Persistent affliction, for king or commoner

For Sean McGarrigle, the current movie The King's Speech was particularly satisfying because "it had a happy ending without being a fairy-tale ending. There was no magical cure. The king still had a hard time of it."

McGarrigle, a 35-year-old software engineer from Havertown, should know. He is one of an estimated three million Americans who stutter. He has dealt with it all his life. And, like King George VI - the subject of the popular movie - he may never totally overcome it barring a therapeutic breakthrough that has eluded speech therapists and researchers for decades.

Officials from the American Stuttering Foundation have been wildly enthusiastic about the film, which is up for 12 Academy Awards on Sunday night. They laud it as an accurate portrayal of the struggles that a stutterer faces and of the courage they must often summon to function in daily life.

Jane Fraser, the foundation's director, said that their video Stuttering: By Kids, for Kids was downloaded 22,000 times in January, about five times the usual number and "we've had donations out of the blue" by people who had seen the movie.

All told, an estimated 68 million people worldwide stutter or stammer - they are the same thing, but the latter term is more commonly used in Britain. This is about one percent of the world's population.

Joe Donaher, stuttering program coordinator at Children's Hospital of Philadelphia, said The King's Speech was the first time he could recall a stutterer portrayed favorably in a film after decades of characters such as Ken Pile, a hoodlum in A Fish Called Wanda or Billy Bibbit, the hapless mental patient driven to suicide by the sadistic Nurse Ratched in One Flew Over the Cuckoo's Nest.

Donaher, Fraser, and others praise the film's realism both as a historic document and for insights into stuttering that hold true to this day.

Australian speech therapist Lionel Logue, who did so much to help the king, died in 1953, the year after his royal patient, and left few treatment notes. But Donaher says that his methods were rooted in the belief in the mid-1930s that stammering was primarily a psychiatric disorder.

Some of the film's most colorful scenes show the king in tension-reducing relaxation exercises such as flapping his arms or shouting curses. But Donaher says neither would be used today.

"You don't stutter because of tension," Donaher says, although a tense situation can make it worse. He adds that since therapy is usually most successful when started at an early age, cursing might be inappropriate for other reasons.

What does ring true for Donaher is the close therapist-patient relationship between Logue and the king, still perhaps the most essential element of success in treating stuttering today.

"Confidence and the clinical relationship are paramount," says Donaher. "We'd love to have a device or pharmaceutical intervention. Nothing has gained FDA approval.

"Therapy is challenging and takes a lot of time and support, but challenging doesn't mean insurmountable. A lot of things he [Logue] was doing are common practice today."

The one mechanical intervention used by Logue - having the king read Shakespeare while the sound of his voice is blocked by music played through headphones - is used in a different form today. An auditory feedback device placed behind the ear plays back the speaker's words with a short delay. Donaher isn't sure how effective it really is and asks, "Does the use of that trick make speech less natural? You never want to give up naturalness for fluency."

According to the Stuttering Foundation, the condition is now traced to four main factors, which can be interrelated:

Genetics: Some 60 percent of those who stutter have a family member with the condition.

Child development: In children, it usually accompanies other speech and language problems.

Family dynamics: "High expectations and fast-paced lifestyles can contribute to stuttering," obviously an issue with King George VI.

Neurophysiology: Recent brain imaging research shows that people who stutter process speech and language in different areas from those who speak normally.

While Donaher and other experts see the brain imaging research as the most promising development for the future, so far it has yet to pay dividends.

"At the moment there's nothing you can do on the basis of these findings," Norbert Lieckfeldt, chief executive of the British Stammering Association, said in an interview with actor Colin Firth, who plays the king in the film. "But you can say to people, 'You don't stammer because you're anxious or neurotic.' It's not something where you can simply pull yourself together. If you're an adult, it's what you have. But you can deal with the emotions that make the speaking process less stable."

"Today," adds Donaher, "we have more refined tools" in speech therapy. Some involve working with the physical act of speaking, others involve pacing, breaking speech into manageable chunks the way the king does in his climactic speech to the British people, warning that war with Germany is inevitable.

One of Donaher's patients, 13-year-old Andrew Bathish, said that when Donaher was helping him prepare for a speech to his fifth-grade class two years ago, some of the methods were very similar to those used by Logue in the film. "I used to stutter on every word," said Andrew, now a seventh grader at Valley Forge Middle School. "I'm now more poised. I can think through stuff. I'm more confident."

Donaher sees the king as a more realistic hero for those who stutter than famous people who have virtually overcome it, like Vice President Biden or actor James Earl Jones.

For him, stutterers like McGarrigle and Henry Pashkow, a 70-year-old retired social worker, are more typical. Pashkow, who lives in Center City, said he has had several courses of therapy in a lifetime of having people finish his sentences or speak louder because they think he can't hear well.

The most recent, about five years ago at the Temple University speech therapy clinic, was the most successful, he says: "I decided, 'I will be helped here.' I decided to have some empathy for the therapist. They're young, they're graduate students and they all have to face angry people, angry like I am. I wanted to help them help me. . . . Therapy is a mutual help situation."

And here and there, a stutterer turns the condition to his or her advantage. The late Homer Bigart, a legendary New York Times reporter, was one.

"He'd let people complete his sentences for him," recalls a Times colleague, former Inquirer executive editor Gene Roberts. "That way they told him more."