Library Link of the Day: Foreign Accent Syndrome As a Psychogenic Disorder

Courtesy of The National Center for Biotechnology Information:

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It has now been over a century that researchers have reported on a motor speech disorder most frequently referred to as “Foreign Accent Syndrome” (FAS). The first patient with FAS was anecdotally described by Marie (1907). The term “FAS” was later coined by Whitaker (1982) who also proposed a set of diagnostic criteria: (1) “the accent is considered by the patient, by acquaintances and by the investigator, to sound foreign”; (2) “it is unlike the patient’s native dialect before cerebral insult,” (3) “it is clearly related to central nervous system damage (as opposed to an hysteric reaction, if such exist)”; (4) “(t)here is no evidence in the patient’s background of being a speaker of a foreign language (i.e., this is not like cases of polyglot aphasia)” (Whitaker, 1982, pp. 196 and 198). These criteria only apply to one of the three FAS subtypes in the taxonomic classification recently developed by Verhoeven and Mariën (2010), who distinguished between a neurogenic (including a developmental subtype), a psychogenic and a mixed variant of FAS.

Psychogenic FAS is defined by Verhoeven and Mariën (2010) as “the variant in which the foreign accent of the patient is grounded in underlying psychological issues” (p. 601). It is also referred to as “non-organic,” “functional,” or “psychosomatic” FAS. Aronson and Bless (1990) have expressed a clear preference for the term “psychogenic” because this term has “the advantage of stating positively, based on an exploration of its causes, that the […] disorder is a manifestation of psychological disequilibrium such as anxiety, depression, personality disorder, or conversion reaction […]” (p. 121). In general, this “sub-category” contains all the cases of FAS in which an organic substrate cannot be identified after careful clinical neurological, neuroradiological, and/or neurophysiological examination, and for which a clear psychological factor is identified (e.g., Verhoeven et al., 2005) as well as the cases for which it is hypothesized that a disclosed organic deficiency cannot be held responsible for the FAS (e.g., Gurd et al., 2001; Van Borsel et al., 2005). The latter is not uncommon.

According to Baumgartner (1999) several researchers in speech and language pathology have published cases in which a clear neurological impairment was identified, but the speech or voice disorder was convincingly argued to be of psychogenic origin (Tippett and Siebens, 1991; Baumgartner and Duffy, 1997). Baumgartner (1999) emphasizes the importance of carefully considering the patient’s medical history, meticulously interpreting the symptoms, and evaluating the coherence between different observations. If medical history, onset of symptoms, symptom characteristics and their evolution, neurological examinations, neuroimaging, and cognitive work-up do not unambiguously point toward a neurological disorder, an alternative interpretation should be considered.”

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