78 Chapter 4
meaning only to him and God. All who knew Joseph suspected that someday he would become a
televangelist and preach to the world. However, two per sis tent small growths on his vocal cords
derailed his meteoric climb in the world of evangelism.
The first indication that all was not well with Joseph’s voice was fatigue. Soon after he took
over the congregation, he noticed that his voice gave out toward the latter part of the ser vices. His
booming sermon gradually disintegrated into a whisper. There was also a soreness in his throat
and a feeling that something foreign had lodged there, causing frequent throat clearing. The frus-
tration he felt was overwhelming, and he suspected that evil forces were at work to prevent him
from spreading the word of God. That frustration took him to a laryngologist, who discovered
nodules on his vocal cords and performed surgery to remove them. For a short time after the
surgery, Joseph’s voice returned to normal. However, the communication disorder returned. The
laryngologist explained that vocal nodules were not the disorder. They were a symptom of vocal
strain and abuse; for a permanent cure, Joseph needed voice therapy.
During the first meeting with the clinician, Joseph was counseled about the nature of therapy
for vocal nodules. He learned that there is a curative phase in which the speech be hav iors causing
and perpetuating the nodules are eliminated. During this phase, Joseph would need to make a
serious commitment to change his speech patterns. After the curative phase ended, Joseph would
need to adopt certain lifelong speech habits to prevent the nodules from recurring. He would also
learn the early signs of vocal nodules so that he could take preventive mea sure at the first stages
of their development.
The clinician explained that the growths on Joseph’s vocal folds, sometimes called preachers’
nodes, had resulted from forcing his voice. Although Joseph used several abusive be hav iors in con-
versational speech, the clinician believed that the sermons were the main culprits. Together, they
reviewed several audiotapes of his sermons and identified the abusive speech patterns.
One of the most abusive aspects of Joseph’s sermons was their sheer loudness. The clinician
explained that loudness is a result of forcing the vocal cords together with great force. The harder
the vocal cords come together, the louder the voice. Joseph habitually shouted his sermons. He and
the clinician agreed that this aspect of the prob lem could be solved by using the church’s public
address system.
Joseph had also gotten into the habit of frequently clearing his throat. This was understand-
able; the irritation on his vocal cords signaled the presence of foreign bodies. The natu ral response
was to remove them, hence the constant throat clearing. However, clearing the throat is an abusive
practice that further irritated his vocal cords, causing further throat clearing— a vicious cycle. To
stop this self- defeating be hav ior, Joseph learned to carry water and to drink it whenever he felt
the throat irritation. He also learned to clear his throat easily and gently, with the least amount of
vocal abuse.
Another vocally abusive be hav ior was Joseph’s speech delivery. His sermons were punctu-
ated with hard glottal attacks in which he emphasized the first words of sentences with increased
loudness and extreme pitch variations. Joseph feared that reducing this practice would render his
sermons boring and monotonous. However, he also realized that unless he changed his speaking