Confabulation

I recently learned a new word, confabulation. I learned it in the context of a memory test I observed. The test was to listen to a short story about a woman who was grocery shopping, lost her wallet, couldn’t pay at checkout, then a little girl found the wallet and called the woman who lost it to return it. There were more details, but not too many more. The test was to listen to the story, then repeat it as accurately as possible, immediately. After this test, other tests occurred and then, maybe 15 minutes later, there was another test asking the test taker to repeat this story. The test taker was able to give about 30-50% of the details, but added details of his own creation to the story, thereby confabulating real details with fictitious ones. With thanks to Google, the definition of confabulation in the world of the mind (i.e., psychology, psychiatry, etc.) is the replacement of a gap in a person’s memory by a falsification that he or she believes to be true. Other definitions of the word point out that the falsifications are not “intentional” in the sense the person is trying to invent the story, but rather, he or she is just filling in the gaps of what he/she remembers to tell the story to completion. The teller often comes across as very certain about the details of the story such that, if one did not know what was reality and what was confabulated, one might believe the erroneous parts of the story. This is a common situation when dealing with someone whose mental faculties are failing, as in the case of a person with dementia. And, it is very difficult to handle because arguing with someone who has dementia is pointless. When someone with dementia confabulates memories, it is sometimes difficult to know what to believe. Thus, it is critical that anyone so afflicted not attend medical appointments alone, or tend to legal and financial matters, as that person cannot handle his or her own affairs. A caregiver is critical in this regard. While thinking about my new word and its definitions, I thought of it another context, that is, our world, of working with jury/juror decision making. We routinely point out the cognitive distortions that occur in juror deliberations. These are the errors the jurors make in recalling the facts of the case. As we tell our clients, they need to know these things to ensure that they explain the case well enough that the real jurors don’t make the same mistakes as the mock jurors because the jurors who get the facts wrong, or who forget them, will confabulate the story of the case in their own mind. Trial attorneys must use all available teaching and learning techniques to avoid both the memory errors of cognitive distortions and the attempts to fill the gaps of confabulation. As I thought of my new word, I couldn’t help but hear the chorus to the song Anticipation (by Carly Simon). The chorus is:

Anticipation, anticipation
Is makin’ me late
Is keepin’ me waitin’

With apologies to Ms. Simon:

Confabulation, confabulation
Is makin’ memories wrong
Is not the truth really

Just as David makes a musical reference, followed by an apology, to Carly Simon, I will first reference, then apologize to, the great band, The Traveling Wilburys. (For the reader who does not know, the Traveling Wilburys was a “super group,” that is, a band comprised of immensely famous musicians. Its members were George Harrison, Bob Dylan, Roy Orbison, Jeff Lynne, and Tom Petty.) The Traveling Wilburys released a song in 1988 titled “Congratulations,” with its first verse containing the following lyrics:

Congratulations for breaking my heart
Congratulations for tearing it all apart
Congratulations, you finally did succeed
Congratulations for leaving me in need

Keeping with David’s musical theme and related to his topic, here are my revised lyrics:

Confabulation of what happened here
Confabulation of a memory so dear
Confabulation, you’ve got it all wrong
Confabulation, you’ve been confused all along

As David correctly notes, confabulation is an unintentional fabrication, distortion, or misinterpretation of a memory. The person who confabulates has forgotten many of the details about an event, a person, etc. and, in an attempt to appear as if everything is normal, fills in details about things that actually never happened, or if they did, were not as described. People who confabulate are often confident that what they are recalling is accurate, thus, to the uninitiated listener, they may seem like they know what they are talking about, while, in reality, the story can be quite different. A person who confabulates is quite different from one who lies or withholds the truth, in that the confabulation is unintentional. The effect on the casual observer, however, is often the same. For example, my late mother, prior to suffering from dementia, had a tendency to, shall we say, “color” the truth so that situations were interpreted in ways most favorable to her. There were numerous occasions when she would fabricate what happened by rewriting history about certain events in her life. This is vastly different from when, after being diagnosed with a form of dementia known as Pick’s Disease, Mom would fill in details about things that had happened according to familiar patterns from her life, in general. It became important for me, in managing her health care, financial, and other needs, to know when she was unable to distinguish between truth and fiction, versus when she was creating a fictional account of an event intentionally. The mind is a complex piece of equipment and sometimes, these truths are stranger than fiction.

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