Do you know the Foreign Accent Syndrome?

By Beatriz Camacho

Translate by Carmen Cayuela

Imagine that one day you wake up and, when you open your mouth you speak as if you had lived for a while abroad. It´s not insanity, it´s a very rare neurological condition with a few documented cases in the world: The Foreign Accent Syndrome, also known as pseudo-foreign accent.

This rare disease affects 40 people in Spain and it produced a change in the natural accent of the patient, making you sound as if you were from another country. For example, we found a case of a woman from Castellón with French accent. Around the world cases in Korean (with Japanese accent), cases in Dutch (with French accent), cases in Norwegian (with German accent) and cases in English (with Chinese, Russian and British accent) have been diagnosed, among others.

The Foreign Accent Syndrome is a disorder of neurological origin, is a consequence of a cerebral damage, which provokes that people speak their mother tongue as if they were foreigners. The greater part of the published cases is monolingual people, without a chance of a source that explains their foreign accent. This doesn´t mean that the person can speak in two languages, but it affects the speech in such a way that it sounds from a different country or another region from his/her own country. Besides, the adopted accent does not have to be from another language, it can be from your own language. For example, from American-English to British-English.

It was first described by Pierre Marie in 1907 but the most popular case date back to World War II: a thirty years old Norwegian woman, who was affected by a fragment of a projectile during a Nazi bombing, started to pronounce her Norwegian with a strong German accent. The woman cannot avoid this alteration of her speech which produced her many problems in her daily life because she was identified as a German citizen.

• How the Foreign Accent Syndrome appears

Despite at the beginning, it seems that the person is faking, FAS is a real disease. What happen is that the affected by this syndrome have suffered a damage in the Broca´s area, the area of the brain that controls the speech and the way in which we pronounce the words. Specifically, it affects the motor system of the production of the speech of neurological origin, what provokes a foreign accent speaking in the mother tongue. The effect is inevitable for the person itself and, for its abrupt appearance, it used to result in emotional problems related to the loss of personal identity and the sense of belonging to a community. 

The damage originated by an apoplexy use to be the mainly cause of the appearance of this syndrome. Also, it could happen after a trauma in the brain like an overwhelming hit, a cerebral hemorrhage or a neurological degenerative condition, like the multiple sclerosis. It is also related with other circumstances like the aphasia – disruption of communication that can affect the capacity to understand and express the language – or the apraxia – disruption of the speech that affects the capacity to produce sounds, syllables and words.

However, this syndrome differs from the aphasia because it does not show deficit of an expressive or comprehensive language, nor phonetical distortions. At the contrary, the speech is perfectly clear and the listener does not interpret it as a pathological one. The people who suffer this syndrome face only to typical situations of a foreign speaker, not of an ill person. In any case, the FAS will be considered as a minor aphasia because it only modifies the pronunciation of some letters, which at first sight may sound as an accent.

According to scientists from the University of Oxford (USA), the person does not acquire the accent but the patterns of the speech are modified. The trauma in the brain may change the length of the syllables, alter the tone or make us pronounce wrong certain sounds. Therefore, cortical or subcortical injury of small size can also produce the syndrome. The majority of the well-known cases belong to injuries in the left hemisphere but there are cases with injuries in the right hemisphere, so it has not been associated with damages in a specific area of the brain.

• Symptoms, diagnoses and treatment

As it is a not very common condition, it is likely that the evaluation is made by a team formed by a pathologist of the speech, a neurologist, a neuropsychologist and a psychologist. Besides a psychical exam, the tests that can be practiced are:

- Psychological evaluation to dismiss psychiatric conditions.

- Valuation of the speech skills. Either by means of exams to evaluate the reading, writing and speech comprehension, using recordings to analyze the patrons of the speech, examining the muscles used to talk or using neuroimaging techniques like the electroencephalogram (EEG) or the scanner PET, among others.

The symptoms can last months or years. The mainly characteristics of the foreign accent syndrome are:

- Loss of the verbal fluency. They expressed with shorter and simpler sentences. In some cases there is a slightly agramatism, that is, to speak as an Indian.

- Inappropriate use of the suprasegmental features of the speech. Like the rhythm, the prosodic accent or the intonation. For example, distortion of the rhythm and the tone of the speech, reduction of the time between one syllable and the other, reduction in the transition of words and changes in the tonality of the sentences.

- Phonetic-phonological and segmental changes of the speech. There is a major affectation in the articulation of vowels rather than in the consonants, although there are also mistakes in the pronunciation of some consonants. 

Spanish investigators published the complete analysis of a patient that showed some features typical of the syndrome. It was examined in detail her capacity to communicate and the linguistic production, especially of the phonetic features. Among various symptoms, they found out a general deceleration in her speech, loss of the prosodic skills, difficulty to emit the right intonation of an interrogative phrase and certain mistakes in the consonants. According to the study, it was specifically flashy the production of the sounds between syllables of “b”, “d” and “g”. A native speaker of Spanish can produce these sounds in a light way or in a strong one, but the patient, as many foreign speakers, tends to the strong pronunciation, as if she divides every word in syllables.

As regards the social impact of the syndrome, the affected have a very reduced level of social interaction and participation. A consequence that the specialists have moved away from psychiatric causes and that base it on the reduction of skills bound to the communication, as for example the initiative to start the verbal emission or to start a conversation, and even the capacity to transmit emotional charge and of her mind through her speech.

There are cases of complete recovery, while in other case there is only partial improvement. The options of treatment include:

- Therapy of the speech. For example, for learning to move better the lips and the jaw while you are speaking.

- Advice. As it is a not very common disruption, it can provoke that the person feels isolated and ashamed because of his/her situation. The advice can help the affected as well as his/her family to deal better with this condition.

In certain cases, like traumatic injuries, this syndrome can be solved reducing the pressure under the brain, either in a surgical way or in a natural one. If the damage is deeper, and maybe irreversible, the brain tries to solve the impossibility of pronounce in the way that it knows, using alternatives. Here is when the therapy of the speech can serve to relearn to “speak” as before.

What would be ideal a combined treatment: a therapy that joins the medicine with the linguistic techniques that so far they are applying to it. Thanks, in part, to the precise identification of the cerebral alterations provoked by the cerebral injury and the linguistic and cognitive consequences.