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Every so often a patient’s family will report to the Moody Neurorehabilitation Institute that since the patient’s injury, the patient makes up false stories all of the time. They state that they correct the patient but that the patient will argue and insist that the story in question is true. This often upsets the family as they feel that the patient is deliberately telling lies. In most cases, the patient is not deliberately telling lies. The patient has a difficulty called confabulation.
Confabulation is a term describing the brain’s act of creating false memories after a brain injury. These false memories feel completely real and there is no way for the survivor to easily discern the difference between a confabulation and an accurate memory. There is no way for the survivor to stop the brain from confabulating. This is quite different from a lie, in which the liar has full control over the information and total understanding of its context. Most people are accustomed to the concept that the memory of an event having happened serves as evidence of its truth. The idea that our memories can be false is a completely foreign, sometimes hostile concept. When a patient has a confabulation, it will not occur to them to doubt the confabulation any more than it would to doubt any real memory.
Imagine if you started to talk about your personal life and someone told you that your recollections were completely wrong. This would probably frustrate you. After all, it is your life. How could someone know your life better than you? This is the conundrum faced by survivors with confabulation. Other people are constantly telling them that they are incorrect regarding their personal memories of their own lives.
Keep in mind that they have clear memories of these false events. Again, they are not deliberately fabricating these memories. This is not a psychological issue but a brain injury issue. Survivors with confabulation need to constantly check to ensure whether a memory is real or confabulation. This may mean checking with significant others or a planner/memory book. It may require that a lot more information needs to be written in their planner/memory book than is typical for other brain injury survivors. They have to get used to the idea of not trusting their own memory. How unnerving must it be when someone else knows your own life better than you?
Sometimes confabulations have a clear starting point while other times they seem to come out of the blue. Some confabulations are more logical than others. An example of a more logical confabulation is when a former church choir member thinks that they have a practice session at church in an hour, despite the fact they have not sung in church for many months. As you can see, it is not terribly odd to confabulate a false choir practice when this has been part of the person’s history. An example of a more bizarre confabulation is when a survivor thinks that their psychotherapist previously did brain surgery on them in a hospital, while the patient was awake. It is much harder to make the connection on this second example. In both cases, the patients believed their confabulations completely.
Confabulation cannot simply be cured by memory exercises or medication. Often they will fade as the patient’s health improves. However, persistent confabulations can be one of the most disabling conditions of a brain injury. If a person has a persistent confabulation that there is a meeting on the other side of town and subsequently wanders from home due to the confabulation, then he or she will need constant supervision to ensure safety.
Hopefully this clarifies the experience of confabulation and how it is differs from the telling of a lie.
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