This is probably why you see things like locals get used a lot as modern Forth programs grow. It doesn't have to be brutal early days Chuck Moore genius programs, but I guess you start getting away from the original ethos.
I think even with locals you're still mentally dealing with a few items on the stack in each word usually. But, yes, locals do help you from passing around items from word to word: you see the usage of the local far easier than you see the location of the stack elements.