ArticlePDF AvailableLiterature Review

Expletives: Neurolinguistic and neurobehavioral perspectives on swearing



Severe aphasia, adult left hemispherectomy, Gilles de la Tourette syndrome (GTS), and other neurological disorders have in common an increased use of swearwords. There are shared linguistic features in common across these language behaviors, as well as important differences. We explore the nature of swearing in normal human communication, and then compare the clinical presentations of selectively preserved, impaired and augmented swearing. These neurolinguistic observations, considered along with related neuroanatomical and neurochemical information, provide the basis for considering the neurobiological foundation of various types of swearing behaviors.
Brain Research Reviews 31 1999 83–104 www.elsevier.comrlocaterbres
Full-length review
Expletives: neurolinguistic and neurobehavioral perspectives on
D. Van Lancker a,b,), J.L. Cummings c
aDepartment of Neurology, UniÕersity of Southern California, Los Angeles, CA, USA
bDepartment of Speech-Language Pathology and Audiology, New York UniÕersity, School of Education, 719 Broadway, Suite 200, New York, NY, 10003,
cDepartments of Neurology and Psychiatry and BiobehaÕioral Sciences, UniÕersity of California at Los Angeles, Los Angeles, CA, USA
Accepted 5 October 1999
Severe aphasia, adult left hemispherectomy, Gilles de la Tourette syndrome GTS , and other neurological disorders have in common
an increased use of swearwords. There are shared linguistic features in common across these language behaviors, as well as important
differences. We explore the nature of swearing in normal human communication, and then compare the clinical presentations of
selectively preserved, impaired and augmented swearing. These neurolinguistic observations, considered along with related neuroanatomi-
cal and neurochemical information, provide the basis for considering the neurobiological foundation of various types of swearing
behaviors. q1999 Elsevier Science B.V. All rights reserved.
Keywords: Neural basis of behavior cursing; Aphasia; Gilles de la Tourette’s syndrome; Coprolalia; Basal ganglia; Limbic system
1. Background........................................................................ 83
2. Swearing in normal individuals ............................................................. 84
3. Swearing in aphasia following stroke and left hemispherectomy ............................................ 86
4. Gilles de la Tourette syndrome GTS .......................................................... 88
5. Exploring coprolalia in GTS: does the Markov model work?.............................................. 91
6. Comparison of swearing in aphasia and GTS ...................................................... 93
7. Emotional and prosodic processing ........................................................... 95
8. Cerebral laterality .................................................................... 96
9. Pathological basis to GTS: a basal-ganglia disorder................................................... 96
10. Limbic system-basal ganglia hypothesis......................................................... 97
11. Conclusion ........................................................................ 98
Acknowledgements...................................................................... 99
References .......................................................................... 99
1. Background
Swearing, the use of deistic, visceral and other taboo
words and phrases, has long held a unique and colorful
)Corresponding author. Department of Speech-Language Pathology
and Audiology, New York University, School of Education, 719 Broad-
way, Suite 200, New York, NY, 10003, USA. Fax: q1-212-995-4356;
status in language behavior. Public awareness of swearing
is far keener than, say, interest in relative clauses or the
semantic features of nouns, yet the topic is much less
studied. Swearing and related verbal usage has ubiquitous
social, legal and political implications, which have touched
each and every person at some time or other. Laws against
swearing in public still exist in some states and, infor-
mally, fines may be incurred in social settings 126 .
Knowledge of swearwords takes hold early in child lan-
0165-0173r99r$ - see front matter q1999 Elsevier Science B.V. All rights reserved.
PII: S0165-017 3 9 9 0 0060-0
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–10484
guage development 117 and often quickly achieves a
solid status in the second language learner 181 . Shortly
after the Norman Conquest of England, King William of
Orange was said to use his native language, French, except
for swearing, which he did in English 65 .
Even more dramatically, swearing takes a prominent
role in various neuropathologies of language. For example,
swearing is frequently one of a small set of speech func-
tions — ‘‘automatic speech’’ — selectively preserved in
the severely aphasic patient. Swearwords and phrases are
produced with normal articulation and prosody, in stark
contrast to the remaining speech and language disability.
Some manifestations of swearing behaviors in clinical
settings may be reactive to the disease condition. Exces-
sive swearing occurs in traumatic brain injury 267 and in
paraplegic, spinal cord patients 149 . It occurs in the
elderly in association with depression 43,226 , encephali-
wx wx wx
tis 118 , dementia 239 and klazomania 16 . Post-ictal
swearing has been reported in epilepsy 50,221 . Tardive
Tourettism, sometimes with coprolalia, has been reported
following use of neuroleptics 15,73 including in a
Japanese patient 141 . Pathological use of expletives and
taboo words and phrases is a key feature of Gilles de la
Tourette syndrome GTS 222 and certain other move-
ment disorders, especially Sydenham’s chorea, which has
clinical similarities to GTS 144,264 .
Despite its obvious role in normal and impaired com-
munication, serious study of the neurology of swearing
behavior is lacking. Neurological treatments of emotional
behaviors discuss related phenomena, such as pathological
laughing and crying, but not swearing e.g., Ref. 20 .
This neglect is due possibly in part to a universal negative
response to use of swearwords, and in part to a belief that
swearing is peripheral to more interesting aspects of com-
municative behaviors. Given the range and variety of
observations, the topic appears to be linguistically and
neurologically complex. Whatever the reasons for a tradi-
tional lack of explanatory commentary on swearing, ad-
dressing this question is warranted to advance understand-
ing of the neurobiology of communicative behavior. De-
scriptive work on historical 123,181 and contemporary
80,101,124,130–132,139,210 normal swearing patterns
has appeared, and sufficient observations from neurologi-
cal patients have accumulated to merit an overview and
exploration of the neurology of swearing.
2. Swearing in normal individuals
The definition, characterization and classification of
swearwords is itself daunting. A useful division breaks the
types of words used into the categories of ‘‘deistic’’
Ž. Ž .
religion-related and ‘‘visceral’’ body functions-related ,
but the actual array of expletives extends into many se-
mantic domains. Data reviewed by Flynn 92 suggest that
sex-related insults are a cultural universal. Particular atten-
tion is commonly paid to the genitals and related regions
in insult behavior. Hughes 123 observes that ‘‘Swearing
draws upon such powerful and incongruous resonators as
religion, sex, madness, excretion and nationality, encom-
passing an extraordinary variety of attitudes’’ p. 3 . Galla-
horn 101 divides his data on normal swearing into three
categories: ‘‘curse words,’’ ‘‘anal-erythral terms’’ and
‘‘genital words’’. It is the use more than the item itself that
determines the swear-like force of the expression.
In his book on the history of swearing, Montagu 181
distinguishes between swearing ‘‘damn it’’ , cursing
‘‘damn you’’ , and oaths ‘‘by God’’ . He offers fourteen
categories of swearwords that have been utilized through
Ž. Ž .
the ages: 1 Supernatural or infernal powers e.g., ‘‘God’’ ;
Ž. Ž . Ž.
2 Sacred matters of religion e.g., ‘‘holy mass’’ ; 3
Ž. Ž . Ž.
Saints; 4 Sacred places e.g., ‘‘Jerusalem’’ ; 5 Future
Ž.Ž. Ž.
life ‘‘Heavens’’ ; 6 Ancestors and heroes; 7 Ruler or
authority e.g., ‘‘by the royal robe’’ ; 8 Oaths by natural
objects sun, German ‘‘Donnerwetter’’, English ‘‘thun-
x. Ž .
derstorm’’ ; 9 Vulgar or obscene words body parts ;
Ž. Ž.
10 ‘‘Bloody’’ and its variants; 11 Miscellaneous phrases
having unusual force ‘‘hang it’’, ‘‘gracious’’, ‘‘shiver my
.Ž. Ž .Ž.
timbers’’ ; 12 Classical divinities ‘‘by Jove’’ ; 13
Animals, plants, products ‘‘goose’’, ‘‘mackerel’’ ; 14
Name of valued personal attributes e.g., ‘‘maidenhead’’ .
A 15th class may be added: social insults, including racial
and ethnic slurs.
Euphemisms, flux of popular terms, and variations in
social attitudes toward the words considered ‘‘taboo’’
further complicate the matter 97,123 . Although crosslin-
guistic surveys are few, observations by anthropologists
suggest that most people in most cultures use expletives
181 ; they do so at different times, in various contexts,
with varying emotive content to the expressions. Accord-
ing to Hughes, 123 , ‘‘virtually all societies, even the
most modern, retain some taboos against swearing’’ p. 8 .
For our purposes, and admittedly using a circular defini-
tion, it is sufficient to identify the group of words that are
socially opprobrious, essentially because they are consid-
ered shocking or obscene. We call this large set of words
‘‘expletives’’, ‘‘swearwords’’ or ‘‘taboo expressions’’, and
we refer to this activity as ‘‘swearing’’ or ‘‘cursing.’’ We
will consider subdivisions as they are useful to this analy-
sis.Although etymologies and historical examples from
literary sources are readily available, there are only a few
sets of available recorded data on the incidence or fre-
quency of use of taboo expressions across contemporary
population samples. Steadman 240 approached the topic
by asking subjects to compile lists of taboo words; males
provided the greater number. de Klerk 139 investigated
use of expletives by male and female adolescents of
differing social and educational backgrounds, and found
differences associated with gender and ‘‘social power’’.
Foote and Woodward 94 asked college students to list
words ‘‘obscene to you’’ using both written and tape-re-
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 85
corded response formats. Mode of production did not
affect quantity of responses, but more examples of obscene
language were produced by males than females. These
authors classified the items into ‘‘denotative classes’’ called
‘‘body process’’, ‘‘body part’’, ‘‘body product’’,
‘‘ancestral allusion’’, ‘‘religious blasphemy’’, ‘‘animal’’,
‘‘social deviation’’, ‘‘ethnic-racial slur’’, and ‘‘unclassi-
fied’’. The most frequent exemplars of each class, in order
of frequency, are given as a in Table 1.
A study by Gallahorn 101 tabulated and analyzed use
of taboo words by psychiatric ward personnel at psychi-
atric staff meetings, consisting of the ward chief, four
1st-year residents, the head nurse, three staff nurses, five
aides and occasional other nurses, aides, and social work-
ers. Gallahorn noted daily events on ward, who attended
the meeting, the time spent discussing a patient, and the
taboo words used. He noted who used the words and to
whom they were addressed. During 128 days, 372 taboo
words were used, averaging 2.9 each meeting see Table
1b . Twenty-eight different words were produced, which
Gallahorn classified into ‘‘curse words, analerythral, and
genital words’’. ‘‘Curse words’’ were most commonly
produced, with more words on days with specific issues.
Interestingly, expletive usage diminished during socially
stressful periods on the psychiatric ward. A similar, briefer
survey was conducted by Nuwer 192 , who asked 30
neurologically normal subjects to list the words ‘‘he or she
would use when upset, but would not use in polite com-
pany or when speaking before an audience’’ p. 364 .
Twelve words resulted from this survey, which could be
classified into two general types: ‘‘religious profanities
and obscenities related to physical acts and organs’’ p.
.Ž .
364 shown as Table 1c .
The most extensive survey work has been done by Jay
130–132 , giving frequency counts of specific expletives
as correlated with speaker’s gender, age, context, theme,
and other variables. A large field study of cursing language
used in public by speakers over the age of 45 revealed that
most cursing is made up of 18 words Table 1d , and that
males curse more than females. Four most frequently used
Žwx w x.
words hell, god damn , shit and Jesus Christ account for
57% of the observations. Data from nursing home resi-
Ž. Ž.
dents over age 70 are similar Table 1e . The top ten
swearwords of West Coast speakers ages 70 and under
obtained from field observations are shown in Table 1f
131 . To explore the words people use privately, survey
questionnaires were administered to an elderly population
in western Massachusetts, containing 26 taboo words de-
rived from Jay’s previous field studies 132 . Subjects were
asked to rate the words for frequency of personal use and
for offensiveness. The results are summarized in Table 1g.
A wide variety of different types of swearwords occur
among the 10 most frequently used.
Linguistic analysis of expletives has been sparse. Pe-
rusal of the grammar of expletives reveals that taboo
words appear to function differently from other words. A
linguistic analysis of swearing in Australian English noted
that swearwords ‘‘combine morphologically and syntacti-
cally with other items in a number of interesting ways,
some of which are peculiar to them’’, while others are
Žwx .
merely ‘‘preferred’’ by them Ref. 244 , p. 18 . To dis-
cuss the grammar of swearwords, Taylor utilized the no-
tion of ‘‘schemata’’, or formulae, developed by Lyons
Žwx .
Ref. 162 , p. 177 . Each word, phrase, or sentence schema
has its own shape and variations: for example, the phrase
schema ‘‘rrin therrhell heck ’’ where the first slot can
Table 1
Data on normal occurrences of swearing descending order of frequency, with counts in parentheses
Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž.
a Nine most frequent swear words fuck 33 , cunt 23 , shit 33 , bastard 25 , God damn 15 , son of a bitch 19 , whore 10 , nigger 8 , fascist 2 ,
Žwx Ž.
by college students Ref. 94 , p. fuckin’ 2
Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž.
b Swear words spoken by psychi- damn 87 , hell 84 , crap 41 , God 34 , shit 33 , bitch 17 , Christ 16 , screw 11 , pissed off 10 , ass 6 ,
Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž.
atric ward personnel in 6-month pe- bastard 5 , butt 3 , can 3 , whore 3 , hot pants 2 , slut 2 , reamed 1 , shaft 1 , son of a bitch 1 , balls 1 ,
Žwx .Ž.Ž.Ž.Ž.Ž.Ž.
riod Ref. 101 , p. 311 come 1 , fuck 1 , laid 1 , piece of ass 1 , pimp 1 , shack up 1 , wet dream 1
Ž. Ž wx
c Normal usage survey Ref. 192 , shit, God, damn, ass, fuck, Jesus, hell, crap, cock, prick, bitch, fart
p. 364
Ž. Ž. Ž .Ž. Ž. Ž .Ž. Ž. Ž. Ž. Ž. Ž.
d ‘‘Public production lexicon’’ of hell 45 , God damn 33 , shit 33 , Jesus Christ 28 , fuck 24 , damn 22 , ass 19 , bitch 13 , bastard 12 ,
Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž.
18 unique words by speakers over asshole 6 , bullshit 4 , balls 2 , prick 2 , blows 1 , blowjob 1 , dildo 1 , Jew 1 , motherfucker 1
the age of 45 132
Ž. Ž . Ž . Ž . Ž. Ž. Ž .Ž. Ž. Ž. Ž.
e Nursing home residents, over age hell 60 , damn 27 , shit 15 , ass 9 , bitch 4 , Jesus Christ 3 , son of a bitch 2 , bastard 1 , piss 1
70 132
Ž. Ž . Ž . Ž. Ž. Ž. Ž. Ž. Ž. Ž.
f Top 10 swear words of West fuck 212 , shit 129 , God 68 , hell 50 , damn 45 , bitch 25 ,motherfucker 23 , ass 22 , asshole 17 , bullshit
Ž.wx Ž.
Coast speakers ages 1–70 131 15
Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž.
g 26 swear words, rated for fre- hell 5.12 , damn 5.11 , goddamn 4.13 , shit 3.86 , bullshit 3.72 , son of a bitch 3.52 , ass 3.51 , Jesus Christ
Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž.
quency in personal use in an elderly 3.45 , bitch 3.33 , pig 3.30 , bastard 3.28 , fart 2.95 , asshole 2.82 , piss 2.76 , whore 2.45 ;.tits 2.33 , slut
Ž. Ž. Ž. Ž. Ž. Ž. Ž. Ž.
population in western Massachusetts 2.32 , queer 2.28 , prick 2.23 , fuck 2.05 , nigger 1.98 , cock 1.95 , dipshit 1.93 , fag 1.86 , peckerhead
132 . frequency 1 meant ‘‘never’’ 1.73 , spic 2.63 , danger 4.45 , dirty 4.44 , table 4.21 , flower 4.17
and 9 meant ‘‘very often’’. Four
nonswear words were included
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–10486
be filled by ‘‘how’’, ‘‘what’’, ‘‘why’’, etc., and the
second with ‘‘fuckin’’, ‘‘bloody’’, ‘‘flamin’’, etc. Sen-
tence schemata can be specified in the same way. Taylor
concludes that people swear according to certain types of
rules, and that the swearing behaviors in Australian En-
glish can be well specified for descriptive and pedagogical
Dong 79 argued that there are two words of the form
‘‘fuck’’; only one of these, the one with the meaning
‘‘fornicate’’, functions as a verb; the second, as in ‘‘fuck
you’’, or ‘‘fuck these problems’’, although superficially
appearing to be a verb, is not a verb. This conclusion is
based on a number of linguistic arguments, including that
when the word is combined with other words, the resultant
phrase does not have the external syntax of a VP verb
phrase ; for example, it is not possible to include adverbial
elements e.g., ‘‘by midnight’’ . These expressions, includ-
ing ‘‘damn’’ and ‘‘Goddamn’’, when used in apparently
sentential frames, have ‘‘neither a declarative nor interrog-
ative nor imperative meaning. These utterances simply
express a favorable or unfavorable attitude on the part of
the speaker towards the thing or things denoted by the
noun phrase’’ p. 6 . This is a bold claim, because current
linguistic theory characterizes the sentence S , the basic
unit of language, as being made up of a noun phrase NP
and a verb phrase VP ; by definition, each VP has a verb
Ž. wx
V . Thus, Dong 79 identified a category of words
certain expletives — that do not fit anywhere in this
characterization. Rather than calling the utterances in which
words like ‘‘fuck’’ and ‘‘damn’’ appear ‘‘sentences’’,
Dong recommends the term ‘‘epithet’’, and that the taboo
words themselves be called ‘‘quasi-verbs’’. Thus there is
linguistic evidence that expletives form a separate class in
human language.
3. Swearing in aphasia following stroke and left hemi-
As stated by Jackson 128 , ‘‘The speechless patient
may occasionally swear’’ p. 160 . In his treatise ‘‘On
affectations of speech from disease of the brain’’ in the
section on recurrent utterances pp. 172204 , he discusses
a patient with one recurrent utterance who also ‘‘swore
when vexed’’ p. 173 . Another patient said ‘‘Oh, my
God’’ and ‘‘Oh my goodness will’’; still another’s exclu-
sive utterance was ‘‘pooh’’. Jackson also cites Trousseau’s
reports of patients saying ‘‘sacre nom de Dieu’’ a French
expletive, literally ‘‘sacred name of God’’, rather like ‘‘Oh
my God’’ in English and another the abbreviated version
‘‘Sacon, sacon’’ p. 184 . Jackson’s interpretation of the
use of recurrent utterances was that the severely aphasic
patient had lost the ability to ‘‘propositionalize’’, leaving
only expletives, interjections and oaths. In his view, a
speechless patient may retain the word ‘‘no’’, and yet have
only the interjectional or emotional, not the propositional,
use of it p. 160 . Thus, expletives were deemed essentially
to be ‘‘involuntary’’. Later, Critchley 64 elaborated on
the notions of ‘‘automatic’’ and ‘‘propositional’’ speech,
with the former being ‘‘expressive’’ and the latter ‘‘com-
Žwx .
municative’’ Ref. 64 , p. 229 . But in discussing recur-
rent utterances, Critchley observed that the utterance reper-
tory of the patient can ‘‘largely fulfill the wishes and needs
Žwx .
of the patient’’. Ref. 64 , p. 230 . This suggests, in
contrast to the view of Jackson, that recurrent utterances,
including swearing, can be used voluntarily.
In the decades since these early observations, it has
been noted commonly that persons with aphasia emit
preserved and fully intact utterances classified as ‘‘auto-
matic speech’’. This observation is striking in global apha-
sia, where speech is almost nonexistent, and in nonfluent
aphasia, where speech is effortful and limited to high
frequency single words and short phrases, pronounced with
errors in articulation and in speech melody. In varying
combinations in different persons with aphasia, ‘‘auto-
matic’’ material, including counting from one to ten and
other serial speech alphabet, days of the week , familiar
Ž. Ž .
expressions how are you , pause-fillers well, ya know ,
and expletives flow fluently with effortlessly normal artic-
ulation and prosody 248 .
A chronically aphasic patient we studied made liberal
use of the expression ‘‘Jesus Christ’’, produced fluently in
comparison with his otherwise severe word finding diffi-
culties and effortful speech. Another produced the term
‘‘shit’’ fluently and liberally. We have had reports of
‘‘motherfucker’’ as a recurrent utterance in American en-
glish speakers with severe aphasia. Patient R.N., diagnosed
with global aphasia following a stroke that involved frontal,
temporal and parietal areas of the left hemisphere, was
unable to speak, name, or repeat, and his auditory–verbal
language comprehension was severely limited. He pro-
duced no speech other than ‘‘well’’, ‘‘yeah’’, ‘‘yes’’,
‘‘no’’, and the two expletives ‘‘goddammit’’ and ‘‘shit’’
256 . These words were produced with good articulation
and prosody. R.N. used these expressions spontaneously
and expressively, in answer to questions, and in attempts
to talk. However, R.N. was unable to produce these utter-
ances on command. When asked to read the written word
‘‘shit’’ aloud, although his affective response to the re-
quest indicated he had comprehended the written word, he
was unable to produce the spoken word, despite intense
effort and concentration over several attempts. R.N. sus-
tained damage to the supplementary motor area on the left
hemisphere, which is known to play an important role in
speech initiation. Whether this damage is specific to the
Ž. Ž.
spontaneous or automatic versus elicited volitional dis-
crepancy seen in R.N.’s swearing remains to be studied.
Following up on the anecdotal observations by Critch-
wx w x
ley 64 and Jackson 128 of aphasic swearing, investiga-
tors examining usage in British English and German have
recently performed new surveys of residual expressions
spoken by persons with severe aphasia Table 2 . Lum and
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 87
Table 2
Recurrent utterances in severe aphasia: Britishaand Germanbcorpora
Swear words
British bloody hell, bloody hell bugger, fuck fuck fuck, fuck off, fucking fucking hell cor blimey, oh you bugger, oh boy
Ž. Ž.Ž .
German ach je oh Lord , ach Gottchen oh God , ach ohroh really
and greetings
British alright, because, down, off, no, yep, yes yes yes, well I know, because, away away away, funny thing funny thing,
goody goody, It’s a pity pity pity, now wait a minute, pardon for you, so so, better better, sister sister
Ž. Ž . Ž . Ž . Ž .
German tja well , natuerlich of course , na also there you are , siehste you see , zacki zacki quick quick , so so ,
Ž. Ž . Ž . Ž . Ž . Ž .
also well , so so so so, so, so , doch butryet , na na na wellrnow , Hallo hello , macht nix doesn’t matter ,
Ž. Ž.Ž. Ž.
weiss es nicht don’t know , danke danke, ya, nein nein nein, nee nope , ja ja yes yes , ya yawohl yes indeed ,
das ist alles hinten, that is all behind us nicht traurig sein don’t be sad , bitte sehr please
British two two two, three three, I want to one two, I try one two, I think one two
German drei three
British I bin to town, I can’t, I can talk, I can try, I can talk and I try, I did not hear, I told you, I said, I want to, you can’t
Ž. Ž .
German Ich bin I am , I will arbeiten und lernen I want to work and study
Proper names
British Bill, Billy, John, Parrot, Percy’s died, BBC
German Heidi, Bayern, Mama-Oma ma-grandma , Mama, Hans nein Hanni, Monika, Moni
British I’m a stane, milk, money, off, oil, factory, policeman, on the corner, paper and pencil, piano, Wednesday, so and so,
somewhere somewhere, time a time, tingaling, today, washing machine, sewing machine
German Das war wesentlich wichtig gewesen this was essentially important , Bauern farmers , Reisen trips , Mittag noon ,
Sie Sie, Dir you
Code 57 .
Blanken 24 .
Ellis 160 studied nonpropositional speech in aphasia in
British English using six tasks, carefully designed to per-
mit a comparison with ‘‘propositional’’ speech ability.
Nonpropositional tasks were counting 110, reciting the
days of the week, months of the year, and nursery rhymes,
repeating familiar phrases, and naming a picture with help
of a familiar phrase, in 28 patients with anomic, Broca’s,
conduction, global or Wernicke’s aphasia. The proposi-
tional match for counting, for example, was reading the
individual Arabic numbers. Of the six tasks, counting
1–10 and naming a picture with the help of a familiar
phrases reliably differentiated between nonpropositional
and propositional speech behaviors. Six patients showed a
clear ‘‘nonpropositional advantage’’. A similar investiga-
tion revealed superior sentence completion for familiar
idiomatic expressions as a form of nonpropositional speech,
compared with sentence completion for propositional ex-
pressions 252 . A functional imaging study compared
counting 1–10 with generating names of animals. Results
indicated that left anterior regions in and near Broca’s area
areas 44 and 45 were activated during the animal naming
task, but not during counting by normal subjects 254 .
In the first actual catalogue of recurrent utterances,
Code 57 reported on 69 ‘‘real word recurrent utterances’’
produced by 75 adult speakers of British English 39 male,
36 female , who suffered aphasia due to a cerebral vascu-
lar accident. From a survey study utilizing this patient
population, Code tabulated a list of real word recurrent
utterances, falling into seven categories. Pronounqverb
was the most common present in 14 of 75 patients and
expletives formed the second most frequent 11r75 . Other
categories of recurrent utterances were proper nouns
Ž. Ž. Ž.
5r75 , yesrno 4r75 , numbers 5r75 , repetitions
Ž. Ž.Ž .
14r75 and other 22r75 see Table 2 . In his overview
of linguistic output observed in adults who have undergone
a left hemispherectomy, Code 60 concluded that utter-
ances of the isolated right hemisphere consist primarily of
automatic and nonpropositional speech p. 331 . A second
study of aphasic speech targeted native speakers of Ger-
man 23–25 . The majority of ‘‘lexical automatisms’’
Žthese authors’ terms for the term ‘‘real word recurrent
utterances’’ used by Code documented from 30 patients
were emotional expressions, such as ‘‘ach je’’ Oh Lord
and ‘‘ach Gottchen’’ oh God and interjections, such as
Ž. Ž . Ž.
‘‘tja’’ well , ‘‘natuerlich’’ of course and ‘‘also’’ well .
see Table 2 . Nonlexical recurrent utterances also occur;
see Refs. 27,58 .
Although much has been written in clinical descriptions
about preserved production of ‘‘automatic speech’’, little
has appeared regarding the observe, impairment of count-
ing, swearing, and other overlearned expressions. One
exception comes from a case of a loss of some types of
overlearned speech behaviors, following a stroke to the
right basal ganglia 235 . A 75-year-old, right-handed man,
bilingual in Hebrew and French, was unable, in contrast to
prestroke function, to recite familiar verses, including well
known prayers and blessings in his native language, He-
brew; count 1–20, or sing familiar songs. He could no
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–10488
Table 3
Transcription of utterances by EC adult left hemispherectomy in a 5-min videotaped interview
Time Expletive Spont words Pausefills Sentence init Naming target Response Rep target Rep response Nonverbal vocs
0 goddammit one un I can’t
goddammit three boy that’s a
I, no place well
well, as book m-book uh mm
goddammit uh house uh-house duhh
NoÕember uh,duh
1no deÕelop de-ve-lop
eh remember sandwich neah
ah President Pres-en-dent
constitution vegent-lich
deÕelop ugh
2 god– uh remember No-vem laugh
goddammit nah NoÕember November sigh
ah sigh
um mmsigh
mm tsk
3uh whaa
oh, yes safety pin sood safe nah
no safety s-no wha
well, yes measuring tape tape
shit oh, yes tape meas-
4 goddammit I don’t
ah I couldn’t
say in then
ah watch laugh
5 look-y ahh
goddammit clock
longer recite familiar blessings, some of which had been
his habit to say daily since he was a young child. His
attempts at longer prayers, such as ‘‘shema Yisrael’’, had
correct rhythm but not the correct words, word order, or
intonation p. 1772 . Although he had not used expletives
a great deal prior to his brain lesion, postmorbidly he no
longer cursed or swore; he also ‘‘could not provide the
correct expletive for situations described to him nor could
he complete a curse’’ p. 1772 .
Well-preserved swearing occurred in E.C., a right-
handed adult, following neurosurgical removal of his left
hemisphere, leading to near total extirpation of proposi-
tional speech. The surgery included removal of all four left
cerebral lobes, limbic forebrain, left thalamus and basal
ganglia 232,233 , following development of an infiltrating
tumor. E.C. was interviewed by N. Geschwind 5 months
after neurosurgical removal of his left hemisphere see
Table 3 . The patient was right handed, and there was no
left-handedness in his family 266 . In the 6 min interview
there is a discrepancy in speech production ability related
to type of utterance. E.C. was unable to name any of 4
target items safety pin, measuring tape, watch, clock ; he
repeated mono- and polysyllabic words book, house, de-
velop, November with articulatory effort and errors e.g.,
‘‘president’’ was repeated as pres-en-dent . His sponta-
neous words were ‘‘one’’, ‘‘three’’, ‘‘I’’, and ‘‘no place’’,
and pause fillers, such as ‘‘um’’, ‘‘boy’’, ‘‘well, yes’’,
and ‘‘well, no’’, and many instances of ‘‘ah’’, and ‘‘oh’’.
In addition, numerous nonverbal communicative vocaliza-
tions occurred during the interview, such as sighs, brief
laughter, and ‘‘tsk’’. The most prevalent speech was
swearing, featuring seven productions of ‘‘Goddammit!’’,
one of ‘‘God!’’ and one instance of ‘‘shit’’ in the 5-min
session Table 3 . Besides the greater quantity noted for
expletives over other types of speech, the speech quality
was better, and sounded normal, in comparison to other
speech spontaneous or repeated which was usually effort-
ful, uncertain and dysfluent. Similar observations were
made by Zangwill 266 who interviewed E.C. 18 months
after surgery, noting E.C.’s ability to swear.
4. Gilles de la Tourette syndrome GTS
GTS is a movement disorder first described by Itard
wx wx
127 and Gilles de la Tourette 104 , and brought to
modern understanding by Shapiro and Shapiro 222 , Com-
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 89
wx Ž
ings and Comings 63 , and numerous others for reviews
see Refs. 44,56,86,88,106,109,112,129,146 151,183,186,
195,218,220,239,247 . The vocal tics required for diagno-
sis of the disorder are classified as a hyperkinetic motor
speech disorder 71 . The clinical symptom of coprolalia,
or foul speaking, is present in approximately 25–50% of
persons with GTS, depending on the nature and age of the
population, and how the clinical population is sampled,
whether in cross-section or longitudinally. Incidence analy-
wx Žwx
ses 223 performed in 146 GTS patients Ref. 85 with
coprolalia documented the highest frequency terms and
the range of terms that have been reported to occur,
providing a listing of coprolalic expressions in order of
frequency Table 4 . As clinicopathological correlates dis-
Table 4
Reported GTS expressions across languages
GTSsnumber of GTS patients with coprolalia.
UK fuck, cunt, bastard, piss, sod, cock, shit descending order of frequency
bŽ. Ž. Ž. Ž. Ž. Ž. Ž.
Spain puta whore , mierda shit , cono cunt , joder fuck , maricon fag , cojones balls , hijo son de puta, hostia host
cŽ. Ž . Ž. Ž . Ž . Ž .
Brazil merda, bosta shit , fihlo de puta son of a whore , bunda ass , buceta cunt , cacete, caralho cock , porra sperm ,
va tomar no cu fuck off
dŽ.Ž. Ž.Ž.Ž.Ž.Ž.Ž.
Denmark kaeft shut up , svin swine , fisse, kusse cunt , pik cock , rov ass , pis piss , gylle manure , Sgu by God
Peru no seas malcreado don’t be bad , batidoras national, ajo ajo, carajo, serve me coffee
f–i Ž. Ž . Ž. Ž .
Germany Nutte, Hure, Prostituierte whore ; Arshloch asshole , Scheisse shit ; Leiche corpse , Tod death verfaulte Knochen
Ž. Ž .
rotten bones , Eingeschlagene Schaedeldecke smashed skull ;
j–k Ž. Ž. Ž . Ž .Ž.
Hong Kong tiu fuck , shui bum , tui ma motherfucker , tiu so aunt fucker tiu fuck , ‘‘shut up,’’ ‘‘behave properly,’’
‘‘Why are you such a nuisance’’
Sri Lanka shit Indian English ; hu, huththi whore .
m,y Ž. Ž .Ž. Ž.
Italy taci, cretinaccio shut up, stupid ; smettila, imbecillaccio stop it, imbecile bastardo bastard , rognoso scabby with scabs ,
Ž. Ž. Ž . Ž . Ž .
vaffan’culo fuck you , riccione faggot , figlio di puttana son of a bitch , stronzo piece of shit , minchia cunt, fem. genitalia ,
Ž.Ž .
minchione stupid cunt , zoccola whore, fem. rat
n–p Ž. Ž. Ž.Ž. Ž . Ž .
Japan sukebe lecherous , chin chin cock , bakatara stupid , dobusu ugly , kusobaa shit grandma , chikusho son of a whore ,
female sexual parts ,
USA fuck, shit, cunt, mother-fucker, prick, dick, cocksucker, nigger, cockey, bitch, pregnant-mother, bastard, tits, whore,
fu. .., doody, penis, queer, pussy, coitus, cock, ass, shi. .., bowel movement, Fangu fuck in Italian , homosexual,
screw, fag, faggot, schmuck, blow-me, wop descending order of frequency
God damn it, damn fool, ‘‘other four-letter expressions’’
Fuck my your fucking fucking fucking cunt t
fuck, shit, ass, bitch, cock, fart, suck descending order of frequency
you fucking idiot, asshole
fuck you, shit on you
fucka, fu. .. x
fuck, shit American Sign Language
Lees et al. 152 20 GTS .
Lees and Tolosa, 1993 8 GTS .
Cardoso et al. 48 9 GTS .
Reuger et al., 1986. 17 GTS .
Asam 7 1 GTS .
Asam and Traeger 10 1 GTS .
Hering 120 1 GTS .
Beckers 18 2 GTS .
Marneros 165 1 GTS .
Lieh-Mak et al. 155 9 GTS .
Singer 231 3 GTS .
lwx Ž.Ž .
Perera 196 , Perera 1983 2 GTS .
Escalar et al. 87 2 GTS .
Kuniyoshi et al. 141 1 Tardive GTS .
Nishida 189 1 GTS .
Nomura and Segawa 190 4 GTS .
Shapiro et al. 227 85 GTS .
Lucas 158 4 GTS .
Martindale 168,169 1 GTS .
Nuwer 192 12 GTS .
Caplan et al. 47 1 GTS .
Wallen and Areneta 258 1 GTS .
Milman 177 4 GTS .
Lang et al. 147 1 GTS .
de Divitiis 78 .
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–10490
tinguishing the various clinical manifestations of the move-
ment disorder have not been established, and as the vari-
ants wax and wane within patients, it may be most useful
to view verbal, vocal, and other motor tics in GTS as
variants in a hyperkinetic syndrome.
Insight into the nature of swearing in GTS can be
obtained by crosslinguistic investigation. Cross-cultural
clinical commonalities in patients with GTS were observed
as early as 1973. It was reported that approximately 60%
wx Ž.
of patients sampled in the US 193 , France ns107 ,
Ž. Ž.Ž
Germany ns57 , United Kingdom ns54 , Italy ns
46 , Eastern Europe ns25 , Scandinavia ns9 , India
Ž. Ž. Ž.
ns5 , Japan ns2 , Czechoslovakia ns4 , Poland
Ž. Ž. Ž.
ns2 Hong Kong ns2 and Hungary ns1 had
coprolalia 1,5 , but the authors did not provide examples
of specific vocalizations in the different languages. Boshes
32 described ‘‘Jamie’’, who ‘‘swore continuously’’ and
‘‘spewed forth an uncontrollable string of obscenities’’ p.
715 but specific words are not listed. Pary 195 reports
‘‘episodic cursing’’. Many authors refrain in this manner
from giving specific coprolalic examples. This practice
retards our ability to perform linguistic analysis of the
specific utterances. In this article, we document all specific
instances to gain insight into the phenomena of neurologi-
cal swearing; and we indicate when coprolalia was re-
ported without specific instances. All examples gleaned
from the international literature are given in Table 4.
An important contribution to our understanding comes
from the American coprolalic linguistic corpus of Shapiro
et al. 223 . Besides this work, several other authors have
provided American English examples 47,107,110,158,
177,187,258 and coprolalic American Sign Language ex-
wx wx
amples 147 . Lees et al. 152 provide a listing of British
coprolalic utterances. The most frequent coprolalic items
observed clinically in the UK are provided by Lees 151 .
Cases have been described for English spoken in Australia
51,53 , and for Canadian English, at least two studies have
reported coprolalia in GTS 49 with one study reporting
that 60% of the GTS subjects used coprolalic expressions
180 . The New Zealand English report speaks of ‘‘four-
letter obscenities’’ in a GTS patient 114 . A child in
Ireland displayed tics accompanied by cursing which was
disruptive socially 161 . A British study includes the
utterance ‘‘maman’’ mama ; this patient had French par-
ents 89 .
Several French cases indicate usage of coprolalia 119
or ‘‘obscene words’’ 153 , but do not list the actual
words; another gives the example ‘‘trois fois par semaine’’
three times a week 265 .
Spanish examples are given in Singer 226 . Four Ar-
gentinean cases were described 175 ; in another study,
28% of Brazilian GTS patients had coprolalia, with exam-
ples given 48 , and a Brazilian patient with coprolalia and
compulsive screaming is described without examples 111 .
Other Portuguese language cases have been described 93 .
A GTS patient from Guyana, South America, had copro-
lalia 81 . A few unusual examples from a Peruvian report
include ‘‘no seas malcreado’’ don’t be bad and ‘‘serve
wxŽ. wx
me coffee’’ 269 see Table 4 . Briones et al. 37 describe
‘‘gritas y insultas; autenticas barbaridades; palabras soe-
ces’’ ‘‘screams and insults; authentic barbarisms; vile
words’’ pp. 1617 all pointing to variants of expletives
but lacking specific examples.
Chinese investigators reported on five 156 and then on
18 GTS patients 155,231 in Hong Kong, 60% of whom
had single or multiple word coprolalic expressions. In
Japanese patients, coprolalia is reported 136 , and exam-
ples are given 48,141,189,190 .
Numerous papers from Germany provide clinical de-
scriptions and some offer specific coprolalic utterances
7–10,18,56,120,165,214 . Certain terms occur across sev-
Žwx w
eral patients Arshloch, asshole , Scheisse, Nutte pros-
titute , while others occur in a single person Leiche
wx wx.
corpse , Tod death . A Dutch coprolalic patient is de-
scribed 238 . The Danish study of 65 patients lists specific
coprolalic utterances 202 .
Coprolalia has been reported in Italy 77 with examples
87 . A few such examples differ somewhat in that they
take the form of imperatives ‘‘taci, cretinnacio’’; ‘‘shut
up, stupid’’ that may be self-directed. de Divitiis 78
provided specific coprolalic examples of a 23-year-old
male GTS patient in a letter responding to our request see
Table 4 .
Three papers describe patients in Czechoslovakia
wx w
90,102,242 . Five reports of 38 Polish 29,140,209,
245,268 and Russian 11 patients mention ‘‘bad’’ or
‘‘obscene’’ words. A Russian report 172 reviewed eight
patients from 9–13 years. GTS patients followed a stereo-
typical chronological sequence, with simple involuntary
facial, head and shoulder movements, nonverbal vocaliza-
tions, screams, inarticulate sounds, and, in three patients,
‘‘bursts of foul language’’. However, the only examples
given are the Russian words for ‘‘yes, yes’’ and ‘‘no, no’’.
Two patients in Sri Lanka were described by Perera
196 , who responded to our inquiry by letter by providing
the specific words in Indian English and Sinhalese spoken
by his young subjects given in Table 4 . Eapen and
Srinath 82 reported coprolalia in an Indian subject but no
examples were given. GTS in the Middle East has been
reported 85,203 . Clinical descriptions appear in publica-
tions from Israel 100,154 . A 37-year-old Turkish male
with GTS and spinal muscular atrophy had coprolalia, but
no examples were given 217 .
Coprolalic signing has included signs for ‘‘fuck’’ and
‘‘shit’’ 147 . These signs are to be distinguished from
copropraxia, the obscene gestures that also occur in GTS.
Perusal of Table 4 reveals that the vocalized words
encountered as part of the clinical presentation in GTS,
whether described as a category or in specific terms, are
best characterized as obscene or socially taboo terms,
primarily with sexual content, sometimes as social slurs or
insults, with minor appearance of imperatives shut-up ,
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 91
phrases of morbid content death , and a few other miscel-
laneous items.
5. Exploring coprolalia in GTS: does the Markov model
The claim that observed coprolalic utterances in English
GTS speakers can be explained by elementary phonatory
positioning 192 related to Markov processes of random
sequencing has been championed in the GTS literature.
This hypothesis suggests that randomly generated strings
of letters or phonemes utilizing higher order probability
tables, where more weight is given to those units with a
higher probability of occurrence, can account for copro-
lalic productions. This claim is untenable for at least five
First, linguists have explained in detail why Markov
processes, having exclusively transitional-probabilistic
properties, are irrelevant to speech and language, which is
structured on several hierarchical levels 54,122,176 . Even
if that were not the case, the example given by Nuwer of
‘‘third order probabilistic computer-generated strings of
letters’’ is unconvincing p. 366 .
It is unconvincing because only one of the phonetic combi-
nations alleged to represent GTS vocalizations appears on
the clinical coprolalic listings in Table 4, except for the list
assembled by Nuwer 192 , and the second randomly
generated item asse only approximates a GTS vocaliza-
tion, which occurs in a low position on the descending
frequency lists in Table 4. Further, the hypothesis would
have to explain why the other combinations seen proba-
bilistically do not occur as part of the GTS repertory or
speech performances generally . The numerous other co-
prolalic utterances, including the multisyllabic expressions,
are unaccounted for. The coprolalic productions of one
GTS patient were analyzed by Martindale 168 see Table
4 , who found that the tics and tic strings consisting of
from 1–7 words exhibited a complex syntax. These pro-
ductions could not be described by ‘‘a grammar in which
any tic element may follow any other’’ — a zero-limited
grammar p. 271 . Nor could the coprolalic productions be
characterized by a one-limited grammar ‘‘one in which
every word is constrained only by the preceding word’’ ,
because tic elements are constrained by more than merely
the words preceding them. Thus the various permutations
Ž.Ž .
of the coprolalic utterance ‘‘Fuck your my your, my
fucking fucking cunt’’ required a two-limited finite state
grammar, which is a level of structure well beyond free
combination of elements, and at least one step beyond
immediately constrained transitional states.
Secondly, the phonetic composition of the most often
observed GTS verbal tics in English does not consist of the
most frequent phonemes in English. Numerous frequency
listings make possible an objective evaluation of phonemes
involved in frequent coprolalic utterances e.g., Refs.
46,76,98,157 . An analysis of relative occurrence of
speech sounds as determined from telephone conversations
Žwx .
Ref. 91 , p. 95 reveals that w, t, th as in then , y, d, and
m are the six most frequent sounds in word-initial position,
having ratings of 9.38 for w, 7.86 for t, 6.72 for th, 6.48
for y, 6.21 for d, and 5.89 for m see Table 5 . In contrast,
the ‘‘top’’ three coprolalic words 223 see Table 4 under
USA contain initial phonetic elements of f, sh, and k,
which occur in 14th ratings3.96 , 18th ratings1.74 ,
and 9th ratings5.55 place, respectively on the phoneme
frequency list. Similarly, the phoneme frequency data for
conversational American English presented in Kent 137
calculates f at 3% of sounds, sh at 1% of sounds, and k at
5% of sounds. For coprolalic consonants in final position,
k, t, and nt, Fletcher’s chart 91 for final consonants
places k at 2.85, t at 14.30, and nt at 4.40. Medial vowels
are uh and ih. While ih is ranked highest 10.27 on a
frequency table for spoken English, uh at 4.14 is 11th out
of a total of 18 vowels. Thus, the sounds of American
coprobalic items are actually among the less probable to
occur in American speech.
For British English, examine the three most common
coprolalic utterances given in Table 4, noting their initial
sounds are f, k and b. According to Fry’s 98 analysis of
the frequency of British vowels and consonants in conver-
sation reproduced in Refs. 105,65 , and a similar result
appears for the consonants: f and k are 9th and 14th,
respectively; the vowels are 1st and 9th. In summary, of 19
consonants and vowels making up the three most frequent
coprolalic words in American and British English, 12
sounds rank between 9th and 18th in phoneme frequency
counts. Of these 19 phonemes, only two vowels and the
final t or d rank in the first three phonemes in phoneme
frequency counts. Thus, facts derived from the statistical
ranking of phoneme frequencies do not descriptively ac-
count for the phonetic shapes of the three most often used
coprolalic utterances in either British or American English.
While too few German examples are available in the
literature to determine a definitive frequency ranking of
coprolalic utterances, a similar result appears from choos-
ing the first 3 1–2 syllable words Nutte whore , Hure
wx w x
whore , Arshloch asshole , and comparing them to a
mean frequency of occurrence of letters in a German text
Žwx .
Ref. 122 , p. 99 . We find that N is ranked 2, T is ranked
6, H is ranked 7, R is ranked 3, A is ranked 9, and L is
ranked 11 see Table 5 . Again, relevant letter frequency is
not among the highest for these words. Added to this range
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–10492
of relatively low probabilities is the uniqueness of the
letter combinations. We conclude that phoneme or letter
frequency counts are not germane to coprolalic utterances.
An occasionally expressed corollary of the Markov hy-
Table 5
Phoneme and letter frequency tables
After Fletcher 91 American English conversation
Vowels Initial consonants Final
articles excluded Consonant
Sound-type Rank Sound-type Rank Sound-type Rank
pin 10.27 w 9.38 t 14.30
pine 7.58 t 7.86 r 13.05
pan 6.89 th then 6.72 n 12.52
pen 6.60 y 6.48 l 8.40
peel 6.44 d 6.21 z 6.01
pool 6.26 m 5.89 m 5.48
pot 5.21 h 5.75 d 4.44
pane 4.78 k 5.55 v 4.23
pole 4.74 s 5.46 ng 3.57
pawn 4.15 n 4.99 s 3.13
pun 4.14 b 4.64 f 1.37
pull 2.96 g 4.33 th with 1.25
pout 1.69 l 4.31 p 1.24
par 1.31 f 3.96 ch 0.53
pair 1.09 r 2.78 b 0.42
purr 0.80 p 2.54 g 0.38
pew 0.26 th thin 2.02 sh 0.32
poise 0.19 sh 1.74 j 0.14
v 1.25 th myth 0.04
f 0.83 zh 0.01
ch 0.55
z 0.34
zh 0.02
After Fry 98 , British english conversion
All consonants All vowels
Sound % Sound %
n 7.58 sof a10.74
t 6.42 bit 8.33
d 5.14 bet 2.97
s 4.81 bite 1.83
l 3.66 but1.75
th then 3.56 bait 1.71
r 3.51 beat 1.65
m 3.22 bawd 1.45
k 3.09 f ather 1.37
w 2.81 hawed 1.24
z 2.46 hoot 1.13
v 2.00
b 1.97
f 1.79
p 1.78
h 1.46
ng 1.15
g 1.05
sh 0.96
j 0.88
dj 0.60
ch 0.41
th thin 0.37
zh 0.10
Table 5 continued
After Hoermann 122 , German: written text
Letter Frequency Letter Frequency
E 147 004 G 26672
N 88351 M 21336
R 68 577 O 17717
I 63770 B 15972
S 53 881 Z 14225
T 47310 W 14201
D 43854 F 13598
H 43554 K 9558
A 43309 V 7350
U 31877 UE 5799
L 29312 P 4992
C 26 733 AE 4907
pothesis was that coprolalic productions in English consti-
tute ancient, ‘‘Germanic’’ utterances, formed of naturally
vocalized, ‘‘gutteral’’ phonetic elements. Here, also, the
facts do not meet the presumptions. Two highly popular
coprolalic utterances, ‘‘fuck’’ and ‘‘cunt’’, are not attested
in Old English 65 .
A third counterargument against the Markov proposal
arises from observations of semantic consistency. The
variety of coprolalic utterances across languages as shown
in Table 4, including nonIndoeuropean languages, consti-
tute an obvious content category of obscene or taboo
words of highly diversely configured phonetic compo-
sition. This fact of semantic category overrides any contri-
bution of recurring or ‘‘more frequent’’ phonological
elements to the classification. In rare cases where the
coprolalic utterance falls outside of the semantic category
of taboo words, as in self-directed imperatives or morbid
phrases , we nonetheless note that the phonetic elements
form a coherent phrase e.g., ‘‘serve me coffee’’ , not a
probabilistic string.
In addition, as a fourth point, actions and mental events
conceptually related to the most common coprolalic se-
mantic subcategory, sexual terms, co-occur with coprolalic
productions. That is, copropraxic behaviors of sexual
touching and obscene hand gestures are common. This
co-occurring behavior lends further support to the notion
that it is a semantic-cognitive category that is involved, not
a probabilistic tendency toward an accidental concatena-
tion of sounds.
Finally, the report of coprolalic signing 147 removes
the symbolic output completely from the realm of letter or
phonemic strings, and given the signed forms, supports the
role of the semantic category obscenity , not phonetic
In conclusion, the Markov model is unable to account
for coprolalic utterances, even the monosyllabic examples.
It is the notion of a particular semantic category, that is,
words with socially taboo andror emotionally charged
meanings, that accounts for nearly all coprolalic items. An
explanation for swearing in GTS that is based in neurobiol-
ogy and not involving probabilities is presented below.
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 93
6. Comparison of swearing in aphasia and GTS
Among speech pathologies, swearwords taboo expres-
sions occur most prominently in aphasia and GTS. Here
we explore the similarities and differences in swearword
presentation in the two conditions. Swearwords have in
common that they are socially taboo utterances, those to be
avoided in ‘‘polite company’’, and that are therefore,
mildly or intensely, ‘‘offensive’’ terms. Unfortunately,
there is no available corpus of aphasic recurrent utterances
for American English, and thus it is necessary to compare
the larger GTS coprolalic corpus for American English
223 with the British corpus for aphasia provided by Code
57,59 . Listings for both speech pathologies are available
in German for comparison. The overview of crosslinguistic
coprolalic utterances provided above will help explore
questions about the clinical presentation of vocalizations in
Differences are found in the manner and in the content
of speech performance for these terms. In aphasia, swear-
ing is selectively preserved in the context of severely
impoverished speech; in GTS, swearwords are overpro-
duced in the context of functional speech. In the aphasic
and left hemispherectomized adult speakers, swearing is
produced nearly normally in articulation, prosody, and
fluency. In the GTS speaker, the coprolalic expression is
defective in articulation and prosody, relative to the ongo-
ing, conversational speech in which it is occurring. Many
reports of coprolalic utterances in GTS describe them as
distortions: they are overly loud, or ‘‘shouted’’, impre-
cisely articulated, expressed with aberrant voice quality,
and sometimes unintelligible, while speech of the patient
with GTS is otherwise normal but see Ref. 159 .
Another difference lies in ‘‘substitution’’ behavior. Per-
sons with coprolalia have been reported to utilize eu-
phemisms in place of the socially offensive term 165 , for
Ž. Ž.
example, using ‘‘gut’’, ‘‘good’’ ‘‘schoen’’, ‘‘fine’’
Ž. Ž.
‘‘wunderbar’’ ‘‘wonderful’’ for ‘‘Scheisse’’ ‘‘shit’’ and
Ž. wx
‘‘Arshloch’’ ‘‘Asshole’’ . Shimberg 225 , giving an
overview of GTS for the general public, states that some
persons with GTS learn to mask words, saying, for exam-
ple, ‘‘fake’’ for the more offensive word ‘‘fuck’’. A
similar process may be underway in the observation that
some persons with GTS ‘‘shout’’ words regularly occur-
ring in sentences 50,212,220,259 , possibly to accommo-
date the coprolalic inpulse in this other way. Neither a
substitution process nor compensatory shouting is ob-
served in aphasia.
Another important difference in manner of production
between adult aphasia and GTS lies in the ‘‘sensory’’
factor proposed for tic behaviors in GTS. Patients report
that they first feel an urge, which is very strong, to
perform a movement e.g., vocalization , and then they
‘‘voluntarily’’ perform the movement 41,143,145 . In a
survey, 147 71% of GTS patients were found to have a
‘‘feeling that tics are imminent’’; 76% experience a sensa-
tion preceding the tics; 25% feel that the sensation will be
relieved by tics. Sensations are described as generalized,
psychic, and focal, and if the sensations involve the phar-
ynx or larynx, then ‘‘vocalizations may be produced’’
Žwx .
143 , p. 733 . One patient describing personal inner
experiences stated that ‘‘coprolalia is a response to the TS
sensitization of the vocal tissues used in forming sounds;
somewhere in the mouth or throat lips, teeth, larynx,
tongue , tissues and air impinge on each other to activate a
Žwx .
single sensory site’’ Ref. 28 , p. 1345 . In another pa-
tient, coprolalic practice was reduced by injection into
vocal folds of botulinim toxin, suggesting that GTS may
involve a ‘‘sensory reflex arc’’ and that the effect of the
injection is to reduce ‘‘local build-up of tension or muscle
contraction’’ on the laryngeal area 219 . There is no
evidence or suggestion of a comparable premonitory sen-
sory component to swearing behavior in aphasia, but this
has not been studied directly.
As coprolalic vocalizations often occur during ongoing
conversation, several studies have evaluated whether or
how their occurrence is related to linguistic structure. One
study evaluating verbal tics in three GTS subjects reported
that two of the subjects produced 70% of tics at natural
pausing points, before and after clauses, while the third
subject produced most tics within stressed words 95 .
Martindale 169 studied the syntactic and semantic corre-
lates of verbal tics in a two h sample of speech in a GTS
subject. Tics were produced at the rate of 4.6 per minute,
often in strings; they appeared to occur at points of low
information or uncertainty, often before conjunctions and,
but and pronouns. In another study, most vocal tics were
produced at the beginnings or ends of a speech clause,
somewhat less during the clause. A small number of tics
were produced in silence 159 .
Other questions pertain to how GTS vocalizations com-
pare to vocal tics occurring in normal speech production.
The notion of normal use of vocalizations has been de-
scribed by Goffman 108 , who states that ‘‘the public
utterance of self-talk, imprecations, and response cries
constitutes a special variety of impulsive, blurted actions,
Ž. wx
namely, vocalized ones’’ p. 116 and by Darwin 72 who
discusses the universality of sound emission as emotional
expression. A comparison of GTS vocal verbal and non-
verbal tics with measures of the same behaviors taken
from normal speakers was conducted 159 . The nonverbal
tic frequent in GTS was also observed in normal speakers,
but verbal tics occurred only in GTS speakers about
35% .
The volitional component of tics is said to distinguish
GTS vocal tic production from abnormal motor behaviors
in the choreas 145,193 . Swearing in aphasia is best
explained by stating that the word choice is fixed but the
use is somewhat volitional in spontaneous speech, in that
the recurrent utterance can be used expressively, along
with facial and other gesturing. What is not known is
whether a typical recurrent utterance can be elicited from
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–10494
the aphasic speaker- whether hershe can produce the
utterance on command. In contrast, GTS patients have
been repeatedly demonstrated to easily produce their co-
prolalic utterance at will and on command, without the
sense of inner tension that accompanies spontaneous co-
prolalia, and without the phonetic distortion. One study
utilized a habituation technique as therapy for coprolalia,
eliciting numerous repetitions of the affected utterance,
until the patient reported no longer being able to say the
word. Following these therapeutic sessions, the compulsive
vocal emissions were temporarily reduced 10 . Voluntary
and spontaneous tics may use different underlying mecha-
nisms; EEG studies 193 reported an absence of the
pre-movement potential normally associated with volun-
tary motor acts prior to GTS tics, which suggested that the
tics are not generated through normal motor pathways
utilized for willed human movements p. 113 . Thus to the
extent that we can locate swearing behavior on a spectrum
from ‘‘voluntary’’ to ‘‘involuntary’’, significant differ-
ences appear in GTS versus aphasic swearing.
Longitudinal studies identify other differences between
swearing in GTS and aphasia. Aphasic speakers generally
emerge from the acute phase with a fixed repertory of
recurrent utterances, which may change and grow some-
what with time, and which eventually may evolve to
propositionally formed expressions 2 . In the chronic pa-
tient, by definition, little change in swearing occurs. In
contrast, GTS vocal phenomena often are reported to begin
as partial, soft and indistinct sounds, which develop even-
tually into louder and clearer vocalizations. Some authors
have speculated that the process is one of a change from a
willed act to a motor habit, that this process is more rapid
in GTS sufferers than in normal persons, and that copro-
lalic behavior progresses from a stage of volition or semi-
volition to compulsion. Some patients report having a
related thought e.g., authentic semantic content behind
the utterance for a while, and then eventually the copro-
lalic utterance proceeds motorically, as it were, on its own.
At the later stages, GTS patients may no longer be aware
of the quantity of their vocalizations. Coprolalia in GTS
has been reported to wax and wane 263 . While careful
studies still are needed, aphasic swearing appears to main-
tain a more stable course.
Coprolalic signing has been reported 147 in a hearing
young adult female with GTS and verbal coprolalia, who
learned fluent sign in her late teens. Although studies of
aphasic signing deficits following left hemisphere damage
in deaf persons have appeared 121 , there is no report of
recurrent automatic speech or residual swearing in sign
19 . However, focused studies on this question have not
yet been done.
Physiological versus psychiatric variables are of differ-
ing significance in GTS and aphasia. Even though the
previously held exclusive role of psychoanalytic explana-
tions for coprolalia, such as hostility toward a parent as the
cause of the verbal tics, is no longer seriously held, some
role of psychological factors is recognized by most persons
working with GTS sufferers 125 . Onset of symptoms is
often associated with a traumatic incident 263 . For exam-
ple, in his case report of a 13-year-old Saudi female
patient, El-Assra 85 states that ‘‘her condition started
seven years previously when she became extremely fright-
ened one night by a group of cockroaches in a dark toilet’’.
p. 397 . The patient exhibited facial tics four days later,
followed by multiple tics of neck, shoulders and hands;
soon utterances appeared, and these developed into copro-
Environmental conditions exacerbate or ameliorate the
intensity of the symptoms 225 ; for example, coprolalia
may be ‘‘worse at home when the individual feels safer’’
p. 31 ; or, in an opposite presentation, worse in the
presence of others 85 . In discussing GTS symptoms,
Bruun and Budman 38 observe ‘‘fewer tics in the office
setting than reported by history’’ p. 28 , and they note the
ability of children to mask their symptoms by use of social
setting affects aphasic swearing. Cultural factors have been
said to influence coprolalic output, with ‘‘quasicoprolalia’’
in Japanese and other Asian GTS cases 129,191 , presum-
ably attributable to lower acceptability of swearing in
Asian culture. Similarly, in aphasia, though to a lesser
extent, less swearing has been reported for German- than
American-speaking aphasic patients, especially in the pres-
ence of the clinician 31 .
Meyer and Rose 174 report psychological factors as
contributing to the clinical picture in GTS. Milman 177
reported that three of four boys with coprolalia also had
‘‘body anxiety and sexual anxiety’’ p. 894 . Pitman and
Jenike 199 studied a patient with obsessive-compulsive
disorder OCD and coprolalia, seeing a role for psycho-
logical factors in the genesis of tic symptomatology. In-
deed, OCD, a neuropsychiatric condition, often appears
clinically in association with GTS 68,96 ; many authors
view an array of motor and behavioral abnormalities as
constituting a spectrum of related phenomena e.g., Refs.
62,241 which include copropraxia. Beckers 18 gives a
strongly psychodynamic interpretation of the clinical pre-
sentations of five patients, although he reported psy-
chotherapy not to be useful in these cases. Lumsden et al.
161 reported a success of family therapy in reducing tics
and coprolalic utterances in an 11-year-old child. Given
that the content of the verbal tics is primarily the feature of
social offensiveness, a significant interface between neuro-
logical and psychiatric features is compelling, and appears
to be a much more significant factor in GTS than aphasia.
Tables of data on swearing in British, German and
American samples in aphasia and GTS reveal little overlap
in pathological swearing. In British, ‘‘fuck’’ appears in
both pathological conditions; in American English, ‘‘shit’’
appears in both conditions. One or both words occur in
various instantiations in most other languages reporting
GTS examples: Spain, Brazil, Germany, Hong Kong, Sri
Lanka, and American Sign Language. These two are the
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 95
words all groups have in common. However, there are
differences in content of the swearword corpus for each
group. Perusal of Tables 1–4 allow comparison of reported
swearing or coprolalic behaviors of normal, aphasic, and
GTS patients. Normal adults use the more mildly obscene
terms in most surveys Table 1 .
In a further difference, aphasic recurrent utterances
include social interjections, sentence stems, proper nouns,
yesrno, numbers, and a large class of miscellaneous words
and phrases Table 2 . In contrast, in GTS, linguistic
vocalizations, visceral and sexually charged obscenities
and insults predominate in a spectrum with nonverbal
vocal and manual gestures Table 4 . We have previously
concluded that specified semantic content is a key parame-
ter in GTS coprolalia. This notion is consistent with fre-
quent reports of sexual preoccupation and copropractic
movements involving sexual gestures 62,69 . These kinds
of words and these gestures are not characteristic of apha-
sic speech.
Taboo expressions are hyperactivated in GTS, and a
subset of these are preserved in left hemisphere damage
and removal. Aphasic speakers retain a set of ‘‘automatic
utterances’’ which include swearwords as the second most
common type, while GTS vocalizations concentrate on
sexually offensive terms, extending sometimes to those not
commonly used as swearwords e.g., ‘‘pregnant-mother’’,
‘‘homosexual’’ , but including an array of nonverbal vocal
sounds. In left hemisphere dysfunction, taboo expressions
emphasize swearwords ‘‘of frustration’’ ‘‘fuck’’, ‘‘shit’’,
‘‘goddammit’’ . Behaviors in GTS extend to sexual con-
tent in copropraxia and mental coprolalia. No such associ-
ated behaviors are observed in focal left hemisphere dis-
ease. Thus the psychosocial dimensions associated with
coprolalia are not present in aphasic swearing.
Persons with GTS are able to transmute, mask and
postpone the vocalizations. Coprolalic frequency is influ-
enced by social setting. While in aphasic swearing,
crosslinguistic cultural differences in production frequency
of expletives have been reported cf. differences between
English and German corpora , variability with social set-
ting is not prominent, and masking of the form of the
residual utterance in aphasia does not occur.
The clinical-linguistic observations are consistent with
the notion of hyperactivation or release from inhibition of
emotionally and sexually charged behaviors in GTS. For
patients with left hemisphere damage, swearing most likely
appears because it is stored and processed differently from
newly created, propositional speech and thus remains
uniquely available.
Studies of the linguistic vocalizations of GTS are com-
plete enough to conclude that sexual-emotional content
characterizes the coprolalia. Thus the notion of a hyperac-
tivation of sexual-emotional processing in vocal and gestu-
ral behaviors is useful in accounting for many of the
clinical symptoms. Habitual vocal–motor patterns may
help originate and maintain the vocalizations. For focal
damage to the left hemisphere, habitual ‘‘island’’ preserva-
tion of motor patterns appear to more essentially underlie
the swearing behavior. In severe aphasia, we propose that
overlearned motor patterns best explain these phenomena.
Frustration, and the genuine expression of emotion, can
and does often trigger the production of the expressions.
Since selectively preserved swearing is seen in extensive
damage to the left hemisphere as well in the left hemi-
spherectomized adult, a role of the right hemisphere is
likely. With one report of deficient swearing and other
automatic speech behaviors in association with a right
basal ganglia lesion 235 , the notion of an interaction of
basal ganglia and right hemisphere is attractive.
7. Emotional and prosodic processing
There have been ample reports of emotional processing
by the right hemisphere 33,40,55,133,246,260 as well as
proposals that right hemisphere dysfunction contributes to
psychoaffective disorders 70 . Emotional changes also are
associated with basal ganglia disorders 170 ; there are
numerous reports of changes in mood and motivation
22,61,66,70,170,173,201,211 . Heightened social aware-
ness may be a right hemisphere property 237,250,251 .
Prosody, the melody of speech, emerges importantly in
emotional speech. This has been recently a major field of
study, with findings of an effect of either left or right
hemisphere andror a basal ganglia damage on prosodic
ability. Some greater role of the right hemisphere has been
reported in prosodic performance, although the reason for
this finding — whether attributable to cognitive, acoustic,
or other factors — has remained elusive. Studies of emo-
tional prosodic comprehension in GTS are rare. One study
wx Ž.
75 using the Profile of Nonverbal Sensitivity PONS test
of nonverbal communication 208 found no deficits in
comprehension of emotional meanings in speech prosody
in five patients with GTS and coprolalia. Other studies of
persons with basal ganglia disease have reported deficient
emotional-prosodic comprehension, whether the move-
ments were of the hyperkinetic variety, as in Huntington’s
patients 234 or hypokinetic, Parkinson’s disease
26,36,67 .
Prosodic production in speech, although a highly active
field of study in normal speakers 215,216 and in neuro-
logical subjects, has not been investigated in GTS. How-
ever, impressionistically, abnormalities involving loudness,
timing, and pitch are observed in the pathological verbal–
vocal expressions of GTS. Acoustic analyses of these
expressions would be of great interest. As mentioned
above, in studies of brain damage, changes in speech
prosody production 138,255 and comprehension occur
with damage to either hemisphere 257 as well as to
subcortical structures 45,253 . Singing of familiar songs is
often intact in aphasia, in adult left hemispherectomy and
in selective anesthetization of the left hemisphere in Wada
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–10496
testing 113 ; reports of singing ability in GTS have not
appeared. Singing, like swearing, appears to remain apart
from propositional language function. Since data are avail-
able on prosodic function in various other neurological
diseases, prosodic studies of coprolalia and swearing in
aphasia would be of value and interest in understanding
these behaviors.
8. Cerebral laterality
While the left hemisphere mediates most linguistic be-
haviors, the right hemisphere is important for broader
aspects of communication 249–251 . Right hemisphere
behavioral functions appear to differ from those mediated
in the left hemisphere with regard to type of stimulus
preferred 6,21,34 . In visual and auditory domains, cere-
bral laterality studies consistently show a superiority for
right hemisphere processing of the configurational aspect
of stimuli 30,236 . Simply stated, the left hemisphere
specializes in analyzing sequences, while the right hemi-
sphere gives evidence of a superiority in processing pat-
terns. These generally accepted facts about hemispheric
specialization pertain to our review of swearing, in that
expletives make up a unitary, ‘‘nonanalytic’’ stimulus,
which in all likelihood is stored and processed as a whole.
In contrast, words making up propositional language are
composed of the building blocks of phonemes, mor-
phemes, and syllables, which can be rearranged in various
ways. The differences between expletives and composed
words and phrases, considered with known differences
between left and right hemisphere processing, lead to a
consideration of the right hemisphere as a more likely
candidate in modulating the motoric production of exple-
tives. This theoretical possibility is supported by the obser-
vations of intact swearing in severe aphasia following
extensive left hemisphere damage and left hemispherec-
tomized adult patients.
9. Pathological basis to GTS: a basal-ganglia disorder
While there is no doubt that brain damage underlies
swearing behaviors in aphasia, it is only more recently
agreed that a neurochemicalrneurophysiological disorder
underlies GTS 150 . The effectiveness of neuroleptics
gave the first clue to these mechanisms 148 . Evidence for
a genetic basis of the disease further supports this view
142,150,194 .
Neuropathological studies of GTS are inconclusive
227 . Examination of three GTS patients at autopsy re-
vealed meningitic thickenings in the region of exit of the
facial nerve in one case, meningitic and vascular changes
throughout the brain in the second case, and no changes in
the third; others suggested that small cells in the corpus
striatum were decreased in size and density 263 . Devin-
sky 74 proposed midbrain involvement as the site of
damage; this proposal was based on metabolic abnormali-
ties implicating the midbrain, similarities between GTS
and encephalitis lethargica, and brain stimulation studies
135 ; midbrain involvement, with a focus on the periaqua-
ductal gray matter, was also later proposed from radiologic
data 213 . A recent post-mortem study showed abnormali-
ties in the globus pallidus with profoundly diminished
dynorphin-like immuno-staining in this region 116 . A
post-mortem study of three patients with GTS revealed
significantly increased dopamine uptake carrier sites in the
caudate and putamen 230 . Although no reproducible
autopsy changes have been described that definitely local-
ize the pathology of GTS to a basal ganglia region, several
lines of evidence support the basal ganglia as the principal
location of dysfunction in GTS.
Of many GTS patients studied with computerized tomo-
graph CT , only 10% have shown abnormalities, and
these appear in various brain systems 17 . Despite these
inconsistencies, there is increasingly compelling evidence
that GTS is a basal ganglia disorder. Studies using mag-
netic resonance imaging show reduced volumes of the
caudate nuclei, lenticular nuclei, putamen, and globus pal-
lidum compared with controls 198 . Activated brain imag-
ing findings are inconsistent, but also tend to implicate
basal subcortical structures. Older studies reported higher
glucose metabolism in the basal ganglia of GTS patients;
other studies by the same group found glucose metabolic
rates to be lower than normal subjects in frontal, cingulate
insular cortex, and inferior corpus striatum 51 . Baxter
and Guze 17 found higher glucose metabolic rates in the
putamen of GTS patients compared to normal subjects.
More recently, studies of brain metabolism and brain blood
flow have shown diminished perfusion and glucose
metabolic activity in the caudate nuclei and variably in the
thalamus, anterior cingulate, and dorsolateral pre-frontal
cortex 83,84,182,261 . Correlative hypometabolism ap-
pears in bilateral temporal lobes of GTS subjects 84 .
wx Ž.
Braun et al. 35 studied 18 GTS patients aged 18–49 and
reported an association of clinical symptoms with ‘‘in-
creasing, apparently dysfunctional synaptic activity in the
medial, lateral, and caudal orbitofrontal cortices’’ p. 151 .
In vivo studies of dopamine receptor binding revealed
increased D2 dopamine receptor binding in the head of the
caudate nucleus and increased dopamine transporter activ-
ity in this same area 164,262 . Disordered biogenic amine
metabolism also is supported by reduced levels of ho-
movanillic acid in cerebral spinal fluid of patients with
GTS 42,52,229 .
Taken together with the clinical response to dopamine
blocking agents such as pimozide evidenced by most
patients with GTS 202 , the available evidence strongly
supports dysfunction of the striatal structures including
caudate, globus pallidus, and putamen in patients with
wx wx
GTS 262 . Shapiro and Shapiro 222 and others point to
the effectiveness of neuroleptics, especially those with
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 97
dopamine D2 blocking effects, as implicating dopamine
dysfunction in GTS. Similarly, Singer 228 assigns an
important role in GTS to frontal-subcortical circuits based
on evidence from dopaminergic neurotransmission. Other
disorders such as Sydenham’s chorea, hemiballismus, car-
bon monoxide intoxication, and post encephalitic Parkin-
sonism, where coprolalia has been reported, also involve
the basal ganglia. Thus, coprolalia of the involuntary,
ego-dystonic type manifested in GTS appears to be at least
partly a manifestation of basal ganglia dysfunction.
The basal ganglia are increasingly recognized to have
important roles in cognitive, emotional, and behavioral
functions as well as in motor activity. The effect of basal
ganglia damage on speech and language function has been
described 39,45,76 . In one model of basal ganglia func-
tion, the basal ganglia are said to provide an internal
timing cue to the supplementary motor to release an action.
Georgiou et al. 103 present evidence that GTS involves
‘‘dysfunction of basal ganglia and interconnections with
ŽŽ .
frontal lobes’’ p. 190 . Studies of three cases of tic
disorder associated with pediatric cerebral malignancies
suggested a role for ventral striatum, corpus callosum,
thalamus, midbrain as important in tics 197 . Following a
notion first proposed by Balthasar 14 in 1957, Palumbo et
al. 194 reviewed a large number of cases and proposed a
‘‘developmental basal ganglia syndrome’’ underlying GTS
and related disorders.
10. Limbic system-basal ganglia hypothesis
The caudate, globus pallidus, putamen, and substantia
nigra are positioned in frontal-subcortical circuits between
frontal cortical regions and thalamic nuclei. These
cortical-striatal-pallidal-thalamic circuits mediate executive
function, motivation, social behavior, and diverse aspects
of emotion 66 . The basal ganglia receive abundant pro-
jections from the limbic system, and the frontal-subcortical
circuits integrate limbic input in the orbitofrontal-subcorti-
cal circuit and the anterior cingulate-subcortical circuit
115 forming at least five structurally and functionally
separate ‘‘circuits’’ 3,66 . Thus, dysfunction of the basal
ganglia simultaneously produces abnormalities of limbic
system function and of limbically mediated emotional
activities. Nespoulous and Lecours 188 propose a limbic
source of coprolalic speech. A number of studies point to a
disorder of the cingulate gyrus a critical component of
the limbic system — in GTS. Stimulation of anterior
cingulate cortex in humans has been associated with lick-
ing, touching lips, and other stereotyped GTS movements,
and it is known that the anterior cingulate cortex receives
dopamine innervation from the midbrain 243 . Several
patients have been treated by stereotaxic surgery directed
toward the limbic system e.g., 77 . Following successful
treatment of GTS by bilateral limbic leukotomy, Robertson
et al. 204 proposed the importance of cingulate cortex in
the mediation of emotionally charged language.
The limbic system has been implicated in emotional
vocalization in animals. In Macaque monkeys, emotional
vocalization occurs with stimulation of the anterior cingu-
late gyrus, amygdala, diagonal band-substantia innominata,
ventral septal region, hypothalamus, nucleus accumbens,
ventral anterior and midline nuclei of the thalamus, and the
tegmentum 205 . Similarly, studies with the squirrel mon-
key revealed that emotional vocalization occurred with
stimulation of the hypothalamus, midline thalamus, amyg-
dala, substantia innominata, septum, orbitofrontal cortex,
cingulate cortex, and anterior inferior temporal cortex 134 .
Ploog 200 reported from animal studies that vocalization
following brain stimulation occurred only in subcortical
cites, while human speech was considered to be primarily
cortically represented. Based on his observations on animal
vocalization, Robinson 25,206,207 has proposed two lev-
els of the nervous system involved in human speechrlan-
guage behavior: an older system, which terminates in
cingulate gyrus at the bilateral, rostral end of limbic sys-
tem, and which is capable of emotive speech behavior; and
a newer system which is cortical, unilateral, and involved
wx Ž.
in planning. Myers 184 similarly proposed that animal
vocalization and human speech are dichotomous.
A similar and related dichotomy is proposed for learn-
ing and memory. Simply stated, the two disparate systems
proposed 178,179 are those for establishing habitual pat-
terns or ‘‘nondeclarative’’ also called ‘‘procedural’’
memories as distinctive from those for establishing new
learning or ‘‘declarative’’ memories 4 . From many kinds
of evidence, the basal ganglia are associated with motor
wx wx
programs that are well established 99,167 . Marsden 166
stated that ‘‘the basal ganglia are responsible for the
automatic execution of learned motor plans’’ p. 514 . A
recent review of behaviors associated with the basal gan-
glia included aspects of motor control, preparation for
action, the formulation of strategies and responses, and the
establishment and selection of emotional responses 211 ,
p. 20 . Baev 12,13 proposes that the basal ganglia pro-
vide a ‘‘model’’ of the motor behavior to be executed.
Basal ganglia function with integrated limbic components
form a likely origin for expletives: these are habitual motor
programs with emotional content.
The basal ganglia in concert with limbic activity
account together for coprolalic production 185 ; the
coprolalic phenomena are thus attributed to a motivational
disorder involving limbic projections to striatum. Copious
interconnections between basal ganglia sensorimotor and
limbic pathways are known from neuroanatomical studies:
basal ganglia caudate nucleus, putamen, globus pallidus,
and substantia nigra are richly interconnected with limbic
structures. The nucleus accumbens receives inputs from
several limbic structures: anterior cingulate, hippocampus,
amygdala 115 . Parallel as well as multiple reciprocally
connected structures lead to optimal conditions for ‘‘cros-
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–10498
stalk’’, such that pathologies could produce ‘‘a variety of
symptoms relating to the motor, cognitive, and limbic
Žwx .
function of the basal ganglia’’ 115 , p. 261 . The role of
basal ganglia in initiating motor behaviors 167 , and the
known circuitry of frontal-subcortical connections 171 ,
provide the basis for positing hyperactivated initiation of
emotionally charged, overlearned vocal output as patho-
physiological basis of coprolalia.
A similar view emerged from specific studies of GTS
verbal behaviors. Following comparisons of language ver-
sus speech behaviors in GTS subjects, Ludlow et al. 159
proposed that the pathology may involve an imbalance
between cortical and limbic systems for processing speech
and language in GTS. These authors noted that the stereo-
typic speech, gestural and motor behaviors of GTS may be
produced without inhibition by the cortical system, and
therefore ‘‘fail to be further modified into purposive be-
havior’’ p. 360 . However, from their language studies,
they also suggested that in GTS, the cortical system also
may be impaired, resulting in ‘‘paucity of speech, lan-
guage, and written expression’’. This may be due, in their
model, to suppression of the supplementary motor area,
while the ‘‘production of stereotypic sets of behaviors is
heightened through increased activation of the cingulate
gyrus. The suppression of one region may be independent
of the increased activation of the other, accounting for the
independence of the two sets of symptoms’’ p. 360 . A
somewhat related proposal comes from Nauta 185 , who
suggested that GTS reflects a disorder not only in the
motor domain, but in the motivational mechanisms of the
limbic system. Baxter and Guze 17 focus on a functional
neuroanatomical involvement of the basal ganglia, pre-
frontal cortex, and limbic system in GTS, pointing to
well-known circuitry involved in the ’gating’ and ’screen-
ing’ of motor outputs, sensory inputs, and possibly even
’thoughts.’ They propose that it is ‘‘impairment in these
gating and screening functions of the striatum’’ which
results the variety of expressed phenomena in GTS, which
include both motor behaviors and sensations p. 299 .
11. Conclusion
Swearing is a common human act and is frequent in
neurological disorders such as spinal cord injury, head
trauma, and aphasia where patients experience frustration
and evidence the emotion through cursing. This type of
cursing differs from the involuntary ego-dystonic type of
coprolalia, in which speech production is separate from
personal intentionality. Ego-alien coprolalia is distinctly
uncommon and is confined to a few neurological diseases.
Coprolalia is most common in GTS, was well described in
post-encephalitic Parkinsonism, and has been noted in
cases of secondary GTS produced by herpes encephalitis,
carbon monoxide poisoning, Sydenham’s chorea, post-
stroke hemiballismus, and head injury 16,224 . Despite
the differences between normal cursing and coprolalia,
there also are substantial shared features: both use some of
the same words, the words have a highly emotional con-
tent, and both normal cursing and coprolalia depend on
invoking the emotional signaling systems — use of verbal
cries andror taboo words in the communicative act.
Comparison of documented expletives for normal, aphasic,
and GTS speakers provided in Tables 1–4 shows notable
similarities as well as differences in the respective taboo
word repertories. Too little is known about swearing in
aphasia, with only the British and German corpora avail-
able, compared to fuller information in normal subjects
speaking American English, and a now broad reportage of
linguistic backgrounds for coprolalia. More complete in-
formation might change the picture. However, with the
current data, it appears that the most frequent expletives
‘‘damn’’, ‘‘shit’’, ‘‘fuck’’ occur in all three conditions,
while sexual taboo items predominate in normal and GTS
speakers, with fewer such items uttered in aphasia.
With yet so little known of relevant neurological mech-
anisms, our conclusions about brain-behavior correlates are
of necessity speculative. Comparison of animal and human
communicative behaviors suggest that two functional sys-
tems, one for emotional vocalization and the other for
propositional speech, may exist. The purpose of animal
vocalization is nearly exclusively social in nature with
some vocalizations indicating anger and warning and oth-
ers facilitating social interactions 75,163 . From this per-
spective, coprolalia in humans might represent the abnor-
mal release of vocalizations mediated by limbic system
structures and normally intended to perform the social
functions of repulsing intruders and expressing anger and
dissatisfaction. The ego dystonic, alien nature of coprolalia
in GTS and related syndromes stems from the involuntary
occurrence of these vocalizations analogous to the involun-
tary occurrence of the motor tics. We hypothesize that
coprolalia represents a limbic vocal tic whose unique
content is informed by the social and emotional commu-
nicative purposes of limbic vocalizations. The considerable
evidence of basal ganglia dysfunction in GTS implicates
those structures in concert with limbic activity. The verbal
form is unitary, not compositional i.e., is not generated by
combining smaller, permutable units, such as phonemes,
syllables and morphemes , in contrast to words in the
propositional language system, and thus possibly draws on
right hemisphere cortical mechanisms for execution.
Voluntary normal cursing and cursing in aphasia may
share the anatomy and physiology of coprolalia. Normal,
aphasic and coprolalic cursing have in common the expres-
sion of certain identical linguistic productions, as well as
the unitary, noncompositional structure of the stimulus.
Persons suffering from aphasia, in whom left hemispheric
areas mediating propositional speech are dysfunctional,
may have access to structures mediating limbic vocaliza-
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 99
tion, modulated by basal ganglia structures and facilitated
by right hemisphere cortical structures. Normal cursing
typically occurs in periods of anger, frustration, and other
intense emotional situations where limbic system struc-
tures are activated and limbic vocalizations may be facili-
tated. In many normal and aphasic individuals, cursing
also occurs frequently as habituated verbal productions.
The overlearned and emotive vocal-motor ‘‘gestures’’ of
cursing are hyperactivated in GTS and remain residually
available in the aphasic speaker.
We appreciate the help of Dr. Alexander Smirnof and
Dr. Costintino Iadacola in translating articles from Russian
and Italian. Cathleen Bannister-Marx assisted in library
research and translation of Spanish articles. Videotaped
recording of a hemispherectomized patient was provided
by Dr. J.E. Bogen. Dr. Van Lancker is supported in part by
a grant from the Pew-McDonnell Foundation. Dr. Cum-
mings is supported by an NIA Alzheimer’s Disease Re-
search Center Grant, an Alzheimer’s Disease Research
Center of California Grant, and the Sidall-Kagan Founda-
1 F. Abuzzahab Sr., F. Anderson, Gilles de la Tourette’s syndrome:
International registry, Minnesota Medicine, June 1973 pp. 492–
wx Ž.Ž .
2 T. Alajouanine, Verbal realization in aphasia, Brain 79 1 1956
3 G.E. Alexander, M.D. Crutcher, Functional architecture of basal
ganglia circuits.
4 H. Allain, A. Lieury, V. Thomas, J.-M. Reymann, J.-M. Gandon,
S. Belliard, Explicit and procedural memory in Parkinson’s disease,
Biomed. Pharmacother. 49 1995 179–186.
5 F.O. Anderson, F.E. Abuzzahab, Current knowledge of the syn-
drome, in: F. Abuzzahab Sr., F. Anderson Eds. , Gilles de la
Tourette’s Syndrome, Vol. 1, International Registry, St. Paul,
Mason Publishing, 1976, pp. 169–183.
wx Ž.
6 A. Ardila, F. Ostrosky-Solis Eds. , The Right Hemisphere: Neu-
rology and Neuropsychology, Gordon and Breach, New York,
7 U. Asam, Das Gilles de la Tourette-Syndrom: Zum gegenwaertigen
Stand von Diagnostik und Therapie, Acta Paedopsychiat. 43 1978
8 U. Asam, Katamnestische Untersuchung ueber jugendliche Patien-
ten mit multiplen Tics unter spezieller Beruecksichtigung des Gilles
de la Tourette Syndroms, Acta Paedopsychiat. 45 1979 51–63.
9 U. Asam, W. Karrass, The Gilles de la Tourette syndrome: an
analysis of published cases dealing with the course of the disease
and its prognosis, Zeitschrift fuer Kinder- und Jugendpsychiatrie 4
Ž.Ž .
1 1976 45–54.
10 U. Asam, S.-E. Traeger, Therapeutische Aspecte der Gilles de la
Tourette’schen Erkrankung, Nervenarzt 46 1975 361–367.
11 L.O. Badalyan, I.A. Skvortsov, L.N. Kamennykh, E.L. Dadoli,
P.A. Temin, E.K. Sepp, Paroxysmal generalized tic Tourette’s
syndrome , Klin. Med. 57 9 1979 28–34.
12 K. Baev, Disturbance of learning processes in the basal ganglia in
the pathogenesis of Parkinson’s disease: a theory, Neurological
Research 17 1995 38–48.
13 K. Baev, Highest level automatisms in the nervous system: a theory
of functional principles underlying the highest forms of brain
function, Progress in Neurobiology 51 1997 129–166.
14 K. Balthasar, Ueber das anatomische Substrat der generalisierten
Tic-Krankheit maladie des tics, Gilles de la Tourette : Entwick-
lungshemmung des Corpus Striatum, Arch. Psychiatr. Ner-
venkrankh 195 1957 531–549.
15 K.J. Barucha, K.D. Sethi, Tardive tourettism after exposure to
Ž.Ž .
neuroleptic therapy, Movement Disorders 10 6 1995 791–793.
16 G.D.L. Bates, I. Lampert, M. Prendergast, A.E. Van Woerkom,
Klazomania: the screaming tic, Neurocase 2 1996 31–34.
wx Ž.
17 L. Baxter, B. Guze, Neuroimaging, in: R. Kurlan Ed. , Handbook
of Tourette’s Syndrome and Related Tick and Behavioral Disor-
ders, Marcel Dekker, New York, 1993, pp. 289–304.
18 W. Beckers, Zur Gilles de la Touretteschen Erkrankung anhand
von fuenf eigenen Beobachtungen, Arch. Psychiatr. Nervenkrankh.
217 1973 169–186.
wx Ž.
19 U. Bellugi, Personal communication 1999 .
20 D.F. Benson, The neurology of human emotion, Bulletin of Clini-
cal Neurosciences 49 1984 4923–4942.
21 T.G. Bever, Cerebral asymmetries in humans are due to the differ-
entiation of two incompatible processes: holistic and analytic,
Annals of the New York Academy of Science 263 1975 251–262.
22 K.P. Bhatia, C.D. Marsden, The behavioural and motor conse-
quences of focal lesions of the basal ganglia in man, Brain 117
1994 859–876.
23 G. Blanken, V. Marini, Where do lexical speech automatisms come
from?, Journal of Neurolinguistics 10 1997 19–31.
wx Ž
24 T. Blanken, The functional basis of speech automatisms recurring
utterances , Aphasiology 5 1991 103–127.
25 G. Blanken, E.-W. Wallesch, C. Papagno, Dissociations of lan-
guage functions in aphasics with speech automatisms recurring
utterances , Cortex 26 1990 41–63.
26 L.X. Blonder, R. Gur, R. Gur, The effects of right and left
hemiparkinsonism on prosody, Brain and Language 36 1989
27 R. de Bleser, K. Poeck, Aphasia with exclusively consonant–vowel
recurring utterances: tan–tan revisited, in: F.C. Rose Ed. , Ad-
vances in Neurology, Progress in Aphasiology, Vol. 42, Raven
Press, New York, 1984.
28 J. Bliss, Sensory experiences of Gilles de la Tourette syndrome,
Arch. Gen. Psychiatry 37 1980 1343–1347.
29 K. Boduch-Cieslinska, A case of Gilles de la Tourette Syndrome,
Klin. Oscna 44 1974 179–181.
30 J.E. Bogen, The other side of the brain II: An appositional mind,
Bulletin of the Los Angeles Neurological Societies 324 1969
wx Ž.
31 J.E. Bogen, Personal communication 1998 .
32 L.D. Boshes, Gilles de la Tourette’s syndrome, American Journal
of Nursing 76 1976 1637–1638.
33 D. Bowers, R. Bauer, K.M. Heilman, The nonverbal affect lexicon:
theoretical perspectives from neuropsychological studies of affect
perception, Neuropsychology 7 1993 433–444.
34 J.L. Bradshaw, N.C. Nettleton, Human cerebral asymmetry, Pren-
tice-Hall, Englewood Cliffs, NJ, 1983.
35 A.R. Braun, C. Randolph, B. Stoetter, E. Mohr, The functional
anatomy of Tourette’s syndrome: An FDG-PET study: II. Relation-
ships between regional cerebral metabolism and associated behav-
ioral and cognitive features of the illness, Neuropsychopharmacol-
Ž.Ž .
ogy 13 2 1995 151–168.
36 C. Breitenstein, I. Daum, H. Ackermann, Affective prosody in
patients with Parkinson’s disease, in: W. Ziegler, K. Deger Eds. ,
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104100
Clinical Phonetics and Linguistics, Whurr Publishers, London, UK,
1997, pp. 382–386.
37 A.V. Briones, C.S. Aguilar, A.C. Fernandez, El sindrome de Gilles
de la Tourette, Actas Luso-espanolas de Neurologia, Psiquiatria y
Ž.Ž .
Ciencias Afines 2 2 1974 15–20.
38 R.D. Bruun, C.L. Budman, The natural history of Gilles de la
Tourette syndrome, in: R. Kurlan Ed. , Handbook of Tourette’s
Syndrome and Related Tic and Behavioral Disorders, Marcel
Dekker, New York, 1993, pp. 27–42.
39 R.J. Brunner, H.H. Kornhuber, E. Seemueller, G. Suger, C.W.
Wallesch, Basal ganglia participation in speech pathology, Brain
and Language 16 1982 281–299.
40 M.P. Bryden, Laterality: Functional Asymmetry in the Brain, Aca-
demic Press, New York, 1982.
41 J.G. Bullen, D.R. Hemsley, Sensory experience as a trigger in
Gilles de la Tourette syndrome, J. Behav. Exp. Psychiatry 14
1983 197–201.
42 I.J. Butler, S.H. Koslow, W.E. Seifert Jr., R.M. Caprioli, H.S.
Singer, Biogenic amine metabolism in Tourette syndrome, Ann
Neurol. 6 1979 37–39.
43 E.J. Byrne, Coprolalia vocal tics and depressive illness: a case
Ž.Ž .
report, International Journal of Geriatric Psychiatry 4 1 1989
44 E.D. Caine, Gilles de la Tourette’s syndrome: A review of clinical
and research studies and consideration of future directions for
investigation, Archives of Neurology 42 1985 393–396.
45 A. Cancelliere, A. Kertesz, Lesion localization in acquired deficits
of emotional expression and comprehension, Brain and Cognition
13 1990 133–147.
wx Ž.
46 E.C. Carterette, M.H. Jones Eds. , Informal Speech: Alphabetic
and Phonemic Texts, University of California Press, Berkeley,
47 R. Caplan, Y. Comair, D.A. Shewmon, L. Jackson, H.T. Chugani,
W.J. Peacock, Intractable seizures, compulsions and coprolalia: a
pediatric case study, Journal of Neuropsychiatry and Clinical Neu-
Ž.Ž .
rosciences 4 3 1992 315–319.
48 F. Cardoso, C.C.M. Veado, J. de Oliveira, A Brazilian cohort of
patients with Tourette’s syndrome, Journal of Neurology, Neuro-
Ž.Ž .
surgery and Psychiatry 60 2 1996 209–212.
49 L.M. Champion, W.A. Fulton, G.A. Shady, Tourette syndrome and
social functioning in a Canadian population, Neuroscience and
Ž.Ž .
Biobehavioral Reviews 12 3–4 1988 25–257, Special Issue:
Tourette’s Syndrome and Movement Disorders.
50 R.A. Chase, J.K. Cullen, E.F.L. Niedermeyer, R.E. Stark, D.P.
Blumer, Ictal speech automatisms and swearing: Studies on the
auditory feedback control of speech, The Journal of Nervous and
Ž.Ž .
Mental Disease 144 5 1967 406–420.
51 T.N. Chase, N.L. Foster, P. Fedio, R. Brooks, L. Mansi, R.
Kessler, G. Di Chiro, Gilles de la Tourette syndrome: studies with
the fluorine-18-labeled fluorodeoxyglucose positron emission to-
mographic method, Annals of Neurology 15 1984 Suppl:S175.
52 T.N. Chase, V. Geoffrey, M. Gillespie, G.H. Burrows, Structural
and functional studies of Gilles de la Tourete syndrome, Revue
Ž.Ž .
Neurologique 142 11 1986 851–855.
53 K.Y. Chee, P. Sachdev, The clinical features of Tourette’s disorder:
an Australian study using a structured interview schedule, Aus-
Ž.Ž .
tralian and New Zealand Journal of Psychiatry 28 2 1994
54 N. Chomsky, Syntactic Structures, Mouton and, The Hague, 1957.
55 M. Cicone, W. Wapner, H. Gardner, Sensitivity to emotional
expressions and situations in organic patients, Cortex 16 1980
56 J.L. Clauss, K. Balthasar, Zur Kenntnis der generalisierten Tic-
Krankheit maladie des tics, Gilles de la Tourett’sche Krankheit ,
Arch. Psychiatr. Nervenkrankh. 191 1954 398–418.
57 C. Code, Neurolinguistic analysis of recurrent utterance in aphasia,
Cortex 18 1982 141–152.
58 C. Code, Language, Aphasia, and the Right Hemisphere, Wiley,
Chichester, 1987.
59 C. Code, Speech automatisms and recurring utterances, in: C. Code
Ed. , The Characteristics of Aphasia, Lawrence Erlbaum, Hove,
60 C. Code, Speech from the isolated right hemisphere? Left hemi-
spherectomy cases E.G. and N.F., in: C. Code, C.W. Wallesch, Y.
Joanette, A.R. Lecours Eds. , Classic Cases in Neuropsychology,
Lawrence Erlbaum, Hove, 1996, pp. 319–336.
61 M.J. Cohen, C.A. Riccio, A.M. Flannery, Expressive aprosodia
following stroke to the right basal ganglia: a case report, Neuropsy-
chology 8 1994 242–245.
62 D.E. Comings, Search for the Tourette Syndrome and Human
Behavior Genes, Hope Press, Duarte, CA, 1996.
63 D.E. Comings, B.G. Comings, Tourette syndrome: clinical and
psychological aspects of 250 cases, American Journal of Human
Ž.Ž .
Genetics 37 3 1985 435–450.
64 M. Critchley, Aphasiology and Other Aspects of Language, Ed-
ward Arnold, London, 1970.
65 D. Crystal, The Cambridge University Encyclopedia of the English
language, Cambridge Univ. Press, Cambridge, 1997.
66 J.L. Cummings, Frontal-subcortical circuits and human behavior,
Archives of Neurology 50 1993 873–880.
67 J.L. Cummings, D.F. Benson, Speech and language alterations in
dementia syndromes, in: A. Ardita, F. Ostrasky Eds. , Brain
Organization of Language: New Directions of Research, Mexico
City, Editorial Trillas, 1989, pp. 107–122.
68 J.L. Cummings, M. Frankel, Gilles de la Tourette syndrome and
the neurological basis of obsessions and compulsions, Biol. Psychi-
atry 20 1985 1117–1126.
69 J.L. Cummings, Clinical Neuropsychiatry, Grune and Stratton,
Orlando, FL, 1985.
70 J. Cutting, The Right Cerebral Hemisphere and Psychiatric Disor-
ders, Oxford Univ. Press, Oxford, 1990.
71 F.L. Darley, A.E. Aronson, J.R. Brown, Motor Speech Disorders,
W.B. Saunders, Philadelphia, 1975.
72 C. Darwin, The Expression of the Emotions in Man and Animals,
University of Chicago, Chicago, 1965r1872.
73 R.J. Davis, J.L. Cummings, Clinical variants of tardive dyskinesia,
Neuropsychiatry, Neuropsychology and Behavioral Neurology 1
Ž.Ž .
1 1988 31–38.
74 O. Devinsky, Neuroanatomy of Gilles de la Tourette syndrome.
Possible midbrain involvement, Archives of Neurology 40 1983
75 O. Devinsky, D. Bear, K. Moya, L. Benowitz, Perception of
emotion in patients with Tourette’s syndrome, Neuropsychiatry,
Ž.Ž .
Neuropsychology and Behavioral Neurology 6 3 1993 166–169.
76 G. Dewey, Relative Frequency Of English Speech Sounds, Harvard
Univ. Press, Cambridge, MA, 1923.
77 E. de Divitiis, A. D’Errico, A. Cerillo, Stereotactic surgery in
Gilles de la Tourette Syndrome, Acta Neurochirurgica 24 1977
73, Suppl.
wx Ž.
78 de Divitiis, E., Personal communication 1982 .
79 Q.P. Dong, English sentences without overt grammatical subject,
in: A.M. Zwicky, P.H. Salus, R.I. Binnick, A.L. Vanek Eds. ,
Studies Out in Left Field: Defamatory Essays Presented to James
D. McCawley, Linguistic Research, Edmonton, Ontario, Canada,
1971, pp. 3–20.
80 R. Dooling, Blue streak: Swearing, Free Speech and Sexual Harass-
ment, Random House, New York, 1996.
81 V. Eapen, M.M. Robertson, Gilles de la Tourette syndrome: a case
report from Guyana in South America, Behavioural Neurology 5
Ž.Ž .
1 1992 39–41.
82 V. Eapen, S. Srinath, Gilles de la Tourette syndrome in India: two
Ž.Ž .
cases, Psychological Reports 70 2 1992 667–668.
83 D. Eidelberg, Functional brain networks in movement disorders,
Current Opinion in Neurology 11 1998 319–326.
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 101
84 D. Eidelberg, J.R. Moeller, A. Antonini, K. Kazumata, V. Dhawan,
C. Budman, A. Feigin, The metabolic anatomy of Tourette’s
syndrome, Neurology 48 1997 927–934.
85 A. El-Assra, A case of Gilles de la Tourette’s syndrome in Saudi
Arabia, British Journal of Psychiatry 151 1987 397–398.
86 R. Eldridge, R. Sweet, R. Lake, M. Ziegler, A. Shapiro, Gilles de
la Tourette’s syndrome: clinical, genetic, psychologic and biochem-
ical aspects in 21 selected families, Neurology 27 1977 115–124.
87 G. Escalar, M.A. Majeron, L. Finavera, P. Zamberletti, Contributo
alla conoscenza della sindrome di Gilles de la Tourette: studio su
due genelli, On the Gilles de la Tourette syndrome: study of two
twins Minerva Medica 63 1972 3517–3522.
88 S. Fahn, The clinical spectrum of motor tics, in: A.J. Friedhoff,
T.N. Chase Eds. , Gilles de la Tourette Syndrome, Advances in
Neurology, 35, Raven Press, New York, 1982, pp. 341–344.
89 S.J.M. Fernando, Six cases of Gilles de la Tourette’s syndrome,
British Journal of Psychiatry 128 1976 436–441.
90 M. Fisarova, Gilles de la Tourette’s Disease, Ceskoslovenska Neu-
rologie 68 1972 202–208.
91 H. Fletcher, Speech and Hearing in Communication, Van Nostrand,
New York, 1953. see Chapter 5: p. 95 .
92 C.P. Flynn, Sexuality and insult behavior, Journal of Sex Research
Ž.Ž .
12 1 1976 1–13.
93 J.L. Fontanari, V.D.C. Vaitses, Sindrome de Gilles de la Tourette e
multiplos tiques-estudo clinico de 15 casos e revao da literatura,
Neurobiologia 49 1986 109–128.
94 R. Foote, J. Woodward, A preliminary investigation of obscene
language, Journal of Psychology 83 1973 263–275.
95 S.M. Frank, Psycholinguistic findings in Gilles de la Tourette
syndrome, J. Hum. Commun. Disord 11 1978 349–363.
96 M. Frankel, J.L. Cummings, M.M. Robertson, M.R. Trimble, M.
Hill, D.F. Benson, Obsessions and compulsions in Gilles de la
Tourette syndrome, Neurology 36 1986 378–382.
wx Ž.
97 S. Freud, Totem and Taboo, Norton, New York 1913r1950 .
98 D.B. Fry, The frequency of occurrence of speech sounds in south-
ern English, Archives Nederlandaises de Phonetique Experimen-
talle 20 1947 .
99 J. Gabrieli, Contribution of the basal ganglia to skill learning and
working memory in humans, in: J. Houk, J. Davis, D. Beiser
Eds. , Models of Information Processing in the Basal Ganglia, The
MIT Press, Cambridge, MA, 1995, pp. 277–294.
100 N. Gadoth, Gilles de la Tourette’s syndrome, Harefuah: Journal of
Ž.Ž .
the Israel Medical Association 86 7 1974 371–373.
101 G.E. Gallahorn, The use of taboo words by psychiatric ward
personnel, Psychiatry 34 1971 309–321.
102 D. Gajdosova, M. Sramka, P. Nadvornik, Some observations in
Gilles de la Tourette’s disease, Ceskoslovenska Neurologie 35r68
1972 294–297.
103 N. Georgiou, J.L. Bradshaw, J.G. Phillips, J.A. Bradshaw, E. Chiu,
Advance information and movement sequencing in Gilles de la
Tourette’s syndrome, Journal of Neurology, Neurosurgery, and
Psychiatry 58 1995 184–191.
104 G. Gilles de la Tourette, Etude sur un affection nerveuse, carac-
terisee par de l’incoordination motrice, acompagnee d’echolalie et
de coprolalie, Arch. Neurol Paris 9 19 1885 158.
105 A.C. Gimson, An Introduction to the Pronunciation of English,
Edward Arnold, London, 1962.
106 C.G. Goetz, H.L. Klawans, Gilles de la Tourette on Tourette
Syndrome, in: A.J. Friedhoff, T.N. Chase Eds. , Gilles de la
Tourette Syndrome, New York, Raven Press, 1982, pp. 1–16.
107 C.G. Goetz, C.M. Tanner, G.T. Stebbins, G. Leipzig, W.C. Carr,
Adult tics in Gilles de la Tourette’s syndrome: description and risk
factors, Neurology 42 1992 784–788.
108 E. Goffman, Forms of Talk, Chap. 2, Response Cries, University of
Pennsylvania Press, Philadelphia, 1981.
109 G.S. Golden, Tourette syndrome in children: Ethnic and genetic
factors and response to stimulant drugs, in: A.J. Friedhoff, T.N.
Chase Eds. , Gilles de la Tourette Syndrome, Raven Press, New
York, 1982, pp. 287–289.
110 J.N. Goldenberg, S.B. Brown, W.J. Weiner, Coprolalia in younger
patient with Gilles de la Tourette syndrome, Movement Disorders 9
1994 622–625.
111 J.H. Golfeto, S.R. Loureiro, M. Ribeiro, O sindrome de Gilles de la
Tourette: estudo de um case, Gilles de la Tourette syndrome: a case
.xŽ.Ž .
report Neurobiologia 51 3 1988 189–202.
112 M. Gonge, A. Barbeau, La Maladie de Gilles de la Tourette, Union.
Ž.Ž .
Med. Can. 106 4 1977 559–563.
113 H. Gordon, J.E. Bogen, Hemispheric lateralization of singing after
intracarotid sodium amylobarbitone, Journal of Neurology, Neuro-
surgery, and Psychiatry 37 1981 727–738.
114 M.H. de Groot, A case of Gilles de la Tourette’s syndrome
occurring in New Zealand, Australian and New Zealand Journal of
Psychiatry 4 1970 155–158.
115 S.N. Haber, E. Lynd-Balta, Basal ganglia-limbic system interac-
tions, in: R. Kurlan Ed. , Handbook of Tourette’s Syndrome and
Related Tic and Behavioral Disorders, Marcel Dekker, New York,
1993, pp. 243–268.
116 S.N. Haber, N.W. Kowall, J.P. Vonsattel, E.D. Bird, E.P. Richard-
son Jr., Gilles de la Tourette’s syndrome: a postmortem neu-
ropathological and immunohistochemical study, Journal of the
Neurological Sciences 75 1986 225–241.
117 S.I. Harrison, M.W. Hinshaw, When children use obscene lan-
Ž.Ž .
guage, Medical Aspects of Human Sexuality 2 12 1986 6–11.
118 J.A. Hartman, R. Yavarajan, Tourette syndrome in the elderly,
Ž.Ž .
International Journal of Geriatric Psychiatry 9 2 1994 157–159.
119 R. Hassler, G. Diekmann, Traitement stereotaxique des tics et cris
inarticules ou coprolaliques consideres comme phenomene d’obses-
sion motrice au cours de la maladie de Gilles de la Tourette, Rev.
Ž. Ž.Ž.
Neurol. Paris 123 2 1970 89–100.
120 V.A. Hering, Zur Aetiologie und Pathogenese der Gilles de la
Touretteschen Erkrankung, Zeitschrift fuer Psychosomatische
Medizin und Psychoanalyse 18 1972 244–270.
121 G. Hickok, U. Bellugi, E. Klima, The basis of the neuronal
organization for language: evidence from sign language aphasia,
Reviews in the Neurosciences 8 1997 205222.
122 H. Hoermann, Psycholinguistics: An Introduction to Research and
Theory, 2nd edn., Springer-Verlag, New York, 1971.
123 G. Hughes, Swearing: A Social History of Foul Language, Oaths,
and Profanity in English, Blackwell, Oxford, 1991.
124 S.E. Hughes, Expletives of lower working-class women, Language
Ž.Ž .
in Society 21 2 1992 291–303.
125 T.M. Hyde, D.R. Weinberger, Tourette’s syndrome: A model
neuropsychiatric disorder, Journal of the American Medical Associ-
ation 273 1995 498–501.
wx Ž.
126 C. Imislund 1999 . Personal Communication.
127 J.M.G. Itard, Memoire sur quelque fonctions involuntaires des
appareils de la locomotion, de la prehension t dela voix, Archives
Generales de Medecine 8 1825 385–407.
´´ ´
128 J.H. Jackson, On affections of speech from disease of the brain, in:
J. Taylor Ed. , Selected Writings of John Hughlings Jackson, Vol.
2, 1878–1879r1932, pp. 155–204. Hodder and Stoughton, Lon-
don, 1932. Originally in Brain, 1 1878–1879 304–330; Brain, 2
1879–1880 203–222 and 323–356; also Reprinted in Brain, 38
1915 .
129 J. Jankovic, Tourette’s syndrome: Phenomenology, pathophysiol-
ogy, genetics, epidemiology, and treatment, Current Neurology 13
1993 209–227, Mosby-Yearbook, St. Louis.
130 T.B. Jay, Sex roles and dirty word usage: a review of the literature
Ž.Ž .
and a reply to Haas, Psychological Bulletin 88 3 1980 614–621.
131 T.B. Jay, Cursing in America, John Benjamins, Philadelphia, 1992.
132 T.B. Jay, Cursing: A damned persistent lexicon, in: D. Hermann,
M. Johnson, C. McEvoy, C. Hertzog, P. Hertel Eds. , Basic and
Applied Memory: Research on Practical Aspects of Memory, Erl-
baum, Hillsdale, NJ, 1996.
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104102
133 Y. Joanette, P. Goulet, D. Hannequin, Right Hemisphere and
Verbal Communication, Springer-Verlag, New York, 1990.
134 U. Jurgens, D. Ploog, Cerebral representation of vocalization in the
squirrel monkey, Exp. Brain Res. 10 1970 532–554.
135 U. Jurgens, D. Pratt, Role of the periaquaductal gray in vocal
expressions of emotion, Brain Research 167 1970 367–378.
136 Y. Kano, M. Ohta, Y. Nagai, Differences in clinical characteristics
between Tourette syndrome patients with and without ’generalized
tics’ or coprolalia, Psychiatry and Clinical Neurosciences 51 6
1997 357–361.
137 R. Kent R., Reference Manual for Communicative Sciences and
Disorders: Speech and Language, Pro-Ed, Austin, TX, 1994.
138 R. Kent, J. Rosenbek, Prosodic disturbance and neurologic lesion,
Brain and Language 15 1982 259–291.
139 V. de Klerk, Expletives: men only?, Communication Monographs
Ž.Ž .
58 2 1991 156–169.
140 E. Koprowski-Milewska, Gilles de la Tourette’s syndrome, in: F.
Abuzzahab Sr., F. Anderson Eds. , Gilles de la Tourette’s Syn-
drome, Vol. 1, International Registry, St. Paul, Mason Publishing,
1976, pp. 117–133.
141 M. Kuniyoshi, K. Inanaga, K. Arikawa, Y. Maeda, J. Nakamura,
N. Uchimura, A case of tardive Tourette-like syndrome, The
Ž.Ž .
Japanese Journal of Psychiatry and Neurology 46 1 1992 67–69.
142 R. Kurlan, J. Behr, L. Medved et al., Familial Tourette’s syndrome:
Report of a large pedigree and potential for linkage analysis,
Neurology 36 1986 772–776.
143 R. Kurlan, D. Lichter, D. Hewitt, Sensory tics in Tourette’s syn-
drome, Neurology 39 1989 731–734.
144 H.I. Kushner, L.S. Kiessling, The controversy over the classifica-
tion of Gilles de la Tourette’s syndrome, 1800–1995, Perspectives
Ž.Ž .
in Biology and Medicine 39 3 1996 409–435.
145 A. Lang, Patient perception of tics and other movement disorders,
Neurology 41 1991 223–228.
146 A. Lang, Clinical phenomenology of tic disorders: selected aspects,
in: T. Chase, A.J. Friedhoff, D.J. Cohen Eds. , Tourette Syn-
drome: Genetics, Neurobiology and Treatment; Advances in Neu-
rology, 58, 1992, pp. 25–52.
147 A. Lang, E. Consky, P. Sandor, ‘‘Signing tics’’ — insights into the
pathophysiology of symptoms in Tourette’s syndrome, Annals of
Ž.Ž .
Neurology 33 2 1993 212–215.
148 M. Langlois, L. Force, Revision nosologique et clinique de la
maladie Gilles de la Tourette evoquee par l’action de certains
neuroleptiques sur son evolution, Rev. Neurol. 113 1965 641–645.
149 S. Laskiwski, J. Morse, The patient with spinal cord injury: The
modification of hope and expressions of despair, Canadian Journal
Ž.Ž .
of Rehabilitation 6 3 1993 143–153.
150 J.F. Leckman, D.L. Pauls, B.S. Peterson, M.A. Riddle, G.M.
Anderson, D.J. Cohen, Pathogenesis of Tourette syndrome, in: T.
Chase, A.J. Friedhoff, D.J. Cohen Eds. , Tourette Syndrome:
Genetics Neurobiology, and Treatment; Advances in Neurology,
Vol. 58, 1992, pp. 15–24.
151 A.J. Lees, Tics and Related Disorders, Churchill Livingston, Edin-
burgh, 1985.
152 A.J. Lees, M. Robertson, M.R. Trimble, N.M.F. Murray, A clinical
study of Gilles de la Tourette syndrome in the United Kingdom,
Journal of Neurology, Neurosurgery and Psychiatry 47 1984 18.
153 J.M. Leger, Y. Ranty, Evolution of three cases of Gilles de la
Tourette’s syndrome observed during four years, in: F. Abuzzahab
Sr., F. Anderson Eds. , Gilles de la Tourette’s Syndrome, Vol. 1,
International Registry, Mason Publishing, St. Paul, 1976, pp. 123–
154 P. Lerman, E. Nussbaum, Treatment with Haloperidol in ‘‘maladie
des Tics’’ in children, Jarefuah, Journal of the Israel Medical
Ž.Ž .
Association 86 5 1974 241–242.
155 F. Lieh-Mak, S.Y. Chung, P. Lee, S. Chen, Tourette syndrome in
the Chinese: A follow-up of 15 cases, in: A.J. Friedhoff, T.N.
Chase Eds. , Gilles de la Tourette Syndrome, Raven Press, New
York, 1982, pp. 281–283.
156 F. Lieh-Mak, S.L. Luk, G. Leung, Gilles de la Tourette syndrome:
report of 5 cases in the Chinese, British Journal of Psychiatry 134
1979 630–634.
157 J.L. Locke, Mechanisms of phonological developmentin children:
maintenance, learning and loss, Papers from the 16th Regional
Meeting of the Chicago Linguistic Society 16 1980 220–238.
158 A.R. Lucas, Gilles de la Tourette’s disease in children: treatment
with haloperidol, American Journal of Psychiatry 124 1967 147–
159 C. Ludlow, R. Polinsky, E. Caine, C. Bassich, M. Ebert, Language
and speech abnormalities in Tourette syndrome, in: A.J. Friedhoff,
T.N. Chase Eds. , Gilles de la Tourette Syndrome, New York,
Raven Press, 1982, pp. 351–362.
160 C.C. Lum, A.W. Ellis, Is ‘‘Nonpropositional’’ speech preserved in
aphasia?, Brain and Language 46 1994 368–391.
161 A. Lumsden, N. McCune, J. McGeown, Tourette’s syndrome: case
report and contribution to the PratarMasson-Nunn controversy,
Ž.Ž .
Journal of Family Therapy 9 1 1987 81–85.
162 J. Lyons, Introduction to Theoretical Linguistics, Cambridge, UK,
Cambridge Univ. Press, 1968.
163 P.D. MacLean, The Triune Brain in Evolution: Role in Paleocere-
bral Functions, Plenum, New York, 1990.
164 R.T. Malison, C.J. McDougle, C.H. van Dyck, L. Scahill, R.M.
Baldwin, J.P. Seibyl, L.H. Price, J.F. Leckman, R.B. Innis, 123I b-
CIT SPECT imaging of striatal dopamine transporter binding in
Tourette’s disorder, American Journal of Psychiatry 152 1995
wx Ž.
165 A. Marneros, Gilles de la Tourette’s syndrome German ,
Ž.Ž .
Fortschritte der Neurologie-Psychiatrie 52 7 1984 250–257.
166 C.D. Marsden, The mysterious motor function of the basal ganglia:
the Robert Wartenburg lecture, Neurology 32 1982 514–539.
167 C.D. Marsden, Motor disorders in basal ganglia disease, Human
Neurobiology 2 1984 245–250.
168 C. Martindale, The grammar of the tic in Gilles de la Tourette’s
Ž.Ž .
syndrome, Language and Speech 19 3 1976 266–275.
169 C. Martindale, Syntactic and semantic correlates of verbal tics in
Gilles de la Tourette’s syndrome: a quantitative case study, Brain
and Language 4 1977 231–247.
170 R. Mayeux, Emotional changes associated with basal ganglia disor-
ders, in: K. Heilman, P. Satz Eds. , Neuropsychology of Human
Emotion, Guilford Press, New York, 1986.
171 M.S. Mega, J.L. Cummings, Frontal-subcortical circuits and neu-
ropsychiatric disorders, The Journal of Neuropsychiatry and Clini-
cal Neurosciences 6 1994 358–370.
172 P.V. Melnichuk, L.A. Sosnoskaya, I.M. Chailova, Gilles de la
Tourette syndrome, Zhournal Nevropatologii I Psychiatrii 778
1977 .
173 M. Mendez, N.L. Adams, K.S. Lewandowski, Neurobehavioral
changes associated with caudate lesions, Neurology 39 1989
174 B.C. Meyer, D. Rose, Single case study: Remarks on the etiology
of Gilles de la Tourette’s syndrome, Journal of Nervous and Mental
Ž.Ž .
Disease 174 7 1986 387–396.
175 F. Micheli, M. Gatto, O. Gershanic et al., Gilles de la Tourette
syndrome: clinical features of 75 cases from Argentina, Behav.
Neurol. 8 1995 75–80.
176 G.A. Miller, Some psychological studies of grammar, American
Psychologist 17 1962 748–762.
177 D.H. Milman, Gilles de la Tourette syndrome: Extended follow-up,
New York State Journal of Medicine, May 1975 pp. 892–895.
178 M. Mishkin, H.L. Petri, Memories and habits: Some implications
for the analysis of learning and retention, in: L.R. Squire, N.
Butters Eds. , Neuropsychology of Memory, Guilford Press, New
York, 1984, pp. 287–296.
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104 103
179 M. Mishkin, B. Malamut, J. Bachevalier, Memories and habits:
Two neural systems, in: G. Lynch, J.L. McGaugh, N.M. Wein-
berger Eds. , Neurobiology of Learning and Memory, Guilford
Press, New York, 1984, pp. 65–77.
wx Ž
180 M. Moldofsky, C. Tullis, R. Lamon, Multiple tic syndrome Gilles
de la Tourette’s syndrome : clinical, biological and psychosocial
variables and their influence with haloperidol, The Journal of
Nervous and Mental Disease 154 1974 282–292.
181 A. Montagu, The Anatomy of Swearing, Rapp and Whiting, Lon-
don, 1967.
182 J. Moriarty, D.C. Costa, B. Schmitz, M.R. Trimble, P.J. Ell, M.M.
Robertson, Brain perfusion abnormalities in Gilles de la Tourette’s
syndrome, British Journal of Psychiatry 167 1995 249–254.
183 T.J. Murray, Tourette’s syndrome: a treatable tic, CMA Journal
118 1978 1407–1410.
184 R.E. Myers, Comparative neurology of vocalization and speech:
Proof of a dichotomy, Annals of the New York Academy of
Science 280 1976 745–757.
185 W.J.H. Nauta, Limbic innervation of the striatum, in: A.J. Fried-
hoff, T.N. Chase Eds. , Gilles de la Tourette Syndrome, New
York, Raven Press, 1982, pp. 41–48.
186 L.E. Nee, R.J. Polinsky, M.H. Ebert, Tourette Syndrome: Clinical
and family studies, in: A.J. Friedhoff, T.N. Chase Eds. Gilles de
la Tourette Syndrome, Raven Press, New York, 1982, pp. 291–295.
187 L.E. Nee, E.D. Caine, R.J. Plinsky, R. Eldridge, M.H. Ebert, Gilles
de la Tourette syndrome: clinical and family study of 50 cases, Ann
Neurol. 7 1980 41–49.
188 J.-L. Nespoulous, A.K. Lecours, Coprolalique chez le patient at-
teint du syndrome de Jule de la Tourette. Aspects formels et
functionnels, Rev. Neurol. 143 1987 220–224.
189 H. Nishida, Two interesting cases of tics in children, Japanese
Ž.Ž .
Journal of Child Psychiatry 16 2 1975 97–102.
190 Y. Nomura, M. Segawa, Gilles de la Tourette syndrome in Oriental
children, Brain Dev. 1 1979 103–111.
191 Y. Nomura, M. Segawa, Tourette syndrome in Oriental children:
Clinical and pathophysiological considerations, in: A.J. Friedhoff,
T.N. Chase Eds. , Advances in Neurology, Vol. 35, Gilles de la
Tourette Syndrome, Raven Press, New York, 1982, pp. 277–280.
192 M. Nuwer, Coprolalia as an organic symptom, in: A.J. Friedhoff,
T.N. Chase Eds. , Advances in Neurology, Gilles de la Tourette
Syndrome, Vol. 35, Raven Press, New York, 1982, pp. 363–368.
193 J.A. Obeso, J.C. Rothwell, C.D. Marsden, The neurophysiology of
Tourette syndrome, in: A.J. Friedhoff, T.N. Chase Eds. , Ad-
vances in Neurology, Gilles de la Tourette Syndrome, Vol. 35,
Raven Press, New York, 1982, pp. 105–114.
194 D. Palumbo, A. Maughan, R. Kurlan, Hypothesis III. Tourette
syndrome is only one of several causes of a developmental basal
ganglia syndrome, Archives of Neurology 54 1997 475–483.
wx Ž.
195 R.J. Pary, The psychotic curse, Journal of Psychiatry 136 1979
196 H.V. Perera, Two cases of Gilles de la Tourette’s syndrome treated
with haloperidol, British Journal of Psychiatry 127 1975 324–326.
197 B.S. Peterson, R.A. Bronen, C.C. Duncam, Three cases of symp-
tom change in Tourette’s syndrome and obsessive–compulsive
disorders associated with paediatric cerebral malignancies, Journal
Ž.Ž .
of Neurology, Neurosurgery and Psychiatry 61 5 1966 497–505.
198 B. Peterson, M.A. Riddle, D.J. Cohen, L.D. Katz, J.C. Smith, M.T.
Hardin, J.F. Leckman, Reduced basal ganglia volumes in Tourette’s
syndrome using three-dimensional reconstruction techniques from
magnetic resonance images, Neurology 43 1993 941–949.
199 R.K. Pitman, M.A. Jenike, Coprolalia in obsessive–compulsive
disorder: A missing link, Journal of Nervous and Mental Disease
176 1988 311–313.
200 D. Ploog, Phonation, emotion, cognition, with reference to the
brain mechanisms involved, Brain and Mind, Ciba Foundation
Symposium, 69, Excerpta Medica, Amsterdam, 1979, pp. 79–98.
201 M. Poncet, M. Habib, Atteinte isolee des comportements motives et
Ž. Ž.
lesions des noyaux gris centraux, Rev. Neurol. Paris 150 1994
202 L. Regeur, B. Pakkenberg, R. Fog, H. Pakkenberg, Clinical fea-
tures and long-term treatment with pimozide in 65 patients with
Gilles de la Tourette’s syndrome, Journal of Neurology, Neuro-
surgery and Psychiatry 49 1986 791–795.
203 M.M. Robertson, M.R. Trimble, Gilles de la Tourette syndrome in
the Middle East. Report of a cohort and a multiply affected large
pedigree, British Journal of Psychiatry 158 1991 416–419.
204 M.M. Robertson, M. Doran, M. Trimble, A. Lees, The treatment of
Gilles de la Tourette syndrome by limbic leukotomy, Journal of
Neurology, Neurosurgy and Psychiatry 53 1990 691–694.
205 B.W. Robinson, Vocalization evoked from forebrain in Macaca
mulatta, Physiol. Behav. 2 1967 345–354.
206 B.W. Robinson, Anatomical and physiological contrasts between
human and other primate vocalizations, in: S.L. Washburn, P.
Dolhinow Eds. , Perspectives on Human Evolution 2, Holt, Rine-
hart and Winston, New York, 1972, pp. 438–443.
207 B.W. Robinson, Limbic influences on human speech, Annals of the
New York Academy of Sciences 280 1976 761–771.
208 R. Rosenthal, J.A. Hall, M.R. DiMatteo, P.L. Rogers, D. Archer,
Sensitivity to Nonverbal Communication: the PONS Test. Johns
Hopkins University, Baltimore, 1979.
209 Z. Rydzynski, W. Siminska, K. Grebowicz, The results of treat-
ment for nervous tics in children, Psychiatr. Pol. 10 1976 465– 469.
210 E. Sagarin, The Anatomy of Dirty Words, New York, 1962.
211 J.A. Saint-Cyr, A.E. Taylor, K. Nicholson, Behavior and the basal
ganglia, Advances in Neurology 65 1995 1–28.
212 P.L. Sand, C. Carlson, Failure to establish control over tics in the
Gilles de la Tourette Syndrome with behavioral therapy techniques,
British Journal of Psychiatry 122 1973 665–670.
213 R. Sandyk, A case of Tourette’s syndrome with midbrain involve-
Ž.Ž .
ment, International Journal of Neuroscience 43 3–4 1988 171–
214 H. Schauenburg, Zur familiaeren Bewaeltigung Gilles de la
Tourette-Syndroms, Coping with Gilles de la Tourette syndrome in
the family Praxis der Kinderpsychologie und Kinderpsychiatrie 39
Ž.Ž .
5 1990 167–172.
215 K.R. Scherer, Vocal affect expression: a review and a model for
future research, Psychological Bulletin 99 1986 143–165.
216 K.R. Scherer, R. Banse, H.G. Wallbott, T. Goldbeck, Vocal cues in
emotional encoding and decoding, Motivation and Emotion 15
1991 123–148.
217 M. Schoelderle, W. Greil, D. Pongratz, Gilles de la Tourette-syn-
drom und spinale Muskelatrophie vom Peronealtyp: Eine Kasuistik,
Gilles de la Tourette’s syndrome and spinal muscular atrophy
Ž. Ž.Ž.
distal form, type IV : a case report, Nervenarzt 58 8 1987 1–2.
wx Ž.
218 J.E. Schowalter, Tics, Pediatrics in Review 2 1980 55–57.
219 B.L. Scott, J. Jankovic, D.T. Donovan, Botulinum toxin injection
into vocal cord in the treatment of malignant coprolalia associated
Ž. Ž .
with Tourette’s syndrome, Movement Disorders 11 4 1966
220 J.N. Seignot, A case of Gilles de la Tourette’s disease after 10
years’ treatment with Haloperidol R. 1625 , in: F. Abuzzahab Sr.,
F. Anderson Eds. , Gilles de la Tourette’s Syndrome, Vol. 1,
International Registry, Mason Publishing, St. Paul, 1976, pp. 159–
221 E.A. Serafetinides, M.A. Falconer, Speech disturbances in temporal
lobe seizures: a study in 100 epileptic patients submitted to anterior
temporal lobectomy, Brain 86 1963 333–346.
222 A.K. Shapiro, E. Shapiro, Tourette Syndrome: History and Present
Status, in: A.J. Friedhoff, T.N. Chase Eds. , Gilles de la Tourette
Syndrome, Raven Press, New York, 1982.
223 A.K. Shapiro, E.S. Shapiro, R.D. Bruun, R.D. Sweet, Gilles de la
Tourette Syndrome, Raven Press, New York, 1977.
224 A.K. Shapiro, E.S. Shapiro, J.G. Young, T.E. Feinberg, Gilles de la
Tourette Syndrome, Raven Press, New York, 1988.
D. Van Lancker, J.L. CummingsrBrain Research ReÕiews 31 1999 83–104104
225 E.F. Shimberg, Living with Tourette Syndrome, Simon and Schus-
ter, New York, 1995.
226 C. Singer, Coprolalia and other coprophenomena, in: J. Jankovic
Ed. , Neurologic Clinics, Tourette Syndrome, Vol. 15, 2, 1997, pp.
wx Ž.
227 H.S. Singer, Pathobiology, in: R. Kurlan Ed. , Handbook of
Tourette’s Syndrome and Related Tic and Behavioral Disorders,
Marcel Dekker, New York, 1993, pp. 267–287.
228 H.S. Singer, Neurobiological issues in Tourette syndrome, Brain
Ž.Ž .
and Development 16 5 1994 353364.
229 H.S. Singer, I.J. Butler, L.E. Tune, J. Seifert, J.T. Coyle, Dopamin-
ergic dysfunction in Tourette syndrome, Ann Neurol. 12 1982
230 H.S. Singer, I.H. Hahn, T.H. Moran, Abnormal dopamine uptake
sites in postmortem striatum from patients with Tourette syndrome,
Ann Neurol. 30 1991 558–562.
231 K. Singer, Gilles de la Tourette’s syndrome: a report on three cases
in the Chinese, in: F. Abuzzahab Sr., F. Anderson Eds. , Gilles de
la Tourette’s Syndrome, Vol. 1, International Registry, St. Paul,
Mason Publishing, 1976, pp. 19–24.
wx Ž.
232 A. Smith, Speech and other functions after left dominant hemi-
spherectomy, Journal of Neurology, Neurosurgery and Psychiatry
29 1966 467–471.
233 A. Smith, C.W. Burklund, Dominant hemispherectomy, Science
153 1966 1280–1282.
234 L.J. Speedie, N. Brake, S. Folstein, D. Bowers, K. Heilman,
Comprehension of prosody in Huntington’s disease, Journal of
Neurology, Neurosurgery, and Psychiatry 53 1990 607–610.
235 L.J. Speedie, E. Wertman, J. Tair, K.M. Heilman, Disruption of
automatic speech following a right basal ganglia lesion, Neurology
43 1993 1768–1774.
236 R.W. Sperry, Lateral specialization in the surgically separated
hemispheres, in: F.O. Schmitt, F.G. Worden Eds. , Neurosciences,
Third Study Program, Mass, MIT Press, Cambridge, 1974, pp.
237 R.W. Sperry, E. Zaidel, D. Zaidel, Self-recognition and social
awareness in the disconnected minor hemisphere, Neuropsycholo-
gia 17 1979 153–166.
wx Ž
238 F.C. Stam, Ziekte van Gilles de la Tourette Klinische lessen, Vrije
Universiteit Amsterdam , Ned. T. Geneesk 115 31 1971 541
239 A.J. Starling, Tourettism as a presentation of dementia, Interna-
Ž.Ž .
tional Journal of Geriatric Psychiatry 2 2 1987 127–129.
240 J.M. Steadman Jr., A study of verbal taboos, American Speech 10
1933 93–103.
241 S.E. Swedo, J.L. Rapoport, D.L. Cheslow, H.L. Leonard, E.M.
Ayoub, D.M. Hosier, E.R. Wald, High prevalence of obsessive–
compulsive symptoms in patients with Sydenham’s chorea, Ameri-
can Journal of Psychiatry 146 1989 246–248.
242 K. Tabarka, M. Ticha, A contribution to the psychopathology of
Ž.Ž .
morbus de la Tourette, Ceskoslovenska Psychiatrie 71 4 1975
243 J. Tailarach, J. Bancard, S. Geier, M. Bordas-Ferrer, A. Bonis, G.
Szilka, The cingulate gyrus and human behavior, Electroen-
cephalogr. Clin. Neurophysiol. 34 1973 45–52.
244 B.A. Taylor, Towards a structural and lexical analysis of ’swear-
ing’ and the language of abuse in Australian English, Linguistics
164 1975 17–43.
245 J. Tomaszewski, R. Seredynski, Therapeutic trials in a case of
Gilles de la Tourette syndrome of organic background in a boy,
Pediatr. Pol. 54 1979 1351–1353.
246 C. Tompkins, Right Hemisphere Communication Disorders, Theory
and Management, Singular, San Diego, 1996.
247 M. Trimble, Psychopathology and movement disorders: A new
perspective on the Gilles de la Tourette Syndrome, Journal of
Neurology, Neurosurgery, Psychiatry special supplement , 1989,
pp. 90–95.
248 D. Van Lancker, Nonpropositional speech: Neurolinguistic studies,
in: A. Ellis Ed. , Progress in the Psychology of Language, Vol. 3,
London, L. Erlbaum., 1988, pp. 49–118.
249 D. Van Lancker, The neurology of proverbs, Behavioral Neurology
3 1990 169–187.
250 D. Van Lancker, Personal relevance and the human right hemi-
sphere, Brain and Cognition 17 1991 64–92.
251 D. Van Lancker, Rags to riches: Our increasing appreciation of
cognitive and communicative abilities of the human right cerebral
hemisphere, Brain and Language 57 1997 1–11.
252 D. Van Lancker, R. Bella, The relative roles of repetition and
sentence completion tasks in revealing superior speech abilities in
patients with nonfluent aphasia, Journal of the International Neu-
ropsychological Society 2 1996 6.
253 Van Lancker, D. and Breitenstein, C. In press. Emotional dys-
prosody and similar dysfunctions. To appear in. Bougousslavsky, J.
and Cummings, J.L. Eds. , Disorders of Behavior and Mood in
Focal Brain Lesions. Cambridge Univ. Press, Cambridge.
254 D. Van Lancker, S. Grafton, PET activation studies comparing two
speech tasks widely used in surgical mapping: Localization of
Broca’s area, NeuroImage 5 1997 S589.
255 D. Van Lancker, N. Pachana, J. Cummings, J. Sidtis, Dysprosodic
speech following basal ganglia stroke: role of frontosubcortical
circuits, Journal of the International Neuropsychological Society 2
1996 5.
256 D. Van Lancker, C. Nicklay, Comprehension of personally relevant
PERL versus novel language in two globally aphasic patients,
Aphasiology 6 1992 37–61.
257 D. Van Lancker, J.J. Sidtis, Brain damage and prosody errors
reconsidered, Journal of Speech and Hearing Research 36 1993
258 V. Wallen, E. Araneta, Gilles de la Tourette syndrome: a case
Ž.Ž .
study, Military Medicine 140 10 1975 705–709.
259 P.J.F. Walsh, Compulsive shouting and Gilles de la Tourette’s
disease, Br. J. Clin. Pract. 16 1962 651–655.
260 A. Wechsler, The effect of organic brain disease on recall of
emotionally charged versus neutral narrative texts, Neurology 73
1973 130–135.
261 R.A. Weeks, N. Turjanski, D.J. Brooks, Tourette’s syndrome: A
disorder of cingulate and orbitofrontal function?, OJM 89 6
1996 401–408.
262 S.S. Wolf, D.W. Jones, M.B. Knable, J.G. Gorey, K. Sam Lee,
T.M. Hyde, R. Coppola, D.R. Weinberger, Tourette syndrome:
Prediction of phenotypic variation in monozygotic twins by caudate
nucleus D2 receptor binding, Science 273 1996 1225–1227.
263 K.M. Woodrow, Gilles de la Tourette’s disease — a review,
Ž.Ž .
American Journal of Psychiatry 131 9 1974 10001003.
264 J.A. Yaryura-Tobias, Gilles de la Tourette syndrome: interactions
with other neuropsychiatric disorders, Acta Psychiatr. Scan. 59
1979 9–16.
265 M. Yvonneau, Etude biologique de deux das de maladie de Gilles
Ž.Ž .
de la Tourette, Revue Neurologique 126 1 1972 65–70.
266 O. Zangwill, Speech and the minor hemisphere, Acta Neurol. Belg.
67 1967 1013–1020.
267 A.H. Zencius, M.D. Wesolowski, W.H. Burke, The use of a visual
cue to reduce profanity in a brain injured adult, Behavioral Resi-
dential Treatment 5 1990 143–147.
268 L. Zgirski, Z. Afeltowicz, Studies on the etiopathologenesis of
nervous tics and the Gilles de la Tourette’s syndrome from the
clinical material of Gdansk Medical Academy Psychiatric clinical
wx Ž.Ž .
sic , Psychiatr. Pol 10 1 1976 57–62.
269 R.L. Zuloaga, La Enfermedad de Gilles de la Tourette, Rev.
Ž.Ž .
Neuropsquitar 36 4 1973 222–232.
... One possible explanation for these discrepancies is that language lateralisation is not correlated with AVH activity per se, but rather the extent of negative emotional valence in AVH content (Sommer et al., 2008). For example, activation of the right inferior frontal region has been associated with production of swear words and abuse terms, usually with negative emotional content (Van Lancker and Cummings, 1999). There were also large differences between individuals with psychiatric disorders in the lateralisation of AVH activity that ranged from strong left lateralisation to strong right lateralisation, with bilateralisation also observed (Sommer et al., 2008). ...
Full-text available
Introduction Auditory verbal hallucinations (AVHs), or hearing non-existent voices, are a common symptom in psychosis. Recent research suggests that AVHs are also experienced by neurotypical individuals. Individuals with schizophrenia experiencing AVHs and neurotypicals who are highly prone to hallucinate both produce false positive responses in auditory signal detection. These findings suggest that voice-hearing may lie on a continuum with similar mechanisms underlying AVHs in both populations. Methods The current study used a monaural auditory stimulus in a signal detection task to test to what extent experimentally induced verbal hallucinations are (1) left-lateralised (i.e., more likely to occur when presented to the right ear compared to the left ear due to the left-hemisphere dominance for language processing), and (2) predicted by self-reported hallucination proneness and auditory imagery tendencies. In a conditioning task, fifty neurotypical participants associated a negative word on-screen with the same word being played via headphones through successive simultaneous audio-visual presentations. A signal detection task followed where participants were presented with a target word on-screen and indicated whether they heard the word being played concurrently amongst white noise. Results Results showed that Pavlovian audio-visual conditioning reliably elicited a significant number of false positives (FPs). However, FP rates, perceptual sensitivities, and response biases did not differ between either ear. They were neither predicted by hallucination proneness nor auditory imagery. Discussion The results show that experimentally induced FPs in neurotypicals are not left-lateralised, adding further weight to the argument that lateralisation may not be a defining feature of hallucinations in clinical or non-clinical populations. The findings also support the idea that AVHs may be a continuous phenomenon that varies in severity and frequency across the population. Studying induced AVHs in neurotypicals may help identify the underlying cognitive and neural mechanisms contributing to AVHs in individuals with psychotic disorders.
... To assess volitional control of crow vocalizations, we adopted an operational definition from clinical neurology where the distinction between volitional and affective vocalizations has long been recognized for the diagnosis of the type of orofacial paralysis: [18][19][20][21][22] First, volitional vocalizations need to be uttered in response to an arbitrary instruction stimulus that is neutral in its value or emotional valence. Second, vocalizations need to be uttered in a manner that is temporally contingent to the instruction stimulus. ...
Full-text available
The neuronal basis of the songbird's song system is well understood. However, little is known about the neuronal correlates of the executive control of songbird vocalizations. Here, we record single-unit activity from the pallial endbrain region "nidopallium caudolaterale" (NCL) of crows that vocalize to the presentation of a visual go-cue but refrain from vocalizing during trials without a go-cue. We find that the preparatory activity of single vocalization-correlated neurons, but also of the entire population of NCL neurons, before vocal onset predicts whether or not the crows will produce an instructed vocalization. Fluctuations in baseline neuronal activity prior to the go-cue influence the premotor activity of such vocalization-correlated neurons and seemingly bias the crows' decision to vocalize. Neuronal response modulation significantly differs between volitional and task-unrelated vocalizations. This suggests that the NCL can take control over the vocal motor network during the production of volitional vocalizations in a corvid songbird.
... We are not arguing that leaders should swear in order to be effective, rather, this research demonstrates that within certain contexts, such as contact sports teams, where swearing is an already established group norm, an effective leader utilises swearing as a way of signalling solidarity while also drawing upon its emphatic force. In situations where an emotive charge needs to be created, swearing is a useful strategy due to the neurological and physiological responses it creates (Van Lancker and Cummings 1999;Allan and Burridge 2006;Stephens and Robertson 2020), hence why we see a greater use of swearing in contexts that are more immediate to the match situation, such as the huddles. If we look at leadership discourse in other contexts, we can see that swearing is used to create solidarity and reinforce messages, but what is more important is that swearing is a group norm in contexts such as the rugby club or on the factory floor (Daly et al. 2004). ...
Full-text available
Although swearing is often perceived as intrinsically offensive language, it is how swearing use is indexed against a person’s understanding of local social norms that constructs swearing as offensive. This paper presents an analysis of swearing within a social context where high frequency swearing is a norm: a male rugby team in New Zealand. Drawing upon a dataset collected from ethnographically collected authentic interactions, an analysis of the frequency of swear words and a comparison with other English corpora is presented, followed by an interactional sociolinguistic analysis of how swearing is used in interactions. The aim of the paper is to demonstrate not only how swearing can be used to engender solidarity, but that a range of socio-pragmatic functions of swearing such as intensifying and indexing a vernacular identity, can be used in performing leadership.
... What is the evidence for such patterns? Van Lancker and Cummings (1999) found that the involuntary swearing of English-speaking patients with Tourette syndrome was phonetically atypical, for example being unusually likely to contain a plosive or fricative consonant (in particular, f or k) at the beginning of the word. Yardy (2010) compared sounds in English swear words with those in carols and lullabies, reporting that the swear words contained a relatively higher proportion of plosive consonants (e.g., k, t), while the carols and lullabies contained proportionately more sonorant consonants (e.g., l, w). ...
Full-text available
Why do swear words sound the way they do? Swear words are often thought to have sounds that render them especially fit for purpose, facilitating the expression of emotion and attitude. To date, however, there has been no systematic cross-linguistic investigation of phonetic patterns in profanity. In an initial, pilot study we explored statistical regularities in the sounds of swear words across a range of typologically distant languages. The best candidate for a cross-linguistic phonemic pattern in profanity was the absence of approximants (sonorous sounds like l, r, w and y). In Study 1, native speakers of various languages (Arabic, Chinese, Finnish, French, German, Spanish; N = 215) judged foreign words less likely to be swear words if they contained an approximant. In Study 2 we found that sanitized versions of English swear words – like darn instead of damn – contain significantly more approximants than the original swear words. Our findings reveal that not all sounds are equally suitable for profanity, and demonstrate that sound symbolism – wherein certain sounds are intrinsically associated with certain meanings – is more pervasive than has previously been appreciated, extending beyond denoting single concepts to serving pragmatic functions.
... Some fMRI studies have revealed a distributed activity in anterior cingulate cortex, insula, and thalamus involved in producing and processing taboo words, with the IFG involved in modulating the emotional meaning and social context of swear words (Hansen et al., 2019;Sulpizio et al., 2019). MRI studies on patients suffering from Tourette's syndrome (TS) showed that the increased swearing in TS patients is likely a result of reduced IFG activity, basal ganglia dysfunction, and activity in the insula, thalamus, and cerebellum, pointing to an involvement of subcortical structures in processing swear words (Finkelstein, 2018;Van Lancker & Cummings, 1999). These observations suggest that processing of formulaic expressions happens away from 'language' regions and into sensorimotor and subcortical regions, depending on how much they are overlearned and on the context in which they are presented (Van Lancker Sidtis & Sidtis, 2018;Sidtis et al., 2018). ...
For centuries, neuroscience has proposed models of the neurobiology of language processing that are static and localised to few temporal and inferior frontal regions. Although existing models have offered some insight into the processes underlying lower-level language features, they have largely overlooked how language operates in the real world. Here, we aimed at investigating the network organisation of the brain and how it supports language processing in a naturalistic setting. We hypothesised that the brain is organised in a multiple core-periphery and dynamic modular architecture, with canonical language regions forming high-connectivity hubs. Moreover, we predicted that language processing would be distributed to much of the rest of the brain, allowing it to perform more complex tasks and to share information with other cognitive domains. To test these hypotheses, we collected the Naturalistic Neuroimaging Database of people watching full length movies during functional magnetic resonance imaging. We computed network algorithms to capture the voxel-wise architecture of the brain in individual participants and inspected variations in activity distribution over different stimuli and over more complex language features. Our results confirmed the hypothesis that the brain is organised in a flexible multiple core-periphery architecture with large dynamic communities. Here, language processing was distributed to much of the rest of the brain, together forming multiple communities. Canonical language regions constituted hubs, explaining why they consistently appear in various other neurobiology of language models. Moreover, language processing was supported by other regions such as visual cortex and episodic memory regions, when processing more complex context-specific language features. Overall, our flexible and distributed model of language comprehension and the brain points to additional brain regions and pathways that could be exploited for novel and more individualised therapies for patients suffering from speech impairments.
Full-text available
The unpleasant expressions (offensiveness) always emotionally affect to the human psyches, and exists in all languages in less or strong degrees and directly or indirectly. Therefore, this study aimed to investigate over the changes of them by corporally-derived data and their registers, times and genders were the pilot targets. BNC and COCA Corpora were put for data collections while the list of previous insulting words was selected to reuse, especially the ones with highest frequencies. The results suggested 4 words damn, shit, fuck and dick had the highest degrees of uses but those from BNC were comparatively fewer than the rest. Moreover, the top four were emerged up to the different periods of times and contexts while men used them considerably more often than the women did.
The past 20 years witnessed a growing interest in philosophy of language and linguistics for expressives and, in particular, for slurs – terms that target people and groups on accounts of their belonging to a certain category (typically having to do with ethnic origins, gender, sexual orientation, religion, and so on). This lively debate often relies on empirical claims – “these terms are not derogatory in this context”, “their use affects the audience’s beliefs and attitudes in this and that way”, “reporting a slur backfires”, and so on and so forth. Some scholars have tried to back up their claims with existing empirical data from psychology and psycholinguistics, while a few others went and investigated their questions on experimental grounds. In this chapter, I offer an overview of this experimental literature on slurs and derogatory labels, and I illustrate an array of ways in which the philosophical issues that slurs raise to the proverbial armchair benefit from empirical studies in psychology, psycholinguistics, and experimental philosophy.
Disability related terms are powerful—so powerful that some have reached the status of taboo words. What do disabled people think of these words? Some choose to reclaim these words while others reject them. For example, the Twitter hashtag #CripTheVote was created by disability advocates to highlight issues affecting disabled people during election campaigns. Despite, or perhaps because of, the perceived offensiveness of the word cripple, these advocates have reclaimed a variant of it to suit their purposes. By contrast, campaigns against use of the ‘r-word’—in any form—have been instigated by individuals with disabilities, and their families and friends, all around the world. In this chapter, we discuss the nature of taboo words and provide some background on disability-related taboo words.KeywordsTaboo wordsPerson-first languageIdentity first languageDisability terminologyDisability#cripthevote
The first minor aim of this synthetical historical survey consisted in showing that the discovery of the internal organization of language within the left hemisphere has been mainly determined by theoretical models and cultural factors, whereas the discovery of the left lateralisation of language and of the right lateralization of emotions and of other cognitive and perceptual functions has been mainly determined by empirical observations. A second more relevant aim of the survey consisted in discussing historical and more recent data suggesting that the different lateralisation of language and emotions has influenced not only the asymmetrical representation of other cognitive, affective and perceptual functions, but also (thank to the shaping influence of language on human cognition) of asymmetries regarding more general aspects of thought (such as the distinctions between 'propositional vs automatic' and 'conscious vs unconscious' ways of functioning). In the last part of the review, these data will be included in a more general discussion, concerning the brain functions that could be subsumed by the right hemisphere for three main reasons: (a) to avoid conflicts with the language mediated activities of the left hemisphere; (b) because of unconscious and automatic aspects of its non-verbal organisation or (c) due to the competition for cortical space determined by the development of language within the left hemisphere.
Communication, specifically the elements crucial for typical social interaction, can be significantly affected in psychiatric illness, especially depression. Of specific importance to conversational competence are familiar expressions (prefabricated expressions known to the language community) including formulaic expressions (conversational speech formulas and idioms; these are high in nuance) and lexical bundles (fixed linguistic segments that are prevalent in naturalistic conversation; low in nuance). The goals of this study were to examine familiar language production in the naturalistic, conversational speech of individuals with treatment-resistant depression before and after receiving surgical deep brain stimulation of the subcallosal cingulate white matter pathways and to compare their performance to healthy adults’ familiar language use. Results revealed fewer conversational speech formulas (typically nuanced) produced by those with depression pre- and post-operatively as compared to healthy controls. There was an increase in the production of non-nuanced familiar expressions (largely lexical bundles) and a decrease in nuanced expressions (formulaic expressions) post-operatively when compared to the pre-operative condition for those with depression. These results conform to a recent model that distinguishes three distinct classes of familiar language, based on linguistic and neurological criteria. This study offers a first look at familiar language in depression and provides a foundation for further study into the pragmatic components of communication to help address the often-reported diminished social connectedness experienced by those with depression.
Full-text available
Cerebral localization is determined by the separation of incompatible mechanisms.-Lashley7 Clinical and experimental evidence suggests that the left hemisphere of the brain is specialized for speech activity and the right hemisphere is specialized for many nonlinguistic functions. Jackson1 related the hemispheric linguistic differences t o differences in cognitive activity, suggesting that the left hemisphere is specialized for analytical organization, while the right hemisphere is adapted for " direct associations " among stimuli and responses. Modern researchers have substantially generalized this differentiation to encompass a wide range of behaviors in normal subjects. Experimental2 and clinical3 investigators of hemispheric asymmetry generally agree on the fundamental nature of the processing differences between the two sides of the brain: the left hemisphere is specialized for propositional, analytic, and serial processing of incoming information, while the right hemisphere is more adapted for the perception of appositional, holistic, and synthetic relations. This asymmetry raises the question of whether there are essential differences in the way in which the two hemispheres organize behavior and process information. Several theories attribute hemispheric differences to a structural differentiation of some kind. Asymmetries might be due to differences intrinsic to each hemisphere: e. g., in the neurospatial organization of functions4 or the existence of modality-specific differences in capacity,S or to some fundamental differences in the way the elementary neu-rological interactions occur. The structural difference might exist because of forces extrinsic to the brain, e. g., a muscular predisposition for handedness, asymmetries in sensory organs, or socially trained asymmetries in such observable traits as handed-ness and eyedness. Each of these views supposes that there is some physical or social structure that specifically and directly causes functional asymmetry to occur; that is, these proposals are all extremely strong in that they make concrete claims about the nature of the phenomenon. Yet the apparent precision of each claim is of little use t o us, since we d o not know the relevant facts that would critically prove or disprove any of them. I shall argue that unless we have evidence conclusively proving any of the more specific claims, we should view cerebral dominance as the result of certain general properties of the mind and of the relationship between the structures of the mind and the anatomy of the brain. The basic view underlying this proposal is that the mind is composed of a number of partially independent faculties, each of which has certain 25 1
Relating breakthroughs in phenomenology and neurobiology and current strategies for diagnosis, assessment, and clinical care, this long-anticipated Second Edition provides expanded descriptions of clinical features, further evidence linking heritability to etiology, and revised epidemiological estimates as observed in the most recent research on Tourette's syndrome (TS) and associated disorders. The latest information about the controversial poststreptococcal hypothesis is also presented and discussed.
The authors discuss four hospitalized cases of the Gilles de la Tourette syndrome, hospitalized at the psychiatric department of the Faculty Hospital in Olomouc from the foundation of the department in 1949 up to the time of writing. Particular attention is devoted to the aetiological basis of the syndrome and the authors' views are expressed especially as far as the effects of somatogenic infection are concerned. Catamnestic findings in patients are also evaluated.
The course and prognosis of the Gilles de la Tourette syndrome are analysed on the basis of 65 published cases. In 17 out of the 65 patients, the course of the disease deviated from the characteristic sequence of symptoms: motor tics, explosive utterances and/or coprolalia. The prognosis is independent of age at the onset of the disease, the appearance of the symptoms and the duration of the disease prior to treatment. The more symptoms appear in the course of the disease, the more unfavourable is the prognosis. A definite therapeutic success was observed only from haloperidol.