The Situation of Confabulation
Posted by The Situationist Staff on April 13, 2009
Helen Philips had a nice article titled “Mind fiction: Why your brain tells tall tales,” in the October 2006 issue of New Scientist. Here are some excerpts.
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The kind of storytelling my grandmother did after a series of strokes . . . [n]eurologists call . . . confabulation. It isn’t fibbing, as there is no intent to deceive and people seem to believe what they are saying. Until fairly recently it was seen simply as a neurological deficiency – a sign of something gone wrong. Now, however, it has become apparent that healthy people confabulate too.
Confabulation is clearly far more than a result of a deficit in our memory, says William Hirstein, a neurologist and philosopher at Elmhurst College in Chicago and author of a book on the subject entitled Brain Fiction . . . . Children and many adults confabulate when pressed to talk about something they have no knowledge of, and people do it during and after hypnosis. . . . In fact, we may all confabulate routinely as we try to rationalise decisions or justify opinions. Why do you love me? Why did you buy that outfit? Why did you choose that career? At the extreme, some experts argue that we can never be sure about what is actually real and so must confabulate all the time to try to make sense of the world around us.
Confabulation was first mentioned in the medical literature in the late 1880s, applied to patients of the Russian psychiatrist Sergei Korsakoff. He described a distinctive type of memory deficit in people who had abused alcohol for many years. These people had no recollection of recent events, yet filled in the blanks spontaneously with sometimes fantastical and impossible stories.
Neurologist Oliver Sacks of the Albert Einstein College of Medicine in New York wrote about a man with Korsakoff’s syndrome in his 1985 book The Man Who Mistook His Wife for a Hat. Mr Thompson had no memory from moment to moment about where he was or why, or to whom he was speaking, but would invent elaborate explanations for the situations he found himself in. If someone entered the room, he might greet them as a customer of the shop he used to own. A doctor wearing a white coat might become the local butcher. To Mr Thompson, these fictions seemed plausible and he never seemed to notice that they kept changing. He behaved as though his improvised world was a perfectly normal and stable place.
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So confabulation can result from an inability to recognise whether or not memories are relevant, real and current. But that’s not the only time people make up stories, says Hirstein. He has found that those with delusions or false beliefs about their illnesses are among the most common confabulators. He thinks these cases reveal how we build up and interpret knowledge about ourselves and other people.
It is surprisingly common for stroke patients with paralysed limbs or even blindness to deny they have anything wrong with them, even if only for a couple of days after the event. They often make up elaborate tales to explain away their problems. One of Hirstein’s patients, for example, had a paralysed arm, but believed it was normal, telling him that the dead arm lying in the bed beside her was not in fact her own. When he pointed out her wedding ring, she said with horror that someone had taken it. When asked to prove her arm was fine, by moving it, she made up an excuse about her arthritis being painful. It seems amazing that she could believe such an impossible story. Yet when Vilayanur Ramachandran of the University of California, San Diego, offered cash to patients with this kind of delusion, promising higher rewards for tasks they couldn’t possibly do – such as clapping or changing a light bulb – and lower rewards for tasks they could, they would always attempt the high pay-off task, as if they genuinely had no idea they would fail.
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What all these conditions have in common is an apparent discrepancy between the patient’s internal knowledge or feelings and the external information they are getting from what they see. In all these cases “confabulation is a knowledge problem”, says Hirstein. Whether it is a lost memory, emotional response or body image, if the knowledge isn’t there, something fills the gap.
Helping to plug that gap may well be a part of the brain called the orbitofrontal cortex, which lies in the frontal lobes behind the eye sockets. The OFC is best known as part of the brain’s reward system, which guides us to do pleasurable things or seek what we need, but Hirstein . . . suggest that the system has an even more basic role. It and other frontal brain regions are busy monitoring all the information generated by our senses, memory and imagination, suppressing what is not needed and sorting out what is real and relevant. According to Morten Kringelbach, a neuroscientist at the University of Oxford who studies pleasure, reward and the role of the OFC, this tracking of ongoing reality allows us to rate everything subjectively to help us work out our priorities and preferences.
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Kringelbach goes even further. He suspects that confabulation is not just something people do when the system goes wrong. We may all do it routinely. Children need little encouragement to make up stories when asked to talk about something they know little about. Adults, too, can be persuaded to confabulate, as [Situationist contributor] Timothy Wilson of the University of Virginia in Charlottesville and his colleague Richard Nisbett have shown. They laid out a display of four identical items of clothing and asked people to pick which they thought was the best quality. It is known that people tend to subconsciously prefer the rightmost object in a sequence if given no other choice criteria, and sure enough about four out of five participants did favour the garment on the right. Yet when asked why they made the choice they did, nobody gave position as a reason. It was always about the fineness of the weave, richer colour or superior texture. This suggests that while we may make our decisions subconsciously, we rationalise them in our consciousness, and the way we do so may be pure fiction, or confabulation.
More recent experiments by philosopher Lars Hall of Lund University in Sweden develop this idea further. People were shown pairs of cards with pictures of faces on them and asked to choose the most attractive. Unbeknown to the subject, the person showing the cards was a magician and routinely swapped the chosen card for the rejected one. The subject was then asked why they picked this face. Often the swap went completely unnoticed, and the subjects came up with elaborate explanations about hair colour, the look of the eyes or the assumed personality of the substituted face. Clearly people routinely confabulate under conditions where they cannot know why they made a particular choice. Might confabulation be as routine in justifying our everyday choices?
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Even when we think we are making rational choices and decisions, this may be illusory too. The intriguing possibility is that we simply do not have access to all of the unconscious information on which we base our decisions, so we create fictions upon which to rationalise them, says Kringelbach. That may well be a good thing, he adds. If we were aware of how we made every choice we would never get anything done – we cannot hold that much information in our consciousness. Wilson backs up this idea with some numbers: he says our senses may take in more than 11 million pieces of information each second, whereas even the most liberal estimates suggest that we are conscious of just 40 of these.
Nevertheless it is an unsettling thought that perhaps all our conscious mind ever does is dream up stories in an attempt to make sense of our world. “The possibility is left open that in the most extreme case all of the people may confabulate all of the time,” says Hall.
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To read the entire article, including a discussion of the problem of relying on eyewitnesses, click here. To read some related Situationist posts, see “The Interior Situation of Complex Human Feelings,” “Magic is in the Mind,” “John Darley on “Justice as Intuitions” – Video,” “The Split Brain and the Interior Situation of Theories of the Self,” “Jonathan Haidt on the Situation of Moral Reasoning,” and “Vilayanur Ramachandran On Your Mind.”