Australasian Science Magazine

By Tim Hannan

Is Foreign Accent Syndrome the result of brain trauma or stress, or not even a foreign accent?

Foreign Accent Syndrome (FAS) is a rare condition in which a person’s speech is characterised by the sudden emergence of a pronunciation perceived by others to be a foreign accent. Generally, the symptoms emerge after a brain injury, but in some cases no neurological event has occurred and the accent is assumed to be a psychological response to a distressing situation or event.

However, new Australian research challenges the simple dichotomy between both organic and psychogenic explanations. Published in the Journal of Neurolinguistics, the study describes a patient who spoke with several different accents over several months following an initial neurological event.

FAS was first described in 1907, when the French neurologist Pierre Marie described a Parisian who developed an Alsatian accent after a stroke. Since then more than 100 cases have been documented, with most arising after cerebrovascular accidents, traumatic brain injuries or other damage to the brain. The accent is often a residual symptom of a more severe speech disorder, and may resolve completely over time.

Studies have suggested that the features of FAS result from disruptions to the prosody of speech – its stress, rhythm and/or intonation – or to the segmenting of phonemes, such as the timing and sequencing of vowels and consonants.

Neuroimaging of FAS patients has often identified lesions in frontal cortical areas in the left hemisphere, a region associated with language production; patients with damage restricted to subcortical regions have also been reported. This accords with our understanding of the neurobiology of speech production, which relies on a distributed network involving cortical and subcortical regions.

Many FAS patients are unaware of their accent, at least until they observe the reaction of family, friends and others. Most are distressed at the effect of the accent on others, and react with anxiety and avoidance of social interactions. However, others have described their accent as interesting or exotic, and have demonstrated changes in behaviour to match the accent.

Recently, Chris Tailby of the Florey Institute of Neuroscience and Mental Health described the case of a 37-year-old woman who presented at hospital with slurred speech, left-sided weakness, headache and photosensitivity. A cerebrovascular event was suspected, and she was immediately treated to break up or reduce the risk of blood clots. While her physical symptoms largely resolved over several days, she was observed by her family to be speaking with what was perceived to be a French accent.

Over the next few months she spoke in several different accents, including South African, New Zealand, Texan and Russian, each of which emerged exclusively while walking. She also exhibited accompanying subtle changes in her personality: when the accent was French, her affect tended to la belle indifference, and she adopted mannerisms she believed to be appropriate to the French.

This case presents a challenge to the simple view that dis­orders like FAS are either organic or psychogenic. As in most other cases, the accent emerged following a neurological event; yet multiple accents cannot be explained by the usual mechanisms of phonological or prosodic changes.

The authors argued that a neurological event produced subtle changes in speech production, and then the patient consciously or unconsciously modified her speech to feel more comfortable with the accent. This may be considered a third variant of FAS, in addition to the organic and psychogenic aetiologies.

There remains one unresolved question: why do listeners perceive prosodic or segmental disturbances as a foreign accent rather than just as a speech disorder? Analysis of speech characteristics indicates that FAS patients do not exhibit the characteristic pronunciations of the perceived language. Furthermore, the perceived accents correspond to the experience of the listeners: Parisian families say the patient produces an Alsatian accent, English families “hear” Scottish or Welsh, and Australians perceive an East Asian accent.

Accordingly, the current hypothesis is that the foreign accent is actually in the ear of the beholder.

Tim Hannan is an Associate Professor of Clinical Psychology at Charles Sturt University, and the President of the Australian Psychological Society.