Clear Speaking : History and treatment of a mysterious malady : KNOTTED TONGUES: Stuttering in History and the Quest for a Cure, <i> By Benson Bobrick (Simon & Schuster: $22; 240 pp.)</i>

What do Moses, Demosthenes, King Charles I of England, Charles Darwin, Henry James, Lewis Carroll, Winston Churchill, W. Somerset Maugham, John Updike, Marilyn Monroe, Benson Bobrick and I have in common?

All were, or are, stutterers. All have suffered from what Bobrick, in “Knotted Tongues,” his history of stuttering and of humankind’s fumbling attempts over the last 2,500 years to explain and treat it, calls “the most complex disorganization of functioning in the field of medicine and psychiatry.”

This crippling and mysterious malady afflicts about 1% of the population in every time and country--2.5 million people in today’s America, 55 million worldwide. It runs in families. Four boys stutter for every girl, and the onset of stuttering comes everywhere at the same early age--2 to 7.

Stuttering, Bobrick notes, has been blamed on “childhood trauma, sibling rivalry, suppressed anger, infantile sexual fixations, deformations of the tongue, lips, palate, jaw or larynx, chemical (or humoral) imbalance, strict upbringing, vicious habit, guilt, approach-avoidance conflict” and demonic possession.

Treatments have varied just as widely. Demosthenes, the great Athenian orator, practiced speaking with pebbles in his mouth. One Native American tribe made stutterers recite, “I give my stuttering to you,” and spit through a knothole in a board to get the devil out of their throats. Medieval European practice often was to blister the tongue. In the 1840s, an operation pioneered by Prussian surgeon J. F. Dieffenbach--cutting a triangular wedge from the tongue without general anesthesia--enjoyed a brief but bloody vogue.

More modern treatments have included “biofeedback, hypnosis, operant conditioning, electric shock, faith healing, drugs and, of course, psychoanalysis.”

Today, Bobrick says, “clinical evidence indicates that stuttering is . . . an inheritable, physically based problem involving a neurological defect” in how we hear ourselves speak through the bones of our skulls. This in turn upsets the extraordinarily delicate mechanism, involving more than 100 tiny muscles, that produces speech.

Bobrick, a historian (“East of the Sun,” “Fearful Majesty,” “Labyrinths of Iron”), touches gently but tellingly on his own story. “My overriding purpose from about the age of 10,” he says, “was, in every situation involving contact with another human soul, to somehow not make a fool of myself--though in one way or another, of course, that happened all the time.”

Even after earning his doctorate, Bobrick was overcome by “a complete sense of worthlessness and failure” because of his stuttering. “I took a number of odd jobs--as leather craftsman, file clerk, book binder . . . often at salaries not much above minimum wage. In truth, I felt myself unfit for anything else.”

Take a stutterer’s word for it: “Knotted Tongues” can be read as Bobrick’s effort to speak of his affliction fluently-- that is, with grace and detachment and a lack of self-pity. No wonder so many stutterers become writers: The self-expression impossible for them in speech can be achieved on the printed page. If Bobrick’s writing here is witty, elegant and humane--which it is--his reward is more than ordinary literary satisfaction.

To entertain us, and to describe the disability without seeming to wallow in it, Bobrick focuses on celebrities who have triumphed in spite of their stuttering. He says Marilyn Monroe’s breathy voice was originally “an attempt to avoid stuttering rather than to sound sexy.” The writers he quotes--such as John Updike in “Self-Consciousness”--offer rueful and sometimes amusing glimpses of the malady from within.

“Artists . . . are probably different” from most people, Bobrick says, “insofar as their inability to communicate in the normal way acts as a spur to creative expression. But I doubt that many, if they could awake one morning to a tongue untangled, would not count it the Day of Jubilee.”

Bobrick returns to his own case after outlining how theories about stuttering have come and gone in the 20th Century. For example, he says, psychologists’ efforts to identify a “stuttering personality” have failed. Today, stuttering is not seen as the result of any particular mental quirk (such as “lost left-handedness” or a covert desire to control conversations by pausing over words), though it can cause neuroses aplenty.

For 50 years, therapy in the United States was dominated by the University of Iowa school led by Charles Van Riper and Wendell Johnson. Bobrick calls it the “stutter differently” school. It focused on “toughening” stutterers by forcing them into social situations and teaching them to stutter deliberately (albeit in more fluent ways) rather than try to hide their disability. Older stutterers will recall such techniques as the “slide” and the “bounce” and warnings that parents who criticized normal childhood dysfluency too harshly might create the very disorder they feared.

Bobrick and I came along in time for the counterrevolution, when what he calls the “speak differently” school was gaining ascendancy. The goal here was fluent, normal speech. The emphasis was on behavior rather than psychology. If stuttering was “learned behavior,” my therapists told me, it could be unlearned and fluent speech could be learned in its place.

In 1986, Bobrick underwent similar therapy that also made allowance for stutterers’ physical peculiarities. Based on principles developed by Ronald L. Webster of the Hollins Communications Research Institute in Roanoke, Va., it enabled him, by mastering “a series of tiny but absolutely critical speech movement characteristics . . . to acquire the true feel of correct speech.” This is essential, he says, because a stutterer’s hearing is not a reliable guide.

Bobrick calls the results “deliverance. . . . I have seldom stuttered since.”

So the message of “Knotted Tongues” is hope, though it’s still a qualified hope. If science is closing in on the causes of stuttering--”centuries of . . . arbitrary theorizing . . . hastening to an end,” as Bobrick says--it hasn’t quite pinpointed them. Most people who stutter, he acknowledges, still “endure it without hope of cure. . . . In the United States and elsewhere, no unified program of experimental therapy yet exists.”

And what therapy is available doesn’t always succeed. “Some stutterers,” Bobrick says, “are unable to take full advantage of (it) because they remain ‘speech doubters’--unable to take that leap of faith into believing in their own ability to speak.” They are prone to “a lack of confidence, a kind of fatalism really, bred . . . by countless episodes of defeat.” Perhaps this is as good an explanation as any for my own repeated relapses.

Even fluency such as Bobrick has achieved is precarious, he says, and requires constant monitoring. Why? Because there’s a “Catch-22” involved, fully as diabolical as the disorder itself: The more fluent a stutterer becomes, the greater the temptation to talk like normal people--without conscious control--and this insidiously leads back to stuttering.