There’s one thing knowing that following a brain injury you can be forgetful. But when what you think you remember might not be the truth, then how are you supposed to feel?

Provoked confabulation

Patients can most commonly have a provoked confabulation, which is when they are trying to answer a question.Therefore it’snot something they have been thinking about before hand. But try to recall in order to answer the question.

I first realised that this sometimes was happening to me when a Neurologist, asked me to describe my journey home from The Royal London Hospital. This was after I had been an inpatient for 10 days following a car accident which caused my brain injury. Easy. I recounted how it was a fairly bright, dry day, and that I talked throughout the trip, pleased with having company. But then he asked my chauffeur that day, my partner James, if that sounded right. No, it was pretty much nonsense. He said I had been extremely quiet, to the point he wasn’t sure if I was still awake. And being after 4 pm in late December, it was dark outside.

Spontaneous confabulation

This is much less common, and is where without being asked about it, a patient will recall an untrue event. At this stage I can’t think of any examples I have of this happening to me. It is much less common, but as all memories feel real, it takes a witness to be able to confirm or deny them. James would be your man for that, but he’s at work now so that question will go unanswered for now.

Autobiographical memory

Usually it is the autobiographical memory which is being affected by neurological issues. This type of memory is how we categorise our own life experiences. Therefore we are used to putting our confidence in them. But this is why it’s important that people understand that confabulating is not lying. The suffer genuinely believes the story they are telling is real. They are not trying to mislead anyone, so a calm approach is needed in this situation.

Dealing with confabulation

When you are talking to someone who is confabulating, there are 3 things you need to understand:

1. It can be a way of the patient making sense of the situation. Although inaccurate, if can be comforting to them to feel they have a handle on things.
2. Personal identity is important to us all, but if your autobiological memory is letting you down, how do you reconcile this? Well, maybe that’s why these false memories happen, perhaps we want to understand who we are and where we fit in.
3. It’s a form of interaction. If you don’t remember much, what do you talk about? Humans are social creatures and we all need to feel we have something to add.

So taking these 3 points into consideration, it’s usually better to not correct the patient. Imagine how distressing it would be if someone told you we all live on Mars and Earth died 200 years ago. Clearly that isn’t the case, but that confusion is what it feels like for someone who has just been told their confabulation is wrong. Usually, like my rose tinted memory of my journey home from the hospital, it’s harmless anyway. So if you can, just bear with us.