“It’s not so important that a memory be accurate.
It’s more important that it helps us define ourselves.”  —Martin Conway, PhD[1]

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I first heard the word confabulation in the Rusk Brain Injury Day Treatment Program. I thought it was such an odd term. Like manipulating a story about yourself to prove that whatever happened or how you responded, somehow proved your value – determination, strength in the face of adversity.

Is confabulation consciously lying? No. Is it a fabrication? Yes. At the very least, confabulation is one of the stories we tell ourselves. So, what does it mean and how is it connected to TBI? I asked Google (for what it’s worth):

Psychiatric Times: the production of false or erroneous memories without the intent to deceive.
Oxford Dictionary: “imaginary experiences as a compensation for loss of memory.”

And from two expert sources:

Brain Fiction, William Hirstein, PhD (MIT Press, 2004): “Anyone broaching the topic of confabulation is faced immediately with a huge problem: there is no… problem-free definition of ‘confabulation’.”

Remembering, imagining, false memories & personal meanings, Martin Conway, PhD[ii]: Confabulation after frontal lobe injury is an attempt to make sense of the world and help create meaning for the disrupted working self. It’s inherently (and unintentionally) false.

But in fact, all human memory is to a degree false, too—it’s a reconstruction which can never be an exact replica of the experience reality. Our perceptions inevitable include past experiences that help us maintain a coherent narrative of who we are.

This really matters to me because I have a story of my own. One I tell again and again. Is it just filling gaps in my memory? Or a fabricated experience of damaged frontal lobes? Confabulation? Could be. But I’m convinced it’s true. Maybe that’s enough.

My story

January 2005, I was 51 years old. A car hit me as I crossed the street. It was my first TBI (traumatic brain injury). Police and hospital reports determined “no LOC” (loss of consciousness)—but how could they know? They didn’t even see it happen, and if they’d asked me, how would I know? Either way, my recollection is crystal clear—what I heard, saw, and thought from the moment I stepped into the street and heard the squealing brakes:

What a stupid way to go

It has been a really good life—work I loved, two great kids, parents, sister

What a relief the boys are grown up, out of the house now

It’ll be really hard on them all. But they’ll manage

And me? I’ll be dead. Won’t know a thing

Next thing I know I’m lying in the street. Someone runs to get ice for my head.
I look back and see the driver standing by the car door.

Dent in the hood [my shoulder?]
Window shield shattered [my head?]

The firemen cut off my fabulous red coat from Paris, and my red “bucket” bag

After that, a lot of “no memory.”

[END OF STORY]

I truly believe that in the split second before being hit I was aware of what was going on, considered the situation and understood the consequences. And I now believe I’m not afraid of death. (on that last point, only time will tell)

The inner monologue I had with myself is an important part of a bigger story—how I’ve changed since my TBI and what I’ve gained as a result. But I can’t ignore the possibility that I’m confabulating. What if it never really happened? Does that mean everything that followed is based on a lie (even though I never knew I was lying)?

This reminds me of when I started to read Dr. Jill Bolte Taylor’s book, My Stroke of Insight (Viking Penguin, 2005), and saw her TED Talk, one of the 5 most viewed of all time (drjilltaylor.com)   At TED, she tells the audience:

In the course of four hours I watched my brain completely deteriorate in its ability to process all information. [1:54 into TED video]

Taylor then proceeds to take you through the event moment-by-moment in mesmerizing detail. She’s incredibly smart and totally credible, but is it really possible to perceive oneself with such clarity while in the throes of a massive stroke? I’m skeptical. Even before I knew the word confabulation, I wondered if she was confabulating. Whether accurate or not, it’s her story. And it was definitively transformative.

Honestly, my story isn’t so transformative, but it may have kept me strong, empowered to go forward remembering that even under duress I wasn’t afraid; I had the presence of mind to think; to say “good-bye.” My real transformation has been learning to live with brain injury, alter my expectations and accept a self I’d never known.

But you know what? I still tell the story to myself. It may be confabulation, but I am absolutely sure it is true.

Back to Dr. Conway, with a reflection on everyday memory.

All memories are to some degree false…. In fact, the main role of memories lies in generating personal meanings—by no means damaging to the individual, but rather of considerable benefit. In particular, they maintain a coherent, confident, and positive self.[iii]

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[1] Conway, M.A., Loveday, C. (2015). “Remembering, imagining, false memories & personal meanings.” Consciousness and Cognition, 33, pp. 574-581. doi: 10.1016/j.concog.2014.12.002. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/)

[ii] Ibid.

[iii] Ibid.