Commentary on “The Pleasantness of False Beliefs”

Being a neurologist working in a rehabilitation clinic and regularly seeing patients who fail to adapt their thinking to ongoing reality, I considered it an extraordinary honor to be invited to comment on the article by Turnbull, Jenkins, and Rowley. But when I read the article, I realized that it has an entirely different approach from my own studies. It starts with an astonishing introduction—confabulations are portrayed as if they represented one homogeneous disorder, with unknown mechanism, and a diffuse anatomical basis! The introduction lumps together extremely broad classes of speculations about confabulations that I thought had been convincingly disproved (“processes related to executive function”). I am quoted within the group of seeming defenders of an executive hypothesis, which we have disproved in a number of studies: neither the severity of amnesia nor the severity of executive failures explains the occurrence of or the recovery from diverse forms of confabulations (Schnider, 2000; Schnider & Ptak, 1999; Schnider, Ptak, von Däniken, & Remonda, 2000; Schnider, von Däniken, & Gutbrod, 1996a). The hypothesis of the study revives, albeit under a new title, the century-old idea that confabulations reflect a desire (wish) to fill gaps in memory (Bonhoeffer, 1904; Pick, 1905). Studies testing this hypothesis found that, in comparison with other brain-damaged subjects, confabulators do not have an increased tendency to fill gaps in memory—that is, to respond to whatever question (Mercer, Wapner, Gardner, & Benson, 1977; Schnider, von Däniken, & Gutbrod., 1996a).

Clinicians have long made a distinction between provoked and spontaneous confabulations, without a clear idea about the pathophysiological and anatomical bases (Pick, 1905). In our observation of memoryimpaired patients, we soon realized that some amnesic patients' tendency to invent items when recalling a word list (provoked confabulations) was completely independent of and doubly dissociated from the