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.
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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.
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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.
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Robins, S.K. Confabulation and constructive memory. Synthese 196, 2135–2151 (2019). https://doi.org/10.1007/s11229-017-1315-1
- Constructive memory
- Memory errors
- Psychiatric nosology