When Science Goes Wrong (36 page)

Was Johnson’s diagnosogenic theory the trigger for the Tudor study? Not according to Ehud Yairi, Professor Emeritus in the Department of Speech and Hearing Science at the University of Illinois at Urbana-Champaign. Yairi is an expert on stuttering who entered the University of Iowa as a graduate student shortly after Wendell Johnson’s death. In a 2005 article, he concluded that the diagnosogenic theory could not have been well enough established in Johnson’s mind to have been the basis for the 1939 study, because Johnson’s first published account of it appeared in 1942, three years after the Tudor study was completed. At the time of the study, Yairi argued, Johnson was still thinking in terms of neurological explanations for the disorder.

Yet other experts have reached different conclusions. One of these is Nicoline Ambrose, an associate professor in the same department as Yairi, who collaborated with him on a detailed reanalysis of the Tudor study published in 2002. When I asked Ambrose in a 2006 interview whether she thought that the Tudor study was intended as a test of Johnson’s diagnosogenic theory, she said, ‘I would basically say yes, or some earlier version of it, as it was being formulated – although I don’t believe the intent was to create stutterers, but to invoke stuttering on a temporary basis. I don’t think there was any intent to say, “Let’s see if we can create a long-term problem in these kids.”’ Another expert who has weighed in with a similar opinion is Oliver Bloodstein, a onetime student of Johnson who is now Professor Emeritus of speech at the City University of New York. Bloodstein has written that Johnson was already entertaining the central idea of the diagnosogenic theory in the years prior to Mary Tudor’s study, and it was indeed this theory that led him to initiate the study.

I recently stumbled on a little-known lecture by Johnson that he published in 1938 – one year before the Tudor study – under the title ‘The Role of Evaluation in Stuttering Behavior.’ This lecture laid out the core of the diagnosogenic theory and even claimed to provide evidence in support of it. ‘[I]n 92 per cent of the 47 child stutterers we have studied to date,’ he wrote, ‘the first order reaction was a simple, loose repetition of sound, syllable or word. When this was negatively evaluated – disapproved by the parents and then by the child – other reactions appeared in series. The higher order reactions tended to be more complex, involved more tension and more stoppages generally.’ In other words, castigating a child for run-of-the-mill disfluencies caused them to spiral into full-scale stuttering.

What’s more, the internal evidence of the Tudor study itself strongly implies that it was designed as a test of the theory. Tudor’s master’s thesis, which was based entirely on the study, was titled ‘An Experimental Study of the Effect of Evaluative Labelling on Speech Fluency.’ This is the ‘Introduction’ section, in its three-sentence entirety:

Certain published statements (Johnson, Language and Speech Hygiene) and examination of case histories suggest the possibility of regarding the diagnosis of stuttering as one of the factors responsible for the development of the disorder.

An investigation of the effects, particularly on speech fluency, of such a diagnosis is indicated from this point of view. In view of this consideration the present study has been done.

In other words, the
only
reason that Tudor put forward for undertaking the study was to test the diagnosogenic theory of stuttering.

In the second section of the thesis, titled ‘Problem’, Tudor stated that the study was designed to answer the following questions:

1. Will removing the label ‘stutterer’ from those who have been so labelled have any effect on their speech fluency?

2. Will endorsement of the label ‘stutterer’ previously applied to an individual have any effect on his speech fluency?

3. Will endorsement of the label ‘normal speaker’ previously applied to an individual have any effect on his speech fluency?

4. Will labelling a person, previously regarded as a normal speaker, a ‘stutterer’ have any effect on his speech fluency?

Evidently, the study was intended to test the effect of evaluative labelling – specifically, labelling as a stutterer or a normal speaker – on children’s speech. Although the written objectives do not spell out what the resulting ‘effects on speech fluency’ might be, it is reasonable to assume that they were expected to consist of the appearance or disappearance of stuttering – either of the complete phenomenon or some of its components – at least on a temporary basis, for otherwise the study does not make a great deal of sense. The use of the more general phrase ‘effects on speech fluency’ may have reflected the experimenters’ open minds about what the results of the study might be. More likely, though, it represented a wish not to spell out too baldly one of the study’s ethically-troubling goals: the attempt to elicit in normal children the very trait that had plagued Wendell Johnson for his entire life.

Looking more closely at the objectives, one can see that objectives 2 and 3 are, by themselves, pointless. No one would expect that continuing to use labels that have been previously applied to a person would have any interesting effect on their speech fluency. Evidently, these two ‘objectives’ were not really intellectual goals in themselves but were listed merely as a way of indicating the need for control groups – subjects who were not manipulated and who were therefore not expected to show any effects. It is objectives 1 and 4, which involved changing a child’s previously applied labels, that incorporated the real goals of the study.

The children at the orphanage – a mix of real orphans and children whose parents had been forced to give them up by economic necessity – were used to being treated as guinea pigs. When Jim Dyer, a reporter, interviewed one of the now-elderly subjects for a 2001 article in the
San Jose Mercury News
, she told him that ‘Every week, somebody else from the university would come down and start testing us for God knows what.’ There is no record of Wendell Johnson’s motive for choosing an orphanage for the study, but we may guess that it was twofold: first, the convenience of having a large, fairly homogeneous collection of children at a single location and cared for by the same staff, and second, the ease of obtaining permission for the study. It would have been much harder, one may guess, to get permission from a child’s parents, given that one possible outcome of the treatment was the development of a speech disorder.

The first day of Mary Tudor’s visit to the orphanage was devoted to the selection of children for the study. There were 10 so-called stutterers in the orphanage – children who the teachers and matrons considered to be stutterers and had labelled as such. All 10 of these children were included in the study. To balance them, Tudor and her five colleagues – fellow graduate students who were familiar with speech disorders – picked 12 children at random from the remaining population of children who had never been called stutterers by the staff. The 22 children selected for the study included both boys and girls, and their ages ranged from five to 16 years.

Each of these two groups was then further divided into two, thus providing the four subject groups needed for testing the four objectives described above. Tudor named the groups IA, IB, IIA, and IIB, but for ease of recall I’ll rename them as follows:

SN: Five children previously labelled as stutterers who were to be relabelled as normal speakers.

SS: Five children previously labelled as stutterers who would continue to be labelled as such.

NS: Six children previously labelled as normal speakers who were to be relabelled as stutterers.

NN: Six children previously labelled as normal speakers who would continue to be labelled as such.

In her thesis, Tudor maintained her subjects’ confidentiality, only referring to the individual children by code numbers. This confidentiality was breached by the Mercury News reporter Jim Dyer, however. The names of the six children in the NS group (the most ethically questionable group, consisting of normal-speaking children who were to be relabelled as stutterers) have also entered the public domain on account of the lawsuit against the state of Iowa in which they or their heirs are plaintiffs, and I will therefore use their names here. They were Norma Jean Pugh (aged five at the time), Elizabeth Ostert (nine), Clarence Fifer (11), Mary Korlaske (12), Phillip Spieker (12) and Hazel Potter (15).

The ages of these children immediately raise a significant issue with regard to the scientific value of the study. Stuttering typically begins in the preschool years; if Wendell Johnson began stuttering at five, as he related, then he was among a minority of late-onset stutterers. The children in Mary Tudor’s NS group, with the possible exception of Norma Jean Pugh, were well beyond the age at which stuttering typically develops. Thus, even if Johnson’s diagnosogenic theory were correct, Tudor’s study might have failed to validate it simply because the children had grown past the sensitive period of speech development during which they could be induced to stutter. Tudor did not discuss this issue in her thesis. It may be that she was forced to use older children because there was an insufficient number of younger ones in the orphanage. Alternatively, she may have felt compelled to use children in the same age range as those in the stuttering groups, who averaged 12 years of age.

The plan of the study was as follows. At the beginning and again the end of the study, the speech of all 22 children was to be assessed by the panel of five judges. Without knowledge of which experimental group each child belonged to, the judges would independently provide a numerical assessment of the child’s fluency and would also make a judgment as to whether the child stuttered or not. During the intervening four months, Tudor would apply labels to the children according to the groups they had been assigned to.

This is how Tudor’s thesis describes what was to be said to the children in the NS group at the beginning of the study. (Her actual words were modified to suit each child’s age and intelligence; some of the children had IQs that were well below average.)

The staff has come to the conclusion that you have a great deal of trouble with your speech. The type of interruptions which you have are very undesirable. These interruptions indicate stuttering. You have many of the symptoms of a child who is beginning to stutter. You must try to stop yourself immediately. Use your will power. Make up your mind that you are going to speak without a single interruption. It’s absolutely necessary that you do this. Do anything to keep from stuttering. Try very hard to speak fluently and evenly. If you have an interruption, stop and begin over. Take a deep breath whenever you feel you are going to stutter. Don’t ever speak unless you can do it right. You see how [the name of a child in the institution who stuttered rather severely] stutters, don’t you? Well, he undoubtedly started this very same way you are starting. Watch your speech every minute and try to do something to improve it. Whatever you do, speak fluently and avoid any interruptions whatsoever in your speech.

The children in the SN group were told the opposite – that they didn’t stutter, that any speech mistakes they made were inconsequential and that they should not worry about them. The children in the SS and NN groups were given messages consistent with their prior identities as stutterers or normal speakers respectively.

Tudor reinforced these messages on subsequent visits to the orphanage. She had eight or nine sessions with each of the children in the NS group, and three or four sessions with the children in the SN group. The thesis doesn’t mention any sessions with the children in the SS or NN groups: either she neglected to list these sessions, or perhaps she thought that their status as controls made the sessions unnecessary.

During the sessions with the children who were being relabelled as stutterers, Tudor would pick on slight speech errors that the children made in the course of their conversation and draw attention to them, saying that they were signs of stuttering and that the child should do everything in his or her power to avoid making the errors. In addition, she attempted to recruit the orphanage’s staff to help reinforce these messages. She told them that the NS and SS children were stuttering and that they should draw the children’s attention to all their speech errors. Similarly, she told the staff that the SN and NN children were not stutterers, and she asked them to ignore these children’s speech errors or to tell them that their speech was fine.

It seems that the staff didn’t cooperate in the fashion that Tudor hoped. Although a couple of the children in the NS group mentioned to her that their teachers had commented on their speech, Tudor wrote in her thesis that the staff generally didn’t follow her instructions, or only did so to a small degree. Thus, the overall amount of indoctrination that the children received was probably much less than Tudor originally desired.