How Foreign Accent Syndrome Works

What's now known as Foreign Accent Syndrome is incredibly rare. Hugh Nutt/Getty Images

Lisa Alamia had an overbite sufficiently pronounced for her to require jaw surgery. That kind of operation is pretty serious and requires complete sedation. When Alamia woke up, she was hoping it would be her new jawline that impressed people. Instead it was the way she spoke.

Before Alamia had the surgery, she possessed a gentle Texas drawl, which made sense because she was born, raised and continued to live in Texas. But after the surgery, Alamia didn't sound Texan at all — she sounded British.


Her husband and three kids thought she was putting it on, but Alamia couldn't seem to shake her new sound. The weird thing was that she'd never even been to England. The only time she'd left the U.S. was to go to Mexico. Alamia's kids used to listen up when she lectured them in her old Texas accent, but now that she sounded like she could be serving tea to the Crawleys of "Downton Abbey," they just couldn't take her seriously [source: Friedman].

Things could be worse. During World War II, a Norwegian woman named Astrid suffered a brain injury from shrapnel that exploded during a bombing raid. When she recovered and was able to speak, she had inexplicably developed a German accent. This was extremely inconvenient: Norway was, at the time, occupied by the Germans. Anybody who didn't know her well assumed she was attached to the occupying enemy force. Shopkeepers refused to serve her, and neighbors shunned her, even though she had never been to Germany and didn't speak a word of German [source: Beck].

When Astrid saw neurologist Georg Herman Monrad-Krohn, he referred to her speech as "dysprosody." Prosody refers to the non-grammatical elements of speech, like tone and rhythm. The condition would come to have a different name by the time Lisa Alamia reported her problem to her doctor and managed to convince him that she wasn't faking it. The neurologist who eventually diagnosed Alamia, referred to her condition as "foreign-accent syndrome" (FAS), a term coined in the 1980s. FAS is an extremely rare form of language disorder — so rare, in fact, that there are only about 100 known case studies of the phenomenon [source: Keulen].


What Is Foreign Accent Syndrome?

Head injuries are one potential cause.
Reggie Casagrande/Getty Images

You know that deeply embarrassing thing that happens when you go into an "ethnic" restaurant with your dad and he inexplicably slips into a terrible rendition of a Chinese/Thai/Indian accent while ordering? That's not foreign-accent syndrome. That's just a mysterious condition that affects dads. Nobody knows why. Something hormonal probably.

This common condition would only be considered foreign-accent syndrome if your dad started in with his accent but then couldn't stop. Not in the restaurant, not in the car on the way home, not on the phone — never. When you're done shuddering at this thought, take a moment to consider how it feels for your dad. It's almost as though he's become somebody else, and it's not clear whether he'll ever get his old, familiar accent back.


Typically, such a transformation doesn't come out of the blue. It's usually triggered by some event, such as head trauma, a stroke, the onset of multiple sclerosis or a mental illness. But sometimes doctors are flummoxed by the appearance of foreign accent syndrome, as they are in the case of Lisa Alamia, for instance. Jaw surgery doesn't typically cause FAS. In fact, there are no other recorded cases of this outcome from such a routine operation.

Still, the sample size for FAS is so small that it's hard to establish a set of norms for it. It's not as though people always end up sounding the same way. There have been Japanese speakers who suddenly began sounding Korean, Brits who are mistaken for French, Scottish people who developed South African accents overnight and Spaniards who are assumed to hail from Hungary [source: Stollznow].

One woman from Plymouth, England, came down with a migraine so severe she landed in the emergency room. Upon recovering, she was stunned to discover she had a Chinese accent [source: UT Dallas]. As an English Caucasian, this was hard to explain. Things can get really embarrassing for victims of FAS, especially if everybody thinks they're being racist.

Experts recommend having a well-rounded team of specialists diagnose the problem:

  • Neurologist: Looks at the functioning of the nervous system
  • Radiologist: Specializes in the imaging technologies that can help determine where a problem lies
  • Neuropsychologist: Examines the links between thought, behavior and brain function
  • Clinical psychologist: Looks at ways of reducing stress and other emotional and psychological imbalances
  • Speech-language pathologist: An expert in the assessment and reduction of speech disorders

[source: UT Dallas]

Once they've diagnosed FAS, the team supplies the patient with a T-shirt that says, "I can't help it. Sorry." Or, at least, they should.


Different Types of FAS

Mental health issues such as bipolar disorder and schizophrenia might be another contributing factor.
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As mentioned earlier, the typical victim of FAS has experienced some form of brain damage, which could be from head trauma, a stroke or a disease like multiple sclerosis. In these cases, researchers find that the damage sustained has occurred in the parts of the brain related to speech, such as the left hemisphere or in the middle cerebral artery. The creation of speech is wildly complex and involves multiple areas of the brain, so damage caused to one area could alter speech without impeding it. People with FAS are often entirely coherent and articulate, although some can have difficulty with speech elements like word order or pronunciation [source: Stollznow].

All of these causes are what researchers would call "neurogenic." Until recently it was thought that FAS was entirely neurogenic in origin. It is now acknowledged that people can develop FAS through psychogenic means. In other words, foreign accent syndrome can be a symptom of different forms of mental illness. Bipolar disorder, conversion disorder or schizophrenia have all been found to correlate with rare cases of foreign accent syndrome [source: Keulen].


In one recent case, an American woman in her mid-30s began speaking in a British accent. This was a relatively minor element of her case file because she ended up in a psychiatric emergency room after attacking her mother's landlady. The attack was precipitated by her belief that said landlady was using voodoo to curse her. It turned out there was a history of schizophrenia in the patient's family and that she herself had experienced psychotic episodes in the past. In fact, the British accent had shown up in her previous episodes as well. And, as often seems to happen in cases of psychogenic FAS, her accent faded away when she recovered from her episodes [source: Beck].

It's all very well to say that neurogenic cases of FAS are caused by damage to certain areas of the brain and that the psychogenic variants are caused by mental health issues, but what do either of these explanations really mean? Why would such factors make people sound like they've suddenly switched nationalities?


Can a Syndrome Really Change Your Accent?

Throw one bit of this anatomy off, and you might wind up with a speech problem that sounds like a new accent.
BSIP/UIG via Getty Images

For most of us, talking is second nature. We don't even think about how complex the process is. But to get words to come out of your mouth sounding the way they need to in a given context requires exquisite control of your jaw, tongue, lip and larynx muscles. If anything messes with this finely calibrated team, your speech could end up sounding funny. Need a good example? Have a little too much to drink, and you'll start slurring your words because of a loss of muscle control.

Take vowels, for instance. Where we place our tongue and how we shape it can result in incredibly subtle variations in the way we pronounce vowels. And shifts in vowel sounds are key to different accents. Lose a bit of control over your tongue, and you could end up sounding, well, foreign.


This appears to be at the heart of foreign accent syndrome. It's not that a person recovers from a stroke with a brand-new cultural identity. It's that the stroke has impaired his control over the fine motor skills required to sound the way he used to. This impairment changes the way his vowels sound above all, which in turn leads listeners to assume that the person has a foreign accent [source: Nickels].

But why would a Texas woman end up with a British accent or a Swedish woman sound German? They don't. Not really. The truth is that an accent lies in the ear of the listener. In many cases of FAS, listeners can't agree on the provenance of the new accent. Some people thought that Astrid, the Swedish FAS sufferer, was French, not German. To demonstrate this phenomenon, researchers conducted a study in which they asked people to identify the accent of a person with FAS. The answers were, quite literally, all over the map — some said French, others African, still others Italian, Welsh, Chinese ... you get the picture [source: Nickels].

So, to be accurate, foreign accent syndrome should really be called "different" accent syndrome. But that doesn't have quite the same ring to it, does it?

If reduced control of the muscles that help you articulate speech explains the onset of FAS, it sounds like that must be a neurogenic explanation. What about those rare instances of psychogenic FAS? What's behind the accent change for some people experiencing a psychotic episode?


Mind Over Patter?

FAS typically fades with the underlying cause.
Tim McGuire/Getty Images

As mentioned previously, most cases of foreign accent syndrome are considered to be neurogenic in origin. In fact, until recently, it was thought that FAS was a completely neurogenic phenomenon. But specialists are now conceding that there are some cases in which no damage or impairment of the brain can be found. In these instances, FAS is often found to occur in tandem with a mental illness.

In some such cases, FAS doesn't just manifest in the form of vowel changes or shifts in speed of articulation, but also in the use of a different vocabulary. So, for instance, an American experienced an episode of FAS in which he not only had a British accent, but also used words like "bloke" instead of "friend," and "loo" instead of "toilet."


In another case, a Dutch woman with FAS developed a French accent and even spoke Dutch using French syntax and sometimes French words, sounding convincingly like a French person in the process of learning Dutch. The fact that she taught the Dutch language to French people was the obvious source for her knowledge of how such a person would sound [source: Keulen].

People with neurogenic cases of FAS don't insert foreign words or use foreign syntax. Neurogenic FAS is a problem of articulation alone. This difference points to why it's important to correctly diagnose the origin of a case of foreign accent syndrome. The treatment of a neurogenic FAS is a specialized form of speech therapy known as "accent reduction techniques" — i.e., retraining the larynx, tongue and lips to articulate the way they once did [source: UT Dallas].

This would be pointless for psychogenic FAS since the syndrome in such cases is a symptom of mental illness. Treatment of psychogenic FAS then requires treatment of the underlying illness; FAS often disappears as a patient recovers from an episode. The length of the episode and, consequently, the FAS, varies widely according to the illness and individual; however, for people whose FAS did fade away with an episode, the syndrome lasted for a few months [source: Keulen].

To make matters more complicated, it seems there's also something called a "mixed variant of FAS," in which the origin of the syndrome is considered to be a combination of psychogenic and neurogenic causes [source: Keulen].

As medical understanding and diagnostic tools advance, perhaps the differences between psychogenic and neurogenic causation will erode a bit. Some recent studies have found that certain mental illnesses can be caused by the immune system's response to infections, showing that sometimes, at least, the mind/body divide is not as pronounced as we might think [source: Velasquez-Manoff].


Lots More Information

Author's Note: How Foreign Accent Syndrome Works

A friend of mine who grew up in the rural U.S. was once in a bad car accident that left her in a coma. When she woke, she couldn't speak a word of English, but instead chatted away in German. This seemed like an insoluble mystery until her mother remembered that the family had spent a year in Germany when my friend was 4 years old. She hadn't spoken the language since, but somehow the brain trauma from the accident brought it to the fore. As she recovered, the German faded and she returned to speaking fluent English. This phenomenon is not foreign accent syndrome. In fact, it's relatively common and has its own cool name: bilingual aphasia.

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More Great Links


  • Beck, Julie. "The Mysteries of Foreign-Accent Syndrome." The Atlantic. Jan. 27, 2016. (Nov. 14, 2016)
  • Bhandari, Hanul Srinivas. "Transient foreign accent syndrome." BMJ Case Reports. Nov. 9, 2011. (Nov. 14, 2016)
  • Friedman, Megan. "A Texas Woman Woke Up From Jaw Surgery With a British Accent." Esquire. June 23, 2016. (Nov. 14, 2016)
  • Keulen, Stefanie et al. "Foreign Accent Syndrome As a Psychogenic Disorder: A Review." Frontiers in Human Neuroscience. Vol. 10. Page 168. April 27, 2016. (Nov. 14, 2016)
  • Nickels, Lyndsey. "Explainer: what is foreign accent syndrome?" The Conversation. June 19, 2013. (Nov. 15, 2016)
  • Shannon, Lucy. "Tasmanian woman Leanne Rowe wakes from car crash with rare Foreign Accent Syndrome." Australian Broadcasting Corporation. June 16, 2013. (Nov. 15, 2016)
  • Stollznow, Karen. "Language Myths, Mysteries and Magic." Palgrave Macmillan. 2014. (Nov. 14, 2016)
  • UT Dallas. "Diagnosis & Treatment." Foreign Accent Syndrome. (Nov. 16, 2016)
  • UT Dallas. "FAS Stories." Foreign Accent Syndrome. (Nov. 17, 2016)
  • UT Dallas. "What is Foreign Accent Syndrome?" Foreign Accent Syndrome. (Nov. 15, 2016)
  • Velasquez-Manoff, Moises. "When the Body Attacks the Mind." The Atlantic. July/August 2016. (Nov. 17, 2016)