Speaking in Tongues: Encounters with Foreign Accent Syndrome

Speaking in Tongues: Encounters with Foreign Accent Syndrome
Jack Ryalls, Ph.D.

Note: These are my personal experiences with the rare neurological disorder “Foreign Accent Syndrome.” This is written as a memoir as I am hoping to stimulate interest in the publication of a book. In case patients wish to remain anonymous, only initials are used, in keeping with medical tradition.

1.
Diane Sawyer sauntered across the studio, sporting a light burnt orange cashmere turtleneck and black wool skirt. She landed gracefully on a wingback chair in front of SU and me and perched like a goddess, balancing a stack of papers on her knees. She smiled warmly, melting the heart-pounding fear of the imminent live national television broadcast. It had all happened with breathtaking speed in today’s world of instant communications. “I’m just going to check a couple of facts,” she said.
We were told the ABC Good Morning America crew first needed to do a screen test. They led us from the green room across the giant studio at Times Square which ABC calls “the crossroads of America,” a multi-storied, city block-sized building. Good Morning America is shot on the second floor, which is a bewildering jumble of cameras, recorders, computers, stage lights, soundstages, and a phalanx of technical wizards. We were led through a dimly lit area, and we had to be careful not to trip on giant electrical cables snaking in every direction. There were several bubbles of brilliant light, in the dim space—what first seemed like little patches of the real world seeping into the science fiction world of the studio. But those brightly lit patches were actually areas of heightened reality.
We were brought to one luminous bubble that looked like someone’s New England living room with a small couch, a wingback chair, a coffee table, a warm, glowing fire in a fireplace behind the furniture. I sat on the settee next to SU and technicians clipped on microphones, checked the wires, and adjusted the lighting. I had been extremely nervous the prior 72 hours since I first got the call from Good Morning America. But now that it was actually happening, a strange calm had set in. Here I was knee to knee with Dianne Sawyer. Her knees were a little higher than mine, and she wore black Manolo Blahnik pumps.
La Sawyer rifled through her notes and then turned to the deceptively young looking sixty-year-old woman sitting next to me. “You’re SU, and you got this accent after a stroke four years ago?”
I was transfixed by Sawyer. Much taller, thinner, and prettier in person, she exuded the calm of an ethereal being. Her peaches-and-cream complexion seemed to glow from within. I couldn’t help myself, and silently articulated the words “You’re so pretty,” which she caught out of the corner of her eye. “Thank you” she mouthed back, without missing a beat in her conversation with SU, who had not noticed our exchange. So Diane Sawyer can read lips, I thought.
I began to have a new appreciation for the multitasking mind of Ms. Sawyer. It occurred to me that the superior language skills of the female brain probably makes it better suited to the high linguistic demands of listening in an earpiece, simultaneously carrying on a conversation and reading lips. I could not imagine the enormous pressure of hosting a live coast-to-coast morning talk show and still making each guest feel as if they were her audience of one. Commands filtered into her discrete earpiece and the flurry of activity suddenly picked up pace just beyond the luminous sphere where we sat. I put myself back in the television viewer’s seat and inferred that our segment was imminent.
Diane Sawyer turned to me, “You’re Dr. Jack Ryalls, a professor in the department of Communicative Disorders at the University of Central Florida.” I’d always hated the way the word “Communicative Disorders” sounds. It had the odd, slightly 1950s feel, like the euphemism “social disease.”
“Yes, but we’re a department that trains speech-language pathologists,” I explained. She smiled and then slipped her notes and clipboard behind her, as the cameras rolled in closer. The lights brightened, and I thought for one second I might pass out. What follows is a verbatim transcript of the next three minutes that I thought were being broadcast live:
DS: Now we have the story of a woman who had a stroke, wound up talking with a compulsive British accent. And it turns out, there are other documented cases. Here now SU and speech pathologist expert and Professor Jack Ryalls. Ms. U, Professor Ryalls, thank you for being here this morning. I want everybody to hear your voice and to hear the story. In 1999 you were doing the Sunday crossword puzzle, right?

SU: Yes.

DS: Then you felt weakness, and what happened?

SU: Well, my hand. I thought it was the pen, quite frankly, that wasn’t working. And I remember flipping it across the room. And I, I remember—I don’t remember this, my ex-hubby said, I called him late at night and said I had a violent headache, it was late at night. He noticed I had slurry speech then.

DS: Headache, slurry speech, weakness, and you got to the hospital and they said it was a stroke?

JR: She drove herself—

SU: Actually, the next morning. I slept; I woke up and my right leg was going and my face was all paralyzed, so I went paralyzed on the right side.

DS: Now we’ve just heard you talk, with a decided British accent. It’s unmistakable.

SU: I know.

DS: So they can hear what we’re talking about with your voice before the stroke, I want to play a recording of your voice for everybody.

SU: Oh my goodness. [SU smiles and shakes her head.]

DS: And I gather it was at a United Way fundraiser, a children’s charity. And here is the way you talked before the stroke.

Tape plays: [much deeper voice, which does not sound like the same woman] “We want to say thank you not only Ron and Euris for signing another guitar today, and we’re looking forward to having you down in our neck of the woods….”

DS: When you hear that now, do you hear the difference?

SU: When I hear that, that part of me died, with the stroke. And, ah, no matter how hard I tried, I couldn’t get her back.

DS: Again the first thing everyone thinks is that ‘she’s just faking this, right?’

SU: Oh, I should deserve an academy award if I could do that for four years, shouldn’t I?

DS: Four years. And you use words like ‘telley’ and ‘loo’: all sorts of British words that you’ve never used before?

SU: No, I haven’t—

DS: Then a friend of yours told you about an Oxford study finally which showed that this in fact was a disorder that had been documented before.

SU: Yes.

DS: Professor Ryalls, I want to turn to you to get a sense of what this is. It apparently is a disruption in the language center of the brain. (DS gestures to the left side of her head)

JR: Underneath the speech areas, and in the subcortical areas that communicate with the speech and language areas—

DS: S, the effect this has had on you and your life has been profound. And I want to explain to everybody once again, four years you have refused to speak about this. You have refused to come forward. You became a recluse. Friends turned on you? Friends just didn’t believe you.

SU: Well, (SU tears up) I guess (she pauses) I’m sorry. This is very difficult for me. Sorry.

DS: It’s okay.

SU: I don’t blame them because people, what they don’t understand they get afraid of. And hopefully, by coming forward now, as the university has asked me to do so, with a discovery for science. Perhaps now, with this new voice that God gave me, I shall be able to speak out for all those who don’t have a voice anymore from a stroke.

DS: Well again, I’m so grateful to you both. And I know one of the things you’ve said that is that with this higher voice, she now sings. So that’s good to hear too.

SU: Thank you. God bless you. I feel vindicated and validated again.

DS: And thank you too, professor.


The intense lights dimmed, and it was over. Only three-and-a-half minutes, yet my constant self-reminders that what I was saying was being broadcast live to millions of viewers across the nation had made it seem like an intense hour had just passed. I immediately remembered with remorse all the important points I had wanted to make about brain damage and stroke, but had not articulated.
The technicians removed the microphones and we were led back to the green room. I heaved a huge sigh of relief as we sat down on the couch. Watching the monitor, Karen Guin --- the Director of Communications for UCF’s College of Health and Public Affairs (who I had insisted vehemently accompany me on my trip to New York City), calmly informed us that our segment had not yet aired. They had recorded us!, the little voice inside of me screamed. It was not live after all! I felt an odd mixture of relief and anger that they had not bothered to let me know that it was not going to be broadcast live. But I quickly reasoned that this was probably intentional in order to keep the interview spontaneous. I had barely slept the past night and had awoken at 3:00 a.m. and stayed up in order to prepare a written statement and not be late for the 5:00 a.m. appointment with the ABC intern in the lobby who was to escort us over to the television studio across Broadway. Just before they led us into the studio for a ‘sound check’, I had requested to use my handwritten notes, like any good teacher, so that I would remember all the important points I wanted to get across. They had declined my request, which immediately increased my anxiety. The short segment, broadcast a few minutes later just a few days before Thanksgiving in the fall of 2003, changed my life forever.
I was convinced that I had said paragraphs of cogent, pithy and useful information that they had seamlessly edited out. Only after a year of viewing and reviewing the recorded segment did I slowly realize that my impression of being cut short was due to the perceptual phenomenon of time compression. I thought they had cut me off mid-sentence, but I had only actually managed to stammer out a single sentence fragment. The intense stress the old part of my brain had experienced had slowed down my perception of time--- something accident victims often experience.
I could not help but reflect over and over again about the events spanning the past two decades and the series of incredible circumstances that had led me to that point in time. At first, I had just written off the long series of miraculous coincidences that led me back to Foreign Accent Syndrome to ‘serendipity,’ and I resisted for a long time. But recently before this television broadcast I had begun to acknowledge a divine intervention.


2.
My involvement with Foreign Accent Syndrome actually began in 1983 when I was working on my doctoral dissertation on aphasia at Brown University under the direction of Professor Sheila Blumstein. The term ‘aphasia’ refers to the language and speech disorders that typically result when a stroke, or “cerebro-vascular” accident, leaves damage in the speech or language centers of the left hemisphere of the brain. Because the right side of the body is controlled by the left side of the brain, aphasia is typically accompanied by a right-sided paralysis, since the motoric representation for the right hand is close to the speech production area in one common form of aphasia. Paralysis of the right arm is a clinical sign that the brain damage has occurred in the anterior lobe of the brain where Broca’s area for speech is also located. In milder cases, the right arm may loose sensitivity, or only the right side of the face may droop. Slurred speech or one-sided loss of sensation are cardinal signs of stroke and deserve immediate medical attention. I cannot emphasize this enough, since the window of opportunity for medical intervention to prevent or stroke altogether, or at very least significantly diminish its devastating effects, is extremely limited. Deprived of the precious oxygen provided by the blood supply, brain tissue begins to die immediately. The American Stroke Foundation (http://www.americanstroke.org) advocates the following extremely simple instructions for recognizing a stroke:
If you think someone is having a stroke, remember the 60 second test:1. Ask the individual to smile. 2. Ask him or her to raise both arms. 3. Ask the person to repeat a simple sentence, like "It is sunny out today." IF THE INDIVIDUAL HAS TROUBLE WITH ANY OF THESE TASKS, CALL 911 IMMEDIATELY! (http://www.americanstroke.org/content/view/17/46/ There is also very useful additional information at http://www.strokeassociation.org/presenter.jhtml?identifier=1020) In an effort to get people to recognize that there are emergency medical procedures which can be undertaken to lessen the debilitating effects of stroke, many medical authorities now advocate the use of the term “brain attack” (akin to ‘heart attack’) instead of the significantly more benign sounding word ‘stroke.’
Thanks to Dr. Blumstein’s excellent connections, I was testing aphasic patients at the Boston Veteran’s Administration Medical Center. Please indulge me in a little bragging here: most experts will agree the Boston V.A. is the foremost center in the world devoted to the study of aphasia. This center is where quintessential aphasia experts Harold Goodglass and Edith Kaplan developed the Boston Diagnostic Aphasia Exam—one of the mostly widely used instruments for the assessment of aphasia worldwide. Dr. Sheila Blumstein had a longstanding association with this research center, since the time of her own doctoral studies at Harvard University. Her own mentor, world-renowned Russian linguist Roman Jakobson, had imported the decidedly atypical broad perspective of investigating both aphasia and child language acquisition to Boston from the old world. Modern linguistics, emanating coincidentally right down the road at the Massachusetts Institute of Technology led by Noam Chomsky, exclusively considered the language production of normal adult native speakers.
I had been going up to Boston for grand rounds in aphasia at the V.A. hospital on a weekly basis, and then testing aphasic patients who met my study’s criteria. I was studying vowel production in aphasia patients—basically trying to map out the different contribution of Broca’s and Wernicke’s areas in the left hemisphere of the brain to the vowel sounds of speech.
Broca’s area of the brain (named in honor of French neurologist Paul Broca), as even the most dilettante student of brain knows, is the center for the motor control of speech production; while Wernicke’s area (named in honor of German neuropsychologist Carl Wernicke) is typically conceived to be the area of the brain which selects the sounds of speech required for the production of various words of the language. Broca’s aphasics typically have slow effortful speech; they often get stuck on words and stutter making repeated unsuccessful attempts to begin words, especially the first words of utterances. Broca’s aphasics are usually very frustrated by their unsuccessful speech production because they have intact comprehension and speech monitoring skills. Wernicke’s aphasics, in contrast, may be loquacious chatterboxes, often oblivious to the fact that their long but fluent sentences are not making much sense. In the most severe presentations, Wernicke’s aphasia may result in unintelligible gibberish--- the so called ‘jargon’ or ‘word salad’. Unfortunately, these same symptoms led these poor souls to the insane asylum in a less enlightened era.
My research compared the speech of aphasic patients, using computer-based acoustic analyses to see if there were subtle differences in the way vowels were affected by damage to Broca’s and Wernicke’s areas of the brain. Of course, my study was heavily inspired by the pioneering work of my mentor, who had conducted similar detailed acoustic comparisons on consonant sounds. I felt very ‘high tech’ and ‘cutting edge’ in my attempt to relate acoustic measures of digitized aphasic speech productions to areas of damaged neural tissue. Our department had just acquired the filing-cabinet-sized Digital Equipment Corporation PDP 11-35 computer during the previous academic year I had spent as a student in Paris in 1979-80 and I was the first doctoral dissertation to use the computer exclusively for acoustic measures. Previous doctoral students before me at Brown had still relied on the decidedly more labor-intensive (and now completely antiquated) sound spectrograph to perform their acoustic measures. Somehow, it felt appropriate that an avid ‘Trekkie’ like myself, employ a computer to digitize and measure speech. I had grown up with visions of the day one could rely on a ‘Universal Translator’ the computer onboard the S.S. Enterprise had provided for reducing intergalactic linguistic barriers! Talk about ‘thinking large’! One has to bear in mind that the early 1980’s predated the ‘digital revolution’ which later made digital recordings, like compact disks, commonplace. My analog tape recordings of the aphasic patients at the Boston VA Hospital were still performed on a German Uher portable reel-to-reel recorder because the wider tape allowed a higher fidelity than the more pervasive cassette tapes of that era. We had not even dreamed of the Digital Audio Tape or DAT recorders which were first available in Japan only a few years later, yet alone digitizing speech directly onto computer. This was before the advent of the ‘Personal Computer’ and the computer disks that the DEC PDP 11-35 used were the size of large pizza boxes. At that time there were only a few research laboratories, such as MIT, ‘Haskins Laboratories’ and “Bell Labs,’ mainly clustered on the Northeastern Seaboard, which had appropriate computer programs to manage the complex mathematical procedures for acoustic analyses of speech. While one might more specifically qualify such an endeavor by the term ‘neurophonetics’ or even ‘neuro-acoustics’ today; this area of specialization was designated ‘neurolinguistics’ at Brown University.
Dr. Blumstein and her research colleagues had shown that Broca’s aphasics had a selective impairment in the precise timing control required for making the difference between the “voiced” and “voiceless” consonants. Blumstein and colleagues’ study had provided the first really objective measures that Broca’s aphasics had a specific problem in the motor control of speech which was qualitatively different than the speech problems of Wernicke’s aphasics.
For my own doctoral dissertation research, I attempted to find a similar distinction in vowel sounds that Blumstein and her colleagues had found for stop consonant speech sounds. I thought I would be able to replicate the differences in vowel production between Broca’s and Wernicke’s aphasics that Blumstein had demonstrated for consonants.
Dr. Blumstein left a note in my box for me to see her office one afternoon, I recall, in the fall of 1983. We were in the Department of Linguistics at the time, but the name changed to the Department of Cognitive and Linguistic Sciences a few years later. As I knocked at her door in the old rustic brownstone carriage house, which housed the department offices and laboratories, I was a little anxious that I had done something wrong in the laboratory. To be honest, I confess I was not the best graduate student right out of the starting gate. Some faculty had raised some concerns that I seemed to lack focus. So there were several possible reasons to be anxious meeting my doctoral mentor.
I recall the late afternoon autumn sun streaming through her office window, lighting up her small frame as she sat behind her large oak desk. Its surface was covered with neat piles of papers. The light gave her head a saintly halo of golden light. I was relieved when she looked up from her work with a smile. It was hard to believe that this small face, framed with light brown pixie hair, belonged to such a world-renowned researcher. Looking back, I do not think I really appreciated at that time just what a world-class scholar I had for a mentor.
Dr. Blumstein had me sit down and got directly to the point. She asked me if I would like to collaborate with her on a study of the speech of a woman from the Boston V.A. with “Foreign Accent Syndrome” that she and her neuropsychologist colleague Mick Alexander had encountered. This poor woman from Massachusetts now sounded like she was from Eastern Europe, although somewhat less sophisticated ears heard her to be from France. This term was new for me, although I knew of a research report of a woman who ended up with a foreign-sounding accent as the result of neurological damage.
I had come across the article on a neurologically-based foreign accent while completing the background research for my doctoral dissertation. This scientific paper by the famous Norwegian neurologist Monrad-Krohn was the most widely known report of the phenomenon that would later be dubbed “Foreign Accent Syndrome” (in a book chapter on a new case by Harry Whitaker in 1982). The case involved a Norwegian woman named Astrid who had suffered a shrapnel wound to the left hemisphere of her brain at the end of the World War II. After she regained consciousness and recovered to some degree from the right-side paralysis that her left-sided brain damage produced, she was left with an accent that sounded “German” to her surrounding community. Yet, she did not speak German, did not have German family, nor had she even visited Germany. This symptom was an incredibly cruel effect of her wound in post-war Norway—not only was the bomb that produced the shrapnel most likely German, but now the wound had left her with a German-sounding accent.
This unfortunate woman suffered a great deal because some of the local shopkeepers refused to serve her. While the exact explanation for this German-sounding accent is not entirely known even today, as the scientific study of Foreign Accent Syndrome is still in its relative infancy, there is one obvious difference between German and Norwegian that undoubtedly contributed to the woman’s accent. While Norwegian and German share many speech sounds, there are distinctive “pitch accents” in Norwegian not found in the German language.
Dr. Blumstein proposed that I work on the vowel production in the woman’s speech-- basically to complete what I was already doing for each of the aphasic patients participating in my dissertation research. I jumped at the opportunity, even though I was deeply involved with the intensive computer-based acoustic analyses for my dissertation. The future success of doctoral students, who intend to pursue an academic career, depends on their ability to participate and publish research projects; therefore, I was only too eager for such unique opportunities.
I will always remember Dr. Blumstein playing the cassette tape of that woman’s speech because it was so remarkable. The woman who had been born in Quincy, Massachusetts, and spent her entire life in New England, had suffered a stroke which had left her with several small areas of brain damage in the left hemisphere of her brain. She had never been out of the United States and never even learned to speak a foreign language. But the woman on this tape definitely sounded like she was not a native speaker of American English. Yet, there were still some faint traces of her New England accent, such as the occasional omission of the ‘r’ sound.
Although she spoke fluently, albeit a bit slow and halting, she did not sound to have the labored groping speech of a Broca’s-type aphasic, nor was her speech like the loquacious but empty speech of a Wernicke’s aphasic. Her speech was clearly something entirely different. She sounded unmistakably foreign, although it was not immediately obvious from what country her accent might be. Dr. Blumstein said that some people at the V.A. Research Unit thought she sounded “French” while others thought it was more “Eastern European.” From the brief sample of speech from an interview, which Dr. Blumstein played from a cassette tape, I remember thinking the woman sounded more Russian or Polish than French. Of course, I had just returned from an academic year in Paris studying in Paris under renowned French neurologist Henri Hecaen, so I had a pretty clear auditory impression of what a French accent would sound like, unlike the naïve ear of most Americans.
My task was to work on her vowel sounds, and a classmate William Katz (now a professor at the University of Texas at Dallas) was going to work on her intonation patterns. Dr. Blumstein would work on her consonant productions with Barbara Dworetzky a very bight undergraduate student at the time. Altogether, under Blumstein’s expert guidance, we were setting out to produce the most detailed analysis ever undertaken of the speech of a person with a Foreign Accent Syndrome. While there were a few published cases of this extremely rare phenomenon, no one had performed the detailed acoustic analyses of our study. This study was published a few years later in the journal Brain and Language in 1987.
I had another brief encounter with FAS after I completed my doctorate and graduated from Brown in 1984. I went to Norway for a month to study how brain damage affected the “pitch-accents” of Norwegians. The American Scandinavian Foundation supported my research. While there, I had many opportunities to discuss the famous Norwegian case of FAS with Ivar Reinvang, the Norwegian neurologist who hosted my research. He mentioned he had come across some notes from Dr. Mondrad-Krohn, a neurologist who had documented the case in 1947. We were working in the same hospital where Monrad-Krohn had been based. Later, we published a short article together based on Monrad-Krohn’s notes, which included his autopsy observations of the Norwegian woman with the German accent which confirmed that her accent was due to her inability to produce the native pitch-accents (Ryalls & Reinvang, 1985).
I had not encountered another case of FAS for the next twenty years. I had also pretty much left research on aphasia and other neurological speech disorders behind. I could not work on neurological aspects of speech production at the University of Central Florida, where I had no contact with a medical setting. I was at the very beginning of my sabbatical from UCF in the fall of 2002. Little did I suspect the series of astonishing coincidences and circumstances, which put me in contact with my own fascinating case of a woman with FAS. I took these events to be pure chance at first, but they were so intricate and improbable that I finally had to believe they were part of a higher plan. In any case, I feel compelled to relay the three most outstanding “strokes of fate,” so to speak that brought me together with Ms. SU.
In late summer 2002, I received a telephone message from a woman named Lila Guterman about Foreign Accent Syndrome and another from a woman in England. I had mixed things up and thought Leila was calling from the U.K. and was hesitant to call her back with the high cost of an international telephone call. By the time I realized that Lila was actually right in the U.S. and worked for the Chronicle of Higher Education, she already had her story basically together and no longer required my input.
She had interviewed Dr. Jennifer Gurd and her colleague Dr. John Coleman at the University of Oxford. But she had called some other “experts” who were knowledgeable about FAS who Gurd had recommended. Gurd and Coleman’s case had already captured some interest in the British press because it was so fantastic. They had studied an English woman who had worked as BBC television spokesperson, who ended up with a decided Scottish accent after her stroke.
I knew Dr. Gurd from my post-doctoral fellowship in Montreal. Jennifer was then a student in psychology at McGill University with an interest in aphasia and other neurological disorders. She had an association with the Research Center where I did my post-doctoral studies, supported by a fellowship from the Medical Research Council of Canada. At that time in 1986, Jennifer had begun collaborative work on a case of Foreign Accent Syndrome of her own. She knew of me from her literature review about the Blumstein’s study on which I had collaborated, and she was eager to discuss her case with someone with some experience with this rare disorder. Jennifer later immigrated to England and has since become one of the world’s leading authorities on Foreign Accent Syndrome at the University of Oxford.
In any case, I had missed this first new opportunity with FAS. But this was not to be my last. Dr. Gurd and I began corresponding by e-mail. She asked if I would like to contribute to the special volume of the Journal of Neurolinguistics which she and Dr. Coleman were editing on FAS. I told her I would like to, but that I had no new cases of my own and I did not think I could rework what I had already written about FAS without new data. She mentioned that she sometimes got cases in the United States. Pessimist that I sometimes tend to be, I imagined they would be in the most far-flung corners of the U.S.
How could I manage to travel and work on these cases on the meager travel funds I had through the University of Central Florida? I had not worked directly on the speech of those with neurological disorders since I left the University of Montreal in 1994. I had been working on gender and ethnicity differences and the normal aging of speech at UCF. I certainly was not seeking out FAS, but apparently FAS was seeking me. Allow me to relay the remarkable set of coincidences that led me back to this rare neurological anomaly.
I was lucky enough to be on sabbatical from teaching early in fall 2002. Dr. Michelle Gentil, a colleague from France, was in Orlando for a neurology conference. She had e-mailed and told me of her visit, and we arranged to meet for dinner. I had previously spoken with Michelle about perhaps coming to visit her where she worked on Parkinson’s disease in Grenoble, France. After a pleasant dinner with Michelle and her charming husband, she asked how my plans for a sabbatical were advancing. I told her I was actually on sabbatical. She asked if I would still like to visit Grenoble, and I told her I would very much like to, but that I had very limited travel funds.
The very next day, I went in to my office at UCF to check my mail and there was a letter informing me that I had received another $750 in travel funds! I took as a definite sign that I should go to Europe. Since I was already planning to visit France, I thought I should also visit England as well, since it was so close and I now had sufficient travel funds. I set about planning to visit a former student of mine, Thora Masdottir, and perhaps to give a talk where she was undertaking doctoral studies at the University of Reading. I would, of course, take the opportunity to visit Jennifer Gurd and her colleague at University of Oxford, which was not too far from Reading. I had visited Cambridge University and was charmed by the idyllic setting. A doctoral student colleague, Susan Behrens, had lived in Cambridge and worked as a researcher for an aphasia researcher based there. I had visited the centuries-old Gothic splendor of the University of Cambridge and toured the grounds. Susan even had me to dinner at a special college for foreign students where she was a member. The students in this college mostly did not wear the black gowns that one pictures on students when imagining Cambridge, but the ceremonious sounding of a gong and standing up together before their meal was served left an impression on me. Although I had previously been through the town of Oxford before, I had never visited the university’s grounds. I hoped to combine a bit of tourism, catching up with a former acquaintance and perhaps renewing a new avenue of research.
They were very pleasant at Reading University and Professor Susan Edwards put me up for the night at her charming town home in picturesque Stokes-upon-Thyme, so I would be able to go directly to Oxford the next day instead of having to return to London first. I had made plans to visit Oxford with my former student Thora, her physician husband Magnus and their four-year-old daughter Thorhilde. Thora is from Iceland and was my student while pursuing her master’s degree in speech-language pathology at Indiana University. Her husband is a neurologist, specializing in pain. Magnus intended to visit some colleagues at Oxford, so we arranged to travel to Oxford together. The train ride through the rolling hills and meadows of southern England took little over two hours. The cloudy morning burst forth in rain, just as the train pulled into the Oxford station. We grabbed a cab at the train station to meet John Coleman at the phonetics laboratory. Jennifer Gurd’s husband John Marshall was having a serious bout of phlebitis, so she wouldn’t be able to meet me that morning. The phonetics department and laboratory was in an old row house. Professor Coleman was very pleasant and served us a delightful tea. As fellow linguists and phoneticians, we struck an instantaneous warm rapport, despite the decidedly chilly weather.
We spoke about the special volume on Foreign Accent Syndrome he was editing with Jennifer Gurd. I mentioned that there seemed to be more cases where there was subcortical damage than cases where the lesion was strictly cortical. I was surreptitiously sounding Coleman out on what I thought might be a potential new contribution to the scientific literature on FAS, but his lack of reaction let me quickly know that my observation was not unique and had not escaped his own attention.
Then Dr. Coleman showed us around the phonetics laboratory, and we met several of his colleagues. He then invited us for lunch at a café not far from the laboratory. The rain still poured down in fitful torrents outside and the air felt downright cold. Thorhilde, still a toddler, slipped on the old stone steps outside the lab and skinned her knee. Thora was noticeably upset at the sight of her daughter’s blood. Coleman kindly offered to run back inside to hunt down a ‘plaster’, but Thora bravely declined because Thorhilde stopped crying once she was in mom’s arms and the spot of blood quickly coagulated.
We had a pleasant lunch in a French café nearby. I had a “croque Monsieur” sandwich and was pleasantly surprised how accurate the English had replicated this French recipe. I had noticed how much English cuisine had benefited over the years since I first visited England from this rather recent French invasion.
Then Dr. Coleman had to leave us because he had to give an examination that afternoon. He was going to have his phonetic students transcribe some Swahili utterances into International Phonetic Alphabet, without even knowing what language they were transcribing. This was not the type of exam that American students would be prepared to do in a phonetics course. Goodness knows, our students in Speech-language pathology back at the University of Central Florida could barely manage this in their native tongue. But Coleman’s calm demeanor seemed to indicate this type of exam to be perfectly normal for Oxford students.
Our initial plan had been to go and visit the central part of the Oxford campus, so we walked in that general direction. But the weather was so miserably cold to my ‘Floridified’ bones and the rain did not relent, so I decided to return to London early. Thora, Magnus and Thorhilde would drop me off at the train station, and then continue on to the bed and breakfast they were staying at for the next few days. We stood under the awning of a café in a square trying to locate a cab, which were in short supply because of the rain. We looked up at the second story of the café where a large banner proclaiming “Air Conditioned.” It was so cold and wet that the banner seemed extremely absurd, even hilarious. Thora decided to take a picture of us huddled together for warmth under the café’s canvas awning, with the incongruous banner above.
We finally hailed down an available cab after a good 45 minutes of frantic arm flailing to already hired cabs (we could not easily see the passengers in the rain), and they dropped me off at the station. I gave them each a hug and stepped out once again into the frigid pouring rain. I remember thinking that they were probably more used to such weather in their native Iceland, but that it probably seemed much worse to me, having spent nearly a decade living again in Florida.
The weather was better in Paris, but I remember walking on one side of the street in the sun and being quite warm, and then crossing the street to the shady side and being very cold. It was still early spring. In Grenoble I stayed with Dr. Sylviane Valdois, a former colleague from Montreal, her engineer husband Christian and their two girls: 14-year-old Sylvie and 8-year-old Valentine. The weather in the south of France was even warmer, and we ate dinner outside on the Sunday I arrived. They lived in a small town outside of Grenoble with a castle in the background and majestic mountains behind. Their home was a converted farmhouse on large grounds with a small stable. They had a horse of their own and boarded another. The alfresco dinner in the fresh spring air seemed idyllic, yet there was frost on the car window the next morning when we set out to visit the hospital where Sylviane formed part of a reading intervention team for young children.
The next night I stayed in town so I could get to the university the next morning where I was giving a talk at the “Institute of Spoken Communication.” The following evening Sylviane gave me a ride from the university to Michele Gentile’s home, since it was on her way home. Michele had invited me to dinner at her lovingly restored 18th century villa. Her husband had completed most of the restoration himself, and the home served as a wonderful little museum of living history. He lovingly explained the clay seal on the ancient ceramic heating system.
My time in Europe ended all too soon, as sabbatical time away from the routine of teaching is all too precious for university professor, and it was time to return the U.S. This was during the period just before the war in Iraq when France’s refusal to support the U.S.-led plan to intervene in Iraq had caused some degree of anti-French sentiment. The French were anxious to point out how much they liked and admired Americans, how much they appreciated what the U.S. had done for them in World War II. But, in general, they did not agree with the U.S. plan to intervene. Many Americans do not realize that since Algeria, Morocco and Lebanon are former French colonies; there is a very large Arab population in France.
I noticed that there was an exceptionally high level of security in Paris that day leaving Charles de Gaulle airport. But it was not until I had arrived in New York that I learned that the war had just broken out in Iraq. It was probably better that I didn’t know this on the second leg of the flight from Bombay to New York, since there were a lot of very “exotically” dressed people on the plane, and I would have been even more vigilant of the suspicious-set turbans discussing with great animation in the back of the plane. I could hardly believe that the United States was once again fighting the Iraqis after the first Gulf War, this time on their own soil and not in Kuwait. I did not know the exact details, but I certainly suspected our oil interests in the region must be at stake. Pacifist that I am, I thought right away about our failed involvement in Vietnam. I had narrowly escaped the draft by starting my university studies at 17 in the fall of 1975. I wondered sometimes if homo sapiens were not the particularly violent ancestors of modern man who had killed off the non speaking Neanderthals. I had speculated that tendency towards a violent reaction to language and other cultural differences were part of modern man’s shady genetic inheritance and might help explain our long bellicose heritage and the hasty disappearance of the ‘missing link.’
I had not been back to Florida for more than a week before I started getting rather desperate e-mails from a woman in Florida named SU with a British accent she claimed resulted from a stroke she suffered four years earlier. Originally, she was supposed to see Jennifer Gurd, but SU had asked Dr. Gurd if there wasn’t an expert in the United States. Jennifer Gurd referred her to me, oddly enough only a few hours drive away in Orlando. She was anxious to speak to me about her condition. It was her fervent hope that I could put her in contact with someone else who had suffered the same problem.
We began to speak on the phone. She had a pronounced accent that certainly sounded British. Sometimes she spoke to me at length, over an hour, and her accent did not waver. Not only did SU have a strong accent, but every now and again, she also used an expression that sounded somewhat British as well.
SU got her accent after having a stroke four years earlier. She had a violent headache and drove herself to the hospital. She lost consciousness and when she awoke, the right side of her body was paralyzed; she was aphasic and had great difficulty speaking at all. Over a period of several months of physical therapy she regained use of her right side and the symptoms of aphasia subsided. She went through a stage where she could formulate speech but it came out slow and garbled sounded—what SU refers to as “sounding like Forrest Gump.”
Then her speech became more fluent and all that remained was an accent that other people heard as British or sometimes Australian. This accent was a source of frustration for SU. Sometimes people refused to believe her when she told them that she was born in the United States and had never even been to England. She became estranged from some of her old friends and began to withdraw socially. She developed agoraphobia. She wanted to understand what had happened to her. Finally one day a friend e-mailed her a short article, which had appeared in the New York Times about Jennifer Gurd’s work with Foreign Accent Syndrome, and this article led to her contacting Dr. Gurd and eventually to be referred to me.
We planned to meet. I had already planned a trip to Montreal before we were able to meet. I saved a message she had left me on my cell phone and played it for my former colleagues in Montreal. My good friend, Shari Baum at McGill University commented that even though she sounded British, she still retained a number of North American features to her speech. My close former colleague Guylaine Le Dorze at the Université de Montréal pointed out that, sometimes, aphasic patients would end up saying things that sounded “foreign,” about which their families would comment with laughter. She also pointed out that the condition was referred to as a “pseudoaccent” in the French literature, since it was not a true foreign accent but rather the result of a neurological disorder.
SU and I finally worked out a date she would come to Orlando in late July. ET, a good friend of hers, drove SU over from Sarasota for the day. In order to keep things as relaxed as possible, I first met her at my home. It had been raining all morning and had just stopped for a short while when SU and her friend arrived. I was a little surprised to meet the rather tall and perky brunette in designer jeans and sequined tee shirt who stepped out of the car. SU did not look her sixty years, and certainly she did not match the timid and retiring voice I had heard over the telephone. But her accent was remarkable and was consistent the entire four hours of her visit. I recorded her speech for further acoustic analysis at a later point in time. Not only was SU’s accent very different, but her voice had also changed drastically.
Her astonishing voice change was quickly confirmed listening to a tape she had of her old voice from a radio fundraiser. She used to run a children’s charity organization and had a cassette recording from a fundraiser she had organized and spoken about on radio. I also asked SU some questions about her emotions concerning her new voice, and she broke down in tears at one point, explaining how she had basically hidden away from people because they did not believe her accent was the result of a stroke. Some friends had pointed out that she even seemed to use some British-sounding expressions. I tested her on her knowledge of British equivalents of some popular U.S. expressions, in an effort to test whether she could possibly be faking the accent. For example I asked what they called a ‘drugstore’ in the U.K. It was a crude and informal test, but it did not seem that she had any more knowledge of British terms that the average American.
Then we drove over to my department’s clinic where my colleague Janet Whiteside conducted some aphasia tests. Janet had certainly heard of this syndrome before, but never encountered an actual case. Janet’s testing revealed that SU had no signs of aphasia; she had normal language and memory and could name objects as well as completely healthy adults of similar age. SU and ET left late in the afternoon hoping to meet up with SU’s sister who was a nurse in Orlando.
Janet and I began to write up our preliminary findings about SU. We only expected the quiet attention of a small group of other experts, each working in different corners of the world. Neither one of us anticipated what would unfold in the course of the next year as you will find out in the next chapters.

3.
Early in 2004, I received a telephone call from Eric Conner, a reporter for a South Carolina newspaper based in Greenville. He wanted to speak with me about a local man C.T. who had a foreign accent after a stroke. He’d found my name via the internet. Eric was a bright man and he instantly understood the scientific ramifications of Foreign Accent Syndrome and how unique an opportunity it offered to gain insight into the way that speech is represented in the brain. Our conversation flowed smoothly. Locals heard C. to have a ‘French accent,’ but from experience, the general public is very poor at judging foreign accents. While everyone can immediately hear what sounds non-native, they are not very adept at linking up an accent with a place. Their ability to identify an accent is very much dependent on the length of exposure to an accent. And ‘French’ is a popular default foreign accent for Americans without very experienced ears.
I told Eric about my former Master’s thesis student, Julius Fridriksson, now conducting functional Magnetic Resonance Imaging studies of stroke patients at the University of South Carolina in Columbia. Julius is especially interested in the way the brain reorganizes after stroke. His work showing how the brain could reorganize and neural tissue could recover function was another indication chipping away at the classic doctrine that damaged brain tissue does not recover. Functional Magnetic Resonance Imaging, which reveals brain activity while a participant preforms specific tasks, had been especially clear in demonstrating that some damaged areas of the brain can remetabolize to some degree over a period of time. Originally from Iceland, Julius is the brightest student I have ever the pleasure of working with. After graduating from UCF, he completed his doctorate at the University of Arizona under the direction of one of the world’s pre-eminent scholars on aphasia, Dr. Audrey Holland.
“Wouldn’t it be interesting,” I told Eric Conner over the phone, “to get Mr. T in for a functional MRI?” I attempted to drive the point home by emphasizing that there were no previous functional MRI studies of a patient with Foreign Accent Syndrome. It would be especially interesting to see if there were different parts of his brain which were active during speech tasks which might help explain the foreign quality. Ultimately, researchers like I are interested in Foreign Accent Syndrome for what it can tell us about how speech is represented in the human brain and how the brain has to be working differently to produce a foreign accent.
Of course, Eric’s first goal had to be to nail down the present story he was working on to meet a deadline. But I communicated with Eric a few more times via e-mails, and he followed up contacting CT. Working together we managed to get Julius Fridriksson in contact with CT. At the time, Julius was still using shared fMRI equipment at the Medical Center in Charleston. So it was already two hours away for Julius, and more like four hours for CT. CT had a scientific curiosity in what had happened in his brain to make his speech different and followed through on the opportunity to have a look at how his brain was functioning differently
Fridriksson and his colleagues applied two separate ‘state-of-the-art” brain imaging techniques with C. The first was Diffusion Tensor Imaging which allows researchers never previously obtained detail on the neural connections in the brain. This technique uses the transmission of water through the brains axons. While water flows smoothly through healthy neural connections when they are damaged the water flow pattern is no longer smooth. This technique allows researchers to view problems in communication between various areas of the brain, which are not observable in traditional fMRI. In other words, it allows researchers to observe interruptions in the neural circuitry of the brain even when there is no observable structural abnormality.
The second technique Fridriksson and his colleagues performed with CT was actually more central to advancing knowledge about Foreign Accent Syndrome. It allows neuropsychologists to compare the activity levels of different portions of the brain during specific tasks and to compare this activation to that of average activity from groups of normal control participants performing the same task. In this manner, the differences in average brain activity for a specific task are highlighted and can be mapped onto brain maps in different colors representing levels of differences.
Astonishingly, it appeared that several speech and language specific areas of the left cortex of C’s brain was significantly more active during a naming task than a group of 11 normal healthy control speakers. Thus it appears that C’s brain has rewired itself and ‘learned’ to compensate for the effects of the small lesion in his left basal ganglia deep in his brain--- specifically an area known as the putamen. It appeared as if C’s cortex (brain surface) was working harder to offset the brain damage underneath the surface.
Upon learning these results I began to speculate that it might only those individuals who could reorganize their brains who ended up with the relatively mild speech impairment we hear as Foreign Accent Syndrome. In other words, FAS would only occur in individuals who could compensate for the effects of their strokes by recruiting more brain activity. Since many individuals would not be able to compensate so effectively, they would be left with more debilitating speech deficits like dysarthria and aphasia. This could help explain why FAS is such a rare phenomenon and why it also typically only occurred after a certain time period when a more severe aphasia was initially present.
Fridriksson and I, along with his other colleagues worked assertively to publish these new and intriguing results as soon as possible. Foreign Accent Syndrome was entirely new terrain for Fridriksson, but I was allowed to act as a kind of catalyst to bring about these exciting new findings, thanks to Eric Conner’s foresight and scientific interest. Not many newspaper writers get involved enough with the object of their pieces, to follow up and add a whole new dimension to the story. But CT was an engaging character and Eric followed his initial story on C’s condition with a follow-up article making these new results accessible to the lay reader. Science and the popular media do not typically interact so harmoniously in such a way to be mutually beneficial.
Later in the year, I come into communication with DM, a woman with Foreign Accent Syndrome in Kansas City. DM had appeared in a very short follow-up segment on Foreign Accent Syndrome on ABC’s Good Morning America. DM had a French-sounding accent, so I thought it would be interesting for her to speak with CT who had experienced a similar condition. DM is a very bright woman who runs her own film production company. I would eventually propose that she would be the ideal person to direct a short documentary film on FAS. But this idea only took shape a couple years after DM’s appearance on television and my subsequent correspondence with her. DM informed me first of the loss of CT’s wife about six months after his initial fMRI in Charleston.
DM was a very bright warm woman with an engaging, “come what may” attitude about her foreign accent. What a different attitude she had about her accent than SU. D was constantly aware of how lucky she was not to have suffered a more devastating speech problem like aphasia. Her accent definitely sounded French, sometimes more Brazilian, on a short television segment which was broadcast on Inside Edition. DM clearly had exceptional organizational skills, but it was especially impressive that she could handle such a cognitively challenging job as video production after a stroke. Her stroke did not seem to slow her down in the least, although she did admit that it certainly provided a challenge.
The knowledge she professionally produced videos apparently simmered away in my subconscious, because it took me a while to realize that she would be the perfect director for a documentary film on FAS. I had begun to shoot home movies of the couple of new patients I had seen in Orlando after the original broadcast on Good Morning America. I had bought a new video camera for my group Fulbright trip to India in the summer of 2004. I think my video project to observe how literacy is taught in India that gave me the original impetus to start videotaping my patients. I started thinking that this video footage might be useful for a documentary and slowly it dawned on me that a person who had lived through this experience would make the ideal producer.
After about a year, CT completely lost his foreign-sounding accent. I initially heard about CT’s recovery from Eric Conner who was doing a follow-up story. Julius Fridriksson was able to complete another fMRI brain activation of CT after he regained his former accent. Initial results were not entirely clear. But it now appears that CT has significantly greater activity in the right frontal cortex compared to normal healthy controls. The frontal lobes are known for planning and monitoring actions. Perhaps CT had relearned his former speech patterns by a kind of “hyper-vigilance” of his speech production. It is not entirely clear yet how these results of greater right hemisphere after CT regained his original speech patterns reconcile with initial results of greater left cortical activation that CT demonstrated with his accent. Research always brings new questions as it slowly answers old ones.
There were two more important developments in 2004. First of all, a bright young graduate student in our program in speech-language pathology at UCF named Teresa Pitts called me. She left a message informing me that her father, a prominent local attorney, was representing a woman with Foreign Accent Syndrome named KE in a suit against a car insurance company. Teresa was very insightful and knew right away what an interesting case KE would be. KE had heard from friends of hers about SU’s case.
I first saw KE with my clinical colleague Dr. Janet Whiteside in the summer of 2004. KE not only had a distinctly Eastern-European sounding accent, but she also dropped articles and prepositions in her speech which contributed to the accent. Russian, Polish and other Eastern European speakers often dropped the articles and prepositions in English because they were not present in their native language. KE’s case was challenging because brain images had not revealed a specific site of brain damage after her automobile accident. She did not lose consciousness but was hospitalized for brain imaging and extensive bruising. Her speech was distinctly foreign sounding within a couple days of her accident.
Janet Whiteside took on KE’s case to treat her for severe memory problems and those of executive function. KE also lost her accent over the next year. We are now lucky enough to have recordings from CT and KE both with and without their foreign accents. My very promising graduate student, Rosalie Perkins, is presently conducting detailed comparisons of their speech production with and without the accents. This study will be unique in that each patient serves as his and her own control. Previous studies have been required to compare speech measures in Foreign Accent Syndrome to published group average measures. There is so much natural acoustic variation in speech that it is difficult to know what is due to individual variation and what can be attributed to the foreign-sounding accent. These new analyses should provide for a new level of clarity into Foreign Accent Syndrome.
At each twist and turn of the story, it was remarkable to me how there was always that human element. The human connections and incredible coincidences along the way slowly convinced me that there was something spiritual to this journey for me. I guess it was especially they way that the story “found” me instead of the other way around. It renewed my faith. I began to believe in a divine intervention. The story was much bigger than me, yet I was a definite part of it. It began to influence who I was. Foreign Accent Syndrome had already changed my life before the television exposure. I can tell you that primetime television exposure changes a person in some inexplicable ways. For me, it brought me into contact with dozens of people who claimed to have experienced FAS. Approximately half of them eventually recovered their former accents.
Going to India in the summer of 2004 was also a fundamental part of my spiritual awakening. India brought home the feeling that all men are related on this Earth. Despite our superficial differences, we are all one tribe. In India, even though there were large differences in religion and language, I learned that there was also something fundamental and unique to being Indian. From the United States, I had always viewed India as basically Hindu, and while I knew there were several languages, I had no idea that over a hundred different languages are spoken there, and that there were significant numbers of Zorastian, Jane, Baha’i and Christian religions. What appeared from a distance as a solitary whole was actually a complex mosaic of different languages and cultures upon closer scrutiny. India was like a complex tapestry, something resembling the jewel colored ornate silk saris I saw being woven in Kanchipuram. There ancient looms in homes encoded the complex border patterns on the looms on punched out cards which were fan-folded and directed the warp and weft of the colorful silk—it reminded me of the computer punch cards I used to register for classes as an undergraduate student in the late 1970s. Yet, these “program cards” were obviously much older.
In India I saw was a complex interplay of high tech, low tech, and sometimes simply no tech. I did not expect to see young girls there in a Montessori school in Chennai learning English on child-friendly brightly colored IBM computers. What was especially impressive were the posters on the walls demonstrating ergonomically appropriate postures for the children to use sitting in pairs at their computers. I learned that with over a billion citizens, India is the largest democracy in the world. From the red-turbaned Gujarati of the pink city of Jaipur, the ancient Sanscrit derived Hindi of chaotic Mumbai, to the lilting cadences of Tamil in sandy Chennai—whose local customs of offering fragrant Jasmine and coconut milk and sign language dancing tradition reminded me of Polynesia. It turns out that there might be a link; apparently the coronation ceremony of Thai royalty is spoken in an ancient Tamil.
Ironically, the more I learned about India’s differences the more I became convinced that we all believe in the same God. Of course there were individual differences when viewed through the crystal of our own culture. But it was the same spiritual energy at the base. I felt that there was one God ubiquitous to all religions. A long time ago, when I was still an undergraduate student in psychology, I had conceived of the brain as a metaphor for religions—that we were also the result of some energy that surpassed the individual electrical discharges in our brain’s neurons. God and religion was somehow analogous to the mysteries of human consciousness. Somehow, as humans we are more than the mere sum of our billions of individual neurons. Individual people were like the individual neurons of a greater brain, and God was analogous to the consciousness of that physical brain. It was our consciousness, greater than our individual brains, which made us divine. Just like each of us, those individual neurons in this view, were simultaneously individual and part of a greater whole. No man is an island, because he is also part of a greater whole, because each has a consciousness that is an inextricable part of what it means to be human. Viewing how an individual neuron functions will only inform us about a part of the story, and not tell us about our consciousness. Studying the anatomy and physiology of a neuron, investigating how it fires, its neuropharmacology, will only take us so far in understanding the human brain. We lose the forest for the trees when we focus too intently on the individual microscopic units of our brains. Perhaps, this helped to explain part of the incomprehensible nature of religion, since we could only experience religion through the filter of our own individual and highly mortal brains. In India, even though there were wide differences, I kept constantly observing how much we are also the same.
I thought of the Tower of Babel in the Bible as man’s first attempt to explain the cultural cost of linguistic diversity. The only reason man could possibly be asked to suffer the unreasonable demands of the world’s incredible diversity of languages had to be the result of divine punishment for his own vanity. Why not the much simpler and harmonious plan of a single international language, like Esperanto? Or perhaps better still, and more historically accurate, why not the Sanskrit ancestral tongue from which all the Indo-European languages had evolved?