Commentary on “The Pleasantness of False Beliefs”

Before I address the specifics of the interesting paper by Turnbull, Jenkins, and Rowley, I would like to review some literature on the issue of the role of motivational and emotional factors in confabulation and anosognosia. In 1944, Paterson and Zangwill described confabulatory patients in a posttraumatic confusional state that misidentified their current location to a geographical location closer to their actual home. Paterson and Zangwill also noted that during the course of recovery, the patients would maintain that they were simultaneously located in both the correct and the incorrect locations, a condition that Pick (1903) called reduplicative paramnesia. Paterson and Zangwill observed that these patients were oblivious to the conflict presented by their dual orientation and would confabulate explanations when confronted with the disparity. These patients might accept the correct orientation in an “abstract geographical” sense, such as knowing the correct locale “according to the map”, but still maintain that they “felt” they were located closer to home.

Paterson and Zangwill made two important observations regarding this disorientation: (1) while amnesia was initially present, the “retention deficit cleared rapidly” and memory was adequate to recall the day's events a full week before correct orientation returned, and (2) some patients with this disorder verbally expressed a strong desire to return home. These features led Paterson and Zangwill to conclude that affective and motivational factors played a significant role in persistent disorientation. They suggested that under the conditions of brain damage, motivational factors were “actively inhibiting the cognitive mechanisms which normally subserve orientation,” and this accounted for the persistent disorientation when “cognitive recovery had proceeded far enough to permit and sustain proper orientation.” They interpreted the disorientation on the basis of both the negative features— in a Jacksonian sense