Confabulation, delusion, and anosognosia: Motivational factors and false claims

Abstract

False claims are a key feature of confabulation, delusion, and anosognosia. In this paper we consider the role of motivational factors in such claims. We review motivational accounts of each symptom and consider the evidence adduced in support of these accounts. In our view the evidence is strongly suggestive of a role for motivational factors in each domain. Before concluding, we widen the focus by outlining a tentative general taxonomy of false claims, including false claims that occur in clinical settings as well as more garden-variety false claims, and incorporating both motivational and nonmotivational approaches to explaining such claims.Keywords: Anosognosia; Confabulation; Delusion; Motivational processes Patients in neurological and psychiatric settings are known to make rather striking claims. Consider the following two examples:1. ''I am the left foot of God.'' 2. ''My father is 95Á96. My mother is 10 years younger so she is 85Á86.'' The first claim is striking because it is bizarre and grandiose, but also because the individual who made it was a brilliant mathematician who went on to win a Nobel prize (see Nasar, 1998 Moscovitch, 1995, p. 228). How are we to account for such claims? And how can we characterise them? According to the scientific literature, the first example is considered to reflect a delusion (David, 1999), whereas the second is a paradigmatic instance of confabulation arising in the context of memory impairment (Moscovitch, 1995). The problem from a theoretical perspective is that it is not clear what the distinctions are between these two classes of symptom, nor what the nature of the overlap is between them, if any. This is most obvious when one considers that certain patient presentations are thought of as involving delusion in some circles, and confabulation in others. An example is anosognosia, which involves unawareness or denial of disease or disability, in particular denial of left hemiplegia following right-hemisphere brain damage. Recent authors have explicitly characterised this condition as either delusion (e.g., Aimola Davies, Davies, Ogden, Smithson, & White, 2009;Davies, Aimola Davies, & Coltheart, 2005) or confabulation (e.g., Heilman, 2009;Hirstein, 2005).One feature common to confabulation, delusion, and anosognosia is that each of these symptoms typically involves some sort of false public claim. There may be exceptions to this*for example, delusions are usually conceptualised as false beliefs (cf. Hamilton, 2007;Stephens & Graham, 2004), and beliefs can be kept private. On the other hand, it is typically because of the public declarations of deluded individuals that delusions attract clinical attention. Another exception involves the fact that delusions and confabulations might be, as it were, ''serendipitously'' true. A patient may lack access to his biographical information, yet by chance may confabulate the correct answer when asked his age. Such exceptions aside, false claims are a key feature of these disorders. Our primary aim in this paper is to consider t...

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