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Here at RealityChek I’ve avoided writing about myself for three main reasons. First, I can’t imagine that my life and experiences are remotely as interesting to others as they are to me. Second, they’re almost never relevant to the public policy issues on which I’d rather focus. And third, when they are, viewing them through a personal lens unavoidably entails using firsthand anecdotes to make a case – which holds no analytical water whatever.

Yet over the last few months, and especially over the last few days, it seems, the personal and political have intersected in a way that I believe does enable me to make a valid point about a headline issue. That’s the matter of whether Joe Biden’s verbal gaffes indicate “cognitive decline,” or whether they simply show that he’s dealing with a lifelong stutter.

The difference of course matters greatly. After all, if the former is the case, then it’s legitimate to wonder whether the 77-year old former Vice President and frontrunner for this year’s Democratic presidential nomination can hold up under the rigors of a general election campaign and, more important, the pressures of the world’s most important job. If the latter, then there’s no reason to suppose that Biden isn’t up to the task mentally. For there’s absolutely no intrinsic relationship between stuttering and intelligence or mental health.

To the former Vice President and long-time Senator’s credit, he’s never tried to excuse these episodes – or any from years past – as a speech impediment. But some of his supporters (or at least opponents of President Trump) have.

My take? Biden’s control over his stutter has faltered from time to time, and explains some of his stumbles and other unusual speech patterns. But many of the instances that have generated concern have nothing to do with a pure speech disorder. Indeed, they at least appear to represent moments of genuine confusion and/or memory lapses often characteristic of advanced age.

And here’s where the personal comes in: My confidence in the above conclusions reflects my own experience as a lifelong stutterer. Not that I’m an accredited expert in speech pathology or gerontology or any aspect of brain science. But I am (way too) intimately familiar with an inability to voice the words I want to say, and with the various tactics stutterers use to try to make their thoughts heard.

Moreover, because I’ve been lucky enough to have received treatment from an outstanding stuttering therapy program developed and run for decades by Ph.D. speech pathologist Ronald A. Webster, I’ve made long-time friendships with literally dozens of fellow stutterers and become acquainted to varying degrees with literally hundreds more. By sharing experiences with them and observing them deal with their own stutters first-hand, like many other stutterers, I’ve learned to identify whether someone is simply encountering the kind of speech disfluency that everyone faces every now and then, and whether they’re dealing with a genuine stuttering problem.

In addition, thanks to listening to many hours of Webster classroom talks and more hours of personal discussions, I’ve learned that the best research in the field (essentially Webster’s own) makes clear that stuttering ultimately represents malfunctions in an individual’s anatomical speech mechanism (consisting mainly of the lips, tongue, vocal folds, and abdomen) that reveal nothing about mental faculties.

(Some more truth in advertising: I have never found any aspect of Biden’s record in public life the slightest big impressive, and cannot imagine voting for him this fall.)

There’s little doubt that chronic stuttering can affect one’s frame of mind, and that it’s worsened by factors like stress and fatigue. But the roots are physical – and as Webster and his program have demonstrated, fluency can be dramatically improved through the kind of muscle-memory-strengthening practice that’s a proven way to enhance all manner of physical skills.

The stress and fatigue points are especially important because they surely explain some kinds of Biden difficulties that seem to be getting more common – specifically, repetitions of certain words or initial sounds of words, and unusual word choices. Here’s why:

Both behaviors amount to ways in which stutterers try to deal with whatever difficulties they’re facing at the moment. The repetitions generally represent efforts to generate enough momentum to power or zoom through the sound in question, or through the next word (which is anticipated to cause a problem). The unusual word choices are examples of “word substitution” – finding a word that’s expected to be easier to pronounce than the one the speaker was originally planning to use, either because he or she is worried about the repetition thing, or because they fear they won’t be able to voice even the initial sound of that word. (Even stranger – stutterers can also worry about words coming further down the verbal road.)

Because I’ve got a decent vocabulary, I’ve gotten pretty skilled at the kind of word substitution that’s difficult even for many other stutterers to detect (though fortunately, because I have learned to produce more fluent speech, I don’t have to use this ploy often any more). But even for someone with such advantages, word substitution can be challenging especially because in order to maintain a reasonably normal speech flow, very rapid decisions are needed. And feelings of slight panic, or memories of past panic and failed word substitution efforts, are never far out of mind.

Moreover – and finally, we get to the fatigue and stress angles – all of these responses are much more difficult to execute for stutterers who are tired and.or stressed, for reasons that should be obvious. What should also be obvious – 77-year olds tend to tire more often than younger folks, and the problem almost never gets better. (I’m 66 and certainly don’t have the energy I had at 56 or even 60. And sometimes it affect my speech.)

Political campaigns, moreover, can get pretty stressful, especially for office-seekers who aren’t killing it. And elderly political candidates can therefore face special problems. So although these Biden difficulties don’t necessarily demonstrate cognitive decline, they do point to emerging age-related issues that are matters of genuine concern.

One prime example of a Biden stumble that I believe has been described mistakenly as a moment of debility: his troubles speaking about healthcare issues during the Democratic debate in Detroit last July. Then, when it was imperative that he rebound from faring poorly in a previous event, and live up to his then-frontrunner status, his speech deteriorated significantly after a strong start.

The story is very different, however, when it comes to Biden episodes like declaring that mass shootings in El Paso, Texas and Dayton, Ohio took place in Houston and Michigan; or claiming that he visited survivors of the Parkland, Florida shootings before the tragedy took place, along with assuming he was still Vice President in 2018. (Keep in mind that gun violence has been a special Biden interest.) Nor does stuttering explain confusing the late British Prime Minister Margaret Thatcher both with a much more recent successor (Theresa May) – not to mention German Chancellor Angela Merkel. Ditto for babbling about the authorization of U.S. military force in the Middle East. (Keep in mind: He’s supposed to be a foreign policy expert.) 

It’s similarly tough to square stuttering claims with mistaking New Hampshire for Vermont and Nevada with New Hampshire and Iowa for Ohio, or calling Fox News anchor Chris Wallace “Chuck,” or calling “Super Tuesday” “Super Thursday,” or telling voters this year that he’s running for the Senate, or claiming that the Democrats can win back the House of Representative this year (they already hold it), or boasting that his campaign “chooses truth over facts.”  (For the cites, see here, here, here, here, here, here, and here.)  

A few of these can be written off to the kind of mixups heard from time to time from people of every age. But not all of them. Moreover, these supposed gaffes are qualitatively different from the type for which Biden has long been known – which have almost always involved indiscretions

And a particularly revealing sign that age is producing both more of these misstatements and even more stuttering (due to the fatigue and/or stress factors): In a long Atlantic piece on Biden’s speech (cited above and written, interestingly, by a reporter who stutters himself), the former Vice President said,

he hasn’t felt himself caught in a traditional stutter in several decades. ‘I mean, I can’t remember a time where I’ve ever worried before a crowd of 80,000 people or 800 people or 80 people—I haven’t had that feeling of dread since, I guess, speech class in college.’”

These Biden problems by no means disqualify him for the Presidency. Even if I’m right about growing signs of cognitive decline, they may stabilize, or worsen very slowly. But they also may accelerate. And however difficult this year’s Democratic primaries have been for Biden, the general election will surely be far worse. (See this article on the physical and emotional strains suffered by recent White House hopefuls.)

So obviously, these issues need to be discussed openly and frankly – and of course for all the candidates. For now that above all mean that not all of Biden’s lapses should be written off as “simple” stutter.