The stories we tell ourselves. Confabulation?

“It’s not so important that a memory be accurate.
It’s more important that it helps us define ourselves.”  —Martin Conway, PhD[1]

I first heard the word confabulation in the Rusk Brain Injury Day Treatment Program. I thought it was such an odd term. Like manipulating a story about yourself to prove that whatever happened or how you responded, somehow proved your value – determination, strength in the face of adversity.

Is confabulation consciously lying? No. Is it a fabrication? Yes. At the very least, confabulation is one of the stories we tell ourselves. So, what does it mean and how is it connected to TBI? I asked Google (for what it’s worth):

Psychiatric Times: the production of false or erroneous memories without the intent to deceive.
Oxford Dictionary: “imaginary experiences as a compensation for loss of memory.”

And from two expert sources:

Memory loss-1 graphic with gearsBrain Fiction, William Hirstein, PhD (MIT Press, 2004): “Anyone broaching the topic of confabulation is faced immediately with a huge problem: there is no… problem-free definition of ‘confabulation’.”

Remembering, imagining, false memories & personal meanings, Martin Conway, PhD[ii]: Confabulation after frontal lobe injury is an attempt to make sense of the world and help create meaning for the disrupted working self. It’s inherently (and unintentionally) false.

But in fact, all human memory is to a degree false, too—it’s a reconstruction which can never be an exact replica of the experience reality. Our perceptions inevitable include past experiences that help us maintain a coherent narrative of who we are.

This really matters to me because I have a story of my own. One I tell again and again. Is it just filling gaps in my memory? Or a fabricated experience of damaged frontal lobes? Confabulation? Could be. But I’m convinced it’s true. Maybe that’s enough.

My story

January 2005, I was 51 years old. A car hit me as I crossed the street. It was my first TBI (traumatic brain injury). Police and hospital reports determined “no LOC” (loss of consciousness)—but how could they know? They didn’t even see it happen, and if they’d asked me, how would I know? Either way, my recollection is crystal clear—what I heard, saw, and thought from the moment I stepped into the street and heard the squealing brakes:

What a stupid way to go

It has been a really good life—work I loved, two great kids, parents, sister

What a relief the boys are grown up, out of the house now

It’ll be really hard on them all. But they’ll manage

And me? I’ll be dead. Won’t know a thing

Next thing I know I’m lying in the street. Someone runs to get ice for my head.
I look back and see the driver standing by the car door.

Dent in the hood [my shoulder?]
Window shield shattered [my head?]

The firemen cut off my fabulous red coat from Paris, and my red “bucket” bag

After that, a lot of “no memory.”


I truly believe that in the split second before being hit I was aware of what was going on, considered the situation and understood the consequences. And I now believe I’m not afraid of death. (on that last point, only time will tell)

The inner monologue I had with myself is an important part of a bigger story—how I’ve changed since my TBI and what I’ve gained as a result. But I can’t ignore the possibility that I’m confabulating. What if it never really happened? Does that mean everything that followed is based on a lie (even though I never knew I was lying)?

This reminds me of when I started to read Dr. Jill Bolte Taylor’s book, My Stroke of Insight (Viking Penguin, 2005), and saw her TED Talk, one of the 5 most viewed of all time (   At TED, she tells the audience:

In the course of four hours I watched my brain completely deteriorate in its ability to process all information. [1:54 into TED video]

Taylor then proceeds to take you through the event moment-by-moment in mesmerizing detail. She’s incredibly smart and totally credible, but is it really possible to perceive oneself with such clarity while in the throes of a massive stroke? I’m skeptical. Even before I knew the word confabulation, I wondered if she was confabulating. Whether accurate or not, it’s her story. And it was definitively transformative.

Honestly, my story isn’t so transformative, but it may have kept me strong, empowered to go forward remembering that even under duress I wasn’t afraid; I had the presence of mind to think; to say “good-bye.” My real transformation has been learning to live with brain injury, alter my expectations and accept a self I’d never known.

But you know what? I still tell the story to myself. It may be confabulation, but I am absolutely sure it is true.

Back to Dr. Conway, with a reflection on everyday memory.

All memories are to some degree false…. In fact, the main role of memories lies in generating personal meanings—by no means damaging to the individual, but rather of considerable benefit. In particular, they maintain a coherent, confident, and positive self.[iii]

[1] Conway, M.A., Loveday, C. (2015). “Remembering, imagining, false memories & personal meanings.” Consciousness and Cognition, 33, pp. 574-581. doi: 10.1016/j.concog.2014.12.002. Published by Elsevier Inc. This is an open access article under the CC BY license (

[ii] Ibid.

[iii] Ibid.


Face What You Fear the Most

This is what we were asked to mull over and discuss:

It’s been said that one should face what they are most afraid of.
What do you think of this idea?
Although it is one of the hardest things to do, great people generally do just that.

Reading it now, it seems pretty straight forward, although no slam dunk because each of us sitting in the circle had a brain injury. As for me? The moment the first line was spoken, I got sucked into a cascade of emotions, memories, frustration—flooded.  Everything else was drowned out. What I heard was this:

What are you afraid of more than anything else?
Can you face your fear?

Brain injury makes me tired, and when I’m tired, I cry. It’s just the way it is. I must have been tired the day this happened, or else the topic hit me like a ton of bricks. So I cried.

The more I thought, the more muddled I got. The fear? I knew what it was but not how to put it into words or give voice to it. Is knowing the same as being aware? Is awareness facing what you’re afraid of? And if so, why hasn’t “knowing” gotten me past my fear?

What about you? Do you also know only too well what you’re most afraid of? If so, chances are you can’t put it into words either, or don’t really want to. Sometimes I think silence keeps the fear at bay, or speaking its name aloud is tempting fate.

But I’m getting sidetracked.
I’m asking because I suspect that what most people are most afraid of comes from within themselves. So the ability to see one’s deepest fears, much less face them, requires awareness and introspection. Well, in the aftermath of a brain injury one of the most common challenges is an organic unawareness—the inability to self-observe. It’s a conundrum. Because of that unawareness we may not be able to fathom a feeling that is so existential, one that is, perhaps, at the heart of our daily struggle: finding who we are. And as long as we can’t clearly see that fear (no matter how hard we try) we won’t be able to face it. At least until we’ve internalized the need and habituated introspection.

When I look back at that day and the idea offered up for discussion, it seems obvious that it is much more complex than I realized at the time— because of our brain injuries. Maybe that’s why it freaked me out; why it struck such a tender chord. I knew I had to consider it outside the circle, alone, in my own time. That’s why I took it home. That’s why I’m writing this.

Let’s return to the question, “what do you think of this idea?” My answer could have been, “It sounds good to me. It also sounds like one of the hardest things to do [I don’t see myself among the ‘greats’], but it’s probably the only thing to do.”

Gian_Lorenzo_Bernini,_self-portrait_c1623 cropped-bigAt the same time, I’m left wondering what “facing” what you’re most afraid of actually looks like, how it works, and the purpose it serves. In my mind it’s not fear that holds me back; I think I’m held back by what it is I fear. I’m afraid of… well, I can’t find the right words. Now what?

Based on a quick online search (note: I didn’t check my sources), and with my own 2 cents added, here’s some (greatly simplified) advice:

Be Mindful: Recognize that your fear is standing in your way. Think about what happens when it does, how you feel, and your response.

Take Charge: It’s your life. Manage stress with music, meditation, exercise, or massage. Breathe in a regular rhythm to calm your system. Do whatever helps you keep the boogyman at bay.

Habituation: When you face the fear you get stronger and it gets easier. Practice living with it and see for yourself—it’s not impossible. There’s no need to worry about when it may come, if you know you can deal with it when it does.

Affirmation: Positive self-talk, repeatedly said out loud and confident.  “My life is in my hands.” “I am stronger than my fear.”  “I am worthy.” “I am happy being alive and being me.”

Last, but not least, if all else fails, do what I do—

Cry: [out with the bad], and

Smile: [there’s research showing that even a forced smile can improve one’s mood and reduce stress!]. Fake it ’til you make it.

The intense gaze illuminating this piece is a detail from Gian Lorenzo Bernini’s self-portrait (c. 1623) via Wikimedia Commons (Public domain, {{PD-1923}}. The painting can be seen here