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A 44-year-old janitor in Turkey, a monolingual native Turkish speaker, was humiliated by her supervisor at work. Her first symptom was silence. "I was unable to reply and felt intense anger towards her," she later told doctors. When her speech came back, it came back altered. She was now speaking Turkish with accents that listeners identified as Russian, Kurdish and Azerbaijani, shifting spontaneously among all three, in languages she had never learned.

Two months later, a 34-year-old widow arrived at an outpatient clinic with a similar story. After her family lost property to a brother-in-law's debt, she too went mute, and then began speaking with Russian and Kurdish accents.

Both cases, which date to 2022, were published in June in Acta Medica Nicomedia, the medical faculty journal of Kocaeli University, by a team of Turkish psychiatrists led by Damla Ak, with Diğdem Göverti as corresponding author. Neither woman was faking.

The Accent Is Built from Small Mechanical Changes

Foreign accent syndrome is a motor speech disorder, and what makes it strange is how intact everything else remains. Grammar and fluency are preserved. This is not aphasia, where language breaks down, and it is not aprosody, where speech goes flat. Patients keep their melodic contours. The melody is redirected into a pattern listeners hear as foreign.

The clinical team recorded and analyzed both women's speech with consent, and the phonetic breakdown they published is unusually detailed. In the first patient, the Turkish word for lemon came out with a harder, velarized L. The word for cat was palatalized. Vowels shifted, with the word for I produced with a markedly more open sound, and the word for night moving toward its Azerbaijani Turkish equivalent.

The rhythm changed too. Turkish stress patterns disappeared and were replaced by a syllable-timed, staccato delivery giving every syllable equal duration, with pitch rising at the end of sentences even when she was not asking a question. Voiced stops devoiced, so the word for father landed somewhere between two harder consonants. Her word order began deviating from standard Turkish subject-object-verb structure.

None of that is an impression. It is a set of small, consistent alterations in how the vocal apparatus is configured, which the ear assembles into a country of origin.

Silence Came First in Both Cases

The detail the authors consider most significant is the sequence. Both women presented with mutism before the accent appeared, and both episodes followed immediately after an acute psychological stressor.

Their argument is that the accent functions as a step in a progression rather than an isolated symptom. Speech stops entirely, then returns in a form that sits at a distance from the patient's own identity. The authors describe the new voice as a protective layer between the internal world and the social environment.

The second woman's history supported that reading. Four years before her accent appeared, she had presented to neurology with fainting episodes, rightward deviation of the jaw and self-harming behavior after a marriage was arranged for her with her brother-in-law. Blood tests, brain MRI, EEG, and EMG were all normal, and neurology referred her to psychiatry on the assumption of a functional origin. The accent was the second chapter of an existing pattern.

Functional Does Not Mean Fabricated

The diagnosis in both cases was functional neurological symptom disorder, the term that replaced conversion disorder in the DSM-5-TR in 2022. The change was made partly because the older label was not etiologically neutral.

That distinction matters here, because a person suddenly speaking with an accent invites the assumption of performance. The authors are explicit that the diagnosis was not made by ruling organic disease out. It was made on positive clinical features specified by the diagnostic criteria: clear internal inconsistency, with speech that fluctuated across a single interview and faded by the end of the session, plus a direct temporal link to a specific stressor.

Both women were nonetheless investigated thoroughly. Blood counts, kidney, liver and thyroid function, electrolytes, vitamin B12, ferritin, vitamin D, vasculitis markers, EEG and cranial MRI were normal in both. Personality testing pointed toward immature defenses, including repression and dissociation, in each woman.

The authors also note a classic feature present in both: la belle indifférence, a striking absence of emotional concern about a speech impairment that most people would find devastating. In neurogenic cases, following stroke or brain injury, patients typically experience significant frustration at losing their native fluency.

What Separates This from the Stroke Version

Foreign accent syndrome, first described by the French neurologist Pierre Marie in 1907, is now classified into three types: neurogenic, psychogenic-functional, and mixed. Neurogenic cases are commonly linked to stroke, brain injury, and speech-motor lesions, and one recently published case was caused by a right frontotemporal meningioma.

Reviewing published cases between 1907 and 2019, researchers identified 112 in total, of which 16.1% were functional. Among functional cases specifically, a review of the psychogenic variant found that 33% carried a diagnosis of functional neurological symptom disorder, with schizophrenia, bipolar disorder and obsessive-compulsive disorder each accounting for a further 13%.

The features pointing toward the functional variant are an inconsistent accent, the ability to produce different accents, and intermittent returns to normal speech. Clinicians writing in the Journal of Neurology, Neurosurgery and Psychiatry have argued that such positive signs belong in the diagnostic criteria rather than being treated as afterthoughts. The authors add a linguistic marker: their patients showed suprasegmental changes in pitch, rhythm and intonation without the articulation and phonation errors that motor-speech damage typically produces.

Treatment followed the psychiatric diagnosis rather than the speech. The first patient, who also had major depressive disorder, was started on sertraline but stopped attending follow-up. The second was started on escitalopram and had a notable decrease in symptoms. Remission in functional cases has been reported around 38%, considerably better than in vascular ones, provided the underlying psychological triggers are addressed.

The authors acknowledge a real limitation. Their evaluation was primarily phenomenological, without neurocognitive or neurolinguistic testing, and two patients cannot establish general rules. Anyone experiencing a sudden change in speech should be evaluated promptly, since stroke remains an urgent possibility that has to be excluded first.

Key Questions Answered

What is foreign accent syndrome?

A rare motor speech disorder in which changes to a person's rhythm, intonation, and articulation cause listeners to perceive their speech as having a foreign accent, while grammar and fluency stay intact.

Are patients pretending?

No. The speech changes are involuntary and medically recognized. In these two cases, the diagnosis was made on positive clinical criteria, not by assumption.

What caused it in these women?

Functional neurological symptom disorder, the DSM-5-TR term that replaced conversion disorder. Both cases began immediately after an acute psychological stressor, and both began with mutism.

Did doctors find anything on their brain scans?

No. Cranial MRI, EEG, and an extensive panel of blood tests were normal in both patients.

How is it distinguished from stroke-related cases?

Functional cases typically show an inconsistent accent, an ability to produce more than one accent, and periods of normal speech. Neurogenic cases usually involve articulation and phonation errors from motor-speech damage.

Does it get better?

Sometimes. Remission has been reported in roughly 38% of functional cases when the underlying psychological triggers are treated. One woman here improved on an antidepressant. The other left follow-up.

Originally published on Medical Daily