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.