She Woke Up With a French Accent

The pain felled her like an ax to the skull. A moment after it hit, Ellen Spencer crumpled to her knees, unable to move.

It was a gloomy Monday during a rain-soaked week in Indianapolis, and Spencer, then a 47-year-old graphic designer, had been feeling odd all day: “I was sitting at the computer doing a project, and I felt the tip of my chin go numb. I thought, This is weird.” As the day progressed, the numbness spread to her lips, then her nose, cheek, eyebrow, and forehead. “It was exactly as if I’d gotten a lidocaine shot from the dentist.”

At 8:30 p.m. she was doing dishes at the sink when something snapped: “I was driven to my knees as if someone had put an ax through the back of my head,” right at the base of the skull. After gathering her strength, she more or less crawled upstairs to bed and woke her husband. Incredibly, she decided to sleep the pain off and call her doctor if she didn’t feel better the next morning.

She awoke at 7:30 a.m. with an excruciating headache and began counting down the minutes until the nearby clinic opened. Even scarier: “The numbness had spread over my right shoulder into my upper arm and armpit. I was afraid,” she says.

There were no openings at the clinic, so they sent her to the emergency room. A long, frustrating day of tests followed. Meanwhile, the numbness continued to spread over her right side, and she worried that it might overtake her lungs. At one point, she recalls, “My husband asked, ‘What did they give you?’” He thought the hospital had medicated her. But she answered, “Nothing. Only saline. Why?” He replied, “Your speech is slurring as if they’d given you something.”

The cause of her numbness and pain was—and still remains—a mystery, as her tests were inconclusive (though she believes she suffered a microbleed too subtle to show up on brain scans). Spencer returned home in the late afternoon and crashed. Her husband brought her dinner a few hours later, but she didn’t stir. In fact, she slept for 16 hours.

Her husband had to work the next morning, so she woke up to find herself alone in the house. The numbness and pain persisted, but she could at least drag herself to the bathroom. One the way, she muttered something to Spirit, her Jack Russell terrier; it was so mundane that she has no recollection of what she said. It was something like: “Hey, girl, are you ready to go downstairs?” But while she doesn’t recall exactly what she said, the way she said it is permanently seared into her memory. Because the voice that emerged from her mouth wasn’t hers. It sounded bizarre, alien, as if she had an accent.

Still foggy, she staggered to a mirror and spoke again, confirming that, yes, the strange voice was coming from her own mouth. Frightened, she kept talking out loud to herself and Spirit, trying to fix the problem. She muttered, “I sound weird.” Except it came out as, “I sound word.” She tried the phrase once more and again butchered it. Thinking she could swap in another word, she said, “I’ll just try something different.” But that came out sounding wrong, too. It sounded French: dee-fah-rawnt. So she tried another remark: “That’s strange.” Again, it sounded French: strahnge.

She broke down crying—something was desperately wrong. She’d been born and raised in Indiana and had spoken with a flat Midwestern inflection her whole life. Now, unaccountably, she had a foreign accent.

Today, 10 years later, she still has this accent. After a little online research, Spencer realized that she’d developed a rare neurological disorder called foreign accent syndrome. FAS is most commonly caused by a stroke or brain lesion. While doctors have never figured out what caused her accent shift, it did leave her with several linguistic quirks.

For instance, she has trouble pronouncing the letters th: mother and father become mudder and fadder. She also chops up words in unusual ways: “I call-ed my doc-tore,” and “I can be quite com-for-tah-bul.” Overall, Spencer describes her accent as “a blend of French, Dutch, and German, with hard consonants like South African or Caribbean. Definitely not my normal Midwest Indiana voice.”

Because language is so closely tied to our sense of self and sense of belonging to a community, FAS can be devastating; it can also shatter friendships and drive spouses away. Voices are “part of our identity,” a powerful part, says Sheila Blumstein, a professor emerita of linguistics at Brown University who has studied FAS. “So imagine if that changes. You wake up, and you don’t sound like you anymore.”

But while the way she speaks has attracted the most attention, Spencer says that FAS has affected other capabilities as well. She has trouble planning tasks and remembering things, and she’s constantly monitoring her own speech to dodge certain words. It’s exhausting.

Well-meaning people, she says, sometimes comment that they “would love to have a French accent.” She isn’t so sure. “Careful what you wish for,” she replies.

A Jumble of Vowels

In many ways, Spencer is a typical FAS patient. Although the syndrome can emerge in children as young as 7, one academic review found that the average age of onset is 48. It’s also more common among women: In one collection of cases, 26 of the 27 patients were female. (Women are more likely to seek medical treatment in general, so some scientists speculate that FAS simply comes to light more often in them.)

In addition, during her initial incident, Spencer felt numbness on her right side, which is controlled by the brain’s left hemisphere; FAS patients usually suffer brain damage on the left side, which dominates speech in most people. Also, patients typically can’t speak the language associated with their accents. Spencer’s accent is regularly mistaken for French or German, but as she often tells people, “I don’t parlez-vous, and I don’t sprechen sie.”

FAS can affect several different aspects of speech. The most obvious shifts involve sound: “sheet” becomes seat or “ship” becomes sheep. Sometimes people pronounce silent letters or add unnecessary syllables reminiscent of Pig Latin: “Standing” becomes suhtanding or “picture” becomes pikuhture. The rhythm and melody of patients’ speech, the prosody, can also be disrupted. Their pitch might rise where you’d expect it to fall, or vice versa, or they might stress the wrong syllables. Sometimes people resort to “telegraphic speech,” eliminating articles or prepositions, or they pause too often, as if struggling to come up with the next word.

A patient’s new accent isn’t connected to any particular foreign language—it’s more a hodgepodge accent. And despite the shifts in sound and rhythm, people with FAS aren’t speaking pidgin: They can still speak fluently in their native tongue and make themselves understood. Nor are they slurring words or stumbling over syllables, the way someone with severe speech difficulties would. No natural language contains those features, and a listener would instantly recognize that something was wrong neurologically. FAS speech, in contrast, is only subtly different, and it contains a suite of sounds and rhythms that could plausibly belong to a real language. “It just happens not to be any particular natural language,” Blumstein says.

Instead, it’s a jumble—with vowels you might hear in native French speakers, rhythms associated with Italian, pitches reminiscent of Chinese, and so on. For these reasons, FAS speech isn’t a true accent, but it contains enough quirks and distortions that our brains classify it as somehow foreign.

In fact, different people often interpret the same accent in different ways. In Boston in the 1980s, Blumstein met her first FAS patient at a hospital during a case presentation with psychologists and neurologists. Afterward, all the health professionals wondered, What accent does she have? Blumstein is a linguist by training, and she found it interesting that some people in the room thought the patient sounded German, while others thought she sounded Russian or French. Yet, as far as sound structure is concerned, those languages are not related. “It intrigued me,” says Blumstein. “What are we really hearing?” In truth, the listeners’ background actually influences what they perceive. Blumstein adds, “We concluded [the accent] is really in the ears of the beholder.”

That heterogeneity, along with its rarity, has made FAS difficult to study systematically. “You get one patient, and then maybe six years later you get another patient, and another one 10 years later,” Blumstein says. And because different researchers use different methods and ask different questions, large-scale analysis hasn’t been possible. Jack Ryalls, a linguist at the University of Central Florida who is one of the world’s leading experts on FAS, even argues that the term “foreign accent syndrome” might be a misnomer. He recently co-edited a book of case studies called Foreign Accent Syndromes, plural, to emphasize the wide variety of types he’s encountered.

The Choreography of Speech

Scientists disagree about what causes foreign accent syndromes, and it’s possible that different types have different causes. But the root of most cases seems to be found in the mouth and throat.

Speaking a word aloud requires two steps: planning, which takes place in the brain, and execution, which involves moving the teeth, tongue, lips, lungs, and voice box in a coordinated way. Neurological speech problems can arise from either step, but execution seems to be the culprit with FAS. As evidence, Blumstein notes that people with difficulties in executive function often make characteristic mistakes, like saying “dappy hays” instead of “happy days.” Her FAS patients never made those oral typos.

More specifically, some scientists have traced the execution problems to motor-articulation. Speaking aloud requires contorting the mouth and throat to alter the flow of air streaming through. The brain controls these delicate movements, and brain damage can affect the ability to choreograph them. Similarly, some people with brain damage struggle to produce the proper tension in their vocal apparatus. All these changes affect the sounds that emerge from a person’s airways, with distorted speech as the result.

Strokes remain the most common trigger for FAS, but scientists have also linked it to multiple sclerosis, infections, withdrawal from Parkinson’s drugs, electrocution, schizophrenia, brain tumors, and neurotoxicity from, of all things, spider bites. Other cases might not involve brain lesions at all. Laura McWhirter, a neuropsychiatrist at the University of Edinburgh, traces some cases of FAS to what are called functional neurological disorders.

In explaining what those are, she makes an analogy with computers. Computers can crash because of hardware problems, software problems, or some combination. Similarly, neurological disorders can arise from brain lesions (akin to hardware), faulty signal processing within the brain (software), or a combination of both.

With functional FAS, McWhirter notes, many patients are dealing with jaw injuries or have recently undergone dental or oral surgery. As a result, there’s “unusual extrasensory feedback from the mouth,” she says. “It’s painful, and you don’t move it as much.” To compensate, the brain’s software “spotlights” the mouth and focuses more attention on it, which is a natural reaction. But in some people this attention backfires and their speech goes awry. She notes, “You’re probably allocating more attention than you need to movements that you would normally do automatically. It becomes effortful.” She adds that people can experience something similar by saying the same word over and over again. “It may even start to feel distorted or to sound different.”

Intriguingly, if articulation problems and effortful speech are, in fact, the root of FAS, then it’s possible that not all accents are equally likely to emerge. FAS appears worldwide and can cause a dizzying array of perceived accent and dialect shifts: from Japanese to Korean, Spanish to Hungarian, Dutch to Turkish, Bronx to Irish, Georgian to Cajun, among other combinations.

But according to one preliminary survey of cases from the Netherlands, most FAS patients start off speaking languages like English or Dutch and acquire accents associated with speakers of Romance, Eastern European, or tonal languages (such as Chinese). Those latter languages, the Dutch scientists argue, require more “muscular effort and breath force,” meaning the throat and lungs have to work harder. And if someone suffers an injury that affects their articulation, they might compensate, consciously or not, by forcing their vocal apparatus to work more.

However, neither Ryalls nor Blumstein subscribes to this theory. Ryalls says, “I’m not convinced that a particular language has more ‘muscular effort and breath force’ than another.” But if that theory does prove true, it would be much more likely for, say, a native English speaker to acquire a faux French or Chinese accent than for the inverse to happen.

Mourning the Voice

Although the first reported case of foreign accent syndrome dates back to 1907, there’s been much more interest recently. One paper found that 93 percent of all known cases have appeared in the neurological literature since 2000. That increased awareness has its pros and cons. Ellen Spencer says she sometimes had eight to 10 neurologists crowded around her during appointments, eager to get a glimpse of a real-life FAS patient.

Patients today are more likely to get a diagnosis and find support, which are big comforts. On the other hand, the media attention can be overwhelming to sufferers, especially when they’re asked to do such frivolous or demeaning things as pose for photographs holding a mini Eiffel Tower. And when sensationalist supermarket tabloids make sufferers feel freakish, Spencer says, “it hurts.”

Ryalls adds that the media tend to focus on dramatic stories of people “waking up” with exotic accents. The late pop singer George Michael, for instance, fell into a coma after a lung infection and awoke speaking a different dialect of British English. (He also believed, reportedly, that he was “king of the world.”) But it’s much more common, Ryalls notes, for patients to lose all ability to speak in the days or weeks after their injuries. The accent emerges only later, as they gradually regain speech. In this way, the accent can be a positive sign of the brain’s healing. As Ryalls says, “I’m starting to see [FAS] as a stage of recovery.”

Still, while having an accent is better than losing all ability to speak, the prospects for full recovery are often dim. “People are very embarrassed about the accent, and they’re very motivated to try and change it,” says Ryalls. They even listen to old recordings of their speech and try to imitate themselves. Many also seek speech therapy. Unfortunately, less than half of patients recover their original accent, he estimates, and despite some anecdotal reports, speech therapy doesn’t seem to help. “I don’t believe it’s effective,” he says. “You have to have conscious control over the accent to change it.”

Those mediocre odds of recovery leave many FAS patients struggling to cope. To be sure, some find a silver lining in their new situation. One normally shy woman reported that the new accent helped her in social situations: It was a natural ice-breaker and made for an obvious topic of conversation. People with FAS often chuckle over other people’s faux pas as well: Overeager strangers rush up to test out their foreign language skills on a “native.” One friend of Spencer’s was convinced that she had a part in a play and that she was trying to stay in character. Spencer also says, “I used to sound like my three sisters. Now when I call my mom, she knows that it’s me.”

Much more common, however, are the frustrations. Spencer remembers a friend calling her up one day after her accent emerged. The friend hung up immediately upon hearing her voice, thinking she’d dialed a wrong number. When the friend called again, Spencer had to prove her identity. “The first thing out of my mouth was, ‘Mary, don’t hang up on me. Last week we went to lunch; I wore that red dress you like.’” Her mother-in-law also told her, more or less, to snap out of it; she insisted that if Spencer slowed down and took her time, she could speak correctly if she wanted to.

Fortunately, Spencer still has a good relationship with her mother-in-law. But not all patients are as lucky with their loved ones. One man quoted in a neurology paper lamented how people would whisper that he had taken to drink. Other patients have been labeled “mentally unstable” or accused of perpetrating a “sick joke.”

In some cases, people grieve for their voices. One patient reported that “my old self died the day I lost the speech.” Another woman cherished a recording of her old voice, saying it was like “a twin sister who has died.” One woman whom Spencer knows can’t pronounce her own name: “Tina” comes out Tee-anna. Even pets sometimes look askance at their owners and don’t know how to react.

People can face discrimination as well. Perhaps the most famous case of foreign accent syndrome involved a 28-year-old Norwegian woman whose skull was dented by bomb shrapnel when Nazi Germany invaded her homeland in 1941. She fell unconscious for half a week and suffered mild brain damage on the left side. When she recovered the ability to speak, her pitch patterns were off. Pitch helps determine a word’s meaning in Norwegian, and her sudden clumsiness made her sound uncannily German—the language of the enemy. As a result, according to her doctor, “she complained bitterly of being taken for a German in the shops, where consequently the assistants would sell her nothing.”

Some modern FAS patients cope with the stigma of being a “foreigner” by shopping at places where they don’t have to interact with anyone. Others go to extreme measures to find a new community. One British woman flew to Poland because she believed that people there shared her accent and that she would feel at home again. An American woman traveled to England for similar reasons—only to find that everyone there assumed she was South African. She also had trouble with immigration officials, who questioned the supposed discrepancy between her speech and her passport.

People with FAS also cope by monitoring and censoring what they say. Spencer laughs and says she’s learned the hard way to avoid certain words. One day, for instance, she was teaching a youth development course on how to train dogs. She remembers telling one mother that her child needed to fill out some sheets. “Only it sounded like s-h-i-t-s. I put my hand over my mouth.” Now she uses the word form instead.

Still, not every word has a workaround. From the very beginning, she could not say the word yesterday. “Even now, I can’t get the t in that word,” Spencer says. “You find me a word you can substitute for yesserday. I’ve spent ten years, and I haven’t found one.”

As a result of such frustrations, she says, “You get conservative with your word choice.” She compares her mental state to learning a foreign language; she is constantly second-guessing herself, and has to think consciously about where to place verbs and nouns and other parts of speech. In sum, holding a simple conversation has become a slog.

Spencer finds some solace in helping others cope. She runs a few FAS support groups on social media that collectively have around 250 members, and she checks in with people who sound down or depressed about their plight. She herself remains upbeat and can laugh at herself most of the time. But there are reflective moments, too. “It’s important to stress that this is not just about sounding funny,” she says.

Anecdotally, she’s noticed that members of the online groups also seem to display poor executive function, which can affect a person’s ability to prioritize and plan. For instance, they struggle to make even simple decisions, like selecting which groceries to buy, and they might suddenly get lost while running on a path that should be quite familiar. An inability to filter out extraneous noise or sensory input also often leaves them overwhelmed.

We often forget how powerful voices are. They form a key part of our identities, and perhaps more than any other trait, they bond us to our communities and declare, I’m one of you; I belong. But Spencer and others with FAS know how fragile those bonds are. “My husband doesn’t get to hear the voice that said ‘I do.’ My child doesn’t get to hear a bedtime story because I can’t say a word in ‘Little Red Riding Hood,’” she says. “We take our speech for granted so much. It’s not like a bad haircut that will grow back tomorrow. This takes work. Sometimes it will get better, and sometimes it won’t.”

Submit your response to this story to letters@psychologytoday.com. If you would like us to consider your letter for publication, please include your name, city, and state. Letters may be edited for length and clarity.

Pick up a copy of Psychology Today on newsstands now or subscribe to read the the rest of the latest issue.

Facebook/LinkedIn image: VGstockstudio/Shutterstock