This website is intended for healthcare professionals

Echolalia; with a note on some synaesthestic phenomena

Posted in Neurological Signs on 12th Dec 2013


  • The term echolalia is used by two canonical American authors: Scott Fitzgerald and Kurt Vonnegut.
  • Synaesthetic phenomena may be described in Vonnegut’s Slaughterhouse-five.
  • Neurological phenomena may be described in works of literature.


Echolalia may be defined as the involuntary automatic repetition of an interlocutor’s speech.1 The involuntary qualification excludes voluntary or wilful repetition, which many of us may have indulged in, perhaps as children, with a view to annoy or ridicule parents or friends. There may be various clinical causes for echolalia, including autism; transcortical aphasias including dynamic aphasia; Tourette syndrome; neurodegenerative disorders such as some cases of Alzheimer’s disease, behavioural variant frontotemporal dementia, and corticobasal degeneration; and focal epilepsy.

Remarkably enough, the word echolalia is used in two classics of the American 20th century literary canon. In The Great Gatsby (1926) by F Scott Fitzgerald (1896-1940), at one of Gatsby’s famed and opulent parties:

There was the boom of a bass drum, and the voice of the orchestra leader rang out suddenly above the echolalia of the garden.2

The word seems to be used here to describe the babble or chatter of voices, and not a clinical phenomenon.

In Slaughterhouse-five, or the Children’s Crusade (1969) by Kurt Vonnegut (1922-2007), a more extensive usage of the word echolalia appears. Billy Pilgrim, the book’s protagonist, is lying in a hospital bed in 1968 having just survived an aircrash. He shares his hospital room with Professor Bertram Copeland Rumfoord of Harvard, Official Historian of the Unites States Air Force. Rumfoord is puzzling over how to incorporate in his one-volume history of the Army Air Force in World War Two an account of the bombing of the German city of Dresden on 13th February 1945 in which around 135000 civilians were killed, an event which Billy witnessed as a prisoner of war, locked in Slaughterhouse-five.

“I was there,” he said.
It was difficult for Rumfoord to take Billy seriously, since Rumfoord had so long considered Billy a repulsive non-person who would be much better off dead. Now, with Billy speaking clearly and to the point, Rumfoord’s ears wanted to treat the words as a foreign language that was not worth learning.
“He’s simply echoing the things we say … He’s got echolalia now.”

The author then tells the reader that:

Echolalia is a mental disease which makes people immediately repeat things that well people around them say. But Billy didn’t really have it. Rumfoord went on insisting for several hours that Billy had echolalia – told nurses and a doctor that Billy had echolalia now. Nobody took Rumfoord’s diagnosis seriously.3

Clearly echolalia is being used in a clinical sense here, although by a non-clinician, to label somebody as mentally deficient.

Synaesthestic phenomena

There are some other passages of possible neurological interest in Kurt Vonnegut’s novel Slaughterhouse-five. Time is an important element in the book, indeed Billy is a traveller in time, as well as space. A passage in which time appears to run backward, such that Billy sees planes taking off backwards (i.e. appearing to land), was apparently a stimulus for Martin Amis’s novel Time’s Arrow: or The Nature of the Offence (1991). Billy is also taken to the planet Tralfamadore (alien abduction phenomenon?) where “the most important thing” he learns is that:

All moments, past, present, and future, always have existed, always will exist.4

This “tenseless” philosophical viewpoint of time is picked up on by Cytowic and Eagleman in their book on synaesthesia. They discuss “number forms” or “spatial sequence synesthesia”, a phenomenon reported by some synaesthetes in which number or time sequences are experienced in precise locations in relation to the body.5

There are some further passages in Vonnegut’s novel which are perhaps suggestive of transmodal sensory experience or cross-modal activation. For example, whilst listening to the singing of a barbershop quartet on his wedding anniversary, an unexpected event occurs:

as the quartet made slow, agonized experiments with chords … Billy had powerful psychosomatic responses to the changing chords. His mouth filled with the taste of lemonade, and his face became grotesque, as though he .. were being stretched on .. the rack.6

This description includes several of the characteristics ascribed to synaesthetic experience: it was involuntary or automatic; generic or categorical (“taste of lemonade”), and affect-laden, although there is no indication as to whether the experience was consistent (how often do we hear a barbershop quartet?). In addition, during his wartime experience in Europe, Billy

had been seeing St Elmo’s fire, a sort of electronic radiance around the heads of his companions and captors. It was in the treetops and on the rooftops of Luxembourg, too, it was beautiful.7

This might be termed illusory visual spread or visual perseveration, other literary examples of which have been noted.8 This might also be a synaesthetic phenomenon: Cytowic and Eagleman report a patient who “has emotionally mediated synesthesia causing him to see colored auras around objects”.9

I do not know whether Vonnegut was synaesthetic, but it is possible he may have suffered from depressive episodes and post-traumatic stress disorder, perhaps related to his war experience in Dresden.10

1. Larner AJ. A dictionary of neurological signs (3rd edition). London: Springer, 2011:125-6.

2. Fitzgerald FS. The Great Gatsby. London: Penguin, 1990 [1926]:50.

3. Vonnegut K. Slaughterhouse-five, or the Children’s Crusade. London: Vintage, 2000 [1969]:140-1.

4. Ibid.:19.

5. Cytowic RE, Eagleman DM. Wednesday is indigo blue. Discovering the brain of synesthesia. Cambridge: MIT Press, 2009:124-5.

6. Op. cit., ref. 3:125-6.

7. Op. cit., ref. 3:46.

8. Larner AJ. Illusory visual spread or visuospatial perseveration. Adv Clin Neurosci Rehabil 2009;9(5):14.

9. Op. cit., ref. 5:10. 10. Shields CJ. And so it goes: Kurt Vonnegut, a life. New York: Henry Holt, 2011.

ACNR2013;13:6:43. Online 5/2/14

Download this Article