Do confabulatory explanations and memory distortions occurring in the clinical population have any epistemic benefits? Let’s start by considering evidence for the view that autobiographical memory is instrumental to self-knowledge and identity formation processes. Autobiographical memory encompasses memories of specific events (e.g. how I felt when I passed my driving test) and memories of facts that are personally relevant (e.g. what was my grandmother’s name). When autobiographical memory is impaired, the capacity to construct, update or preserve a coherent sense of self is compromised.
Addis and Tippett (2004) explore how impairments in autobiographical memory in patients with Alzheimer’s disease impact on perceptions of themselves including knowledge of their own character traits, and personal narratives describing events in their lives. The evidence suggests that loss of childhood and early adulthood memories in particular has a negative effect, leading, for instance, to providing vague answers to key questions about the self.
Reflecting on the fabrication and distortion of memory in a patient with brain damage, Fotopoulou et al. (2004) talk about the complex ways in which autobiografical memories and sense of the self interact. The sense of self contributes to the reconstruction of our autobiographical memories: present values and goals influence the way we read our past. But memory shapes our sense of self too. Consistently with what was observed in Alzheimer’s patients, autobiographical memories provide constraints on one’s sense of self and, when some of those memories are no longer available, then maintaining the same (or any) sense of self becomes a challenge.
Questions about the self may receive vague answers or no answers at all, but when an answer is given, it may be a confabulation. In the absence of autobiographical content and constraints, values and goals take over and the confabulated self is often an enhanced self. The patient studied by Fotopoulou and colleagues “filled the gaps” by reconstructing a better life for himself – his hospital stays became holidays in exclusive resorts.
The confabulatory explanations provided by people living with the often devastating effects of dementia or brain damage are an extreme version of the confabulatory explanations we all engage in. People act a script that is known to them (the hospitable lady, the successful businessman, the proficient chess player) linking their current experiences to routines from their previous lives, which are often remembered in a superficial, fragmented and motivationally biased way.
It is not uncommon for a person with Alzheimer’s disease to deny the death of loved ones, and recall happy moments spent with them as if they happened recently. A person seriously debilitated by brain damage may describe her impairments as minor and maintain a picture of her premorbid self as healthy and independent. In this context, coherence with a poorly remembered or a wished-for self trumps correspondence with the actual self.
The ensuing explanations and narratives are unreliable, misleading, often groundless. But it may not always be a good idea to challenge them. They play a role by enabling people to preserve the link between past and present and hang onto a sense of self which imperfectly connects them to their physical and social environment, and provides meaning. Fotopoulou (2008) argues that “confabulations represent attempts to define one’s self in time and in relation to the world” and as such they “serve important identity formation functions” (page 542).
From an epistemic point of view – this is what I would like to think more about – confabulations may facilitate the preservation of relevant knowledge and self-knowledge which would otherwise be lost, the price to pay being a good measure of distortion and self-enhancement. But even supposing that, in the described clinical contexts, some knowledge could be preserved by engaging in confabulatory explanations and memory distortions, this would not be sufficient to make such cognitions epistemically innocent.
We would need to ask in what circumstances a false self is to be preferred to a fading self.