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This paper reports an empirical reinvestigation of data collected by Karen Kaplan-Solms and Mark Solms. It focuses on neurological patients with medial frontal lesions, who exhibit striking and strongly held false beliefs, generally referred to as confabulations. Most accounts of the cause of confabulations are cognitive, focusing on the importance of memory or executive deficits. This study attempts to test the underinvestigated suggestion that confabulations may not be emotionally neutral, having a (“wish-fulfillment”) bias that shapes the patient's perception of reality in a more affectively positive direction. When recast in psychoanalytic terms, this proposal is consistent with Kaplan-Solms and Solms's (2000) claim about the role of Freud's (1915) special characteristics of the system unconscious in understanding confabulation. The present study tests this claim by a quantitative investigation of the process notes from which the Kaplan-Solms and Solms account was generated. We replicated our previous claim that confabulations show a positive emotional bias, finding that the vast majority (79%) of confabulations occurred when the patients were in a low mood state and, simultaneously, when the confabulations were affectively positive. The possible importance of these findings, and a range of important methodological issues in relation to these data, are discussed.