Brain Fiction: Self-Deception and the Riddle of Confabulation

By Wilkes, Bailey C. | Journal of Medical Speech - Language Pathology, March 2007 | Go to article overview
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Brain Fiction: Self-Deception and the Riddle of Confabulation

Wilkes, Bailey C., Journal of Medical Speech - Language Pathology

AUTHOR: William Hirstein

PUBLISHER: The MIT Press, 2004

ISBN: 0-26208-338-8, 288 pages, $35.00

Speech-language pathologists serving individuals with dementia, frontal lobe damage, or right hemisphere syndrome are likely familiar with confabulation, a phenomenon in which individuals create false answers to probe questions that would otherwise result in a response such as "I don't know" or a true-to-fact answer. Confabulation syndrome is most commonly associated with neurologic conditions such as Alzheimer's disease, split-brain syndrome, schizophrenia, Anton's syndrome, Capgras' syndrome, and Korsakoff's syndrome. However, it also has been found to occur in cognitively intact individuals with no prior history of brain damage or chemical imbalances.

William Hirstein's Brain Fiction provides a detailed multidisciplinary overview of the confabulation syndromes that may be observed in patients with neurogenic disorders. Hirstein commences with a thorough description of confabulation and explores possible explanations for the behavior. He discusses that confabulation is traditionally divided into two categories, spontaneous and provoked. Hirstein proposes that spontaneous confabulation likely reflects the expression of delusional thoughts experienced by the confabulator. Provoked confabulation, observed when the patient is confronted with a question, potentially reflects a deficit in inhibition. Automated or stereotyped responses, exhibited by many patients with aphasia, may also be considered a form of confabulation, although Hirstein notes the underlying nature of the error in the case of aphasia is likely unique from those displayed by patients who do not have aphasia.

Discriminating "true" confabulation from other error responses is addressed in the first chapter. Hirstein suggests that it is necessary to determine whether the person intends to deceive and whether there is a motive behind the confabulation. A confabulator does not intend to lie, but in turn denies the truth and forms his or her own truth to satisfy his or her "gap" in reality. In later chapters, Hirstein compares and contrasts the falsehoods of confabulation with those displayed by liars and sociopaths. He reviews evidence that both confabulators and sociopaths can "pass" lie detector tests--confabulators because they are unaware they are lying, and sociopaths because they lack emotional (and thus physiologic) responses to their lying. Sociopaths, unlike confabulators, are fully aware of the inaccuracies in their statements, but are apparently unable to appreciate the social consequences of lying.

The title Brain Fiction appropriately encases the theme of confabulation, in that considerable evidence exists to suggest that deficits in neurologic function frequently accompany the behaviors observed in the syndrome. According to Hirstein, the widely accepted focal area of damage resulting in confabulation syndrome is the orbitofrontal cortex or frontal lobe. Hirstein goes on to discuss the relative contributions of the frontal and temporal lobes to cognitive communicative functions. He argues that patients with temporal lobe damage are more likely to self-monitor and correct their communication errors when responding to memory tasks than those with frontal lobe damage.

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