Confabulations: A Conceptual History

Confabulations are inaccurate or false narratives purporting to convey information about world or self. It is the received view that they are uttered by subjects intent on 'covering up' for a putative memory deficit. The epidemiology of confabulations is unknown. Speculated causes include amnesia, embarrassment, 'frontal lobe' damage, a subtype of 'personality', a dream-like event, and a disturbance of the self. Historical analysis shows that 'confabulation' was constructed at the turn of the century as part of a network of concepts (e.g. delusion, fixed idea, etc.) Meant to capture narratives with dubious content. This paper deals with the history of the construction of the word and concept of confabulation and with earlier recognitions of the behaviours that serve as their referent and puts forward a model based on historical data. Two phenomena are included under 'confabulation': 'untrue' utterances by subjects with memory impairment and 'fantastic' utterances marshalled with conviction by subjects suffering from psychoses and no memory deficit. Under different disguises, the 'covering up' or 'gap filling' hypothesis is still going strong. Although superficially plausible, it poses problems in regards to the issue of 'awareness of purpose': if full awareness is presumed, then it is difficult to differentiate confabulations from lying; if no awareness is presumed then the semantics of the concept of 'purpose' is severely stretched and confabulations cannot be differentiated from delusions. The received view of confabulations also neglects the clinical observation that confabulations (particularly provoked ones!) Do occur in dialogical situations: i.e., the manner of the asking may increase their probability. It is suggested here that confabulations are a disorder of a putative narrative function which is also found in 'normal' subjects. It is also hypothesized that this trait is normally distributed in the population. In the absence of adequate epidemiological information, research efforts should be directed at mapping the distribution of this narrative (or confabulatory) capacity in the community at large. Only then it will be possible to understand the significance of its disorders. In the long term, this approach will prove more heuristic than unwarranted speculation based on few anecdotal cases.