Shirah Vollmer MD

The Musings of Dr. Vollmer


Posted by Dr. Vollmer on October 15, 2010

    Bella, eighty-six, the mom of Nell, sixty-two, told her daughter that Nell was not invited for Thanksgiving because Nell’s sister Stephanie was mad at her ever since Nell was “too busy” to take Stephanie to get an MRI of her brain. Nell was furious. Stephanie and Nell had a misunderstanding. They cleared the air. Nell called Stephanie immediately, but Stephanie took a while to get back to her, so Nell was stewing on this for days. Ultimately, Stephanie and Nell concluded that Bella made the whole thing up. It is true that Stephanie and Nell “had words.” It is also true that Stephanie was not having Thanksgiving this year. The connection between these two events were woven together in Bella’s mind such that she created a narrative which made sense, but was not true. Confabulation describes what happened to Bella. The mind wants to make sense of events, so when there is confusion, some people, with brain damage (early dementia is possible in the case of Bella), fill in the narrative rather than saying “I don’t know”. Understanding that Bella’s narrative could be an early sign of underlying organic disease is helpful since now Nell knows that everything Bella says must be subject to corroboration. Nell learned the hard way. What if Nell did not understand that confabulation was a sign of brain disease? I imagine so many families with misunderstandings about their elderly loved ones such that heated arguments and frustrations ensue, secondary to attributing blame or maliciousness to these innocent, but hurtful, tales. Brain disease, at any age, is terrifying. Understanding brain decay, as with so much of human behavior, is the first step.

4 Responses to “Confabulation”

  1. Shelly said

    Is confabulation only associated with dementia? It sounds like it could be a normal part of human processing or thinking: not given all the facts in a situation, we make up parts which seem reasonable to fill in the blanks. I can imagine this happening in many day-to-day interactions.

    • To a certain degree, confabulation is normal; you are right. However, let’s say you knew that your sister and your nephew were not talking to each other, but you did not know why. You also knew that they fought over who was responsible to make dinner, but this was many years ago. Most people would not connect those two distinct memories and believe it to be true (ie say they are not talking to each other because he did not make dinner one evening). With confabulation, two memories, unrelated to each other, can be connected to make sense out of a situation where there is a piece missing.

  2. kristin said

    Are the links that Bella’s mind makes meaningful in understanding her internal world, or are they just random noise? I have an elderly relative who has started to have very vivid hallucinations that she likes to talk about in detail. They have very complicated story lines like dreams. I know that freud said that dreams are the royal road to the unconscious. Do these sorts of confabulations and hallucinations provide valuable information about a person’s unconscious fears, wishes, desires etc.? For example could Bella’s confabulation reflect a fear that her children will grow apart when she dies? Or is garbled contemt that is generated by brain damage meaningless?

    • It is hard to say. I think you are right to equate Bella’s associations to a dream. They are fragments of thought, and as such, they are subject to interpretation, as opposed to a fact.

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