Understanding Foreign Accent Syndrome

Lisa Alamia had a significant overbite that necessitated jaw surgery. Such a procedure is complex and requires full anesthesia. Upon waking, Alamia expected her new jawline to be the topic of conversation. Instead, it was her altered speech that caught everyone's attention.

Prior to the surgery, Alamia spoke with a soft Texan accent, fitting for someone born and raised in Texas. However, post-surgery, her Texan twang was replaced with a distinctly British tone.

Her husband and children initially thought she was joking, but Alamia couldn't revert to her original accent. Strangely, she had never visited England, having only traveled outside the U.S. to Mexico. Her children, who once heeded her advice in her Texan drawl, now found it hard to take her seriously as she sounded like a character from "Downton Abbey" [source: Friedman].

Things could have been more dire. During World War II, Astrid, a Norwegian woman, sustained a brain injury from shrapnel during a bombing raid. Upon recovering her ability to speak, she inexplicably developed a German accent. This was highly problematic, as Norway was under German occupation at the time. Strangers assumed she was associated with the enemy forces, leading shopkeepers to refuse her service and neighbors to avoid her, despite her never having visited Germany or spoken a word of German [source: Beck].

When Astrid consulted neurologist Georg Herman Monrad-Krohn, he described her speech as "dysprosody." Prosody refers to the non-grammatical aspects of speech, such as tone and rhythm. By the time Lisa Alamia reported her issue to her doctor and convinced him she wasn’t pretending, the condition had a new name. The neurologist who diagnosed Alamia referred to her condition as "foreign-accent syndrome" (FAS), a term coined in the 1980s. FAS is an exceedingly rare language disorder, with only about 100 documented cases worldwide [source: Keulen].

What Is Foreign Accent Syndrome?

You know that awkward moment when you’re at an ethnic restaurant with your dad, and he suddenly starts speaking in a cringe-worthy imitation of a Chinese, Thai, or Indian accent while ordering? That’s not foreign-accent syndrome. That’s just a peculiar phenomenon that seems to affect dads. No one knows why—perhaps it’s hormonal.

This everyday scenario would only qualify as foreign-accent syndrome if your dad began using his exaggerated accent and couldn’t stop—not in the restaurant, not during the drive home, not even on the phone. Ever. After you recover from the discomfort of imagining this, consider how your dad might feel. It’s as if he’s transformed into someone else, with no guarantee of ever reclaiming his original, familiar way of speaking.

Such a dramatic change rarely happens without a cause. It’s often linked to specific events like head trauma, a stroke, the emergence of multiple sclerosis, or mental health issues. However, doctors are sometimes baffled by cases like Lisa Alamia’s, where jaw surgery—an unlikely trigger—led to FAS. In fact, no other documented cases exist of this condition arising from such a common procedure.

Given the limited number of FAS cases, establishing clear patterns is challenging. The outcomes vary widely: Japanese speakers suddenly sounding Korean, Britons mistaken for French, Scots adopting South African accents overnight, and Spaniards perceived as Hungarian [source: Stollznow].

A woman from Plymouth, England, experienced a migraine so intense it sent her to the emergency room. After recovering, she was shocked to find herself speaking with a Chinese accent—a baffling change for someone of English Caucasian descent [source: UT Dallas]. Such cases can lead to awkward situations, with others mistakenly assuming the individual is being racially insensitive.

Experts advise assembling a multidisciplinary team of specialists to accurately diagnose the condition.

[source: UT Dallas]

After diagnosing FAS, the team might as well provide the patient with a T-shirt that reads, "It’s not my fault. My apologies." Or at least, that would be a thoughtful gesture.

Different Types of FAS

As previously noted, most FAS cases stem from brain damage caused by events like head trauma, strokes, or diseases such as multiple sclerosis. Researchers have observed that the damage often occurs in brain regions associated with speech, such as the left hemisphere or the middle cerebral artery. Speech production is an intricate process involving multiple brain areas, so damage to one region can alter speech without completely disrupting it. FAS patients are typically coherent and articulate, though some may struggle with word order or pronunciation [source: Stollznow].

These causes are classified as "neurogenic" by researchers. Until recently, FAS was believed to be solely neurogenic. However, it is now recognized that FAS can also arise from psychogenic factors, meaning it can manifest as a symptom of mental illnesses like bipolar disorder, conversion disorder, or schizophrenia [source: Keulen].

In a recent case, a woman in her mid-30s from the U.S. began speaking with a British accent. This was a minor detail compared to her psychiatric emergency admission after she assaulted her mother’s landlady, believing the landlady was using voodoo to curse her. The patient had a family history of schizophrenia and had experienced prior psychotic episodes, during which the British accent also appeared. Interestingly, her accent disappeared once she recovered from these episodes [source: Beck].

While it’s clear that neurogenic FAS results from brain damage and psychogenic FAS is linked to mental health issues, what do these explanations truly mean? Why do these factors cause individuals to sound as though they’ve adopted a new nationality?

Can a Syndrome Really Change Your Accent?

For most people, speaking feels effortless. However, producing words that sound appropriate in a given context requires precise control of the jaw, tongue, lip, and larynx muscles. Any disruption to this finely tuned system can make your speech sound unusual. For example, consuming too much alcohol can cause slurred speech due to impaired muscle control.

Consider vowels, for instance. The position and shape of the tongue create subtle variations in vowel pronunciation, which are crucial to different accents. Losing even a bit of tongue control can make you sound foreign.

This is the essence of foreign accent syndrome. It’s not that someone gains a new cultural identity after a stroke. Rather, the stroke disrupts the fine motor skills needed to produce their original speech patterns. This change primarily affects vowel sounds, leading listeners to perceive a foreign accent [source: Nickels].

But why does a Texan sound British or a Swede sound German? They don’t, not truly. An accent is largely in the ear of the listener. In many FAS cases, listeners can’t agree on the origin of the new accent. For example, some thought Astrid, the Swedish FAS patient, sounded French rather than German. In a study, researchers asked participants to identify the accent of an FAS patient, and the responses varied widely—French, African, Italian, Welsh, Chinese, and more [source: Nickels].

To be precise, foreign accent syndrome might be more accurately termed "altered" accent syndrome. However, that doesn’t quite have the same appeal, does it?

If diminished control over speech muscles explains neurogenic FAS, what about the rare psychogenic cases? What causes the accent shift in individuals experiencing psychotic episodes?

Mind Over Patter?

As previously noted, most FAS cases are neurogenic. Until recently, FAS was believed to be entirely neurogenic. However, experts now acknowledge cases where no brain damage or impairment is detected. In these instances, FAS often coincides with mental health conditions.

In certain cases, FAS doesn’t just alter vowel sounds or speech rhythm but also introduces a different vocabulary. For example, an American experiencing FAS not only adopted a British accent but also began using terms like "bloke" instead of "friend" and "loo" instead of "toilet."

In another instance, a Dutch woman with FAS developed a French accent, even speaking Dutch with French syntax and occasionally inserting French words. She sounded remarkably like a French person learning Dutch, likely influenced by her job teaching Dutch to French speakers [source: Keulen].

Neurogenic FAS cases don’t involve foreign vocabulary or syntax. The issue is purely related to articulation. This distinction highlights the importance of accurately diagnosing FAS origins. Treatment for neurogenic FAS involves specialized speech therapy, such as accent reduction techniques, which retrain the larynx, tongue, and lips to regain their original function [source: UT Dallas].

Such therapy would be ineffective for psychogenic FAS, as the condition stems from mental illness. Treating psychogenic FAS requires addressing the underlying mental health issue. Often, FAS resolves as the patient recovers from the episode. The duration varies based on the illness and individual, but in cases where FAS fades, it typically lasts a few months [source: Keulen].

Complicating matters further, there’s also a "mixed variant" of FAS, where the syndrome arises from a combination of psychogenic and neurogenic factors [source: Keulen].

As medical knowledge and diagnostic technologies progress, the distinction between psychogenic and neurogenic causes may blur. Recent studies suggest that some mental illnesses can stem from the immune system's reaction to infections, indicating that the separation between mind and body isn’t always as clear-cut as previously believed [source: Velasquez-Manoff].