Confabulation is a behavioral problem caused by producing false memories. Confabulated memories may never have happened or they could be a confused combination of events. The event could be real but the people or dates may be completely wrong. There is always an element of truth in a confabulated memory.
The fact that a confabulated memory sounds both reasonable and real to someone who doesn't possess more detailed knowledge points more to the need for an active family caregiver. Many times only such a caregiver can spot the false memory.
Doctors and therapists may not be able to recognize such a false memory. Friends and family may not realize the storied account being told to them is false. Now, imagine a doctor, therapist, friend or family member taking some sort of action based on a falsehood.
Cathy Crimmins, author of Where Is the Mango Princess?, walked into her husband's Philadelphia hospital room as he was telling a co-worker about an event. Al told the lady that the girl who had injured him had come to him on the sidewalk in front of the hospital and apologized for causing the accident. In fact, Al said, she said is wasn't the first time she had run over someone in a boat.
When the lady ended her visit, Cathy asked Al to repeat the story he'd told, and he told it a second time without missing a word. She asked Al what color the girl's hair was and, sure enough, he was stumped. Cathy then told him the girl was in Canada and that he had never been allowed outside the hospital. Nothing in his story was true.
Confabulators Are Not Liars
- The injured brain has fed them bits and pieces of information from an unknown origin.
- Frontal lobe damage has interrupted the executive functioning of weighing evidence and making a decision about it.
- The confabulated memory is as real to a victim of brain injury as are other memories.
Why Brain Injury Victims Confabulate
Brain injury has numerous levels. The Rancho Level of Cognitive Functioning Scale (LCFS) was developed in 1972 to assess cognitive functioning in post-coma patients. There are eight classifications that go from No Reponse to Purposeful- Appropriate.
You may hear the phrase high functioning to describe a brain injury victim whose skill level with memories and cognition are above average.
High functioning brain injury victims, many times, have no visible signs of injury. This can be a curse because society does not see the injury and expects more out of the person - whether they can do it or not.
The brain injured person may very well have progressed through terrible memory deficits, cognitive issues and behavioral problems but now appears to be "normal" once again. And this pressure to be normal can cause its own problems such as confabulation.
Given the spotlight to tell a story or answer a question, the victim does not want to exhibit word-finding problems or stare blankly with nothing to say. Those aren't "normal" things to do. The injured brain feeds bits and pieces of information that do not pass through the brain's self-awareness filter properly, and out come the words.
The brain injured person is part of a normal conversation with normal people. Wow! That feels good. And no one knows the difference - including the story teller. A confabulated story is a way to deny having an injured brain.
Neuropsychologist John DeLuca, Ph.D., director of neuroscience research at the Kessler Medical Rehabilitation Research and Education Corporation in West Orange, New Jersey, says, "They really believe with conviction that what they're saying is absolutely true."
The Value of Family Caregivers
Family caregivers may be the only ones able to recognize when a story or answer is confabulated. Remember that your loved one truly believes what they are saying, but that belief was created from bits and pieces of information delivered by an injured brain.
If at all possible, do not correct your loved one in public. Respect their desire to appear normal. Your goal is to correct the facts so the confabulated story becomes truly accurate.
If, however, they are giving false information to a medical professional, you may want to speak privately with the doctor or therapist to correct the information before something is prescribed based on that false information. Then you can later speak to your loved one about the correct information.
"Knowledge is Power to a Brain Injured Person."
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