By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
What is confabulation?
Confabulation is sometimes called “honest lying” because the person telling the tale actually believes that it is true despite the apparent inaccuracy of their story. It is related to false memories but appears to have specific causes other than incorrect memory storage and retrieval or implanted false memories.
Confabulation is that tendency for the brains of people who can’t remember things to try to fill in the gaps of missing memory thereby making up an explanation that will answer questions. This is particularly common among chronic alcoholics, though other brain issues also cause these symptoms.
It is common in chronic alcoholics, particularly those with Wernicke-Korsakoff’s syndrome. These two syndromes used to be listed separately but current usage is to consider them both parts of the same disorder.
The Wernicke part has to do with eye movements, confusion, uncoordinated movement and sometimes even losing consciousness followed by death, which is always a bad side effect of any activity.
Wernicke-Korsakoff’s syndrome is caused by a lack of Thiamine (vitamin B-1) as a result of chronic alcoholism or malnutrition. This condition is sometimes referred to in alcoholism literature as “wet brain.” While it is treatable to some degree many chronic alcoholics never recover from the condition. In addition to confabulation and blackouts people with Korsakoff’s syndrome develop amnesia, lack insight, have reduced speech and stop caring about themselves and others.
The brains of chronic alcoholics shrink in volume and cells stop working resulting in many defects in thinking and memory.
Some authors report that confabulation results from gaps in the memory do to Blackouts or brownouts after which the brain needs to fill in the gaps by adding details from other events in the alcoholic’s life or by suggesting things that are possible even if they did not happen.
Sometimes these explanations are fantastic but it is the only explanation the person with confabulation can imagine. Confabulation can occur even without amnesia and can be extra details added onto memories.
With repeated efforts to fill in those gaps in memory, the alcoholic begins to believe those created memories.
Confabulation is also seen in people with traumatic brain injuries, Alzheimer’s disease or those with a severe mental illness which has interfered with the accurate storing of memories. This and other memory problems can also be found in people with eating disorders or excessive vomiting which results in poor nutrition to the brain.
Confabulation is most commonly verbal as in storytelling to self and others. It can become actions when the impaired person believes the story and takes action on that false memory.
The person confabulating can become confused and mix events from their real-life experiences with fictional accounts and stories they have heard in the past. They are especially at risk to confuse time, believing they did something yesterday which they did months or even years ago. They will swear they attended an appointment yesterday at an agency they have not visited in many months or possibly years.
Those with Korsakoff’s syndrome also get sources of information confused believing that they were told something by a counselor or case manager when they heard it from a friend or drinking buddies.
This might be a good place to repeat the rule of counseling. If there is any chance that the symptoms are caused by a medical condition and Wernicke-Korsakoff’s syndrome, eating disorders and other conditions causing confabulation clearly have medical causes, see a medical doctor first.
Mental health treatments are only effective once the medical issues are managed.
This post was, I realize, a bit brief. I thought while we were talking about thinking problems that affect memory it was important to remind readers of the way in which alcohol, drugs, and medical issues might be impacting those memory issues.
It would be a mistake to dismiss memory issues, confabulation or other thinking defects as being purely psychological or learning based, without the client having been checked out by a medical doctor to rule out underlying medical issues.
Here is hoping that this post on confabulation, Wernicke-Korsakoff’s syndrome and false memories was helpful and got you thinking about these issues.
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