False selves in neuropsychological rehabilitation: The challenge of confabulation

Abstract

The presence of confabulation following brain damage can obstruct neuropsychological rehabilitation and management. A recent theoretical approach to confabulation emphasises that neurocognitive deficits are not sufficient to account for the content of confabulation. As a result, they are also insufficient to address the unique rehabilitation challenges that confabulation raises. Instead, confabulation could be best understood as the magnification of existing reconstructive memory processes, influenced by both neurocognitive and motivational factors. The paper reviews recent experimental findings showing that confabulations serve important functions of self-coherence and self-enhancement, despite their poor correspondence to reality. Case material is used to illustrate the meaningfulness of confabulation from the subjective perspective of the patient and to demonstrate that such a theoretical approach to confabulation can best inform management and rehabilitation efforts.

Keywords:

• Confabulation
• Emotion
• Memory
• Rehabilitation
• Self
• Motivation

Acknowledgments

I am thankful to RM and his family. I am also particularly grateful to Stephen Tyrer and Philippa Griffiths for their valuable advice, collaboration and clinical insights.

Notes

¹The term confabulation has also been used to describe the unintentionally false statements of patients in many other memory-independent neurological syndromes, such as right-hemisphere unawareness syndromes (e.g., Feinberg & Roane, 1997; Fotopoulou & Conway, 2004; Tallberg, 2001). Some of the issues raised here in relation to confabulations about personal memory may be of relevance to the rehabilitation of other forms of false memories and beliefs. However, different neurocognitive deficits and motivational factors may need to be emphasised in each syndrome and these considerations go beyond the scope of the current paper.