The title of this book suggests two major challenges. First, to describe the confabulating mind, and second, to answer the question how the brain creates reality.
With regards to the first question the author does a very neat historical introduction citing all those from Korsakoff to Kopelman who have contributed to the development of the concept of confabulation. Based upon his own research, he comes up with four different forms of confabulation which include simple intrusions, momentary confabulations, fantastic confabulations and behaviourally spontaneous confabulations. This covers various forms of confabulations from the momentary, often as a consequence of embarrassment, to the persistent, and from those which have at least some basis in reality, to others which are simply nonsensical and illogical. The author then reviews the background aetiology and pathology of those conditions that can lead to confabulation. The Papez circuit figures strongly here, although the contribution of frontal lesions is well explored the clinical chapters are peppered with brief case histories and brain imaging for examples of damaged brain.
Amongst the conditions discussed are psychiatric ones such as schizophrenia and dementia syndromes. The areas of the frontal cortex most favoured following review of the data are the ventromedial prefrontal cortex particularly the medial orbitofrontal cortex and adjacent basal forebrain.
The author then goes on to describe psychological syndromes that overlap with confabulation, which include not only amnesia as part of the original description of Korsakoff Syndrome, but also disorders of recognition and paramnesic syndromes, déjà vu, and even anosognosia.
Essentially this broadens considerably the usual discussions that surround confabulation, which leads on to the second challenge of the book, namely how is it that false memories arise, even in the absence of course brain disease or recognized psychiatric disorder. Thus, there is a discussion of false memories, and how easy it is to manipulate memory. The author comments ‘any person with a normal memory may retrieve objectively false memories and make false statements about previous events – anyone may confabulate!’ (p. 200). This leads to a discussion of the ‘real battlefield of confabulation research: the dispute of the mechanism or mechanisms of confabulations’ (p. 203).
Earlier models of confabulation had assumed that there was one common disorder. It is clear from this book that confabulation is the outcome of a variety of processes both neurological and psychological. These concern patients' own interests, particularly with the mechanism of those confabulations that reveal the conviction of the patients' statements and which are always associated with amnesia and disorientation, and usually linked to some kind of executive dysfunction. These are the ones with the more secure anatomical foundation and which the author believes do indeed represent a unique syndrome, distinguishing them from the other forms of confabulations discussed. This form they refer to as behaviourally spontaneous confabulation, for which they provide interesting experimental support. It relates to confabulation as a failure to distinguish between memories that pertain to ongoing reality and memories that do not, representing a failure based on an inability to suppress or filter currently irrelevant memories which relates much to the activity of the orbital frontal cortex.
The book is nicely produced, easy to read and well structured. It is a good overview for anybody with an interest in confabulation, their own or other peoples, and with memory in mind.
