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Expletives: Neurolinguistic and

neurobehavioral inquiries into swearing
Article in Brain Research Reviews December 1999
DOI: 10.1016/S0165-0173(99)00060-0 Source: PubMed

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Brain Research Reviews 31 1999. 83104

www.elsevier.comrlocaterbres

Full-length review

Expletives: neurolinguistic and neurobehavioral perspectives on

swearing
D. Van Lancker
b

a,b,)

, J.L. Cummings

a
Department of Neurology, Uniersity of Southern California, Los Angeles, CA, USA
Department of Speech-Language Pathology and Audiology, New York Uniersity, School of Education, 719 Broadway, Suite 200, New York, NY, 10003,
USA
c
Departments of Neurology and Psychiatry and Biobehaioral Sciences, Uniersity of California at Los Angeles, Los Angeles, CA, USA

Accepted 5 October 1999

Abstract
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. q 1999 Elsevier Science B.V. All rights reserved.
Keywords: Neural basis of behavior cursing; Aphasia; Gilles de la Tourettes syndrome; Coprolalia; Basal ganglia; Limbic system

Contents
1. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Swearing in normal individuals . . . . . . . . . . . . . . . . . .
3. Swearing in aphasia following stroke and left hemispherectomy .
4. Gilles de la Tourette syndrome GTS. . . . . . . . . . . . . . . .
5. Exploring coprolalia in GTS: does the Markov model work? . . .
6. Comparison of swearing in aphasia and GTS . . . . . . . . . . .
7. Emotional and prosodic processing . . . . . . . . . . . . . . . .
8. Cerebral laterality . . . . . . . . . . . . . . . . . . . . . . . . .
9. Pathological basis to GTS: a basal-ganglia disorder . . . . . . . .
10. Limbic system-basal ganglia hypothesis . . . . . . . . . . . . . .
11. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . .
References

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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 Broadway, Suite 200, New York, NY, 10003, USA. Fax: q1-212-995-4356;
e-mail: [email protected]

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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, informally, fines may be incurred in social settings w126x.
Knowledge of swearwords takes hold early in child lan-

0165-0173r99r$ - see front matter q 1999 Elsevier Science B.V. All rights reserved.
PII: S 0 1 6 5 - 0 1 7 3 9 9 . 0 0 0 6 0 - 0

84

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

guage development w117x and often quickly achieves a

solid status in the second language learner w181x. 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 w65x.
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 functions 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. Excessive swearing occurs in traumatic brain injury w267x and in
paraplegic, spinal cord patients w149x. It occurs in the
elderly in association with depression w43,226x, encephalitis w118x, dementia w239x and klazomania w16x. Post-ictal
swearing has been reported in epilepsy w50,221x. Tardive
Tourettism, sometimes with coprolalia, has been reported
following use of neuroleptics w15,73x including in a
Japanese patient w141x. Pathological use of expletives and
taboo words and phrases is a key feature of Gilles de la
Tourette syndrome GTS. w222x and certain other movement disorders, especially Sydenhams chorea, which has
clinical similarities to GTS w144,264x.
Despite its obvious role in normal and impaired communication, 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. w20x..
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 communicative behaviors. Given the range and variety of
observations, the topic appears to be linguistically and
neurologically complex. Whatever the reasons for a traditional lack of explanatory commentary on swearing, addressing this question is warranted to advance understanding of the neurobiology of communicative behavior. Descriptive work on historical w123,181x and contemporary
w80,101,124,130132,139,210x normal swearing patterns
has appeared, and sufficient observations from neurological 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
religion-related. and visceral body functions-related.,
but the actual array of expletives extends into many semantic domains. Data reviewed by Flynn w92x 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 w123x observes that Swearing
draws upon such powerful and incongruous resonators as
religion, sex, madness, excretion and nationality, encompassing an extraordinary variety of attitudes p. 3.. Gallahorn w101x 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 w181x
distinguishes between swearing damn it., cursing
damn you., and oaths by God.. He offers fourteen
categories of swearwords that have been utilized through
the ages: 1. Supernatural or infernal powers e.g., God.;
2. Sacred matters of religion e.g., holy mass.; 3.
Saints; 4. Sacred places e.g., Jerusalem.; 5. Future
life Heavens.; 6. Ancestors and heroes; 7. Ruler or
authority e.g., by the royal robe.; 8. Oaths by natural
objects sun, German Donnerwetter, wEnglish thunderstormx.; 9. Vulgar or obscene words body parts.;
10. Bloody and its variants; 11. Miscellaneous phrases
having unusual force hang it, gracious, shiver my
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 w97,123x. Although crosslinguistic surveys are few, observations by anthropologists
suggest that most people in most cultures use expletives
w181x; they do so at different times, in various contexts,
with varying emotive content to the expressions. According to Hughes, w123x, virtually all societies, even the
most modern, retain some taboos against swearing p. 8..
For our purposes, and admittedly using a circular definition, it is sufficient to identify the group of words that are
socially opprobrious, essentially because they are considered 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 analysis.
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 frequency of use of taboo expressions across contemporary
population samples. Steadman w240x approached the topic
by asking subjects to compile lists of taboo words; males
provided the greater number. de Klerk w139x 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 w94x asked college students to list
words obscene to you using both written and tape-re-

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

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 unclassified. The most frequent exemplars of each class, in order
of frequency, are given as a. in Table 1.
A study by Gallahorn w101x tabulated and analyzed use
of taboo words by psychiatric ward personnel at psychiatric 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 workers. 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 w192x, who asked 30
neurologically normal subjects to list the words he or she
would use when upset, but would not use in polite company 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.
364. shown as Table 1c..

85

The most extensive survey work has been done by Jay

w130132x, giving frequency counts of specific expletives
as correlated with speakers 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
words hell, godwdamnx, shit and Jesus wChristx. account for
57% of the observations. Data from nursing home residents 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
w131x. To explore the words people use privately, survey
questionnaires were administered to an elderly population
in western Massachusetts, containing 26 taboo words derived from Jays previous field studies w132x. 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. Perusal 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 syntactically with other items in a number of interesting ways,
some of which are peculiar to them, while others are
merely preferred by them Ref. w244x, p. 18.. To discuss the grammar of swearwords, Taylor utilized the notion of schemata, or formulae, developed by Lyons
Ref. w162x, 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.
a. Nine most frequent swear words
by college students Ref. w94x, p.
270.
b. Swear words spoken by psychiatric ward personnel in 6-month period Ref. w101x, p. 311.
c. Normal usage survey Ref. w192x,
p. 364.
d. Public production lexicon of
18 unique words by speakers over
the age of 45 w132x
e. Nursing home residents, over age
70 w132x
f. Top 10 swear words of West
Coast speakers ages 170. w131x
g. 26 swear words, rated for frequency in personal use in an elderly
population in western Massachusetts
w132x. frequency 1 meant never
and 9 meant very often.. Four
nonswear words were included

fuck 33., cunt 23., shit 33., bastard 25., God damn 15., son of a bitch 19., whore 10., nigger 8., fascist 2.,
fuckin 2.
damn 87., hell 84., crap 41., God 34., shit 33., bitch 17., Christ 16., screw 11., pissed off 10., ass 6.,
bastard 5., butt 3., can 3., whore 3., hot pants 2., slut 2., reamed 1., shaft 1., son of a bitch 1., balls 1.,
come 1., fuck 1., laid 1., piece of ass 1., pimp 1., shack up 1., wet dream 1.
shit, God, damn, ass, fuck, Jesus, hell, crap, cock, prick, bitch, fart
hell 45., God damn. 33., shit 33., Jesus Christ. 28., fuck 24., damn 22., ass 19., bitch 13., bastard 12.,
asshole 6., bullshit 4., balls 2., prick 2., blows 1., blowjob 1., dildo 1., Jew 1., motherfucker 1.
hell 60., damn 27., shit 15., ass 9., bitch 4., Jesus Christ. 3., son of a bitch 2., bastard 1., piss 1.
fuck 212., shit 129., God 68., hell 50., damn 45., bitch 25.,motherfucker 23., ass 22., asshole 17., bullshit
15.
hell5.12., damn 5.11., goddamn 4.13., shit 3.86., bullshit 3.72., son of a bitch 3.52., ass 3.51., Jesus Christ
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
2.32., queer 2.28., prick 2.23., fuck 2.05., nigger 1.98., cock 1.95., dipshit 1.93., fag 1.86., peckerhead
1.73., spic 2.63., danger 4.45., dirty 4.44., table 4.21., flower 4.17.

86

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

be filled by how, what, why, etc., and the

second with fuckin, bloody, flamin, etc. Sentence 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 English can be well specified for descriptive and pedagogical
purposes.
Dong w79x 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, including damn and Goddamn, when used in apparently
sentential frames, have neither a declarative nor interrogative 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
V.. Thus, Dong w79x 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 hemispherectomy

As stated by Jackson w128x, 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 anothers exclusive utterance was pooh. Jackson also cites Trousseaus
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.. Jacksons 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 w64x elaborated on
the notions of automatic and propositional speech,
with the former being expressive and the latter communicative Ref. w64x, p. 229.. But in discussing recurrent utterances, Critchley observed that the utterance repertory of the patient can largely fulfill the wishes and needs
of the patient. Ref. w64x, 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 automatic speech. This observation is striking in global aphasia, 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, automatic material, including counting from one to ten and
other serial speech alphabet, days of the week., familiar
expressions how are you., pause-fillers well, ya know.,
and expletives flow fluently with effortlessly normal articulation and prosody w248x.
A chronically aphasic patient we studied made liberal
use of the expression Jesus Christ, produced fluently in
comparison with his otherwise severe word finding difficulties and effortful speech. Another produced the term
shit fluently and liberally. We have had reports of
motherfucker as a recurrent utterance in American english 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 auditoryverbal
language comprehension was severely limited. He produced no speech other than well, yeah, yes,
no, and the two expletives goddammit and shit
w256x. 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 utterances on command. When asked to read the written word
shit aloud, although his affective response to the request 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. sustained 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
spontaneous or automatic. versus elicited volitional. discrepancy seen in R.N.s swearing remains to be studied.
Following up on the anecdotal observations by Critchley w64x and Jackson w128x of aphasic swearing, investigators 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. Cummingsr Brain Research Reiews 31 (1999) 83104

87

Table 2
Recurrent utterances in severe aphasia: Britisha and Germanb corpora
Swear words
British
German
Interjections
and greetings
British
German

Numeral
British
German
Sentence-stems
British
German
Proper names
British
German
Other
British
German
a
b

bloody hell, bloody hell bugger, fuck fuck fuck, fuck off, fucking fucking hell cor blimey, oh you bugger, oh boy
ach je oh Lord., ach Gottchen oh God., ach ohroh really.

alright, because, down, off, no, yep, yes yes yes, well I know, because, away away away, funny thing funny thing,
goody goody, Its a pity pity pity, now wait a minute, pardon for you, so so, better better, sister sister
tja well., natuerlich of course., na also there you are., siehste you see., zacki zacki quick quick., so so.,
also well., so so so so, so, so., doch butryet., na na na wellrnow., Hallo hello., macht nix doesnt matter.,
weiss es nicht dont 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 dont be sad., bitte sehr please.
two two two, three three, I want to one two, I try one two, I think one two
drei three.
I bin to town, I cant, 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 cant
Ich bin I am., I will arbeiten und lernen I want to work and study.
Bill, Billy, John, Parrot, Percys died, BBC
Heidi, Bayern, Mama-Oma ma-grandma., Mama, Hans nein Hanni, Monika, Moni
Im 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
Das war wesentlich wichtig gewesen this was essentially important., Bauern farmers., Reisen trips., Mittag noon.,
Sie Sie, Dir you.

Code w57x.
Blanken w24x.

Ellis w160x studied nonpropositional speech in aphasia in

British English using six tasks, carefully designed to permit 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, Brocas,
conduction, global or Wernickes aphasia. The propositional match for counting, for example, was reading the
individual Arabic numbers. Of the six tasks, counting
110 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 investigation revealed superior sentence completion for familiar
idiomatic expressions as a form of nonpropositional speech,
compared with sentence completion for propositional expressions w252x. A functional imaging study compared
counting 110 with generating names of animals. Results
indicated that left anterior regions in and near Brocas area
areas 44 and 45. were activated during the animal naming
task, but not during counting by normal subjects w254x.
In the first actual catalogue of recurrent utterances,
Code w57x 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 vascular accident. From a survey study utilizing this patient
population, Code tabulated a list of real word recurrent
utterances, falling into seven categories. Pronounq verb

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
5r75., yesrno 4r75., numbers 5r75., repetitions
14r75. and other 22r75. see Table 2.. In his overview
of linguistic output observed in adults who have undergone
a left hemispherectomy, Code w60x concluded that utterances of the isolated right hemisphere consist primarily of
automatic and nonpropositional speech p. 331.. A second
study of aphasic speech targeted native speakers of German w2325x. The majority of lexical automatisms
these 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
tja well., natuerlich of course. and also well..
see Table 2.. Nonlexical recurrent utterances also occur;
see Refs. w27,58x.
Although much has been written in clinical descriptions
about preserved production of automatic speech, little
has appeared regarding the observe, impairment of counting, 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 w235x. 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, Hebrew; count 120, or sing familiar songs. He could no

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

88

Table 3
Transcription of utterances by EC adult left hemispherectomy. in a 5-min videotaped interview
Time

Expletive

Spont words

Pausefills

Sentence init

goddammit
goddammit

one
three
I, no place
well, as

un
boy
well

I cant
thats a

goddammit

no
eh
ah

god
goddammit

uh
nah
ah
um
mm
uh
oh, yes
no
well, yes

Response

uh

Naming target

shit
goddammit

safety pin
measuring
tape

oh, yes
ah
oh
ah

sood

Rep target

Rep response

Nonverbal vocs

book
house
Noember
deelop
remember
President
constitution
deelop
remember
Noember

m-book
uh-house

uh mm
duhh
uh,duh

safe
safety
tape

de-ve-lop
sandwich
Pres-en-dent
vegent-lich
No-vem
November

s-no
tape

neah

ugh
laugh
sigh
ah
sigh
mmsigh
tsk
whaa
nah
wha

tape measI dont

I couldnt
say in then
watch

laugh

goddammit
5

look-y
goddammit

ahh
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 righthanded adult, following neurosurgical removal of his left
hemisphere, leading to near total extirpation of propositional speech. The surgery included removal of all four left
cerebral lobes, limbic forebrain, left thalamus and basal
ganglia w232,233x, 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 w266x. 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, develop, November. with articulatory effort and errors e.g.,

president was repeated as pres-en-dent.. His spontaneous 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 vocalizations 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 effortful, uncertain and dysfluent. Similar observations were
made by Zangwill w266x 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
w127x and Gilles de la Tourette w104x, and brought to
modern understanding by Shapiro and Shapiro w222x, Com-

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

ings and Comings w63x, and numerous others for reviews

see Refs. w44,56,86,88,106,109,112,129,146x w151,183,186,
195,218,220,239,247x. The vocal tics required for diagnosis of the disorder are classified as a hyperkinetic motor
speech disorder w71x. The clinical symptom of coprolalia,
or foul speaking, is present in approximately 2550% of
persons with GTS, depending on the nature and age of the

89

population, and how the clinical population is sampled,

whether in cross-section or longitudinally. Incidence analyses w223x performed in 146 GTS patients Ref. w85x 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
GTS s number of GTS patients with coprolalia.
UK a
Spainb
Brazil c
Denmark d
Perue
Germany f i
Hong Kong j k
Sri Lankal
Italy m,y

Japann p
USAq w

fuck, cunt, bastard, piss, sod, cock, shit descending order of frequency.
puta whore., mierda shit., cono cunt., joder fuck., maricon fag., cojones balls., hijo son. de puta, hostia host.
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.
kaeft shut up., svin swine., fisse, kusse cunt., pik cock., rov ass., pis piss., gylle manure., Sgu by God.
no seas malcreado dont be bad., batidoras national, ajo ajo, carajo, serve me coffee
Nutte, Hure, Prostituierte whore.; Arshloch asshole., Scheisse shit.; Leiche corpse., Tod death. verfaulte Knochen
rotten bones., Eingeschlagene Schaedeldecke smashed skull.;
tiu fuck., shui bum., tui ma motherfucker., tiu so aunt fucker. tiu fuck., shut up, behave properly,
Why are you such a nuisance
shit Indian English.; hu, huththi whore..
taci, cretinaccio shut up, stupid.; smettila, imbecillaccio stop it, imbecile. bastardo bastard., rognoso scabby with scabs.,
vaffanculo fuck you., riccione faggot., figlio di puttana son of a bitch., stronzo piece of shit., minchia cunt, fem. genitalia.,
minchione stupid cunt., zoccola whore, fem. rat.
sukebe lecherous., chin chin cock., bakatara stupid., dobusu ugly., kusobaa shit grandma., chikusho son of a whore.,
female sexual parts.,
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. q
God damn it, damn fool, other four-letter expressions r
Fuck my your. fucking.. fucking. fucking. cunt s
fuck, shit, ass, bitch, cock, fart, suck descending order of frequency.t
you fucking idiot, assholeu
fuck you, shit on youv
fucka, fu . . . w
fuck, shit American Sign Language. x

Lees et al. w152x 20 GTS..

Lees and Tolosa, 1993 8 GTS..
c
Cardoso et al. w48x 9 GTS..
d
Reuger et al., 1986. 17 GTS..
e
Asam w7x 1 GTS..
f
Asam and Traeger w10x 1 GTS..
g
Hering w120x 1 GTS..
h
Beckers w18x 2 GTS..
i
Marneros w165x 1 GTS..
j
Lieh-Mak et al. w155x 9 GTS..
k
Singer w231x 3 GTS..
l
Perera w196x, Perera 1983. 2 GTS..
m
Escalar et al. w87x 2 GTS..
n
Kuniyoshi et al. w141x 1 Tardive GTS..
o
Nishida w189x 1 GTS..
p
Nomura and Segawa w190x 4 GTS..
q
Shapiro et al. w227x 85 GTS..
r
Lucas w158x 4 GTS..
s
Martindale w168,169x 1 GTS..
t
Nuwer w192x 12 GTS..
u
Caplan et al. w47x 1 GTS..
v
Wallen and Areneta w258x 1 GTS..
w
Milman w177x 4 GTS..
x
Lang et al. w147x 1 GTS..
y
de Divitiis w78x.
b

90

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

tinguishing the various clinical manifestations of the movement disorder have not been established, and as the variants 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%
of patients sampled in the US w193x, France n s 107.,
Germany n s 57., United Kingdom n s 54., Italy n s
46., Eastern Europe n s 25., Scandinavia n s 9., India
n s 5., Japan n s 2., Czechoslovakia n s 4., Poland
n s 2. Hong Kong n s 2. and Hungary n s 1. had
coprolalia w1,5x, but the authors did not provide examples
of specific vocalizations in the different languages. Boshes
w32x described Jamie, who swore continuously and
spewed forth an uncontrollable string of obscenities p.
715. but specific words are not listed. Pary w195x 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 neurological swearing; and we indicate when coprolalia was reported 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. w223x. Besides this work, several other authors have
provided American English examples w47,107,110,158,
177,187,258x and coprolalic American Sign Language examples w147x. Lees et al. w152x provide a listing of British
coprolalic utterances. The most frequent coprolalic items
observed clinically in the UK are provided by Lees w151x.
Cases have been described for English spoken in Australia
w51,53x, and for Canadian English, at least two studies have
reported coprolalia in GTS w49x with one study reporting
that 60% of the GTS subjects used coprolalic expressions
w180x. The New Zealand English report speaks of fourletter obscenities in a GTS patient w114x. A child in
Ireland displayed tics accompanied by cursing which was
disruptive socially w161x. A British study includes the
utterance maman mama.; this patient had French parents w89x.
Several French cases indicate usage of coprolalia w119x
or obscene words w153x, but do not list the actual
words; another gives the example trois fois par semaine
three times a week. w265x.
Spanish examples are given in Singer w226x. Four Argentinean cases were described w175x; in another study,
28% of Brazilian GTS patients had coprolalia, with examples given w48x, and a Brazilian patient with coprolalia and
compulsive screaming is described without examples w111x.
Other Portuguese language cases have been described w93x.
A GTS patient from Guyana, South America, had copro-

lalia w81x. A few unusual examples from a Peruvian report

include no seas malcreado dont be bad. and serve
me coffee w269x see Table 4.. Briones et al. w37x describe
gritas y insultas; autenticas barbaridades; palabras soeces screams and insults; authentic barbarisms; vile
words pp. 1617. all pointing to variants of expletives
but lacking specific examples.
Chinese investigators reported on five w156x and then on
18 GTS patients w155,231x in Hong Kong, 60% of whom
had single or multiple word coprolalic expressions. In
Japanese patients, coprolalia is reported w136x, and examples are given w48,141,189,190x.
Numerous papers from Germany provide clinical descriptions and some offer specific coprolalic utterances
w710,18,56,120,165,214x. Certain terms occur across several patients Arshloch, wassholex, Scheisse, Nutte wprostitutex., while others occur in a single person Leiche
wcorpsex, Tod wdeathx.. A Dutch coprolalic patient is described w238x. The Danish study of 65 patients lists specific
coprolalic utterances w202x.
Coprolalia has been reported in Italy w77x with examples
w87x. 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 w78x
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
w90,102,242x. Five reports of 38 Polish w29,140,209,
245,268x and Russian w11x patients mention bad or
obscene words. A Russian report w172x reviewed eight
patients from 913 years. GTS patients followed a stereotypical chronological sequence, with simple involuntary
facial, head and shoulder movements, nonverbal vocalizations, 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
w196x, 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 w82x reported coprolalia in an Indian subject but no
examples were given. GTS in the Middle East has been
reported w85,203x. Clinical descriptions appear in publications from Israel w100,154x. A 37-year-old Turkish male
with GTS and spinal muscular atrophy had coprolalia, but
no examples were given w217x.
Coprolalic signing has included signs for fuck and
shit w147x. 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. Cummingsr Brain Research Reiews 31 (1999) 83104

phrases of morbid content death., and a few other miscellaneous items.

5. Exploring coprolalia in GTS: does the Markov model

work?
The claim that observed coprolalic utterances in English
GTS speakers can be explained by elementary phonatory
positioning w192x 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 coprolalic productions. This claim is untenable for at least five
reasons.
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 w54,122,176x. 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..
SE KIN HE SPER GOT IN THE WORSE FART
YOUESS WELL DIN OPTION IN ITIMENTRAND
TWO AS TO BE JURGAINS FART ASSE GIVE
ONEGS LOVE BE HALLETURN MAY POCK
MOUNT ME SAM WE SNOTLEAKETIFULNT
MIGH TOONT MIT BAR SOMADE SAM SAY
It is unconvincing because only one of the phonetic combinations alleged to represent GTS vocalizations appears on
the clinical coprolalic listings in Table 4, except for the list
assembled by Nuwer w192x, and the second randomly
generated item asse. only approximates a GTS vocalization, 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 probabilistically. do not occur as part of the GTS repertory or
speech performances generally.. The numerous other coprolalic utterances, including the multisyllabic expressions,
are unaccounted for. The coprolalic productions of one
GTS patient were analyzed by Martindale w168x see Table
4., who found that the tics and tic strings consisting of
from 17 words. exhibited a complex syntax. These productions 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
of the coprolalic utterance Fuck your my. your, my.

91

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.
w46,76,98,157x.. An analysis of relative occurrence of
speech sounds as determined from telephone conversations
Ref. w91x, 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 w223x see Table 4 under
USA. contain initial phonetic elements of f, sh, and k,
which occur in 14th rating s 3.96., 18th rating s 1.74.,
and 9th rating s 5.55. place, respectively on the phoneme
frequency list. Similarly, the phoneme frequency data for
conversational American English presented in Kent w137x
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, Fletchers chart w91x 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 Frys w98x analysis of
the frequency of British vowels and consonants in conversation reproduced in Refs. w105,65x., 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 account 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 choosing the first 3 12 syllable words Nutte wwhorex, Hure
wwhorex, Arshloch wassholex, and comparing them to a
mean frequency of occurrence of letters in a German text
Ref. w122x, 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. Cummingsr Brain Research Reiews 31 (1999) 83104

92

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 hyTable 5
Phoneme and letter frequency tables
After Fletcher w91x American English conversation
Vowels

Initial consonants
articles excluded.

Sound-type

Rank

Sound-type

pin
pine
pan
pen
peel
pool
pot
pane
pole
pawn
pun
pull
pout
par
pair
purr
pew
poise

10.27
7.58
6.89
6.60
6.44
6.26
5.21
4.78
4.74
4.15
4.14
2.96
1.69
1.31
1.09
0.80
0.26
0.19

w
t
th then.
y
d
m
h
k
s
n
b
g
l
f
r
p
th thin.
sh
v
f
ch
z
zh

Rank
9.38
7.86
6.72
6.48
6.21
5.89
5.75
5.55
5.46
4.99
4.64
4.33
4.31
3.96
2.78
2.54
2.02
1.74
1.25
0.83
0.55
0.34
0.02

After Fry w98x, British english conversion

All consonants
Sound
n
t
d
s
l
th then.
r
m
k
w
z
v
b
f
p
h
ng
g
sh
j
dj
ch
th thin.
zh

All vowels
%
7.58
6.42
5.14
4.81
3.66
3.56
3.51
3.22
3.09
2.81
2.46
2.00
1.97
1.79
1.78
1.46
1.15
1.05
0.96
0.88
0.60
0.41
0.37
0.10

Sound

sof a
bit
b et
bite
but
b ait
b eat
b awd
f ather
h awed
hoot

10.74
8.33
2.97
1.83
1.75
1.71
1.65
1.45
1.37
1.24
1.13

Final
Consonant
Sound-type

Rank

t
r
n
l
z
m
d
v
ng
s
f
th with.
p
ch
b
g
sh
j
th myth.
zh

14.30
13.05
12.52
8.40
6.01
5.48
4.44
4.23
3.57
3.13
1.37
1.25
1.24
0.53
0.42
0.38
0.32
0.14
0.04
0.01

Table 5 continued.
After Hoermann w122x, German: written text
Letter

Frequency

Letter

Frequency

E
N
R
I
S
T
D
H
A
U
L
C

147 004
88 351
68 577
63 770
53 881
47 310
43 854
43 554
43 309
31 877
29 312
26 733

G
M
O
B
Z
W
F
K
V
UE
P
AE

26 672
21 336
17 717
15 972
14 225
14 201
13 598
9558
7350
5799
4992
4907

pothesis was that coprolalic productions in English constitute 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 w65x.
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, constitute an obvious content category of obscene or taboo
words of highly diversely configured phonetic composition. This fact of semantic category overrides any contribution 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 semantic 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 concatenation of sounds.
Finally, the report of coprolalic signing w147x 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
shape.
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 neurobiology and not involving probabilities is presented below.

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

6. Comparison of swearing in aphasia and GTS

Among speech pathologies, swearwords taboo expressions. 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
w223x with the British corpus for aphasia provided by Code
w57,59x. 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
GTS.
Differences are found in the manner and in the content
of speech performance for these terms. In aphasia, swearing is selectively preserved in the context of severely
impoverished speech; in GTS, swearwords are overproduced 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 ongoing, conversational speech in which it is occurring. Many
reports of coprolalic utterances in GTS describe them as
distortions: they are overly loud, or shouted, imprecisely articulated, expressed with aberrant voice quality,
and sometimes unintelligible, while speech of the patient
with GTS is otherwise normal but see Ref. w159x..
Another difference lies in substitution behavior. Persons with coprolalia have been reported to utilize euphemisms in place of the socially offensive term w165x, for
example, using gut, good. schoen, fine.
wunderbar wonderful. for Scheisse shit. and
Arshloch Asshole.. Shimberg w225x, giving an
overview of GTS for the general public, states that some
persons with GTS learn to mask words, saying, for example, fake for the more offensive word fuck. A
similar process may be underway in the observation that
some persons with GTS shout words regularly occurring in sentences w50,212,220,259x, possibly to accommodate the coprolalic inpulse in this other way. Neither a
substitution process nor compensatory shouting is observed 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 w41,143,145x. In a
survey, w147x 71% of GTS patients were found to have a
feeling that tics are imminent; 76% experience a sensa-

93

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 pharynx or larynx, then vocalizations may be produced
w143x, 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
single sensory site Ref. w28x, p. 1345.. In another patient, 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 w219x. There is no
evidence or suggestion of a comparable premonitory sensory 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 w95x.
Martindale w169x studied the syntactic and semantic correlates 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 w159x.
Other questions pertain to how GTS vocalizations compare to vocal tics occurring in normal speech production.
The notion of normal use of vocalizations has been described by Goffman w108x, who states that the public
utterance of self-talk, imprecations, and response cries
constitutes a special variety of impulsive, blurted actions,
namely, vocalized ones p. 116. and by Darwin w72x who
discusses the universality of sound emission as emotional
expression. A comparison of GTS vocal verbal and nonverbal. tics with measures of the same behaviors taken
from normal speakers was conducted w159x. 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 w145,193x. 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

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D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

the aphasic speaker- whether hershe can produce the

utterance on command. In contrast, GTS patients have
been repeatedly demonstrated to easily produce their coprolalic utterance at will and on command, without the
sense of inner tension that accompanies spontaneous coprolalia, 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 w10x. Voluntary
and spontaneous tics may use different underlying mechanisms; EEG studies w193x reported an absence of the
pre-movement potential normally associated with voluntary 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 differences 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 somewhat with time, and which eventually may evolve to
propositionally formed expressions w2x. In the chronic patient, 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 eventually 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 coprolalic behavior progresses from a stage of volition or semivolition to compulsion. Some patients report having a
related thought e.g., authentic semantic content. behind
the utterance for a while, and then eventually the coprolalic 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 w263x. While careful
studies still are needed, aphasic swearing appears to maintain a more stable course.
Coprolalic signing has been reported w147x 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 w121x, there is no report of
recurrent automatic speech or residual swearing in sign
w19x. However, focused studies on this question have not
yet been done.
Physiological versus psychiatric variables are of differing significance in GTS and aphasia. Even though the
previously held exclusive role of psychoanalytic explanations 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 w125x. Onset of symptoms is
often associated with a traumatic incident w263x. For example, in his case report of a 13-year-old Saudi female
patient, El-Assra w85x states that her condition started
seven years previously when she became extremely frightened 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 coprolalia.
Environmental conditions exacerbate or ameliorate the
intensity of the symptoms w225x; 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 w85x. In discussing GTS symptoms,
Bruun and Budman w38x 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 w129,191x, presumably 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 presence of the clinician w31x.
Meyer and Rose w174x report psychological factors as
contributing to the clinical picture in GTS. Milman w177x
reported that three of four boys with coprolalia also had
body anxiety and sexual anxiety p. 894.. Pitman and
Jenike w199x studied a patient with obsessive-compulsive
disorder OCD. and coprolalia, seeing a role for psychological factors in the genesis of tic symptomatology. Indeed, OCD, a neuropsychiatric condition, often appears
clinically in association with GTS w68,96x; many authors
view an array of motor and behavioral abnormalities as
constituting a spectrum of related phenomena e.g., Refs.
w62,241x. which include copropraxia. Beckers w18x gives a
strongly psychodynamic interpretation of the clinical presentations of five patients, although he reported psychotherapy not to be useful in these cases. Lumsden et al.
w161x 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 neurological 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. Cummingsr Brain Research Reiews 31 (1999) 83104

words all groups have in common. However, there are

differences in content of the swearword corpus for each
group. Perusal of Tables 14 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 parameter in GTS coprolalia. This notion is consistent with frequent reports of sexual preoccupation and copropractic
movements involving sexual gestures w62,69x. These kinds
of words and these gestures are not characteristic of aphasic 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 content in copropraxia and mental coprolalia. No such associated behaviors are observed in focal left hemisphere disease. 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 influenced 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 setting 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 complete enough to conclude that sexual-emotional content
characterizes the coprolalia. Thus the notion of a hyperactivation of sexual-emotional processing in vocal and gestural behaviors is useful in accounting for many of the
clinical symptoms. Habitual vocalmotor patterns may
help originate and maintain the vocalizations. For focal

95

damage to the left hemisphere, habitual island preservation 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 hemispherectomized 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 w235x, 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 w33,40,55,133,246,260x as well as
proposals that right hemisphere dysfunction contributes to
psychoaffective disorders w70x. Emotional changes also are
associated with basal ganglia disorders w170x; there are
numerous reports of changes in mood and motivation
w22,61,66,70,170,173,201,211x. Heightened social awareness may be a right hemisphere property w237,250,251x.
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 emotional prosodic comprehension in GTS are rare. One study
w75x using the Profile of Nonverbal Sensitivity PONS. test
of nonverbal communication w208x 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 movements were of the hyperkinetic variety, as in Huntingtons
patients w234x or hypokinetic, Parkinsons disease
w26,36,67x.
Prosodic production in speech, although a highly active
field of study in normal speakers w215,216x and in neurological subjects, has not been investigated in GTS. However, 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 w138,255x and comprehension occur
with damage to either hemisphere w257x as well as to
subcortical structures w45,253x. Singing of familiar songs is
often intact in aphasia, in adult left hemispherectomy and
in selective anesthetization of the left hemisphere in Wada

96

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

testing w113x; reports of singing ability in GTS have not

appeared. Singing, like swearing, appears to remain apart
from propositional language function. Since data are available 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 behaviors, the right hemisphere is important for broader
aspects of communication w249251x. Right hemisphere
behavioral functions appear to differ from those mediated
in the left hemisphere with regard to type of stimulus
preferred w6,21,34x. In visual and auditory domains, cerebral laterality studies consistently show a superiority for
right hemisphere processing of the configurational aspect
of stimuli w30,236x. Simply stated, the left hemisphere
specializes in analyzing sequences, while the right hemisphere gives evidence of a superiority in processing patterns. 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, morphemes, 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 expletives. This theoretical possibility is supported by the observations of intact swearing in severe aphasia following
extensive left hemisphere damage. and left hemispherectomized 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 w150x. The effectiveness of neuroleptics
gave the first clue to these mechanisms w148x. Evidence for
a genetic basis of the disease further supports this view
w142,150,194x.
Neuropathological studies of GTS are inconclusive
w227x. Examination of three GTS patients at autopsy revealed 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 w263x. Devin-

sky w74x proposed midbrain involvement as the site of

damage; this proposal was based on metabolic abnormalities implicating the midbrain, similarities between GTS
and encephalitis lethargica, and brain stimulation studies
w135x; midbrain involvement, with a focus on the periaquaductal gray matter, was also later proposed from radiologic
data w213x. A recent post-mortem study showed abnormalities in the globus pallidus with profoundly diminished
dynorphin-like immuno-staining in this region w116x. A
post-mortem study of three patients with GTS revealed
significantly increased dopamine uptake carrier sites in the
caudate and putamen w230x. Although no reproducible
autopsy changes have been described that definitely localize 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 tomograph CT., only 10% have shown abnormalities, and
these appear in various brain systems w17x. Despite these
inconsistencies, there is increasingly compelling evidence
that GTS is a basal ganglia disorder. Studies using magnetic resonance imaging show reduced volumes of the
caudate nuclei, lenticular nuclei, putamen, and globus pallidum compared with controls w198x. Activated brain imaging 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 w51x. Baxter
and Guze w17x 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 w83,84,182,261x. Correlative hypometabolism appears in bilateral temporal lobes of GTS subjects w84x.
Braun et al. w35x studied 18 GTS patients aged 1849. and
reported an association of clinical symptoms with increasing, 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 activity in this same area w164,262x. Disordered biogenic amine
metabolism also is supported by reduced levels of homovanillic acid in cerebral spinal fluid of patients with
GTS w42,52,229x.
Taken together with the clinical response to dopamine
blocking agents such as pimozide evidenced by most
patients with GTS w202x, the available evidence strongly
supports dysfunction of the striatal structures including
caudate, globus pallidus, and putamen in patients with
GTS w262x. Shapiro and Shapiro w222x and others point to
the effectiveness of neuroleptics, especially those with

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

dopamine D2 blocking effects, as implicating dopamine

dysfunction in GTS. Similarly, Singer w228x assigns an
important role in GTS to frontal-subcortical circuits based
on evidence from dopaminergic neurotransmission. Other
disorders such as Sydenhams chorea, hemiballismus, carbon monoxide intoxication, and post encephalitic Parkinsonism, 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 w39,45,76x. In one model of basal ganglia function, the basal ganglia are said to provide an internal
timing cue to the supplementary motor to release an action.
Georgiou et al. w103x present evidence that GTS involves
dysfunction of basal ganglia and interconnections with
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 w197x. Following a
notion first proposed by Balthasar w14x in 1957, Palumbo et
al. w194x 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 w66x. The basal ganglia receive abundant projections from the limbic system, and the frontal-subcortical
circuits integrate limbic input in the orbitofrontal-subcortical circuit and the anterior cingulate-subcortical circuit
w115x forming at least five structurally and functionally
separate circuits w3,66x. Thus, dysfunction of the basal
ganglia simultaneously produces abnormalities of limbic
system function and of limbically mediated emotional
activities. Nespoulous and Lecours w188x 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 licking, touching lips, and other stereotyped GTS movements,
and it is known that the anterior cingulate cortex receives
dopamine innervation from the midbrain w243x. Several
patients have been treated by stereotaxic surgery directed
toward the limbic system e.g., w77x.. Following successful
treatment of GTS by bilateral limbic leukotomy, Robertson

97

et al. w204x 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 cingulate gyrus, amygdala, diagonal band-substantia innominata,
ventral septal region, hypothalamus, nucleus accumbens,
ventral anterior and midline nuclei of the thalamus, and the
tegmentum w205x. Similarly, studies with the squirrel monkey revealed that emotional vocalization occurred with
stimulation of the hypothalamus, midline thalamus, amygdala, substantia innominata, septum, orbitofrontal cortex,
cingulate cortex, and anterior inferior temporal cortex w134x.
Ploog w200x 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 w25,206,207x has proposed two levels of the nervous system involved in human speechrlanguage behavior: an older system, which terminates in
cingulate gyrus at the bilateral, rostral end of limbic system, and which is capable of emotive speech behavior; and
a newer system which is cortical, unilateral, and involved
in planning. Myers w184x similarly proposed that animal.
vocalization and human speech are dichotomous.
A similar and related dichotomy is proposed for learning and memory. Simply stated, the two disparate systems
proposed w178,179x are those for establishing habitual patterns or nondeclarative also called procedural.
memories as distinctive from those for establishing new
learning or declarative memories w4x. From many kinds
of evidence, the basal ganglia are associated with motor
programs that are well established w99,167x. Marsden w166x
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 ganglia included aspects of motor control, preparation for
action, the formulation of strategies and responses, and the
establishment and selection of emotional responses w211x,
p. 20.. Baev w12,13x proposes that the basal ganglia provide 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 w185x; 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 w115x. Parallel as well as multiple reciprocally
connected structures lead to optimal conditions for cros-

98

D. Van Lancker, J.L. Cummingsr Brain Research Reiews 31 (1999) 83104

stalk, such that pathologies could produce a variety of

symptoms relating to the motor, cognitive, and limbic
function of the basal ganglia w115x, p. 261.. The role of
basal ganglia in initiating motor behaviors w167x, and the
known circuitry of frontal-subcortical connections w171x,
provide the basis for positing hyperactivated initiation of
emotionally charged, overlearned vocal output as pathophysiological basis of coprolalia.
A similar view emerged from specific studies of GTS
verbal behaviors. Following comparisons of language versus speech behaviors in GTS subjects, Ludlow et al. w159x
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 stereotypic 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 behavior 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, language, 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 w185x, 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 w17x focus on a functional
neuroanatomical involvement of the basal ganglia, prefrontal cortex, and limbic system in GTS, pointing to
well-known circuitry involved in the gating and screening 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, Sydenhams chorea, poststroke hemiballismus, and head injury w16,224x. 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 content, 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 14 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 available, compared to fuller information in normal subjects
speaking American English, and a now broad reportage of
linguistic backgrounds for coprolalia. More complete information 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 mechanisms, our conclusions about brain-behavior correlates are
of necessity speculative. Comparison of animal and human
communicative behaviors suggest that two functional systems, 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 others facilitating social interactions w75,163x. From this perspective, coprolalia in humans might represent the abnormal 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 involuntary occurrence of the motor tics. We hypothesize that
coprolalia represents a limbic vocal tic whose unique
content is informed by the social and emotional communicative 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 expression 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. Cummingsr Brain Research Reiews 31 (1999) 83104

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 structures are activated and limbic vocalizations may be facilitated. 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.

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Acknowledgements
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. Cummings is supported by an NIA Alzheimers Disease Research Center Grant, an Alzheimers Disease Research
Center of California Grant, and the Sidall-Kagan Foundation.

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