The affective neuropsychology of confabulation and delusion

Abstract

The paper reviews the history of the scientific understanding of the role of emotion in confabulation and delusion. I argue that the significance of emotion in the pathogenesis of these symptoms was obscured by academic polarisation between psychodynamic and neurocognitive traditions and was also often obfuscated by rigid distinctions between psychogenic and neurogenic explanations. This tradition of epistemic dualism was implicitly maintained in the fields of cognitive neuropsychology and cognitive neuropsychiatry. This paper focuses on memory-related confabulation following ventromedial frontal lobe lesions, awareness-related confabulation following right perisylvian lesions, and delusions of various aetiologies. Ambiguity regarding the definition and taxonomy of symptoms renders direct comparison difficult, but certain overriding principles are becoming discernible. Recent findings suggest that emotion and motivation influence both confabulation and delusion. These influences may be instigated directly by neural dysfunction or indirectly by life changes and altered social circumstances, or by a combination of these. Importantly, the rejection of epistemic dualism in the conceptualisation of both symptoms can allow us to study them in parallel and draw conclusions about the relation between cognition and emotion. Specifically, confabulation and delusion can be described as faulty attempts to balance the conflicting demands of accurate and self-serving reality representation.

Keywords:

• Confabulation
• Delusion
• Emotion
• Motivation
• Reality monitoring

Acknowledgements

I would like to thank the organisers of the Symposium on Confabulation and Delusion, Max Coltheart, Robyn Langdon, and Martha Turner. I am grateful to Ryan McKay, and all other presenters of the symposium, for their inspiring presentations and for helping me shape my thoughts on these issues. I would also like to thank Martin Conway for his support in organising a similar symposium during the fourth international conference on Memory in Sydney and all the participants of that symposium.