 33 years old.
The Sheehans encouraged their students to simply speak, and even to stutter intentionally. At the heart of their approach was fostering an idea of acceptance among those who stutter — acceptance of themselves and how they talk.
MOST MODERN SPEECH THERAPIES FOR STUTTERING, except those aimed at very young children, include a major element of self-acceptance. One of Dr. Sheehan’s university students in the 1970s, Vivian Sisskin, has carried on the Sheehans’ work in her own private practice and as a clinical professor in the Department of Hearing and Speech Sciences at the University of Maryland.
Sisskin hadn’t intended to make stuttering her career until she met Dr. Sheehan. As an undergraduate at UCLA, she took his class on a whim as an elective. “I can’t tell you how fascinated I was. It was the first time I was truly fascinated with a topic,” Sisskin says. “Joe — in those days, Dr. Sheehan — was a very funny man who stuttered, who explained stuttering in a way that made it look so incredibly interesting to me. He talked about the paradoxical nature of stuttering and that the harder you try to be fluent, the more you stutter.”
Sisskin became an apprentice of Dr. Sheehan, working with him in the speech psychology lab and sitting beside him as he conducted his therapy clinics. She went on to develop a treatment approach called Avoidance Reduction Therapy for Stuttering (ARTS), which is now taught all over the world. ARTS calls for accepting one’s identity as a person who stutters and becoming aware of “avoidance behaviors” — those personal tricks adopted to escape or outwit blocks and sound repetitions — to gently release them. It encourages stuttering openly and self-disclosing the speech issue as a form of self-advocacy. The goal is forward-moving speech, without behind-the-scenes mental maneuvering, no matter how it sounds.
There are various approaches to speech therapy for people who stutter, she says, including “fluency shaping,” which focuses on eliminating sound and word repetitions so speech sounds smoother. But acceptance-based therapy has endured for decades. “I think because times are changing right now, the therapy is even more popular and more interesting to people, because it resonates with the way our society is going in terms of general acceptance and inclusion,” Sisskin says.
But speech therapy isn’t cheap, and it isn’t always covered by insurance. Nathan Mallipeddi, a UCLA graduate and now a first-year medical student at Stanford University who grew up with a severe stutter, didn’t have access to private speech therapy as a child. Beyond the expense of such treatment, there was a cultural barrier in his South Asian community, he says. “There’s a more pronounced cultural stigma. So when you have a stutter, the automatic reaction is hide it and stop it, not go out and get help.”
He received some therapy at his public elementary school, where fewer than 5% of speech therapists are specifically trained in stuttering, but, otherwise, was on his own to overcome the impediment, which he did through sheer determination and consistent practice. “In high school, I kind of forced myself to stop letting it really dominate my life,” Mallipeddi says.
He volunteered to give presentations. He got involved with student council. He talked to anyone he could. And he eventually identified strategies that allow him to speak more smoothly. “It’s called ‘covert stuttering,’ and some days are better than others,” he says. “I can still feel the stutter coming, but, through hours of practice growing up, I kind of developed a way similar to how Biden does it, where he’ll stop talking, he’ll take a pause, he’ll switch his words.”
Mallipeddi calls stuttering an “invisible disability,” and he still feels the sting of humiliation when he stumbles on a word. “Every time I slip up — and I still do, a lot — then it’s automatically: ‘He’s not smart. He’s nervous,’” he says. “That is the most debilitating part for people who stutter.” Though he hasn’t undergone acceptance therapy, Mallipeddi is such a proponent of the approach that he created a nonprofit organization to provide the treatment to young people who stutter who otherwise wouldn’t have access. While pursuing a double-major in biology and political science during his undergraduate studies at UCLA, Mallipeddi founded the Southern California Stuttering Service in 2017. The organization is sponsoring speech therapy for 100 economically disadvantaged children a year and providing low-cost therapy for scores more in the U.S. and Canada.
Most speech-language pathologists work in private practice, and a course of therapy can cost upwards of $15,000 a year, Mallipeddi says. “There are people from severely financially disadvantaged backgrounds who might be struggling to make ends meet, let alone afford therapy. There’s this whole community whose potential is being hindered,” he says. “And when you provide them with a voice — once you provide that opportunity, we can create so much change in the world.”
Like Dr. Sheehan, Mallipeddi’s academic and professional paths have been shaped by his experiences with stuttering as he envisions a career dedicated to improving the lives of people with disabilities. “If you ask people who stutter if they could take a magic pill and make it go away, would they? For me, I wouldn’t do it, because it’s brought me so much,” Mallipeddi says. “Honestly, I’m not sure where I would be without stuttering. It’s been everything.”
MALLIPEDDI MIGHT DECLINE A MAGIC PILL, but Gerald Maguire, MD, believes that others could make a different choice. Dr. Maguire, a psychiatrist and neuroscientist and former chair of the National Stuttering Association, is one of the foremost researchers on the condition. He currently is leading a clinical trial at the UC Riverside School of Medicine to study if a drug called ecopipam might help adults who have stuttered since childhood to speak more smoothly. He also published a study in February 2021 in Frontiers in Neuroscience that examined the effects of risperidone, a drug generally prescribed for schizophrenia or bipolar disorder, on the brains of people who stutter. No medications to treat stuttering have been approved to date by the U.S. Food and Drug Administration.
Like Mallipeddi and Dr. Sheehan, Dr. Maguire was inspired by his own experiences with stuttering to devote his career to alleviating the emotional pain associated with the condition. He recognized at age 5, as a kindergartener who had to give an oral presentation about his family in class, that he had trouble making certain sounds — words starting with “B” were difficult — but also that he could substitute words. “What 5-year-old uses the word ‘sibling?’” he jokes. This experience showed him that his stutter wasn’t reflective of his intelligence. By the time he was in high school, he knew he wanted to study the brain to discover the origins of stuttering.
His uncles stuttered. So did his older brother, who took his own life in 2003. “I think a lot of that related to his stuttering,” Dr. Maguire says. “So that emboldened me even further.”
He’s spent decades researching and treating the disorder, and publishing cutting-edge brain-imaging studies seeking to identify where speech processing goes awry. He recently launched a project with UCLA’s Human Brain and Spinal Fluid Resource Center, a brain bank where he plans to study human tissue from a recently deceased 94-year-old donor who stuttered throughout his life. “No one has ever looked at the human brains of stutterers,” Dr. Maguire says. “I hope to go into the tissue mechanism underlying how we’re connecting the dots from the various understandings of stuttering.”
Dr. Maguire experimented with medication for stuttering long before the ecopipam study, Speak Freely, sponsored by Emalex Biosciences, got underway in December 2020. “I’m my first candidate,” he says, adding that he has been under the care of a prescribing doctor since 1993 and is not taking ecopipam, the study medication.
Ultimately, he hopes to develop, in partnership with the National Institutes of Health and researchers in the U.S. and abroad, a “unified theory of stuttering.” He believes it’s a multifactorial genetic and neurological condition. For those who continue to stutter beyond childhood, it’s a lifelong issue, he says, but an individual’s ability to speak fluently can be significantly improved with tailored combinations of speech therapy, psychotherapy and medication. “You can overcome stuttering in many respects, but it’s like diabetes,” he says. “Even when it’s under control, you’re still diabetic.”
Dr. Maguire still repeats certain sounds from time to time, but speaks with comfort and ease. “Once a stutterer becomes fluent, you can’t shut us up,” he says, with a laugh. “We’ve been pent up our whole lives.”
He and other experts interviewed for this story say that Biden still stutters. As Mallipeddi notes, the president is a covert stutterer. Sisskin and Dr. Maguire, neither of whom has worked with Biden, agree. “My husband and I watch him stutter all the time on TV,” Sisskin says. It may not sound like syllable repetition, she says, but it comes across in substituted words and “closing his eyes during a disfluency.”
“Regardless of experts picking apart his stuttering, I think the fact that there’s a person who stutters in the White House right now is the best thing ever for young people who stutter,” Sisskin says. “We say to our young clients, ‘You can stutter and be anything you want. You can stutter and be a teacher. You can stutter and be a police officer.’ And now we can say, ‘You can stutter and be president of the United States.’” Beyond that, people who stutter grow up with greater empathy and humility, Dr. Maguire says. “It breeds a lack of narcissism,” he says. “You realize that other people are better than I am at some things. You say to yourself, ‘I have some limitations and I need some help here.’”
Biden is hardly the first high-profile person who stutters — from Moses in the Old Testament to King George VI, dramatized in the film The King’s Speech, to such actors as Nicole Kidman and James Earl Jones — but he is, perhaps, the first to publicly characterize it as a strength. “People talk about him going through adversity. His first obstacle was stuttering, and that, I think, helped him when he was going through the other tragic events that happened in his life,” Mallipeddi says. “There are a lot of us who go through this without anyone ever knowing.
So, seeing that highlighted [at the Democratic National Convention], I had chills for, like, a month.” The president himself says stuttering has made him a better person. “I learned so much from having to deal with stuttering,” he said. “It gave me insight into other people’s pain, other people’s suffering. It made me understand that everyone — everyone — has something they’re fighting to overcome and, sometimes, trying to hide. “It taught me,” Biden said, “that there isn’t anything you can’t overcome.”
Sandy Cohen is a senior writer in UCLA Health Communications and a former national writer for The Associated Press.