The Tartan

When Sarah Colwill spoke, it was always with a Devon drawl, with all its softened vowels and accentuated Rs. This accent was part of her personal and collective identity — a reflection of the community and culture she grew up with in Plymouth, United Kingdom. It was a voice that all her friends and family recognized. A voice that, when they heard over the phone, they would immediately exclaim “Sarah!” without ever having to glance at the caller ID.

But after a series of migraines and an emergency hospital trip, Colwill awoke to find that her familiar Devon accent was gone. In its place was a new, lilting voice — she now spoke with a Chinese accent.

“I have never been to China,” Colwill reported to The Guardian. “It is very frustrating and I just want my own voice back.”

The doctors were perplexed by the phenomenon, unable to offer an explanation or a cure. 

Overnight, Colwill’s voice, a cornerstone of her identity and sense of belonging, had vanished. Friends, mistaking her for an imposter, dismissed her calls as scams, abruptly hanging up. Even strangers treated her differently, assuming she was unfamiliar with the region and explaining to her how the bus systems work. But she was a native and intimately acquainted with all aspects of English life.

Colwill was frustrated. It felt as though she had become a stranger in her own homeland, and despite all efforts, her new accent would not go away. Yet, the question lingered: How did this unexpected accent come about in the first place.

Colwill was diagnosed with Foreign Accent Syndrome (FAS), a rare medical condition that shifts the way you speak. It typically occurs following neurological damage or trauma to the brain, such as stroke, traumatic brain injury, or other unknown causes.

There are two main types of FAS: structural FAS and functional FAS, each characterized by distinct underlying causes and symptoms.

Structural FAS arises from structural abnormalities or damage to the brain, affecting areas responsible for speech and motor control. This damage can result from various neurological conditions that affect the brain’s frontal lobe, including stroke, traumatic brain injury, brain aneurysms, or degenerative diseases such as multiple sclerosis. 

In cases of structural FAS, difficulties in controlling the muscles used to speak lead to the emergence of a perceived foreign accent, often accompanied by changes in intonation, rhythm, and pronunciation. However, FAS sound changes are not always consistent with the accent it is similar to — there are often differences in pronunciations of certain sounds. 

Functional FAS, on the other hand, is less common and believed to have a psychological rather than neurological origin. 

Unlike structural FAS, functional FAS occurs in the absence of identifiable structural brain damage and may be associated with psychological factors such as stress, emotional trauma, or mental health conditions that involve hyperactivity. It may also occur following seizures or migraines.

While the exact reason why functional FAS develops is not well understood, it is thought that individuals with functional FAS develop a perceived foreign accent due to hyperactivity in certain brain regions. Some of its symptoms are shared with structural FAS, such as disruptions in talking speed, length of sounds, and stressing of syllables. However, it is also linked with symptoms associated with mental health conditions, such as psychosis and disruptive mood and energy changes. 

Distinguishing between structural and functional FAS is crucial for accurate diagnosis and appropriate management. 

Treatment strategies depend on what caused the development of FAS. For structural FAS, treatment largely depends on each individual case and what abnormality or damage caused the sound changes. For functional FAS, the condition may improve with treatment of the underlying mental health condition. All types of FAS can benefit from speech therapy. 

Aside from the physical trauma that arises from FAS, there is also the impact the condition has on the individual’s mental health. Skepticism from family and friends, difficulty obtaining a diagnosis due to its rarity, fears of ridicule, communication challenges, employment issues because of the way you talk, and exacerbated mental health conditions all contribute to these psychological challenges. Comprehensive support is crucial for those affected by FAS.

There are only about 100 confirmed cases of FAS. Causes are not always detectable. Cases can last for a few days or for years. For Colwill, it’s been three years since she developed FAS, and now she simply wishes to hear her British accent once more.