Foreign Accent Syndromes

The stories people have to tell

Jack Ryalls, Nick Miller

• Publisher: Psychology Press
• Year: 2014
• ISBN:
  9781317974055
• Edition: 1
• Topic: Psychologie
• Subtopic: Histoire et théorie en psychologie

What does it feel like to wake up one day speaking with a foreign accent from a country one has never visited?

Why does someone wake up doing this?

This book seeks to portray the broad and diverse experiences of individuals with a rare neurological speech disorder called Foreign Accent Syndrome (FAS). Through a combination of personal testimony and scientific commentary, the book aims to shed unprecedented light on the understanding of FAS by elucidating the complex links between how the brain produces speech, how listeners perceive speech and the role that accent plays in our perception of self and others.

The first part of the book provides a comprehensive introduction to FAS and covers a number of key subject areas, including:

• The definition and phenomenology of FAS

• A history of research on FAS

• The causes and psychosocial consequences of FAS

• A guide to further reading and a glossary of specialized terms.

The chapters in part two provide a unique insight into the condition through personal testimony and accounts from family members. This collection of 28 testimonies from across the world underlines the importance of listening carefully to patients explain their cases, and in their own words. The final section contains a questionnaire for use by clinicians to support case history taking.

The authors are two leading global experts on FAS, and this is the first volume of its kind to provide such a broad and comprehensive examination of this rare and poorly understood condition. It will be of great interest to practising clinicians in neurology, psychiatry, psychology and speech and language therapy/pathology, as well as students in health disciplines relevant to neurorehabilitation, linguists and also to families and caregivers.

Part I

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Introduction

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Chapter 1

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Introduction

Jack Ryalls

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The purpose of this book is to relay the personal experience of Foreign Accent Syndrome (FAS). We seek to portray the broad and diverse experiences of those who have experienced this curious but compelling disorder; and who better to speak about this than those individuals who have lived with FAS themselves? For those who have, or have had FAS and for those who encounter these individuals, whether in clinic, home or the media, we also offer some insights from the history of FAS and comments from the science behind the condition.

We have purposely used ‘syndromes’ in the title, because it has become clear that there is more than one disorder, if disorder is the appropriate word. We wish to emphasise the breadth of experiences and aetiologies; to focus on how individual the experience is, despite the congruencies. While there are many different theories put forward to explain FAS, in this book we wanted to avoid a potentially turgid tome on the neurology, physiology, neuropsychology and phonetics of FAS, and gather together as many human experiences as possible. While it has been a century since a similar condition was described by the French neurologist Pierre Marie, there is not yet a single accepted theory for FAS.

In fact, a comprehensive account would probably have to be as diverse and individual as those who have written here about their experiences. We wanted to emphasise the individual and their personal experience. There have been some important historical developments in our understanding of this syndrome, as will be detailed below. But many attribute the first fully detailed case study where the psychosocial aspects of the condition were first brought to the fore, to the description by Monrad-Krohn of a Norwegian woman who lost her ability to produce the tonal accents of her native language. He established the term ‘dysprosody’ in 1947. His patient, Astrid, who ended up with a German-sounding accent, is probably the most famous and poignant case of FAS in the specialist literature. How much worse an experience can be imagined, than ending up with the accent of the occupying enemy army? Local shopkeepers refused her service, believing she was a collaborator.

There was also the notable coining of the term ‘Foreign Accent Syndrome’ by Whitaker in 1982 and his insistence on its neurological basis. For Whitaker, it was inappropriate to use the term ‘Foreign Accent Syndrome’ without clear evidence of a neurological basis. But oftentimes the aetiology is not clear, and not all neurological disturbances leave a clearly visible trail. As we have learned over the past few years, there are many cases of foreign accented speech related to all sorts of neurological disorders – migraine, dystonia and so forth, where brain consequences may be quite different to those in stroke or other head injury. While migraines are clearly recognised as neurologically based, there are no neuroimaging techniques to confirm the neurological basis of FAS associated with this disorder.

We are not seeking to solve the issues surrounding diagnosis or aetiology in the cases here. Rather our goal is to portray the broad existential content – what it feels like to experience this bewildering condition from the point of view of the speaker with FAS and the listener. Despite all the scientific scrutiny, we still know relatively little about this rare condition. But what we do know will be reviewed in the sections which follow.

While it has been claimed in various scientific publications that there are less than fifty cases of FAS in the world, from our experience we now know this condition to be hugely more prevalent than previously thought. Not only can a ‘foreign accent’ be associated with a much wider spectrum of conditions than previously suspected (drug interactions, a rather wide range of neurological conditions, even neurotoxins such as spider bites), but increased communication in the world has allowed us to hear from many more cases than ever previously possible.

One may well wonder why it is that human beings possess such an exquisite perception of different accents in the first place. It is tempting to speculate the existence of a ‘module’ in the human brain for detecting accent. Certainly the brain is highly skilled at detecting differences, whether they are changes in the visual, physical or auditory landscape. However, it is most likely several steps too far to assume there is some unique neurological substrate for ‘accent’. Nevertheless, registering differences in accent is socially important in human intercourse. One could account for the biological motivation for such sensitivity to accent in the drive for diversification of the gene pool: alertness to threat identification of sameness and difference. Once one has allowed oneself to speculate on such a mechanism in the processing of speech, there are the roots of an account for the natural curiosity in different accents of the globe. It does not take too great a leap of the imagination to understand the natural ‘attractiveness’ of a foreign accent or interest listeners would have in it. Such an account may eventually explain why many of the contributors here have complained about the doggedness of listeners to find an acceptable ‘explanation’ or satisfactory account of their accent.

We cannot overemphasise the contribution of a private Facebook page to our cause. To the best of our knowledge, this was an outgrowth of the initial effort of Paula Westberry (a person living with FAS whom we will meet in her personal account) to establish an internet forum. The self-governed site has essentially nominated long-standing members to ‘officiate’. Initially, the site served as an important information highway between the United States and Great Britain, but in recent years the network has broadened and is now truly global. Not only have people with FAS been able to reach out to each other around the world and exchange symptom relief information, but it has also served as a valuable and practical conduit of information, even in communicating various aspects of coordinating this book. It’s no wonder that members now refer to themselves on this site as ‘family’.

On the one hand, it is still true that there are precious few very well-documented and vetted cases which have undergone the full cycle of scientific scrutiny, including modern science’s well-known ‘peer review process’. On the other hand, both of us have heard from dozens of cases, which make it patently obvious just how under-reported this disorder really is. At the same time, though, there are too few true specialists dedicated to fully documenting all new cases. Oftentimes, the general public does not understand that it is not enough to simply report a new case. Rather, it is the more stringent requirement that each scientific article report something entirely new, in a systematic and rigorous fashion, which ultimately pushes science forward.

Our goal here has been to take inventory, to listen carefully to individuals explain their perception in their own words, and to share these experiences with the world – to be as broad and inclusive as possible. One may liken this role to medical cultural anthropologists investigating through personal stories. We endeavoured to keep editing of submissions to a bare minimum without judgement on what should or should not be told. Contributors were asked just to ‘relate your story as you experienced it’.

While the original definition of FAS by Whitaker dictates a neurological aetiology, we embrace a somewhat wider view in this volume, one that does not clearly eliminate the important psychological consequences or origins of this often devastating condition. Eventually, it will become important to delineate subtypes to allow better scientific scrutiny and treatment. For the time being, we view at least three broad varieties: FAS which arises in association with a rather wide range of neurological conditions; FAS that accompanies structural changes to the vocal tract; and altered accent that appears for psychological or functional reasons. These are discussed in greater detail below.

It is important to point out that we do not feel that FAS from a functional or psychological origin is any less real in terms of its phenomenology compared to when it arises for neurological reasons. Furthermore, in some cases there is a definite blending of neurological and functional determinants of accent which is often difficult to disentangle. As the insightful neuropsychologist Kurt Goldstein so aptly pointed out more than a century ago, with neurological disorders such as aphasia (or here FAS) not only do we observe the direct neurological consequences of the disorder itself, but also the individual’s adjustment to the devastating condition.

Many patients find their own coping mechanisms, and one can only admire the highly creative and adaptive manners in which they have got on with their lives. We are happy and proud to be able to showcase their tenacity of human spirit in this book. For this and many more reasons, it is misguided, even simply wrong to speak of ‘patients’ or ‘sufferers’. Let us call them ‘persons with FAS’.

As we shall see in the personal accounts and in the introduction to psychosocial effects, there are many routes to adaptation to the condition. Some adapt by allowing their interlocutors to believe that they are indeed from the country their accent suggests. This is often much simpler, and more expedient, than having to explain over and over again that their perceived accent results from a subtle and rare form of neurological injury.

There is evidence that, in neurological cases, FAS may emerge as a stage of recovery from nervous system damage and may have been preceded by a more severe speech and language disorder (i.e. aphasia). It is a given that in recovery or decline in neurological conditions the symptomatic picture evolves, not just in overall severity, but in the constellation of which impairments are present or not, prominent or not. This evolving clinical portrait stems partly from direct recovery of initially damaged tissue (or in progressive conditions loss of more cells/capacities). It is also well attested that the evolution arises as an effect of the brain reorganising its pattern of function to compensate for lost centres or pathways. An fMRI study of one individual with FAS from a subcortical (putamen) lesion clearly demonstrated this finding, with increased cortical activity in speech areas representing apparent reorganisational compensation. Individuals may also instigate compensatory tactics themselves to overcome impairments. This opens up the speculation that perceived accent change in neuro logical conditions may be one manifestation of a stage in recovery representing not just loss of particular aspects of speech programming and control, but also the effects of reorganisational or compensatory mechanisms. One path of future research may be to examine whether the pattern of natural and conscious compensation is different in speakers with FAS compared to other people with other communication disorders from brain damage.

We also note the remarkably greater number of females who contributed to this volume, despite the fact that at least one retrospective study determined a nearly equal incidence by gender. It is certainly tempting to relate this fact to the observation that females recover differently from stroke, although the empirical evidence to back up this claim remains a topic of debate. Are we witnessing some preliminary evidence of a true gender difference here, or is this difference attributable to the more mundane explanation that males are simply more reluctant to share their stories than women? We certainly made our best efforts to solicit stories from everyone willing to share. While we are aware of a few males who did not elect to share their story in this forum, the overwhelming majority of female cases here leads us to speculate that this gender difference is neurologically based, and merits much closer scientific scrutiny. This issue is considered again later on.

One of the important lines of contemporary research into brain function concerns attempts to understand the recovery process better after injury, not only for insight into the function of the human brain per se, but for the wealth of information it promises in terms of rehabilitation. FAS offers a fascinating and potentially fruitful forum for gaining greater insights into understanding the human brain and the speech processes that define our species.

All too often the media have focused on the ‘circus freak’ aspects of FAS, and devoted precious little attention to its scientific basis. It is our fervent hope that this volume will serve to reorient this unfortunate precedence. If the public can better comprehend the predicament of individuals with this bewildering disorder, it is hoped this volume can pave the way to a brighter future where individuals with FAS no longer suffer in isolation and are no longer exposed to the prejudices of miscomprehension.

The internet has provided some previously unavailable opportunities for people with FAS to communicate with fellow speakers. We should again acknowledge the contribution of the private Facebook page devoted to FAS which has been fundamental to communication and which presently numbers more than fifty participants worldwide – and we know of many individual cases who have chosen not to join the Facebook ‘FAS Family’, as they refer to themselves. The interaction with those who experience this syndrome has been a highly rewarding part of our work in this area. Many people with FAS have commented on the joy of being able to be put in touch directly with others with the condition.

There have been remarkably few published accounts of speech therapy with patients with FAS, and there is no clear evidence of speech therapy techniques that might prove most beneficial to individuals with FAS. Certainly we possess only anecdotal evidence of whether direct work on speech output has any real ameliorative effect. It is not known if very cutting edge and high tech methods such as electromagnetic articulography (which provides visual feedback about the largely invisible movements of the tongue) might assist speakers to achieve their former speech patterns.

This is just one of the variety of questions that remain to be explored. People with FAS sometimes report listening to tape recordings or viewing video recordings of their former accents and attempting to retrain themselves into their old speech patterns. Unfortunately, they typically report such attempts to be extremely frustrating.

It seems worthwhile to point out that often (and again anecdotally, since no one has carried out evidence-based systematic study) those individuals, who reach a point in their lives where they accept their speech changes, seem to make the most satisfactory adjustment. It is not impossible that, unless performed very judiciously, it may turn out that speech therapy may even interfere with this acceptance process. Certainly several personal accounts here have expressed dissatisfaction. But we are not presently equipped with the requisite evidence-based practice to make informed clinical decisions. We simply know too precious little. Before turning to the very special, often amazing and emotional personal testimonies of those individuals who have lived with FAS, we will next turn our attention to definitions, aetiologies, history and differential diagnosis of the syndrome.

Chapter 2

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All about Foreign Accent Syndrome

Nick Miller

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Definitions, phenomenology

What is Foreign Accent Syndrome? What are its characteristics?

Foreign Accent Syndrome (FAS) has been held up as ‘real twilight zone stuff’, a ‘strange ailment waiting out there to ambush us’. It has been billed as the ‘mysterious acquisition of a (foreign) accent’. To some pundits it comes from damage to the ‘accent’ module in the brain. People have claimed it is a sign of long-dead relatives from a far-off country struggling to communicate across the divide of time and space. It is linked to miraculous reports of people being knocked off their motorbike and suddenly having the power to speak a language they never knew before. The stream of aberrant assertions, mis -perceptions, sheer theatre, journalistic invention and misguided medicine that has surrounded this syndrome over recent years has meant that people with Foreign Accent Syndrome are typically totally misunderstood, and people who search for serious, accessible and accurate information on it are faced with a wall of distorted or fanciful facts making it difficult or impossible to glean a clear, reliable view.

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Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements and dedications
• Part I Introduction
• Part II Personal testimonies
• Part III Additional resources
• Index