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A Neuroscientific Perspective on Confabulation:Commentary by
Edward Nersessian (New York)Edward Nersessianaa 72 East 91st
Street, New York, NY 10128, e-mail:Published online: 09 Jan
2014.
To cite this article: Edward Nersessian (2000) A Neuroscientific
Perspective on Confabulation: Commentary by EdwardNersessian (New
York), Neuropsychoanalysis: An Interdisciplinary Journal for
Psychoanalysis and the Neurosciences, 2:2,163-163, DOI:
10.1080/15294145.2000.10773301
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Confabulation
A Neuroscientific Perspective on ConfabulationCommentary by
Edward Nersessian (New York)
Dr. DeLuca's extensive review of the confabulationliterature and
his own findings on the subject presentus with an opportunity to
briefly review psychoana-lytic ideas about memory and attempt to
find areas ofcomplementary interest and dialogue.
Heretofore, psychoanalysis has not attempted acomprehensive
study of memory in all its complexityas has been done in cognitive
psychology. Issues suchas the distribution of memory, short term
versus longterm, encoding, storage, retrieval,
consolidation,priming, and types of memory such as implicit
versusexplicit, procedural versus declarative have not beenat the
forefront of psychoanalytic investigation. How-ever, there has been
some recent and perhaps bur-geoning interest in memory types and
their possiblerelevance to understanding transference and
charactertraits. This last matter, though of great potential
inter-est in regards to possibly refining our understandingof
aspects of procedural and semantic memories, willnot be discussed
in this brief commentary.
The main focus of study for psychoanalysts inthe area of memory
has been autobiographical mem-ory, that is to say, memory that in
one way or anotherinvolves the self. Whereas most researchers
studyingthis type of memory-often classified under explicitand/or
declarative memory-have recognized the al-terations and
unreliability of such memories over time(Loftus, 1980), to my
knowledge only psychoanalystsdirect much attention to the specific
nature and moti-vation for such distortions. In other words,
distortionsin the recollection of short- and long-term
memoriesconstitute an essential component of psychoanalyticwork.
This focus derives from a basic tenet of psycho-analytic theory-the
pleasure-unpleasure princi-ple-which is assumed to underlie the
functioning ofthe mental apparatus. According to this principle,
theorganism strives at all times to minimize unpleasure(pain) and
to (perhaps) maximize pleasure. Therefore,in memory functioning and
specifically in recollectionor remembering, most if not all
distortions are as-sumed to be motivated, that is to say, the
alterationhas occurred in order to minimize distress, even at
Dr. Nersessian is Associate Professor of Psychiatry, Cornell
Univer-sity Medical College; Supervising and Training Analyst, New
York Psy-choanalytic Institute.
163
times at the cost of an impairment in reality testing.A point
that needs to be stressed here, and which isnot always fully
appreciated, is that the psychoanlyticmethod, particularly the
aspect of it known as freeassociation, continues to be the method
that providesthe data to substantiate this assertion. (It goes
withoutsaying that the aim of the dialogue and
collaborativeresearch between neuroscientists and psychoanalystsis
to investigate other potential sources of data.) Thispsychoanalytic
data demonstrate that memory is dy-namic and alive, not fixed and
static, and furthermore,that part of this activity is the ongoing
interaction be-tween the past and the present. As Kris (1956)
wrote:"Not only does the present experience rest on the past,but
the present supplies the incentive for the viewingof the past; the
present selects, colors, and modifies.Memory, at least
autobiographical or personal mem-ory, i.e., the least autonomous
area of memory func-tion, is dynamic and telescopic" (p. 303).
A brief clinical example may help clarify the waythat
psychoanalysts look at the motivated distortionsof autobiographical
memory.
A 30-year-old man in psychoanalytic treatment(in this case, four
50-minute sessions per week), intalking about the death of his
father, described howhe had called home as usual on a Sunday
evening andwas told by his mother that his father had suffered
afatal heart attack that afternoon. This man's father wasa highly
authoritative and at times physically punitiveman, and the son had
always felt overpowered by him,both physically and intellectually.
Two years into hispsychoanalysis, this same patient retold the
story ofhis father's death. In this version, he had been homefor
the weekend when his father had died, but hadleft to go back to
college on Sunday afternoon. Uponarriving in his dorm, he had
called home, and was toldabout his father's heart attack. In the
fourth year ofhis analysis, having resolved much of his
repressedrage and the accompanying guilt toward his father, hethen
recalled that on the Sunday of his father's death,they had an
altercation, and that he had felt so badlyabout it that he had
called home from a gas station onthe way to college, only to be
told that father hadcollapsed and died soon after the patient had
left. Thislast version was later verified by the patient's
motherand older brother when eventually he was able to dis-cuss
with them the events surrounding the death.
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The first two versions of the memory of eventsdiminished
unpleasure by distorting the events. Thethird recollection, insofar
as it is closer to the actualevents, could be recalled because much
of what in hisrelationship to his father had been painful to him
hadbeen diminished.
This tendentious nature of memory distortion andalteration may,
I think, have some bearing in under-standing confabulation. It also
points to a potentialavenue of research, namely, can methods of
investiga-tion be devised to prove or disprove this basic
psycho-analytic assertion? And, if found to be valid, at whatlevel
of brain dysfunction (functional or physical innature) does the
principle no longer apply?
From a psychological and psychoanalytical pointof view, the
pleasure principle may be somewhat over-ridden in cases of severe
(and specially sustained)trauma, such as those seen in wars. These
conditions,currently diagnosed under the rubric of
posttraumaticstress disorder (PTSD), offer a unique opportunity
toobserve the effect of trauma on the mind-brain, andresearch in
the group of patients suffering from PTSDmay help elucidate the
limits of the pleasure principle.It is, in fact, through his study
of war neurosis duringthe First World War that Freud came to the
conclusionthat mastery of the trauma, through a repetition of
thememories in the present (flashback), took precedenceover the
pleasure principle. Given that an unexpectedstroke or a sudden
ruptured aneurysm can be safelyassumed to be traumatic for the
mental apparatus, itmay be interesting to explore the effect of
these partic-ular traumas on memory and the executive
functiondisorders that ensue.
Another area of psychoanalytic work that per-tains to the
subject of confabulation is that of "screenmemories," first
described by Freud and later elabo-rated upon by Fenichel (1927),
Greenacre (1949), andLoftus (1980) among others. Neuropsychologists
usethe term observer memories to describe one character-istic of
such recollections. The person rememberingsees himself or herself
as observing the scene, whichdistinguishes the memories from field
memories(Schacter, 1984). While such memories can be wovenaround
adult experiences, psychoanalytic interest hasbeen primarily
focused on the recollection of adultsabout their childhood.
Typically, such memories aredated by the person recalling them as
occurring be-tween the ages of 5 and 8. Screen memories havecertain
particular qualities: they are regular scenesworked out in plastic
form, they can be compared torepresentations on the stage, the
person rememberingalways sees (watches) himself or herself as a
child in
Edward Nersessian
the scene, there is usually a quality of distinctness
andclarity, at times even of luminosity to these scenes,and when
explored, there are always some elementsof the scene that are
either impossible or different fromwhat the person knows to be
true. These inconsisten-cies in the memory are not spontaneously
recognizedby the person but are readily acknowledged whenbrought to
their attention. For example, the windowin a scene may be different
from where it actually is,or a picture might be hanging from a wall
where, infact, a window is located. There are also alterationsin
terms of time. For example, an older brother mayappear in the
memory as much younger than he couldpossibly have been. One such
memory, for example,involved a patient seeing himself watching his
motherbeing taken by a stretcher to the hospital because shewas
having a miscarriage. When during his psycho-analysis he asked his
mother about this event, she toldhim that though she did indeed
have a miscarriage, ithappened before he was born, and she was not
takento the hospital on a stretcher.
The alterations in these memories have some ofthe features that
Solms describes in his commentaryin the present issue regarding
primary and secondaryprocess and conscious and unconscious
systems.Freud understood these memories as screening or cov-ering
other more emotionally salient or even traumaticevents. The screen,
then, is an amalgam of some aspectof the event and other more
mundane and affectivelyneutral events, and also, importantly,
fantasies. Inother words, such a memory, which in fact is
totallyfictitious in the shape it is remembered, refers to
actualevents but also to fantasies that can only be
discoveredthrough the analytic method. Thus some real events,some
fantasies, and some elements of a possibly trau-matic event combine
to create a memory which, de-spite its easily discoverable inherent
contradictions, isheld by the patient as an actual series of
events. Infact, in a good number of cases, the individuals
arerather insistent that the memory is accurate and quitereluctant
to submit it to the process of analysis. Whatgives rise to this
reluctance is no different from whatoriginally contributed to the
formation of the memory,namely the pleasure-unpleasure
principle.
Another area of interest, and one that remainscontroversial, is
the fate of the original memory andwhether it remains unaltered,
with other variants justbeing added to it. Freud believed that
memory tracespersisted forever and that under the right
conditions,that is to say, with the lifting of repression, they
couldbe recalled or in some instances, affectively relived.Given
the fact that past and present events are occa-
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Confabulation
sionally combined to alter memories both in normalindividuals
and in patients with the kinds of brain in-jury DeLuca discusses,
this issue is also relevant toconfabulation. In other words, once
patients are nolonger confabulating, are they capable of
remember-ing the events that occurred at the time of their
illnesswhich they could not remember while still confabulat-ing?
This could be particularly interesting in regard tothe tests
DeLuca's patients were given; for example,how much of the stories
they were told in a test situa-tion could they remember after
recovery?
What I have done in this brief and highly incom-plete excursion
into the complex area of memory andpsychoanalytic notions about
memory is to try to un-derscore that for psychoanalysts a
significant part ofwhat happens when memories are altered, which
isinevitable, is that there is a motive behind their distor-tion
and that the motive stems from the requirementof the mental
apparatus to decrease unpleasure andoptimize pleasure. Furthermore,
I have tried to showthat this tendentious nature of memory is so
prevalentthat the person is not aware of the distortion and
notinfrequently resists any attempts to correct it. In otherwords,
in the normal, not brain-injured individual, thefunctions that
evaluate the accuracy of the memory,the time period in which it
occurred, whether it ismemory or fantasy, whether it is one event
or twoor three events condensed into one, do not performperfectly
as they would in a machine or a computer;rather, they perform
imperfectly to satisfy other moreimportant exigencies of the
individual and the mind.
I think all the phenomena described above fallwithin DeLuca's
broad sense confabulation. Fromwhat has been said above, it can be
concluded that atone end, broad sense confabulation is the natural
stateof things, since the mental apparatus is constantly al-tering
facts to make sure that affects are regulatedwithin an optimal
range, though broad sense involves awhole range from somewhat
altered to unrecognizablyaltered. Incidentally, Gazzaniga's
Interpreter (1998)and the kind of confabulatory rationalizations
offeredafter posthypnotic suggestion do not represent
contra-dictions to psychoanalytic understanding.
In the usual situation of psychoanalytic workwith patients whose
brain is intact (see Kaplan-Solmsand Solms's work with patients who
have sustainedbrain damage; Kaplan-Solms and Solms, 2000) andwhere
no massive trauma has occurred, the pleasureprinciple holds, but
what about cases where brain in-tegrity is compromised? In other
words what aboutnarrow sense confabulation? Do the basic
regulatorymechanisms of the mind continue to operate, but op-
165
erating on and with functions that are to a greater andlesser
degree damaged? Or, are the regulatory mecha-nisms themselves to a
greater or lesser degree im-paired? The Solms' work would suggest
that the basicregulatory principle remains and that whatever
execu-tive functions are intact attempt to prevent unpleasureeven
at the cost of a denial of reality. Whether thedenial of reality is
for the purpose of affect regulationor is itself a consequence of
the underlying pathologi-cal condition, is an interesting question
and one thatcould be a subject of an investigation, possibly
leadingto a better delineation of the underlying
physicaldamage.
Additionally, while thinking of confabulation inthe broad sense
may be crucial in recognizing themechanisms common to all
confabulation, as well asuseful in directing research toward
finding the cerebralcorrelates for certain executive functions, it
is of lim-ited value in the clinical setting where diagnostic
is-sues are more pressing. Here, it is the notion of narrowsense
confabulation with more specific characteristicsthat is helpful. In
one Korsakoff patient I saw manyyears ago, the distinctive feature
was his telling anentirely different story when he was asked the
samequestion after a relatively brief interval. Such is, ofcourse,
not the case with the everyday variety of con-fabulation I focused
on above, nor is it the case withdelusions seen in paranoia or
certain schizophrenias.An intermediate state may be provided by
cases ofpseudologia fantastica, where the patient's storieskeep
constantly changing and where clearly not all theevents have a
basis in reality. With the advent of mod-ern methods of studying
brain function (PET, fMRI,etc.) pseudologia fantastica may provide
importantclues regarding confabulation.
The distinction between broad sense and narrowsense
confabulation does help to narrow the field ofstudy. Nevertheless,
a problem of definition continuesto persist and judicious
dissection of all the phenom-ena currently collected under the
rubric of confabula-tion is in order. The fixed nature of
someconfabulations versus the variability of a confabula-tion from
one moment or hour or day to the next, theseverity or bizarre
quality of the distortion, the tempo-ral alteration in only some
cases, the rigid adherenceto the distorted memory despite all
evidence to thecontrary, as in the case of the man with a dead
friendmentioned in Solms's target discussion, even the ab-sence of
confabulation in some amnesia where theperson recognizes his
inability to remember-all theseneed further study and careful
delineation. The psy-choanalytic perspective offers a way of
understanding
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the content and the form of distortions, but simultane-ously
points to the need for a better understandingof the nature of
specific executive dysfunction, or inDeLuca's words, the
"cognitive-perceptual disorderin confabulation."
Finally, I would like to end this brief commentaryon DeLuca's
very clear delineation of the pertinentissues in confabulation,
with a quote from David Ra-paport (1951). In a paper entitled
"States of Con-sciousness," Rapaport compares and contrasts
threesets of phenomena: fugue states with loss of personalidentity;
dreams, hypnogogic reverie, and daydreams;and Korsakoff s syndrome.
In doing so, he usesFreud's speculation about the early development
ofthe mind and describes the distinctions between pri-mary and
secondary process reviewed in this issue byMark Solms in his
commentary. He then concludeswith the following:
The gradual development from thought as "hallucina-tory
gratification" to thought as "experimental ac-tion" reflects the
gradual development frommonoideic consciousness of the drive
gratification topolydideic consciousness of the relation of
perceivedexternal reality, internal need, and memories of
pastexperiences. The gradual development corresponds tovarieties or
forms of consciousness in which variousbalances are struck between
perception of internaland external reality, in which internal
experience isto various (ever-decreasing) degrees experienced
asexternal reality, and in which internal and externalperception
(thought and perception of reality) are dif-ferentiated with
increasing clarity. Correspondingly,the thought forms consciously
experienced changefrom prelogical to logical, from syncretic to
abstract,from idiosyncratic to socialized. When thought hasreached
the differentiation where it appears as experi-mental action,
exploring reality for the safest and mostfeasible path toward
gratification, it has attained acomplex organization of safeguards
guaranteeing acorrect appraisal of reality and a sharp distinction
ofwish and reality, certainty and uncertainty, etc. It isthis
complex organization that is reflected in thosevarieties of
conscious experience which I have de-scribed above with the
Korsakoff syndrome, in whichthese safeguards are to a considerable
extent put outof action by the pathological process [po 402].
Edward Nersessian
The forward development in judgment, realitytesting,
differentiation between internal and externalperception, change in
thinking from prelogical to logi-cal and from syncretic to abstract
that occurs in child-hood development, are all to a greater or
lesser degreereversed (last in, first out hypothesis; Schacter,
1984)in the brain-damaged patients DeLuca describes,
withconfabulation as only one manifestation of this gen-eral
reversal.
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Edward Nersessian72 East 91st StreetNew York, NY 10128e-mail:
[email protected]
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