A commonly-used definition of a stammer was coined by Professor Pam Enderby in 1996. A stammer is:

characterised by stoppages and disruptions in fluency which interrupt the smooth flow and timing of speech. These stoppages may take the form of repetitions of sounds, syllables or words, or of prolongations of sounds so that words seem to be stretched out, and can involve silent blocking of the airflow of speech when no sound is heard.

There's no such thing as a typical 'stammer'. Or as a typical 'stutter' - a term which in most places means the same thing, but which is more commonly used in North America. Every individual stammer is different, but broadly speaking, there are three forms of 'disfluency' – repetition ('Don't P-P-P-Panic'), stretching (Don't Paaaaaanic) and blocking (Don't...... Panic). Most stammering starts from a very early age ('developmental' stammering), but stammering can also be 'acquired' later in life through neurological trauma such as a stroke. More rarely, major trauma can also start a stammer, but this is usually temporary.

Some Things that are True about Stammering

Approximately 5% of under-5s stammer, dropping to 1% of adults. 1% of the adult population is really quite a lot... so the chances of you not knowing (or having known) someone with a stammer is really quite small. If there are 25 people in the average extended family, then one in four people reading are likely to have a family member with a stammer. The average Facebook user apparently has around 150 'friends' - so, statistically, the chances are that one or two will stammer. If the UK population is 60 million, that's at least 600,000 people with a stammer of some sort. Actually, it's higher than that because of the increased prevalence among children. I'm labouring this point somewhat because it's a condition that's much more common than a lot of people think, and relative to the numbers, it is a particularly widely (and often wildly) misunderstood and heavily stigmatised condition.

Among adults, between three and a half and four times as a many men as women stammer. Research so far indicates that these figures are consistent over time, across cultures, and across social classes. There is no 'cure'. No one knows what causes stammering, but it looks as if there is a genetic component, albeit a fairly weak one. Research has shown fairly conclusively that there are consistent differences in brain scans between those who stammer and those who don't, indicating that the cause is physical, rather than psychological. However, psychological factors can make a difference - most people who have a stammer do report that stress and tiredness can make it worse, and that they have some days that are better or worse than others.

Oddly, many people with a stammer do not stammer when whispering, singing, acting (there's a weirdly high number of actors who are said to stammer), faking a different accent, or when speaking the same words as someone else at the same time. All this is very weird, and given these oddities, people could perhaps be forgiven for thinking that psychological - rather than physiological factors - are to blame. However, there are good reasons for thinking that different neural pathways are involved in these tasks, which may be affected (or not) differently.

Things That are Not True about Stammering

Stammering is not a sign of slow wits or low intelligence. It's not a sign of mental illness. It's not a sign of a lack of confidence or shyness - that's mixing up cause and effect. No one should be surprised that some people with a stammer can sometimes be quite shy and withdrawn, but given the nature of the condition and the way people often react to it, that's to be expected. But stammering is not caused by shyness or a lack of confidence. While improving confidence and overcoming shyness might also help someone cope with a stammer, it won't make it go away.

Stammering is not caused by a dysfunctional upbringing or childhood trauma. It won't magically go away or get markedly better by (a) suffering a mild concussion; (b) meeting the boy/girl of their dreams or having some kind of fantastic life experience; (c) becoming Emperor of Rome; (d) running over Kevin Kline with a steamroller. Which is a pity.

What is Covert Stammering?

Well, 'covert' means hidden or disguised, and so a covert stammer is one that is not obvious to the casual listener. This is generally because the person with the stammer goes to great lengths to conceal it, and to keep their speech sounding as 'normal' as possible. My stammer, for example, exclusively takes the form of blocking – being literally and absolutely unable to make a sound for a few seconds.

Another word that's sometimes used is 'interiorised', and I think it's a better description of what's actually happening - it is happening, but the outward signs are very limited. It's a bit like a swan apparently serenely gliding across a lake – all effortless grace on the surface, but frantic kicking underneath. To the casual observer, it may appear that there's nothing wrong with my speech, but the truth is rather different. By definition, 'covert' stammers tend to be less severe, because they can be more or less successfully hidden in a way that a more severe stammer cannot. But it's also true to say that what many so-called 'cures' and 'treatments' for stammering do is turn an overt stammer into a covert stammer. And that's not necessarily a good thing at all.

Passing for Normal: Faking Fluency

The prime weapon in my armoury in my attempts to appear normal is word substitution. If there's a word I think I'll struggle with, I'll substitute a different word, an alternative phrase, another term, or a near-synonym. A lot of people with a covert stammer develop extensive vocabularies and an impressive mental thesaurus for precisely that reason. My other tricks include temporary absent-mindedness – pretending to forget something to cover for the fact that I can't say it. Indecisiveness is another good one – I generally know what drink I want or main course I want before the bartender or waiter asks me, but more often than not, I reply as if I've only just made up my mind, to cover the fact that I can't say what I want fluently. If I were to really analyse my speech pattern, rhythm, idioms, and habits, I reckon I'd find that pretty much everything about the way I speak is designed to help me hide my stammer. Looking thoughtful before starting a sentence that doesn't really require much thought. Letting sentences tail off, or finishing them with a gesture or a facial expression. The fact that I seldom use people's names when speaking to them unless I have to, lest I stammer on it and give the impression I've forgotten who they are. But then... you lot, you so-called fluents do at least some of this too - just because you're fluent doesn't make you eloquent. Innit, though? Know what I'm saying?

Word substitution has limitations - the main one being that it doesn't work when words can't be substituted. My name is what it is, my address is what it is, and so on. And it's these kinds of situations that tend to be difficult for those with a covert stammer. It's common in meetings to go 'around the table' and for everyone to introduce themselves. I hate this – I can't say my name or what my job title is straight out... I just can't. I need a kind of run up, so I say 'My name is [little block] Otto Fisch, and I'm a Researcher for h2g2'. And even then, it sounds strangled. Sometimes I get an odd look or two (even when I use my real name and job title), but mostly I get away with it.

More problematic than using tricks like word substitutions are what's called 'avoidant behaviours'. These aren't ways to cope... they're forms of withdrawal and retreat. If you rarely speak, you'll rarely get caught out. Simple, really. Don't answer questions in classes, don't volunteer opinions in meetings, don't go and talk to that girl/boy you like, don't 'network', don't go to parties unless you know most of the people going. Don't do any job that involves public speaking. And most of all, don't pick up the phone (of which more later) if you can possibly, possibly help it. Don't... in short... do anything that might get you found out as not being normal. I am guilty of these kinds of behaviours at times, but my aim is to set limits on how avoidant I allow myself to be. So, even though I really should talk to that person I don't know before the meeting starts, I'm having a difficult speech day and I know I'll struggle to make small talk fluently then, well, I'll give myself a break and just not bother... just this once.

There are two problems with coping mechanisms and avoidant behaviours. The first is that they're not perfect. However 'good' at pretending to be normal you are – and believe me, I'm pretty good – you're going to get caught out from time to time. And when that happens, it feels awful. Putting a huge amount of mental effort and energy into appearing normal, and making the odd strategic withdrawal when it feels like it's unlikely to work, makes it all the more difficult when I am caught out, or even just feels like I've been caught out. If my deception is generally good enough, most people won't be aware of my stammer, and so won't understand what's going on or know how to react. And in turn, I'm not used to explaining my stammer, or knowing how to respond. With avoidant behaviours, there are times when avoidance ceases to be a realistic option, and there's always the danger that the occasional withdrawal can turn into a full-scale retreat.

The second problem is that it's exhausting. Imagine what it's like to have all that going on constantly in the background, all the time, in every conversation, in every social situation. I'm struggling for a good analogy for this, as - after all - it's all I have experience of. But the best metaphor I can think of is that it's like a resource-hungry program running in the background of your PC, potentially or actually reducing efficiency and taking resources away from what you're actually using the computer for.

Treatment and Speech Therapy

This section is going to be a bit sketchy, as I don't know very much about treatment for stammering, as I've seen a speech therapist precisely once. Put on a waiting list when I was 11, I reached the top of the list a whole four years later, aged 15 or 16. By that stage, I had four more years of experience at pretending to be normal, the additional self-consciousness of an adolescent, and a stammer which had been driven from being 'overt' to 'covert'. I think I was so far in denial about it that I probably believed what I said when I said it was pretty much gone.

In broad terms, treatment varies depending on the goal of treatment. Historically, the aim of most treatments was achieving the greatest possible degree of fluency - 'fixing' the 'problem'. While there's no cure, the symptoms can at least be minimised or reduced. 'Fluency Shaping' therapy seems to involve breaking down the components of speech and building them back up again, leaving a new way of speaking which is more fluent, but which may not be sound particularly natural, and which may not be sustainable over time.

More recent approaches have shifted the aim of treatment from a quest for total fluency to attempts to make the stammer more manageable. Part of this involves technical exercises and particular coping mechanisms which don't seek to hide the existence of the stammer, but instead make incidents of stammering easier. Part of this approach involves addressing the very powerful emotions and feelings which people who stammer will have about their speech. I'm told that it's not uncommon for people undertaking this kind of therapy to learn to fake their own stammer in order to desensitise them to other people's reactions, and to practice telling people about their stammer.

Psychologist and speech expert Joseph Sheehan, who himself had a stammer, described it as ...like an iceberg. The part above the surface, what people see and hear, is really the smaller part. By far the larger is the part underneath the shame, the fear, the guilt, all those other feelings that we have when we try to speak a simple sentence and can't. He argued that addressing those underlying emotions, and being willing to stammer more or less openly, would reduce negative feelings and reducing fear and stress would in turn make speech easier.

Particular Challenges - Public Speaking and Phone Calls

A fair proportion of the 99% of the adult population that do not stammer are not comfortable with public speaking, and it's usually right up there in any list of common fears and phobias. It's a particular dread for many people who stammer. When giving a presentation or lecture, or asking/answering a question in a large meeting or in class, you're the centre of attention and everyone is judging you. People are judged not only on the content of what they say, but the degree of fluency and clarity with which it's expressed, levels of confidence, and so on. This can be tough for anyone, but for people who stammer it's even harder. There is - literally - nowhere to hide. And because some people just aren't able to separate the mode of delivery from the message, someone who stammers who is perfectly competent and capable may not be interpreted that way. I guess I'm quite lucky as regards public speaking - I'm not brilliant, but I've always been more confident and more fluent than many people who don't stammer. It helps that I've had a lot of practice in various different situations, and I think the main thing in my favour is that I'm able to treat it as a performance, like acting. This reduces anxiety, because I can play the character of me doing the talking, and it's possible that it's using different neural pathways or something. I dunno. Something I've taken to doing fairly recently is telling people at the start of a presentation that I have a stammer, and generally that's worked fairly well for me. Oddly, I can find small talk before and afterwards to be harder work.

Similarly, there is a fair proportion of the 99% of the adult population who don't stammer who don't like phones much. I think it tends to be men more than women, but it's not uncommon to find someone who's confident and outgoing in person but who really doesn't get on with phone calls. For people who stammer, though, phone calls can be a real source of dread, because, well, voice is the only source of information. If I want to phone someone up, I need to explain who I am and what I want, and these aren't things that lend themselves to word substitution. Non-verbal communication doesn't work, and there's no way of punctuating silences... they're just silences. And these are particularly bad at the very start and end of phone calls. I especially hate call centres - well, everyone does, I know - but identity checks can't be word-substituted, and a stammer could be mistaken for nerves or suspicious behaviour. To give them their due, though, I've found that most call centre staff seem reasonably well trained and will at least have some understanding of the problem.

A Few Words on Stammering in Culture, TV, and Film

A full discussion on the portrayal of speech impediments in popular culture would be worth an Entry in itself, but to cut a long story short, most of it is wildly wrong. Broadly, there seem to be four broad ways in which characters who stammer are used. The first is comic relief, because obviously people who are unable to speak properly are funny. Aren't they? Otherwise why would pretty much every 'Loony Tunes' cartoon character have some sort of speech impediment? The second is as a cipher for social dysfunction, or a shorthand way of marking a character an inadequate, an outsider, a loser, or a misfit. And possibly criminal and/or evil. The third is as a way of making one or more of the more important characters look sensitive and compassionate by the way they treat him or her. The fourth is as an outside manifestation of personal growth over the course of the narrative, generally with the stammer becoming less pronounced or somehow vanishing entirely. Hooray!

What do I think about all this? Well, in debates about the treatment of disadvantaged groups, I tend to try to distinguish between offence and harm. I'm not on particularly strong ground when it comes to offence, because complaining about being offended about the portrayal of people who stammer sounds rather like special pleading. Harm, on the other hand, is rather different, and I think there's a stronger case for complaining about 'serious' portrayals of people who stammer, which perpetuate harmful myths about the condition, than about those which just want a cheap and easy laugh.

Two myths in particular I don't want to see perpetuated. One is that stammering is caused by a dysfunctional childhood. It isn't. The second is that it is the result of shyness or a lack of confidence that can be magically overcome. While it's true that confidence and openness and speech therapy can make a difference, the danger is that a stammer becomes seen as a character or personality flaw, and therefore something that I'm to blame for - something I could overcome if only I were brave enough. Oh, if only I could just pull myself together....

In general, I think it's a good thing that films like 'The Kings Speech' and even 'A Fish Called Wanda' exist, and that there are characters elsewhere who stammer. Being misrepresented is generally better than being ignored entirely, although I do wish that actors, writers, and directors would take the trouble to inform themselves and get it right. I don't even mind there being some comedy in the portrayal, as long as careful thought is given to how it's done, and it's not used for cheap and lazy laughs. A character with a stammer should have more attributes and traits than just a stammer. And most importantly, any humour actually has to be funny. Otherwise it really is inexcusable.

How Not to Make a Fool of Yourself in Front of Someone who Stammers

It's only fair to tell you that if you ever, ever utter any of the following phrases to someone with a stammer, then the chances are that the person you were talking to secretly hates you, or was at least tempted, however briefly, to punch you repeatedly in your stupid face. My violent revenge fantasies often feature a spade.

1. Spit it out  – Yep, that'll work. I'm clearly struggling with my speech just to annoy you.
2. Slow down.. take your time  – My God... that's it! That's it! If only I'd thought of that before! I'm cured!
3. Take a breath  – It's surprising how many amateur speech therapists there appear to be.
4. Just relax  – This strikes me as a generally counter productive thing to say to anyone at any time.
5. Stammer? You don't have a stammer  – Don't I? Oh, silly me! What a fuss to make about nothing for all those years!
6. [some deeply improbable anecdote about someone they know having been 'cured']  – Really? How fascinating! You do know the difference between 'cured' and 'you don't notice it'? No? Would you like to buy some magic beans?

I'm sure they'd also appreciate it if you'd try not to laugh in their face or mimic their stammer. You'd think this would just be basic politeness, but apparently not. I know I'd appreciate it if no one ever asked me ever, ever again if I'd 'forgotten my name'. Barring a case of sudden-onset amnesia that would probably make medical history, the chances are that's not what's going on. I'd also appreciate it if people didn't patronise the hell out of me, talk down to me or start speaking SLOWLY AND CLEARLY AND LOUDLY for no apparent reason. Having said that, I'd take being patronised by someone who at least has enough awareness to work out what's going on, over having some boorish oaf laugh in my face.

To be fair to you lot, it is genuinely difficult for you to know how not to make fools of yourselves. A lot of equal ops and disability awareness training courses are (ironically) pretty much silent about all speech impairments, which is odd, given the figure of 1% of the adult population just for stammering, and that stammering generally counts as a disability under anti-discrimination legislation. And as I've said, you can't count on popular culture for any useful guidance. So I've got some empathy for you, not least because it's not easy for me either when I meet other people who stammer. You'd think there would be a kind of kinship or camaraderie, but that's not always the case - sometimes it's difficult to be confronted by something in another person that you fear and despise in yourself.

It's not the easiest thing for you to react appropriately. A stammer can be a weird, alien, strange, disturbing thing to be faced with. It can feel awkward - embarrassing even - and if I'm feeling generous I put some of the most inappropriate reactions down to that sense of surprise or awkwardness or embarrassment. But generally the best thing you can do is not to react at all, and just to shut up, be patient, and listen to what you're being told. Try to concentrate, as best you can, on what's being said to you rather than how it's being said. If you can manage to stay calm and relaxed, it'll make it much easier for someone with a stammer to talk to you. Stress and pressure often makes a stammer worse, so if you're patient, you will make it easier. It also helps that you're even prepared to listen - one common reaction that you lot sometimes have is to get out of the conversation as quickly as possible. That's been my experience, anyway, although I shouldn't discount the influence of my toxic personality or the possibility that I smell.

Oh, and it's 'people who stammer', not 'stammerers', if you'd be so kind. There is generally more to most of us than that single fact, and I'd rather not be defined by it.

One question that often comes up is whether you lot should finish sentences for someone who stammers, and I think the default position is that you should consider it to be patronising and you shouldn't do it. Certainly, you should never interrupt someone who stammers, and you should never finish an idea or thought for them, but surely everyone should be given this basic respect. Being interrupted really, really annoys me because I've usually planned out in some detail what I'm going to say, and I can't quickly recalibrate it to either take account of an interruption, or assertively continue to talk over the interruption. I remember one regular work meeting that I used to dread because two characters in particular did this all the time, and not just to me. I was very covert at the time - I wouldn't stand for that kind of behaviour now. But... if you do ever chair meetings, it really shouldn't matter if anyone stammers or not. It shouldn't be happening, and as Chair, it's up to you to stop it.

But opinions do differ on finishing sentences. I don't mind someone finishing my sentences or filling in a block for me, as long as it's occasional rather than routine, and it's someone I know and trust. Try to take over my communication for me, though, and that's a different matter. Anyone finishing my sentences has to get it right, though, otherwise it makes things very difficult, because then I've got to correct them. I also don't mind people subtly making life easier for me. For example, when out with friends, I've noticed that one or two don't ask me what I'd like to drink any more, but ask if I'd like drink X, where X is what I normally drink. I don't know whether this is deliberate or not, but even if it is, it's subtle and I don't mind it. A former boss tended to introduce me rather than leaving me to introduce myself, but then he liked to talk, so it may not have been deliberate.

As I said at the start, every stammer is different and everyone with one is also different. One way of finding out about finishing sentences and other ways to make things easier is just to ask. But I'd suggest using a great deal of care and tact about how you go about it. Some people will be relatively comfortable about discussing their stammer, others won't be - and that's particularly true of those who are putting such effort into appearing normal. Loops of non-communication can develop in workplaces, in social groups, even in families - where a stammer becomes the elephant in the room which everyone is too nervous to mention. Sometimes someone has to take a bit of chance, though.

Some readers might be a little surprised at the title of this section - 'how not to make a fool of yourself', rather than the more positive 'how to help'. But that's deliberate, and I mean it when I place the onus on you, as someone who is more or less fluent, and aims at being a decent human being, to behave and react in an appropriate manner; not as a favour, but as something that you ought to do. Someone with a stammer is already carrying enough, and doing enough, and - very probably - working hard enough at making things easier for you. The least you can do is have sufficient awareness and common courtesy to at least not make things more difficult for them - the 1% of the adult population.

Here endeth the lesson.