Confabulation and delusion: A review of Hirstein's Brain Fiction

Confabulation, according to Hirstein (2005), takes many forms of ill-grounded storytelling. It can be seen in clinical conditions, including amnesia and delusional syndromes, and in healthy adults who fabricate excuses and self-deceive. Hirstein suggests that confabulation, in all its diverse forms, is caused by a combination of two "errors": a knowledge error, which disrupts creative explanation-making, plus a checking error-a failure to detect and curb ungrounded fabrications. The second error, he suggests, is common to all confabulators. In clinical cases, it is caused by damage to the orbito-frontal cortex (OFC) and, in nonclinical cases, the OFC checking mechanisms are functionally misdirected away from the fabricated content. While I found much of interest in this first "big-ideas" book of its kind about confabulation, I doubt that any single checking mechanism, whether broken or derailed, will unify the diverse phenomena which Hirstein describes as confabulatory. I distinguish between the various symptoms of "confabulation" under discussion in Hirstein's book and pay particular attention to the relation between confabulation and delusion.