Wishful reality distortions in confabulation: A case report

Several theories have been proposed to account for the complex cognitive mechanisms underlying the various forms and manifestations of confabulation. As regards the content of confabulations, deficit accounts explain what is lacking in the confabulations, but accounts of the positive features of the content may also be required to explain what remains. There is reason to believe that the content of confabulations is not motivationally neutral; in particular, they appear to 'improve' the world experienced by the patient, making it more pleasant than the reality of the situation demands. The present study investigated the content of the confabulations of a neurological patient, ES: a 56-year-old man, who developed a striking confabulatory syndrome following removal of a meningioma in the pituitary and suprasellar region. ES's cognitive abilities were severely compromised, and he confabulated continuously and bizarrely. Raters presented with transcriptions of ES's confabulations found them to represent significantly more pleasant experiences than their corresponding, misrepresented realities. This finding suggests that confabulations include motivated (or 'wishful') content. The influence of this motivational feature of confabulation must be considered in parallel with the memory and executive deficits which contribute to the mechanism of confabulation. © 2003 Elsevier Ltd. All rights reserved.