Foreign accent syndrome (FAS): the consequences of a stroke or severe head trauma

Foreign accent syndrome is a very rare neurological dysfunction that appears following a stroke or severe head trauma, forcing people who have just awoken from a coma to rehabilitate their language functions with a different accent from the one they are familiar with

The study of the relationship between brain structure and language is a cornerstone of neurology.

The fact of witnessing the loss of such a specific and culturally organised communicative ability as a result of the lesion of a small layer of cells in the cerebral cortex was the historical spur to the search for the significance of the nervous system in terms of the correlation between location and function.

Thus, from the pioneering research of Broca and Wernicke at the turn of the century, a long road of knowledge began that has produced the current interpretative models that attempt to describe the complexity of brain activity.

It is interesting to note that this pathway was marked from the outset by two diverging trends: on the one hand, the finding of an apparent linearity between nerve tissue location and functional competence, hence the reproducible and inevitable correlation between topographical focus of the lesion and type of impaired function (‘classical’ functional anatomy), on the other hand, the equally punctual inclusion of apparently distant functions in terms of executive modality and perception in a multivariate architectural scheme (e.g. the multiple nodes of sensorimotor integration on overlapping and parallel levels of information processing that arise in separate functional abilities, such as eye movements or tactile perception).

The apparent contradiction between these two tendencies has historically produced theoretical drifts bordering on factionalism, such as Lombroso-style localisationism (the famous ‘genius bump’) on the one hand, and radical holism on the other, which has ended up denying any validity and usefulness to the study of functional anatomy.

The currently shared model is that of a reticular system in which connections are organised according to overlapping priorities delineating a species-dependent phyllo-ontogenetic scheme that is continually reworked by cultural stimuli. In other words, the organisational complexity model includes and harmonises the apparent contradictions between linear connections and ubiquitous brain functions.

Foreign accent syndrome, what happens to language

All this preamble can perhaps give a key to the interpretation of the curious ‘foreign accent syndrome’: the cerebral areas in charge of verbal linguistic expression see several functional instances converge, some bearing the information concerning ‘the thought’ that wants to be converted into a programme of movement by the phonatory organs, others bearing the physical state (state of muscular contraction, tendon tension, articular geometry, ect) in which the latter are found (proprioception), others collect the ‘feed-back’ of one’s own linguistic emission that is constantly rechecked during verbal emission.

As can be guessed, this behavioural production, similarly to others characterised by the voluntary control of motor function, is the result of several recurrent ‘circuits’ that converge on a structure that can be functionally interpreted as the ‘final pathway’, i.e. language.

But since this structure is simultaneously composed of the projection of other structures, one can always assume a lesion so small as to disturb one aspect of its production in isolation.

Thus, if the information component that contains the recognition of one’s own voice and speech articulation is missing, the linguistic emission may be ‘disturbed’ with respect to what the subject normally produces verbally, without the normal ‘self-correction’ of his phonetic emission occurring.

Why do we talk about epigenetics when referring to foreign accent syndrome?

The dissociation between the constituent elements of the final product, i.e. the speech, can produce these ‘bizarre’ phenomena.

But, in detail, what are the instances that are disrupted in this dissociation?

What is the accent of a language or dialect made of? Language acquisition is a process, we believe, predominantly extra-uterine.

The child possesses an innate terrain prepared for the formation of linguistic competence (there is such an extensive and detailed scientific literature on this subject that it is impossible to even mention it here), on which it builds a set of competences closely linked to the environmental stimuli connected to its cultural environment.

This set is thus the result of a genetically determined palimpsest (genotype) on which neuronal pathways bearing specific structural relationships between phoneme (verbal sound) and thoughts are delineated and reinforced.

This latter process is the result of a structural rearrangement that inserts itself on the Genotype and which we call phenotype.

We are led to believe, at least according to dominant scientific thinking (i.e., not yet troubled by the new frontiers of cutting-edge research), that the distinction between genetic terrain and cultural influence is insurmountable.

However, this ‘dogma’ prevents us from understanding a phenomenon such as the ‘foreign accent syndrome’.

In which area of the cerebral cortex would the competence of the English accent be genetically deposited?

And of the Russian one?

And if a patient from Sochi (Russia), following a stroke, began to speak with an accent from the province of St. Petersburg, should we assume that somewhere in his cerebral cortex there were already vowel variations and prosodic musicalities?

Evidently there is something we are missing….

A ‘contrivance’ to this kind of paradox had been elaborated, albeit indirectly and with far more far-reaching arguments, by the Swiss anthropologist and psychiatrist C.G. Jung in the early 1900s: in essence, according to Jung, every individual (understood as a complex mental entity) originates from a reservoir of ‘information’ that is sedimented in humanity and that is transmitted in unconscious form through a source of ‘universal cultural heritage’.

What we recognise rationally through conscious communication channels would be nothing more than a rind that in fact conceals a kind of global knowledge common to all mankind throughout the ages.

It is worth noting, apart from the enormous philosophical leap that renders punctilious research into the relations between nerve structure and function useless at that point (it is no coincidence that Jung, unbeknownst to him and I believe to his otherworldly regret, is often brought in to support all the various wacky new-age holistic theories that, under the guise of ‘complexity’, arrogate to themselves the right to treat patients without first studying anatomy and physiology), which the Swiss scholar brings to the observation of clinical cases somewhat similar to those of schizophrenic patients who deliriously use foreign words they had never studied, even ‘language’ dreams in which passages from ancient poems are quoted, and various other examples of unexplained ‘cultural leaps’.

On the other hand, this kind of ‘wonder’ is a constituent part of the supernatural imagery of human culture, from shamans acquiring the language of animals to (respectfully speaking) the miracle of Pentecost in which Jesus’ disciples suddenly became masters of all the world’s languages.

Here, where modern scientific research seems to be succumbing to the allure of metaphysics (in the proper Aristotelian sense), a breach has nevertheless opened up: for some time now, on the back of important research in various biological and physiological fields, an awareness has been emerging that the gap between genotype and environmental influence is not so insurmountable.

In other words, there is evidence that acquired traits (which can be single variations of a protein, but also complex behavioural patterns) are passed on to the genome, which is then able to project the new phenotype into subsequent generations as a genetically determined trait.

This new perspective, on which hundreds of scholars around the world are now working, is called epigenetics.

Transferred to the study of neurophysiology, epigenetics can certainly reopen the game.

We still don’t know how it is possible for a sick Neapolitan to start speaking with a Venetian accent.

We will probably first have to understand which morpho-structural characteristics of the brain express this variability; however, epigenetics will perhaps prevent us from thinking that the sight of the sick ‘foreign accent syndrome’ should prompt us to call an exorcist instead of a doctor.

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