Oct 2011

When Conviction Becomes Confabulation

Ever since I started working on Miracle Detectives, the TV show that I co-hosted on the OWN network, I’ve been fascinated by circumstances in which a person maintains a particular belief in the face of contradictory evidence. My goal on the show was never to shake someone’s faith but rather to explore mysterious phenomena with the tools that science has to offer. Most people could incorporate whatever new information I was able to glean into their existing worldview but once in a while, I met someone who stuck to a certain belief regardless of the evidence for or against it. That sort of conviction is considered noble in many situations: we value loyalty in friends and employees, we admire religious fervor, we encourage determination in the pursuit of wildly ambitious dreams and we set instincts on a higher pedestal than data in many business decisions.

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(c) Dragoncrafted.com


But when does conviction turn into confabulation? Confabulation is a term that neurologists coined to describe a disorder of memory in which a patient gives a false or contrived answer to questions about the past but who believes that these answers reflect the truth. It was first described in patients with Korsakoff’s syndrome, whose memories have been obliterated by thiamine (vitamin B1) deficiency usually following years of alcohol abuse and/or severe malnutrition. Oliver Sacks poignantly described a case study in The Lost Mariner and A Matter of Identity in his book The Man who Mistook his Wife for a Hat.*

But while the Korsakoff’s patient represents one extreme, we have all confabulated at one time or another. Young children reporting their own memories often confabulate, as they learn how to distinguish remembering from fantasizing. We often indulge in impulse buying, justifying our purchases after the fact with false memories and constructing a narrative that makes sense and leaves our ego intact. We deny our shortcomings; the vast majority of us consider ourselves to be ‘above average’ in most instances. In the extreme cases of anosognosia, or denial of illness often following stroke, some patients will deny that part of their anatomy has been paralyzed, insisting that if they really wanted to, they could move the affected region.

Doubt, particularly in Western society, is interpreted as a sign of weakness. For many people, the term ‘skeptic’ is synonymous with Doubting Thomas, someone who refuses to believe unless shown direct evidence, and being called a skeptic is seen as pejorative amongst many social groups. Confabulation involves a lack of doubt, about something that is inherently doubtful: one’s memory for the past. But confabulation also involves a skill that humans have perfected: story-telling.

Some evolutionary psychologists argue that our propensity for creating, telling and remembering stories emerged about the same time that the proliferation of our neocortex began to differentiate us from other primates, and that this metabolically-expensive leap in brain size was driven by the need to communicate with each other and navigate social relationships. As our ancestors found strength in numbers, understanding and predicting the behavior of fellow co-habitants afforded a certain advantage, genetically-speaking. Stories might have served as tools for accomplishing this delicate task. But when that storyteller is let loose, and the Doubting Thomas in the brain is silenced, either unintentionally by brain damage or deliberately by conviction, confabulation is the result. Perhaps what fascinates me, then, is the interplay between the interpreter and the doubter in different people: how the relationship between these two components of the mind can result in belief or doubt.

*This book has also been made into an opera with music by Michael Nyman, which I’ve been dying to perform.

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A World Without Meaning

Winning the 2011 Society for Neuroscience Brain Awareness Video Contest this year is a heart-wrenching animated poem told with the voice of a 10-year old boy whose grandfather has suffered a stroke and developed aphasia, a language impairment. It’s called The Treasure Hunt and it does a wonderful job of humanizing and explaining the condition. Language is such a central part of our minds that it’s very difficult for most of us to imagine a world in which our capacity to talk and express ourselves using speech is stripped away.

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As the fall settles in, and the holiday season has officially kicked off with Canadian Thanksgiving, opera singers everywhere are performing superstitious rituals with the aim of fending off illnesses. Some rinse their sinuses with saline daily, others add honey to their tea in generous portions; everyone’s hands begin to dry up from the liberal application of sanitizing gels and the first sensation of an itchy throat sends us burrowing under our covers to nap the germs away. For a singer, losing one’s voice means losing work and opportunities to generate future work. Because our productivity and happiness depend on a healthy voice, and getting sick is relatively unpredictable and mysterious, we latch onto home remedies and folk wisdom more readily than the average Joe.

When we do get sick, however, we refrain from talking as much as possible and, for a short while, we glimpse a world in which speech is an inaccessible form of communication. Being theatrical people by nature, we rely more heavily on facial expressions and gestures. Individuals with aphasia are also encouraged to use other forms of communication such as writing, or gesturing or drawing to get their ideas and desires across.

But what if the very meaning of the words is what begins to deteriorate rather than the ability to form them? What does it feel like to lose concepts? If you no longer know that an eagle is an eagle and a mouse is a mouse, does the world seem full of wonder or mystery? The patients that I’ve been studying at UCSF are suffering from semantic dementia, a progressive degenerative brain disease that slowly erases their conceptual knowledge. A baby learns first that a bird is a type of animal, and then that an eagle is a type of bird: patients with semantic dementia first forget that eagles and hawks are different types of birds, and eventually they can’t distinguish a bird from another animal.Their loss follows the development of language in reverse.

Often, these patients choose to engage in activities that involve complex visual images as their disease progresses: they love working on jigsaw puzzles, playing solitaire on the computer, gardening, and some even begin to paint or sculpt works of art. My goal has been to try to understand the changes in the mind that lead to this paradoxical emergence of visual creativity. I’ve approached this question using the rigorous methods of neuroscience: tracking where patients look when they are viewing pictures or art work or searching for a specific target in a large array, comparing the brain volumes of patients with healthy counterparts and patients with other diseases and correlating these volumes with specific behavior, timing how long it takes them to find a target and how accurately they can perform a difficult visual search task. It turns out that they are faster and more accurate than healthy controls in tasks like ‘Where’s Waldo?’, and the brain regions that correlate with performance on those tasks are the same regions involved in grapheme-color synaesthesia, a condition in which people ‘see’ letters and numbers in color.

When a video like The Treasure Hunt puts the experience of aphasia into a simple and elegant poem, I can’t help but wonder what it must be like to experience the world through the lens of semantic dementia: when things lose their meaning, are they less distracting? Does the world become more vivid and alive? Many of their paintings seem to suggest that it does. And the fact that these patients find new ways of communicating underscores the central role that relationships and social interactions play in our lives. The holidays are designed to strengthen the ties that bind us to friends and family, and as the days get shorter and the nights grow colder, it’s as good a time as any to return those personal calls.

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Five Lessons Opera Singers can learn from Moneyball

My husband is a pretty serious baseball fan: there are 162 games in the regular season that his team plays and he listens to almost all of them. So in the interest of sharing that part of his life, and not simply becoming an off-season wife, I developed an understanding and eventually a love for the game and our team.


It’s hard not to be romantic about baseball. ~ Billy Beane, GM of the Oakland A’s



One of the aspects of baseball that I’ve come to love is the conversation. I love listening to broadcast legends Jon Miller and John Sterling call the games of our two favorites teams. Often, when Adam and I are cooking dinner together, he reads me the latest post from Joe Posnanski’s blog. I love the soap opera, the human drama, the boyish charm and the respect for the past that infuses the game. All of these qualities baseball has in common with opera.

But I was surprised by how much opera singers can learn from the movie Moneyball.

Five Lessons for Opera Singers from the movie Moneyball

1. No scout has a crystal ball. In industries as competitive as baseball and opera, no one can predict who will be a major player and who will spend a career languishing on the sidelines. Anyone who claims to have that knowledge should be avoided. The truth is that what worked in the past might not work in the future and the best thing an aspiring athlete, musician, actor or entrepreneur can do is work hard to hone the necessary skills and be ready when opportunity knocks. But there is also room for analysis: not everyone can be a home-run hitting machine, and a team needs guys who consistently get on base. There are other roles in opera besides the leads and consistently nailing them with grace and precision will lead to more work.

2. Take time to react. The performances by the actors in the movie were spectacular. There were many scenes in which their faces took up the entire shot and their thoughts and feelings were projected onto the screen without the usual help from the musical score. Onstage, it’s often hard to resist the temptation to react to what your fellow actors or singers are going to do, rather than what they have just done, especially in opera, where much of the timing is dictated by the composer. And 5 seconds onstage can feel like an eternity. But the performances in the movie underscore the power of the well-timed reaction. Give the audience time to digest and we’ll be with you the whole way through. There is power in doing nothing but listening.

3. Make every pitch count. If you make the starting pitcher work hard and never swing on the first pitch, chances are your team will be up against relievers sooner rather than later. The same advice applies to how singers should rehearse and perform. Mindlessly breezing through blocking or vocal exercises accomplishes very little but focussed practice leads to exceptional performance. Make every rehearsal count.

4. Don’t bunt. If you’re going to swing, make it a homerun. Don’t cheat the audience of your best performance. If you’re sick, underprepared or in any way unable to do your best, send in your backup. By the same token, don’t just throw together a performance, no matter how little the pay or how small the audience. Swing to send it over the fence. Every time.

5. It’s easy. It’s incredibly hard. The audience wants to think that you’re so talented and skilled that it’s easy for you to do this very difficult thing. No one wants to see your effort. But it’s incredibly hard. Work at it until you can make it look easy, even if it doesn’t feel that way. Always underestimate the effort when speaking to your audience - they don’t need to know about your trials and tribulations - that just ruins the romance.

And there’s no point in playing baseball or singing opera if the romance is missing.
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