Brain Fiction (2)

Self-Deception and the Riddle of Confabulation

As already mentioned in an earlier blog, I came across the book titled ‘Brain Fiction - Self-Deception and the Riddle of Confabulation’ -  by William Hirstein (2006). Hirstein is a philosopher exploring neurological syndromes that may lead to a variety of strange behaviors, like confabulation (i.e. giving ill-grounded explanations of an event or happening), deficit of self-awareness leading to a wrongful representation of one’s own body condition (termed anosognosia), or a delusion that friends or family members have been replaced by an impostor (Capgras delusion).

But it also deals with other subjects like Obsessive-Compulsive Disorders (OCD), Hypochondria, Sociopathy, and the difference between delusion-induced confabulation, self-delusion and (deep or shallow) lying.

Now, I would like to deal a little more on this interesting subject (with some repetitions of the earlier blog).

The book is very fascinating to me (although far from easy to read). It is from 2006 (so, much time has since passed by and the book may not represent the current state of the art) but it still delivers valuable insights into the way our ‘mind/brain’ works. There is a new book by Hirstein (Responsible Brains: Neuroscience, Law, and Human Culpability (2018), but I haven’t read this one.

 

The reason why I became interested in this book is that Hirstein attempts to describe mental states such as confabulation, self-delusion and disinhibition – all of them leading to ill-grounded beliefs or (dangerous) actions.

But first some clinical examples of delusion-induced confabulation.

A patient with alcohol-induced severe memory defect (Korsakoff syndrome) was asked what he did over the weekend, and the response was: Oh, I was on a professional conference in New York City and planning a project with a large research team. He utters this quite confidently – despite the fact the he had been hospitalized for already three months. Korsakoff’s Syndrome is a disorder where the brain memory function is severely affected and cannot remember recent events – but still may be able to come up with ad-hoc confabulations to answer questions about what the affected person has been doing most recently. Such a patient may be very pleased by their ill-grounded answer and not feel any need for reconciling any contradictory claims.

A woman with (one-sided) paralysis of the arm (hemiplegia)  was talking to her daughter and claiming that she is perfectly fine (denial of paralysis). When the doctor approached her and asked if she thinks that both of her hands are equally strong, she confirms it. When asked to move the paralyzed hand, the woman rubs her paralyzed shoulder (with the other arm) and replied: Oh, I’ve got severe arthritis in my arm, you know that Doctor; it hurts. She is not lying but completely unaware of her condition and engages in a confabulatory answer (this syndrome is called: asomatognosia =  loss of recognition or awareness of parts of the body).

Such delusions are typically caused by brain deficits, defects or injuries. And since the brain is ‘extortionately complex’, so are the symptoms of an impaired brain.

Further examples of delusions and subsequent confabulations:

A blind person may deny their blindness (Anton’s syndrome). When asked what object is placed in front of their eyes, the answer might be: Oh, I can’t quite see right now, it is so dim in here. Or: I don’t have the right glasses at hand ... and quickly lose interest in this matter.

A patient says that several unfamiliar people, although they look different, are in fact the very same person (Fragoli’s syndrome)

A person may say, that they are already ‘dead’ or ‘empty’ .. and may even be placed right nowb into a coffin and buried (Cotard’s syndrome)

A person may claim that they have a ‘doppelganger’

A person may say that people change into other people (inter-metamorphosis)

A person (mostly a woman) may believe that a another person (often a famous man of higher social or professional standing) is secretly in love with them (DeClérambault’s syndrome).