For the past several months, we have noticed a tendency in my father where he doesn’t quite answer a question, but rather talks around and around and around and around and around and so forth. He used to do this when he was in posssession of his full mental faculties (because you know, Jesuit-trained abstract philosophical thinkers are inherently unable to give you a direct answer), but it has gotten considerably worse. It’s no longer about teasing out the various permutations of an argument, or enjoying a certain form of casuistry, but rather it became pure rambling, with messed up details. Mum and I thought that this was a normal thing amongst those of a certain age. Apparently, not really.
When we visited the neurologist last week, he asked Apa a question, to which he spent about 2 minutes replying. The doctor (a reputable neurologist that closely studies PART) confirmed that Apa was confabulating. Obviously, as a researcher myself, I had to learn more.
According to Wikipedia, confabulation is “a disturbance of memory, defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world, without the conscious intention to deceive” (emphasis mine). It is, in essence, when the person misremembers, and starts to change the details, ranging from minor alterations to the absolutely bizarre. HOWEVER, and this is important: they are not doing this on purpose. They are not lying. So, for example, Apa cannot seem to remember that he had dinner. After dinner, him and Mum will go and watch a bit of tele, and then he will go to bed. However, inevitably, he will ask whether or not he will get dinner. Even if the plates are not clear, and it’s obvious that he ate it, he will say ‘not him’ (or since when!) and will claim that it’s the boy who has somehow sat in his place and ate his food. Even presented with evidence, Apa will believe the boy came in, sat in his place, ate his food, and left. His brain cannot accept that he already ate a mere hour and half ago.
So to sum up, it’s a disturbance in the force of the memory (as a Sci-Fi geek, you know I had to put in a Star Wars reference), where the person is creating a narrative based on misremembered or skewed memories because their brain is incapable of properly making the connections. They aren’t lying. They aren’t even distorting the reality in order to fit their preconceived notion of how it should be, then believing it (so when a person told themselves that they got fired because their boss made them mess up, and then telling that lie so many times that they believe it, rather than admit that they were a piss-poor employee). Rather, in confabulation, their brain is literally telling them that what they are saying is true. The eerie part? While it’s partially made up, it’s primarily based on memory; it’s just that the context is way off. So that boy? It may have been my brother, as he used to sit in our father’s place and eat, and one time drank from Apa’s favourite mug. That was, however, over 30 years ago, and that ‘boy’ knows better than to drink out of anyone’s favourite mug. The point is, while based on memory, it is utterly false in the present (my brother is something like over 2400km away), but Apa truly believes it.
Researchers are not sure why a person confabulates. Theories ranges everything from an inherent need to preserve identity (self-identity theory; that is we know that our memory is shot, and so in order not to lose ourselves, we create the narrative) to a dysfunction in the cognitive processes of the brain (neuropsychological theories;that the link between the short and long-term memories are destroyed, so the brain creates that link between the two to explain the gap). There are also many other theories. And just to add another wrench in this: there are many different types of confabulations.
There are several signs and symptoms:
1. There is usually an autobiographical inclusion, but can also include historical facts, elements from fairy-tales, or other details that they may have been familiar with (such as stories, or television programmes).
2. They are logical in that it could make sense (even if it’s in an alternate universe), but can be either based in reality or completely fantastical.
3. The premise of the narrative, context, or the details, are false (or both)
4. The account is usually drawn from the person’s memory of actual experiences, and can include what they were thinking of (so what you thought about when you saw Vin Diesel kissing that girl on film could end up you claiming that he was kissing you. To which I would be very very jealous).
5. The person is completely unaware that it’s not based in reality.
6. The person is unconcerned with the errors, will be convinced that their version is correct when pointed out, and is confident in their confabulation.
7. There is no motivation for the person in telling the confabulation.
This may beg the question whether or not this is a delusion. It’s a difficult line to draw: they both believe the distortion of reality. One of the major differences is that confabulation is almost always associated with memory, whereas delusion is associated with belief. One is located in the past, the other one is located in the present. Someone with delusion may believe they are being actively followed. Someone who is confabulating may just seem to remember that they were being followed. The line isn’t always clear, especially as sometimes, confabulation may cause a person to actually believe something.
So what causes it? We aren’t sure, but it has to do with the brain not acting and connecting the way it should. For whatever reason, the pathways are shot. It’s also not limited to demensia; certain brain damage (such as aneurysm) causes a person to confabulate; Wenicke-Korsakoff syndrome; schizophrenia, or even traumatic-brain injury.
What can a caretaker do? Not much, unfortunately. Try to accept that this narrative is their reality. It helps to know that the confabulation is not them trying to lie, it is that their memory is just misfired. Do not try to convince them of our reality; you cannot. It’s a case of smile and nod. On the more intriguing ones, I record my father’s ramblings, and usually for the others just listen with half an ear. Mum and I try to figure out what time period he is talking about, and then make the appropriate comments. Or, in the case of dinner, we will give him a three-quarters portion, and the rest when he asks it. But the truth is, they can be slightly odd and annoying (like the supper). But that’s his disease, not him.
Sometimes, on the other hand, it can be actually pretty funny. Like how Apa was describing how he was finding chickens in hidden trap doors. In various churches. Yeah. I know. Holy chicken.
William Hirstein, Brain Fiction: Self-Deception and the Riddle of Confabulation (Cambridge MA: The MIT Press, 2005)