Abstract
Confabulation is a symptom central to many psychiatric diagnoses and can be severely debilitating to those who exhibit the symptom. Theorists, scientists, and clinicians have an understandable interest in the nature of confabulation—pursuing ways to define, identify, treat, and perhaps even prevent this memory disorder. Appeals to confabulation as a clinical symptom rely on an account of memory’s function from which cases like the above can be contrasted. Accounting for confabulation is thus an important desideratum for any candidate theory of memory. Many contemporary memory theorists now endorse Constructivism, where memory is understood as a capacity for constructing plausible representations of past events (e.g., De Brigard in Synthese 191:155–185, 2014; Michaelian in Philos Psychol 24:323–342, 2012, 2016). Constructivism’s aim is to account for and normalize the prevalence of memory errors in everyday life. Errors are plausible constructions that, on a particular occasion have led to error. They are not, however, evidence of malfunction in the memory system. While Constructivism offers an uplifting repackaging of the memory errors to which we are all susceptible, it has troubling implications for appeals to confabulation in psychiatric diagnosis. By accommodating memory errors within our understanding of memory’s function, Constructivism runs the risk of being unable to explain how confabulation errors are evidence of malfunction. After reviewing the literature on confabulation and Constructivism, respectively, I identify the tension between them and explore how different versions of Constructivism may respond. The paper concludes with a proposal for distinguishing between kinds of false memory—specifically, between misremembering and confabulation—that may provide a route to their reconciliation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
This characterization of confabulation is meant only as a first pass at the term’s definition. As I discuss in Sect. 3, there are many competing characterizations of confabulation, including some broader definitions that capture non-memorial delusions of perception, intention, and emotion as well.
Vernacular use of confabulation dates back further—see Berrios (1998).
Korsakoff himself described these as “pseudo-memories.” Wernicke (1906) was the first to label them confabulations.
Kraepelin originally characterized these patients as suffering from a distinct disorder, paraphrenia, which is now considered a form of schizophrenia (Schnider 2008).
Many now believe that schizophrenia lumps together several genetically distinct disorders (see Arnedo et al. 2014).
It is, of course, possible that patients intend some form of deception—to convince the clinician of their improvement, or to conceal the depths of their illness (see Coltheart and Turner (2009) for a discussion of this issue). I do not mean to discount this possibility, only to emphasize what is readily apparent in most cases—i.e., that most patients believe that these reports are experiences from their own past.
For this reason, Langdon and Turner (2010) recommend a distinction between the initial adoption of confabulated content and the maintenance of belief in this confabulated content over time. Coltheart et al. (2010) argue that confabulations need not be considered delusional until the latter justificatory confabulations are produced. The cases quoted in the text exemplify such persistent confabulations.
Hirstein’s account does not lack for critics. Bortolotti and Cox (2009) challenge Hirstein for his failure to acknowledge that confabulation can confer some benefits upon the confabulator expressing them. Bortolotti continues, however, to view confabulations as malfunctions, arguing elsewhere that any account of them must be capable of distinguishing between pathological and non-pathological cases (see Bortolotti 2011).
For a discussion of the differences between accounts of philosophical Constructivism, see Robins (2016).
Even Presidents are not immune to such errors (Greenberg 2004).
Murphy (2006) offers a comprehensive discussion of such missteps in the history of psychiatry.
These remarks are intended as an appeal to a widely accepted way of characterizing the distinction between these two forms of perceptual error, not as an endorsement of any particular theory of perception.
Thanks to an anonymous reviewer for pointing out this case as an example of misremembering.
Confabulations do not appear to be useful to the act of remembering, but they may of course be of broader use to the person—e.g., by promoting self-esteem (e.g., Fotopoulou 2010). Thanks to an anonymous reviewer for raising this point.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington: American Psychiatric Association.
Arnedo, J., Svrakic, D. M., del Val, C., Romero-Zaliz, R., Hernandez-Cuervo, H., & Fanous, A. H., et al. (2014). Uncovering the hidden risk architecture of the schizophrenias: Confirmation in three independent genome-wide association studies. American Journal of Psychiatry, 172(2), 139–153.
Berrios, G. E. (1998). Confabulations: A conceptual history. Journal of the History of the Neurosciences, 7, 225–241.
Bortolotti, L. (2011). Psychiatric classification and diagnosis: Delusions and confabulations. Paradigmi, 1, 99–112.
Bortolotti, L., & Cox, R. (2009). Faultless ignorance: Strengths and limitations of epistemic definitions of confabulation. Consciousness and Cognition, 18, 952–965.
Brainerd, C. J., & Reyna, V. F. (2005). The science of false memory. Oxford: Oxford University Press.
Buchanan, A. (1991). Delusional memories: First-rank symptoms? British Journal of Psychiatry, 159, 472–474.
Christianson, S., & Loftus, E. F. (1987). Memory for traumatic events. Applied Cognitive Psychology, 1, 225–239.
Chrobak, Q. M., & Zaragoza, M. S. (2008). The cognitive consequences of forced fabrication: Evidence from studies of eyewitness suggestibility. In W. Hirstein (Ed.), Confabulation: Views from neuroscience, psychiatry, psychology, and philosophy (pp. 67–90). Oxford: Oxford University Press.
Clancy, S. A., McNally, R. J., Schacter, D. L., Lenzenweger, M. F., & Pittman, R. K. (2002). Memory distortions in people reporting abduction by aliens. Journal of Abnormal Psychology, 111, 455–461.
Coltheart, M., Langdon, R., & McKay, R. (2011). Delusional belief. Annual Review of Psychology, 62, 271–298.
Coltheart, M., Menzies, P., & Sutton, J. (2010). Abductive inference and delusional belief. Cognitive Neuropsychiatry, 15, 261–287.
Coltheart, M., & Turner, M. (2009). Confabulation and delusion. In W. Hirstein (Ed.), Confabulation: views from neuroscience, psychiatry, psychology, and philosophy (pp. 173–188). Oxford: Oxford University Press.
Dalla Barba, G. (1993). Different patterns of confabulation. Cortex, 29, 567–581.
De Brigard, F. (2014). Is memory for remembering? Recollection as a form of episodic hypothetical thinking. Synthese, 191, 155–185.
DeLuca, J. (2001). A cognitive neuroscience perspective on confabulation. Neuropsychoanalysis, 2, 119–132.
Demery, J. A., Hanlon, R. E., & Bauer, R. M. (2008). Profound amnesia and confabulation following brain injury. Neurocase, 7, 295–302.
Dewhurst, S. A., Thorley, C., Hammond, E. R., & Ormerod, T. C. (2011). Convergent, but not divergent, thinking predicts susceptibility to associative memory illusions. Personality and Individual Differences, 51, 73–76.
Ellis, H. D., Whitley, J., & Luaute, J. P. (1994). Delusional misidentification: The three original papers on the Capgras, Fregoli, and intermetamorphosis delusions. History of Psychiatry, 5, 117–146.
Feinberg, T. E., Venneri, A., Simone, A. M., Fan, Y., & Northoff, G. (2010). The neuroanatomy of asomatognosia and somatoparaphrenia. Journal of Neurology, Neurosurgery, and Psychiatry, 81, 276–281.
French, L., Garry, M., & Loftus, E. (2008). False memories: A kind of confabulation in non-clinical subjects. In W. Hirstein (Ed.), Confabulation: Views from neuroscience, psychiatry, psychology, and philosophy (pp. 33–66). Oxford: Oxford University Press.
Fotopoulou, A. (2010). The affective neuropsychology of confabulation and delusion. Cognitive Neuropsychology, 15, 38–63.
Fotopoulou, A., Conwat, M., Griffiths, P., Birchall, D., & Tryer, S. (2007). Self-enhancing confabulation: revisiting the motivational hypothesis. Neurocase, 13, 6–15.
Greenberg, D. L. (2004). President Bush’s false ‘flashbulb’ memory of 9/11/01. Applied Cognitive Psychology, 18, 363–370.
Haidt, J. (2001). The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychological Review, 108, 814–834.
Hirstein, W. (2005). Brain fiction. Cambridge: MIT Press.
Hirstein, W. (2009). The name and nature of confabulation. In J. Symons & P. Calvo (Eds.), The Routledge companion to philosophy of psychology (pp. 647–658). New York: Taylor & Francis.
Howe, M. L., Garner, S. R., Charlesworth, M., & Knott, L. (2011). A brighter side to memory illusions: False memories prime children’s and adult’s insight-based problem solving. Journal of Experimental Child Psychology, 108, 383–393.
Johnson, M. K., O’Connor, M., & Cantor, J. (1997). Confabulation, memory deficits, and frontal dysfunction. Brain and Cognition, 34, 189–206.
Korsakoff, S. (1889). Psychic disturbance in conjunction with peripheral neuritis. Trans. M. Victor & P. I. Yakovlev. Neurology, 5, 394–406 (1955).
Kraepelin, E. (1919). Dementia praecox and paraphrenia. G. M. Roberston (Ed.). Trans. R. M. Barclay. Edinburgh: E&S Livingstone.
Langdon, R., & Turner, M. (2010). Delusion and confabulation: Overlapping or distinct distortions of reality? Cognitive Neuropsychiatry, 15, 1–13.
Lofuts, E. F., Miller, D. G., & Burns, H. J. (1978). Semantic integration of verbal information into a visual memory. Journal of Experimental Psychology, 4, 19–31.
Loftus, E. F., & Pickrell, J. E. (1995). The formation of false memories. Psychiatric Annals, 25, 720–725.
McKenna, P. J., Lorente-Rovira, E., & Berrios, G. E. (2009). In W. Hirstein (Ed.), Confabulation: Views from neuroscience, psychiatry, psychology, and philosophy (pp. 159–172). Oxford: Oxford University Press.
Michaelian, K. (2011). The epistemology of forgetting. Erkenntnis, 74, 399–424.
Michaelian, K. (2012). Generative memory. Philosophical Psychology, 24, 323–342.
Michaelian, K. (2016). Mental time travel: Episodic memory and our knowledge of the personal past. Cambridge, MA: MIT Press.
Moscovitch, M. (1989). Confabulation and the frontal systems: strategic vs. associative retrieval in neuropsychological theories of memory. In H. Roediger & F. I. M. Craik (Eds.), Varieties of memory and consciousness: Essays in honor of Endel Tulving (pp. 133–160). Hillside: Erlbaum Associates.
Murphy, D. (2006). Psychiatry in the scientific image. Cambridge: MIT Press.
Nisbett, R. E., & Wilson, T. D. (1977). Telling more than we can know: Verbal reports on mental processes. Psychological Review, 84, 231–259.
Paradis, C. M., Solomon, L. Z., Florer, F., & Thompson, T. (2004). Flashbulb memories of personal events of 9/11 and the day after for a sample of New York City residents. Psychological Reports, 95, 304–310.
Ramachandran, V. S. (1996). What neurological syndromes can tell us about human nature: Some lessons from phantom limbs, Capgras syndrome, and anosognosia. Cold Spring Harbor Symposia on Quantitative Biology, 65, 115–134.
Robins, S. K. (2016). Misremembering. Philosophical Psychology, 29(3), 432–447.
Roediger, H. L. (1996). Memory illusions. Journal of Memory and Language, 35, 76–100.
Schnider, A. (2008). The confabulating mind: How the brain creates reality. Oxford: Oxford University Press.
Swartz, B. E., & Brust, J. C. (1984). Anton’s syndrome accompanying withdrawal hallucinations in a blind alcoholic. Neurology, 34, 969–973.
Talberg, I. M., & Almkvist, O. (2001). Confabulation and memory in patients with Alzheimer’s disease. Journal of Clinical Experimental Neuropsychology, 23, 172–184.
Talland, G. A. (1965). Deranged memory. New York: Academic Press.
Wernicke, C. (1906). Grundriss der Psychiatrie (2nd ed.). Leipzig: Thieme.
Acknowledgements
I am grateful to attendees of the Early Career Scholars Conference in Philosophy of Psychiatry at the University of Pittsburgh and the audience at a University of Kansas colloquium for helpful comments on previous drafts of this paper. Special thanks to Serife Tekin and Kourken Michaelian for their feedback and conversations about confabulation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Robins, S.K. Confabulation and constructive memory. Synthese 196, 2135–2151 (2019). https://doi.org/10.1007/s11229-017-1315-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11229-017-1315-1