Stuff You Should Know - Episode: How Foreign Accent Syndrome Works

Hosts: Josh Clark and Chuck Bryant
Release Date: January 18, 2025
Production: iHeartPodcasts

Introduction to Foreign Accent Syndrome (FAS)

In this episode of Stuff You Should Know, hosts Josh Clark and Chuck Bryant delve into the intriguing and rare neurological condition known as Foreign Accent Syndrome (FAS). FAS causes individuals to suddenly speak with a perceived foreign accent, a phenomenon that captivates both medical professionals and the general public due to its mysterious nature and profound impact on personal identity.

Chuck Bryant opens the discussion by introducing the topic:

"Good afternoon, Gubner. It's Chuck here on a Saturday, and I'm going to pick a selection called How Foreign Accent Syndrome Works." ([01:09])

Understanding Foreign Accent Syndrome

Josh Clark provides a foundational understanding of FAS, distinguishing it from mere accent imitation or code-switching. He explains that FAS is an involuntary condition resulting from neurological damage, leading to changes in speech patterns that make individuals sound as though they have adopted a different, often foreign, accent.

"And what makes it different from somebody taking on the affect or dialect or accent of somebody else. This is where you can't stop. It's involuntary." ([09:16])

The hosts emphasize that FAS is not about someone choosing to adopt an accent but rather an involuntary change caused by damage to areas of the brain responsible for speech prosody—the rhythm, stress, and intonation of speech.

Case Studies of Foreign Accent Syndrome

To illustrate the complexities of FAS, Josh and Chuck discuss several notable cases:

1. Lisa Alamea
   Lisa underwent jaw surgery to correct an overbite. Upon awakening, she unexpectedly began speaking with a British accent despite never having lived in the UK.

   "She'd never been to England. I mean just straight up sounds Chinese and like broken." ([23:08])

   Remarkably, Lisa experienced an increase in sociability, as the new accent served as a conversation starter, shifting her previously shy demeanor.

2. Astrid - The Norwegian Case During WWII
   Perhaps the most historically significant case, Astrid, a Norwegian woman, suffered a brain injury from shrapnel during a German bombing raid. Post-injury, she began speaking with a German accent. This transformation had dire social consequences, as Norway was under German occupation, leading to her being unfairly labeled as a German spy.

   "She couldn't even speak German. But she had that accent and was obviously very distraught by this." ([12:18])

   Dr. Jorg Erman Monrad Krone first identified Astrid's condition, initially naming it "dysprosity" to describe the abnormal prosody.

3. Sarah Caldwell
   An English woman in her mid-30s, Sarah developed a Chinese accent following severe migraine attacks. Her condition worsened over time, leading to significant physical and psychological challenges, including mobility issues where her limbs did not respond despite being physically functional.

   "She said that she can't look in the mirror while she's speaking any longer. She just doesn't feel like herself anymore." ([23:08])

Types of Foreign Accent Syndrome

The hosts categorize FAS into three primary types based on its origins:

1. Neurogenic FAS
   The most common form, accounting for approximately 86% of cases, arises from neurological damage such as strokes, traumatic brain injuries, or multiple sclerosis. This type is characterized by irreversible changes in speech patterns, requiring extensive speech therapy for management.

   "With neurogenic, the only treatment that they can come up with is through speech therapy, where a speech language pathologist basically retrains you to talk the way you did before." ([20:14])

2. Psychogenic FAS
   Representing about 14% of cases, psychogenic FAS stems from psychological factors without any identifiable neurological damage. This form is often associated with mental health conditions like schizophrenia, anxiety, or personality disorders. Notably, psychogenic FAS tends to be transient, resolving as the underlying psychological condition improves.

   A notable case involves a woman with a family history of schizophrenia who, after attacking her mother's landlady under delusional beliefs, exhibited a British accent during the incident.

   "She had spoken with a British accent. And taking a family history, they found that, number one, she had schizophrenia in her family." ([21:53])

3. Mixed FAS
   This rare form combines elements of both neurogenic and psychogenic factors, where psychological issues may arise alongside physical brain lesions, compounding the syndrome's effects.

Diagnostic Criteria and Challenges

Dr. Harry Whitaker, a neurologist, coined the term "Foreign Accent Syndrome" in 1982 and established a four-point diagnostic criterion:

1. Perceived Foreign Accent: The accent must be considered foreign by the patient, their acquaintances, and researchers.
2. Change in Prosody: There must be a noticeable difference from the individual's original speech patterns.
3. Central Nervous System Damage: The condition should be linked to neurological damage.
4. No Pre-existing Foreign Language Proficiency: The individual should not have a background in the foreign language associated with the new accent.

However, these criteria have evolved as more cases emerge, particularly with the identification of psychogenic FAS, leading to debates within the medical community about the classification and understanding of the syndrome.

The Psychological Impact of FAS

FAS can lead to significant psychological distress, including identity crises and social isolation. Individuals may feel disconnected from their sense of self due to the involuntary nature of their altered speech.

"You couldn't stop. You're trapped in your body." ([36:18])

The distress is compounded by societal reactions, where misunderstandings about the condition can lead to stigma and misinterpretation of the individual's intentions.

Therapeutic Approaches and Prognosis

Neurogenic FAS: Treatment primarily involves speech therapy aimed at retraining the affected individual's speech patterns. However, recovery can be slow and incomplete, depending on the extent of neurological damage.

"With neurogenic, they have no cure whatsoever. And basically the only treatment that they can come up with is through speech therapy." ([20:14])

Psychogenic FAS: Often more hopeful in terms of recovery, as addressing the underlying psychological condition can alleviate the foreign accent.

Ethical and Social Considerations

The episode highlights the ethical complexity surrounding FAS, particularly in distinguishing between genuine neurological or psychological causes and instances where individuals might knowingly or unknowingly mimic accents for personal reasons.

"So you didn't actually adopt a Chinese accent. You're just creating sounds in the same way that somebody who was a native Chinese speaker would." ([32:03])

This distinction is crucial for both medical professionals and society to understand and appropriately support individuals affected by FAS.

Conclusion

Josh Clark and Chuck Bryant conclude by emphasizing the enigmatic nature of Foreign Accent Syndrome and the ongoing need for research to better understand its mechanisms and develop effective treatments. They also reflect on the human aspects of the condition, recognizing the profound personal struggles faced by those who experience sudden and involuntary changes in their speech.

"When you suffer foreign accent syndrome, your dialect, your brain is damaged so that you can't produce that anymore, and you just kind of haphazardly producing something else you don't actually follow." ([34:16])

The episode serves as a comprehensive exploration of FAS, blending scientific insight with empathetic storytelling to shed light on a rare but impactful condition.

Notable Quotes:

• Chuck Bryant ([21:53]): "She believed the landlady was practicing voodoo on her, against her, and she attacked the woman."

• Josh Clark ([09:16]): "This is where you can't stop. It's involuntary."

• Chuck Bryant ([23:08]): "She can't look in the mirror while she's speaking any longer. She just doesn't feel like herself anymore."

• Josh Clark ([32:03]): "So you didn't actually adopt a Chinese accent. You're just creating sounds in the same way that somebody who was a native Chinese speaker would."

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