Confabulation: Response to Commentaries

I am grateful for the responses to my article on confabulation by the commentators. They have all raised very important and stimulating questions. I am not sure I can address all of the points made, but I hope to address the major issues.

In the presentation of the psychoanalytic perspective on confabulation, Mark Solms provides an intriguing argument for viewing confabulation within the framework of psychoanalytic theory. I was particularly intrigued with the apparent overlap in constructs between the four characteristics of the “system unconscious” and some of the constructs in neuropsychology and cognitive neuroscience, to describe confabulation. The characteristic of tolerance of mutual contradiction, whereby two incompatible ideas can exist side by side, can be analogous to neuropsychological concepts of unawareness or impaired self-monitoring found under the rubric of executive functions. Timelessness, where mental contents are not coded in chronological sequence, is very similar to the temporal order difficulties observed in ACoA confabulators. Replacement of external reality by psychical reality, where subjective mental contents predominate over objectively derived (or reality-based) contents, in some way is related to Weinstein's notion that the content of confabulation has a “psychic” basis (Weinstein and Kahn, 1955; Weinstein and Lyerly, 1968). Primary process, where the activation of ideas is unconstrained by external processes to allow for the expression of inner needs and desires, in some broader sense can be analogous to the issues of self-monitoring in executive control systems in the brain. Dr. Solms's examples of the first two characteristics were very interesting and provocative. In the discussion of the third and fourth unconscious characteristics, the notion of “wishes” driving the content of confabulation seems more challenging to ascribe to all of the confabulations a person may make. What Dr. Solms refers to as “wishful” has the feeling of bei