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Neuropsychoanalysis: An Interdisciplinary Journal

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A Neuroscientific Perspective on Confabulation:

Commentary by Edward Nersessian (New York)
Edward Nersessian

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 Edward
Nersessian (New York), Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 2:2,
163-163, DOI: 10.1080/15294145.2000.10773301
To link to this article: http://dx.doi.org/10.1080/15294145.2000.10773301

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A Neuroscientific Perspective on Confabulation

Commentary by Edward Nersessian (New York)

Dr. DeLuca's extensive review of the confabulation

literature and his own findings on the subject present
us with an opportunity to briefly review psychoanalytic ideas about memory and attempt to find areas of
complementary interest and dialogue.
Heretofore, psychoanalysis has not attempted a
comprehensive study of memory in all its complexity
as has been done in cognitive psychology. Issues such
as the distribution of memory, short term versus long
term, encoding, storage, retrieval, consolidation,
priming, and types of memory such as implicit versus
explicit, procedural versus declarative have not been
at the forefront of psychoanalytic investigation. However, there has been some recent and perhaps burgeoning interest in memory types and their possible
relevance to understanding transference and character
traits. This last matter, though of great potential interest in regards to possibly refining our understanding
of aspects of procedural and semantic memories, will
not be discussed in this brief commentary.
The main focus of study for psychoanalysts in
the area of memory has been autobiographical memory, that is to say, memory that in one way or another
involves the self. Whereas most researchers studying
this type of memory-often classified under explicit
and/or declarative memory-have recognized the alterations and unreliability of such memories over time
(Loftus, 1980), to my knowledge only psychoanalysts
direct much attention to the specific nature and motivation for such distortions. In other words, distortions
in the recollection of short- and long-term memories
constitute an essential component of psychoanalytic
work. This focus derives from a basic tenet of psychoanalytic theory-the pleasure-unpleasure principle-which is assumed to underlie the functioning of
the mental apparatus. According to this principle, the
organism strives at all times to minimize unpleasure
(pain) and to (perhaps) maximize pleasure. Therefore,
in memory functioning and specifically in recollection
or remembering, most if not all distortions are assumed to be motivated, that is to say, the alteration
has occurred in order to minimize distress, even at
Dr. Nersessian is Associate Professor of Psychiatry, Cornell University Medical College; Supervising and Training Analyst, New York Psychoanalytic Institute.

times at the cost of an impairment in reality testing.

A point that needs to be stressed here, and which is
not always fully appreciated, is that the psychoanlytic
method, particularly the aspect of it known as free
association, continues to be the method that provides
the data to substantiate this assertion. (It goes without
saying that the aim of the dialogue and collaborative
research between neuroscientists and psychoanalysts
is to investigate other potential sources of data.) This
psychoanalytic data demonstrate that memory is dynamic and alive, not fixed and static, and furthermore,
that part of this activity is the ongoing interaction between 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 viewing
of the past; the present selects, colors, and modifies.
Memory, at least autobiographical or personal memory, i.e., the least autonomous area of memory function, is dynamic and telescopic" (p. 303).
A brief clinical example may help clarify the way
that psychoanalysts look at the motivated distortions
of autobiographical memory.
A 30-year-old man in psychoanalytic treatment
(in this case, four 50-minute sessions per week), in
talking about the death of his father, described how
he had called home as usual on a Sunday evening and
was told by his mother that his father had suffered a
fatal heart attack that afternoon. This man's father was
a highly authoritative and at times physically punitive
man, and the son had always felt overpowered by him,
both physically and intellectually. Two years into his
psychoanalysis, this same patient retold the story of
his father's death. In this version, he had been home
for the weekend when his father had died, but had
left to go back to college on Sunday afternoon. Upon
arriving in his dorm, he had called home, and was told
about his father's heart attack. In the fourth year of
his analysis, having resolved much of his repressed
rage and the accompanying guilt toward his father, he
then recalled that on the Sunday of his father's death,
they had an altercation, and that he had felt so badly
about it that he had called home from a gas station on
the way to college, only to be told that father had
collapsed and died soon after the patient had left. This
last version was later verified by the patient's mother
and older brother when eventually he was able to discuss with them the events surrounding the death.

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164
The first two versions of the memory of events
diminished unpleasure by distorting the events. The
third recollection, insofar as it is closer to the actual
events, could be recalled because much of what in his
relationship to his father had been painful to him had
been diminished.
This tendentious nature of memory distortion and
alteration may, I think, have some bearing in understanding confabulation. It also points to a potential
avenue of research, namely, can methods of investigation be devised to prove or disprove this basic psychoanalytic assertion? And, if found to be valid, at what
level of brain dysfunction (functional or physical in
nature) does the principle no longer apply?
From a psychological and psychoanalytical point
of view, the pleasure principle may be somewhat overridden in cases of severe (and specially sustained)
trauma, such as those seen in wars. These conditions,
currently diagnosed under the rubric of posttraumatic
stress disorder (PTSD), offer a unique opportunity to
observe the effect of trauma on the mind-brain, and
research in the group of patients suffering from PTSD
may help elucidate the limits of the pleasure principle.
It is, in fact, through his study of war neurosis during
the First World War that Freud came to the conclusion
that mastery of the trauma, through a repetition of the
memories in the present (flashback), took precedence
over the pleasure principle. Given that an unexpected
stroke or a sudden ruptured aneurysm can be safely
assumed to be traumatic for the mental apparatus, it
may be interesting to explore the effect of these particular traumas on memory and the executive function
disorders that ensue.
Another area of psychoanalytic work that pertains to the subject of confabulation is that of "screen
memories," first described by Freud and later elaborated upon by Fenichel (1927), Greenacre (1949), and
Loftus (1980) among others. Neuropsychologists use
the term observer memories to describe one characteristic of such recollections. The person remembering
sees himself or herself as observing the scene, which
distinguishes the memories from field memories
(Schacter, 1984). While such memories can be woven
around adult experiences, psychoanalytic interest has
been primarily focused on the recollection of adults
about their childhood. Typically, such memories are
dated by the person recalling them as occurring between the ages of 5 and 8. Screen memories have
certain particular qualities: they are regular scenes
worked out in plastic form, they can be compared to
representations on the stage, the person remembering
always sees (watches) himself or herself as a child in

Edward Nersessian
the scene, there is usually a quality of distinctness and
clarity, at times even of luminosity to these scenes,
and when explored, there are always some elements
of the scene that are either impossible or different from
what the person knows to be true. These inconsistencies in the memory are not spontaneously recognized
by the person but are readily acknowledged when
brought to their attention. For example, the window
in a scene may be different from where it actually is,
or a picture might be hanging from a wall where, in
fact, a window is located. There are also alterations
in terms of time. For example, an older brother may
appear in the memory as much younger than he could
possibly have been. One such memory, for example,
involved a patient seeing himself watching his mother
being taken by a stretcher to the hospital because she
was having a miscarriage. When during his psychoanalysis he asked his mother about this event, she told
him that though she did indeed have a miscarriage, it
happened before he was born, and she was not taken
to the hospital on a stretcher.
The alterations in these memories have some of
the features that Solms describes in his commentary
in the present issue regarding primary and secondary
process and conscious and unconscious systems.
Freud understood these memories as screening or covering other more emotionally salient or even traumatic
events. The screen, then, is an amalgam of some aspect
of the event and other more mundane and affectively
neutral events, and also, importantly, fantasies. In
other words, such a memory, which in fact is totally
fictitious in the shape it is remembered, refers to actual
events but also to fantasies that can only be discovered
through the analytic method. Thus some real events,
some fantasies, and some elements of a possibly traumatic event combine to create a memory which, despite its easily discoverable inherent contradictions, is
held by the patient as an actual series of events. In
fact, in a good number of cases, the individuals are
rather insistent that the memory is accurate and quite
reluctant to submit it to the process of analysis. What
gives rise to this reluctance is no different from what
originally contributed to the formation of the memory,
namely the pleasure-unpleasure principle.
Another area of interest, and one that remains
controversial, is the fate of the original memory and
whether it remains unaltered, with other variants just
being added to it. Freud believed that memory traces
persisted forever and that under the right conditions,
that is to say, with the lifting of repression, they could
be 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 normal

individuals and in patients with the kinds of brain injury DeLuca discusses, this issue is also relevant to
confabulation. In other words, once patients are no
longer confabulating, are they capable of remembering the events that occurred at the time of their illness
which they could not remember while still confabulating? This could be particularly interesting in regard to
the tests DeLuca's patients were given; for example,
how much of the stories they were told in a test situation could they remember after recovery?
What I have done in this brief and highly incomplete excursion into the complex area of memory and
psychoanalytic notions about memory is to try to underscore that for psychoanalysts a significant part of
what happens when memories are altered, which is
inevitable, is that there is a motive behind their distortion and that the motive stems from the requirement
of the mental apparatus to decrease unpleasure and
optimize pleasure. Furthermore, I have tried to show
that this tendentious nature of memory is so prevalent
that the person is not aware of the distortion and not
infrequently resists any attempts to correct it. In other
words, in the normal, not brain-injured individual, the
functions that evaluate the accuracy of the memory,
the time period in which it occurred, whether it is
memory or fantasy, whether it is one event or two
or three events condensed into one, do not perform
perfectly as they would in a machine or a computer;
rather, they perform imperfectly to satisfy other more
important exigencies of the individual and the mind.
I think all the phenomena described above fall
within DeLuca's broad sense confabulation. From
what has been said above, it can be concluded that at
one end, broad sense confabulation is the natural state
of things, since the mental apparatus is constantly altering facts to make sure that affects are regulated
within an optimal range, though broad sense involves a
whole range from somewhat altered to unrecognizably
altered. Incidentally, Gazzaniga's Interpreter (1998)
and the kind of confabulatory rationalizations offered
after posthypnotic suggestion do not represent contradictions to psychoanalytic understanding.
In the usual situation of psychoanalytic work
with patients whose brain is intact (see Kaplan-Solms
and Solms's work with patients who have sustained
brain damage; Kaplan-Solms and Solms, 2000) and
where no massive trauma has occurred, the pleasure
principle holds, but what about cases where brain integrity is compromised? In other words what about
narrow sense confabulation? Do the basic regulatory
mechanisms of the mind continue to operate, but op-

165

erating on and with functions that are to a greater and

lesser degree damaged? Or, are the regulatory mechanisms themselves to a greater or lesser degree impaired? The Solms' work would suggest that the basic
regulatory principle remains and that whatever executive functions are intact attempt to prevent unpleasure
even at the cost of a denial of reality. Whether the
denial of reality is for the purpose of affect regulation
or is itself a consequence of the underlying pathological condition, is an interesting question and one that
could be a subject of an investigation, possibly leading
to a better delineation of the underlying physical
damage.
Additionally, while thinking of confabulation in
the broad sense may be crucial in recognizing the
mechanisms common to all confabulation, as well as
useful in directing research toward finding the cerebral
correlates for certain executive functions, it is of limited value in the clinical setting where diagnostic issues are more pressing. Here, it is the notion of narrow
sense confabulation with more specific characteristics
that is helpful. In one Korsakoff patient I saw many
years ago, the distinctive feature was his telling an
entirely different story when he was asked the same
question after a relatively brief interval. Such is, of
course, not the case with the everyday variety of confabulation I focused on above, nor is it the case with
delusions seen in paranoia or certain schizophrenias.
An intermediate state may be provided by cases of
pseudologia fantastica, where the patient's stories
keep constantly changing and where clearly not all the
events have a basis in reality. With the advent of modern methods of studying brain function (PET, fMRI,
etc.) pseudologia fantastica may provide important
clues regarding confabulation.
The distinction between broad sense and narrow
sense confabulation does help to narrow the field of
study. Nevertheless, a problem of definition continues
to persist and judicious dissection of all the phenomena currently collected under the rubric of confabulation is in order. The fixed nature of some
confabulations versus the variability of a confabulation from one moment or hour or day to the next, the
severity or bizarre quality of the distortion, the temporal alteration in only some cases, the rigid adherence
to the distorted memory despite all evidence to the
contrary, as in the case of the man with a dead friend
mentioned in Solms's target discussion, even the absence of confabulation in some amnesia where the
person recognizes his inability to remember-all these
need further study and careful delineation. The psychoanalytic perspective offers a way of understanding

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166
the content and the form of distortions, but simultaneously points to the need for a better understanding
of the nature of specific executive dysfunction, or in
DeLuca's words, the "cognitive-perceptual disorder
in confabulation."
Finally, I would like to end this brief commentary
on DeLuca's very clear delineation of the pertinent
issues in confabulation, with a quote from David Rapaport (1951). In a paper entitled "States of Consciousness," Rapaport compares and contrasts three
sets of phenomena: fugue states with loss of personal
identity; dreams, hypnogogic reverie, and daydreams;
and Korsakoff s syndrome. In doing so, he uses
Freud's speculation about the early development of
the mind and describes the distinctions between primary and secondary process reviewed in this issue by
Mark Solms in his commentary. He then concludes
with the following:
The gradual development from thought as "hallucinatory gratification" to thought as "experimental action"
reflects the gradual development from
monoideic consciousness of the drive gratification to
polydideic consciousness of the relation of perceived
external reality, internal need, and memories of past
experiences. The gradual development corresponds to
varieties or forms of consciousness in which various
balances are struck between perception of internal
and external reality, in which internal experience is
to various (ever-decreasing) degrees experienced as
external reality, and in which internal and external
perception (thought and perception of reality) are differentiated with increasing clarity. Correspondingly,
the thought forms consciously experienced change
from prelogical to logical, from syncretic to abstract,
from idiosyncratic to socialized. When thought has
reached the differentiation where it appears as experimental action, exploring reality for the safest and most
feasible path toward gratification, it has attained a
complex organization of safeguards guaranteeing a
correct appraisal of reality and a sharp distinction of
wish and reality, certainty and uncertainty, etc. It is
this complex organization that is reflected in those
varieties of conscious experience which I have described above with the Korsakoff syndrome, in which
these safeguards are to a considerable extent put out
of action by the pathological process [po 402].

Edward Nersessian
The forward development in judgment, reality
testing, differentiation between internal and external
perception, change in thinking from prelogical to logical and from syncretic to abstract that occurs in childhood development, are all to a greater or lesser degree
reversed (last in, first out hypothesis; Schacter, 1984)
in the brain-damaged patients DeLuca describes, with
confabulation as only one manifestation of this general reversal.

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Edward Nersessian
72 East 91st Street
New York, NY 10128
e-mail: enerss@worldnet.att.net