Ruth Porteous has been a pioneer in speech pathology in Australia. She was asked to present her recollections of those early years to the Speech Pathology Australia National Conference to close the three-day meeting in Hobart, Tasmania, May 8, 2003. Here are her insights.

...not past historic, but present continuous

Nature, Nurture Knowledge and Experience in the life of our profession

by Ruth Porteous

My thanks to the conference organizers for giving me the privilege of the last word at this splendid conference. When I asked the conference committee what they would like me to talk about, they said, "Well, some of the history of the early days, and something about the conference themes, include Tasmania if you can, just take us back to the grass roots."

So I'll attempt to keep this clean and green, but I must warn you that some of the revelations may horrify and some of the historic language may offend! I've added to the brief an attempt to find the current that flows from our past to our present; the spirit that makes me feel "at home" in a gathering like this one, and that made Judith Duchan so instantly "one of us".

This is the question. Is the past of our profession "a foreign place where they do things differently", as the novelist L.P. Hartley suggests, or would you recognize it if I could transport you back fifty years or so to my first clinic. I came as a new graduate to a sole-charge position in the Royal Hobart Hospital, and was the only speech therapist on the island.

Some things would be very familiar: a low table and chairs, children's paintings and drawings on the wall, a desk, cupboards, filing cabinet, sink, some children's books, a basket of toys. But what is that medium-sized suitcase-looking thing on a stand in the corner? Well, that's my wire recorder, the predecessor of the reel- to-reel tape recorder, a monstrous creature which rewinds fiendishly, snapping wire and unravelling furiously, just as I'm trying to impress a plastic surgeon with the progress of my young patients with cleft palate.(when I can get it to perform it is easy to impress as the microphone is not sensitive enough to record nasality!)

And why is there a built-in single bed with an inner-spring mattress? General relaxation was the treatment of choice for persons who stuttered, followed by practice of smooth rhythmic sound patterns printed with an ancient wax copying machine.

However, as a 20-year old, with my clinic in a rather isolated area of the hospital, I was a little diffident about stretching out the mostly young male stutterers who came my way, and opted for teaching what we called differential relaxation in the large and comfortable armchair which was also part of the furnishings.

Record keeping was pen and paper, and we had few therapy resources. Even texts had not arrived on the scene! Nor had the lavishly coloured picture books which we now enjoy. Little Golden Books were just becoming available ---and we thought they were exciting!

The children with articulatory disorders you would recognize today, although we talked about dyslalia and lalling and sigmatism when identifying their problems. You would also recognize their parents' anxiety, their fear about children being teased or mocked or failing at school: and their willingness to keep therapy appointments and carry out home practice.

While articulatory problems were readily identified, language delay was not, and most family doctors told parents children would "grow out of it". As we only accepted clients referred by a medical practitioner, education of these potential referring agents had to be a priority.

My greatest interest was in aphasia, and there were always adults with acquired language disorders, most commonly stroke, less commonly traumatic head injuries---the achievements of modern medicine now keep alive many who would not have survived in the fifties. We had never heard of dysphagia. Then, as now, counselling families about aphasia and dysarthria was very important; for the first time I became aware how important it was to name a frightening condition.

We had been taught that we didn't have anything to offer to the severely "retarded "individual, (although we were later to learn otherwise) and what we had to offer to children with cerebral palsy was pitiful. Many children with recognizable syndromes like Down's were institutionalised from a very early age, as were others with apparent severe developmental delay. Sometimes these sad children were later found to be hearing impaired or dysphasic or autistic or cerebral palsied, and started therapy well after the age at which we would think it important to begin now

So, just as in your clinics today, there was a constant stream of people deprived in some way of the ability to communicate freely, and, just as now, it was immensely rewarding to work with them. Of course I made many mistakes, and sadly missed having a peer group on whom to unload my uncertainties. Today there are 60 speech pathologists working in Tasmania, and I'm told 51 of them have been at the conference.

Although their -and your- curriculum and preparation for becoming speech pathologists has been very different from mine; I want to suggest that the children and adults whose lives are diminished by speech or language disability today, are, in spite of all the changes in the external world, not so very different from the children and adults who came through my clinic door fifty years ago. It is this continuity of our central concern that unites past and present.

When I asked the speech pathology retirees group, (all five of them) what I should talk about, they said "tell the speech pathologists of today how much we admire their professionalism, their ability to use the vast reserves of information available to them, the skills with which they use technology, their articulateness, and the way in which they run the affairs of our association."

How have those high standards been achieved? This is what I want to examine now, through frameworks provided by the themes of this conference. How have nature, nurture and knowledge interacted to shape our profession?

It is common knowledge that our foundation schools of Speech Therapy were based on British models and that these were strongly influenced by those medical specialities whose patients often presented with speech and language problems, namely neurology, otolaryngology, psychiatry, pediatrics and plastic surgery. Indeed, our first president was a plastic surgeon and practitioners in those other specialties served periods on the management boards of training schools and were mentors to the pioneering members of our profession. In recent years the medical model has had a bad press.

It is perhaps hard to believe now that when speech therapy began in Australia, we were closer to the 19th century than to the 21st, and so to an older tradition of medicine as Science and Art. Those doctors who gave their time volountarily to help us get established were doing so because they had been seeing patients who, in spite of successful medical or surgical treatment, suffered from ongoing speech or language or voice problems. They recognized that this was often of far more significance to the individual than a cleft lip, hemiplegia or even the cancer which had led to the removal of a larynx. From their kind of whole-person medicine we learned our skills of clinical observation, history taking, case discussion and empathetic listening.

But they couldn't teach us what to do with the individuals they referred to us, and we had no established norms. Our methods were largely empirical; trial and error based on the few publications of British therapists .We had no guidelines to help us decide when to start and when to stop treatment, and no, repeat no standardized tests. Fortunately, a sufficient number of our clients did think we were helping them---and so encouraged us to keep trying.

Until the sixties, under a trade agreement with British publishers, American publications could only reach Australia indirectly. When they did become available, American journals and texts introduced us to ideas generated in psychology and education and linguistics, and as our concepts increased in complexity, therapy began to change its focus.

It seems our British parent contributed our Nature, the basic structure with which we began life as an independent profession, and now we were growing up nurtured by the sustenance we found in American research. Nature and Nurture ...these two divergent streams meeting in our current practice, have, I believe, given us a uniquely Australian perspective on our profession.

In the remaining time, I have chosen to highlight some significant decisions and social changes which have shaped the subsequent development of Speech Pathology in Australia over the last half century; that is how we have acquired and chosen to use our Knowledge and Experience. First was the establishment of our professional association as a national body in the early 1950s. The Australian College of Speech Therapists. This was a breathtakingly ambitious undertaking for the tiny group (not more than twenty) therapists practising around the country at that time (the Australian Medical Association was at that time only a branch of its British parent) and interstate travel and communication was expensive and difficult.

Anyone who has read the Memorandum of Association, the legal document which defined our purpose, cannot fail to be impressed by its comprehensiveness and vision. I believe it is now integrated into the constitution of Speech Pathology Australia. The support being part of a national body gave to isolated therapists, particularly in the numerically smaller states, has been important in our growth, as has the absence of interstate rivalry.

A decade later, the introduction of Commonwealth Scholarships was a recognition of our training schools as respectable academic institutions .The availability of scholarships for what had been until then fee-paying courses diversified the pool from which students came, and immensely enriched the profession.

Soon after this, the establishment of the first University Department of Speech Therapy consolidated the status of the discipline. It was a significant turning point. Until then, the ACST had been the sole examining body, and so controlled the syllabus; indeed, administering the affairs relating to the training schools in Melbourne and Sydney took up a great deal of its time. What was to be its new role? The College needed the graduates of university courses as members, but would they need the College?

You all know the outcome. The subsequent development of our association, freed of its role as an examining body, has been impressive. This year, with graduates from nine Australian universities, we expect to reach a membership of 3400.

World events were significant too, in our predominantly female profession. By the seventies, the pill, the women's movement, development of child-care services, disposable nappies, cheaper cars and washing machines, meant that more women chose to stay in the work force and a new stability entered the profession. This in turn gave us a better base from which to negotiate pay and conditions. The experience of women who were themselves mothers of young children contributed greatly to pediatric teams, and to the child language research which by the seventies was giving us new techniques and new confidence in working with children with delayed language.

A footnote here--- as a topic the linguistic revolution of the sixties and seventies has been in and out of this script several times. In because having worked for twenty years in the area of language disorder with no coherent language theory it was the most important development in my professional life; out because if I started talking about it I wouldn't stop! In my life B.C. means before Chomsky!

Since the eighties the establishment of higher degrees has significantly expanded our knowledge base and introduced new rigour into professional development, conferences, and publications. What a long way we had come since the days when any of us wanting to further our academic studies had first to do an undergraduate degree in another discipline, and then find a sympathetic department which would allow us to proceed to a higher degree within a field of our choice. This year, according to the Australian newspaper, there are 133 post-graduate enrolments, and 1464 under-graduate students.

My last significant event is the growth of the internet and its accessibility. Our ability to communicate so easily with colleagues has made unlimited new resources available, and professional isolation has lost its meaning. Caroline Bowen, through her articles in Australian Communication Quarterly, has kept us continually aware of what we are missing, if we do not take up the opportunities offered by modern technology, and it has been a great pleasure to hear her give such an exciting vision of the future this morning.

Last week I had dinner in Melbourne with colleagues whose friendship I have shared for more than fifty years. They said, "Say what a great life we have had in speech pathology, how much we have learned from our clients and colleagues, not only about the practice of speech pathology & therapy, but about the human condition."

The friendships formed at conferences are very special, and it is high time now to take part in the farewell rituals for this one. As you go out of these doors look again at the broad and beautiful Derwent River. Beginning as a small and insignificant little stream, its strong current carries it through some rough and rocky stretches, until here it meets the ocean, and the world.

This serves as a metaphor for what I had in mind when trying to suggest that the past "is not a foreign place," but the source of all our futures---not past historic, but present continuous.