Narratives of Dubious Content: Towards a taxonomy of confabulation Yolande Lucire PhD, MB BS DPM FRANZCP School of Ru

1. Narratives of Dubious Content: Towards a taxonomy of confabulation Yolande LucirePhD, MB BS DPM FRANZCPSchool of Rural Health, Albury NSWForensic Psychiatrist. Woollahra Sydney

2. Many researchers have attempted to define confabulation/memory distortion/lying/ pathological lying/distorted perception/delusion/memory  and where these phenomena interface.No one has yet been able to define and classify thesedubious narratives. some of which attract clinical or forensic interest.

3. Confabulation, from fabulare, (L) is story telling. It is a universal phenomenon.

4. Confabulations have been defined as Inaccurate or false narratives purporting to convey information about world or self.Psychiatrists, Kraepelin and Jaspers wrote extensively about confabulation and those who did it, and called it Pseudomemory. 

5. Psychiatrist, Karl Jaspers referred to hysterical personalities "who, in order to heighten life and find new ways of making an effect, will resort to lying, at first quite consciously but soon this becomes unconscious and they come to believe themselves". Jaspers, did not invent the term, but he said this was pseudologia fantastica which is confabulation in its most elaborated form.

6. Initially described in 1891, Pseudologia fantastica is typified by these characteristics: (1) the stories are not entirely improbable and often involve real people and a background of real events(2) the stories are enduring; (3) the stories are not told for profit but for attracting attention(4) they are distinct from delusions in that the person when confronted with facts can acknowledge these falsehoods. 

7. Pseudologia fantastica is a fascinating symptom. The pseudologue spins tales that appear plausible on the surface but do not hang together over time. Fact and fiction are woven together in an interesting matrix until the two are virtually indistinguishable. Unlike a delusional psychotic person, the pseudologue will abandon the story or change it if confronted with contradictory evidence or sufficient disbelief. The stories do have an enduring quality and after repeating them enough times, even the pseudologue begins to believe them (King and Ford 1988)

8. 100 years ago, confabulations concerned real people but factitious accounts of of rape and murder and false identity interwoven with real events.Confabulations were divided into fantastic and plausible

9. Berrios classified confabulations thus:Untrue" utterances by subjects with memory impairment and Fantastic utterances marshaled with conviction by subjects suffering from functional psychoses and no memory deficit.This might be OK if we call the dissociated states that occur with personality disorders, 'functional psychoses' but it raises the question of whether it is the confabulation that defines the psychosis. 

10. What is plausible to one person is not plausible to anotherSome psychiatrists believe in multiples, in ritual satanic abuse, alien abductions, repressed memories which are clearer and more detailed than normal ones

11. Much confabulation is poorly recognised. Much passes for delusion or truth. Is this because psychiatrists owe a patient empathy? Or is the cause more sinister, Feminist political correctness? Or the influence of the current moral panic about child sexual abuse

12. Since the late 1970s, a school of feminist psychiatrists have taken the position that women's accounts of incest and rape had been disregarded for too long. Judith Herman, Lenore Terr, Lyn Frederickson,Bennet Braun, Colin Ross all treated women who had recovered memories of rapes, murder, incest ritual and satanic abuses while they were in treatment with them. Their accounts were subsumed under the name of RECOVERED MEMORYalso called �repressed memory� but called �false� or �pseudo memory� by the sceptics

13. Their research was conducted on women seeking �therapy for having been sexually abused.� As some of their subjects were very disordered, Herman, Terr and van der Kolk and others came to the conclusion that sexual traumas in childhood caused borderline personality disorder. All of them except Herman have been sued for causing false beliefs and have paid out huge sums of money in compensatory damages.

14. At the same time, feminists exerted pressure to exclude hysteria from the diagnostic systems. Hysteria was split into conversion and dissociative disorders

15. Hysterical personality was dispersed throughout the Cluster B personality disorders, histrionic, narcissistic, borderline and antisocial.

16. By the late 1970s, following the death of Mayer Gross and the demise of influence of the German school in UK, psychiatry started to take a narrow view of the phenomenon of confabulation limiting the term to the false productions of brain-damaged and developmentally disabled persons filling memory gaps with plausible scenarios.

17. At the same time, hysterical confabulations were subsumed in the Dissociative Disorders with multiple personality disorder, confabulation about the self leading the field.And Munchausen syndrome, and the proxy, confabulation about health, sexual abuse and pity-invoking events, not far behind.

18. Other times and cultures produced other culture bound confabulations and found them to be plausible Witches and their activities. 300 years in Europe. Influenced by clergy and witch hunters. Salem and the Abigail syndrome.Spectral evidence, no evidence at all of events which should have had high visibility.

19.  That one has lived before in a different body. That one has been abducted by aliens, popular around Harvard psychiatrist John Mack. That one was a baby bred and raised by the CIA which farms babies who remain subject to mind control. Currently popular around Psychiatrist Colin Ross and displayed on his websites

20. MULTIPLE PERSONALITY DISORDER or DISSOCIATIVE IDENTITY DISORDER involvestales about one's alters or personalities, unaware of each other living different lives in a day.It has become epidemic since its legitimation as a specific disorder by the American Psychiatric Association which has a lot to answer for. Its presentation depends entirely on the credulity of the listener, which in turn depends on culture.

21. Confabulations were generated by Sibyl in therapy.She later admitted that she made the stories up to please her analyst.Nature followed Art and the American Psychiatric Association bought it

22. Cultic beliefs eg Heaven�s Gate that a spaceship will come and transport forty seemingly normal people so they committed serial ritual suicide.

23. MULTIPLE PERSONALITY DISORDER or DISSOCIATIVE IDENTITY DISORDER involvestales about one's alters or personalities, unaware of each other living different lives in a day.This has become epidemic since its legitimation as a specific disorder by the American Psychiatric Association which has a lot to answer for. Its presentation depends entirely on the credulity of the listener, which in turn depends on culture. 

24. Confabulation about sexual matters  That one has been sexually abused in satanic rituals. Usually associated with multiple personality. In USA, clustered around 'True Believers', feminist psychiatrists Terr and Fredrickson as well as s Colin Ross, Bennett Braun, (damages US$ 12.4 million, class action pending) Currently popular in NSW in DOCS, the Department of Community Services and among RANZCP colleagues in Queensland and NSW who had better remain nameless.

25. Multiple Personality and satanic sexual abuse are being �treated� in Brisbane by psychiatrists in a hospital whose regimen resembles the Rush Presbyterian hospital which has paid out millions for Bennett Braun.What should be done? Has the local Medical Board been informed?Are you lobbying the Royal Australian college of Psychiatrists?This is Australian Psychiatry�s next Chelmsford.

26. Confabulations are generated by hypnotic suggestion, by fantasising, guided imagining, by 'desentisation' or immersion treatment for PTSD. So-treated persons report flashbacks to an accident that they did not see, believe they experienced events which had occurred only in films or had only been discussed in veterans groups.

27. Red flag confabulations about the bodyMunchausen syndrome: abused childhood, false rape claims and other bids for pity,Munchausen by proxy: 'My child is being sexually abused'. Tip: If you are asked to assess a potential Munchausen or proxy, look for cluster B personality disorder. Child deaths occur at random. All Munchausen cases occur in this tiny band of Cluster B personality disorders.Similarly, if you suspect confabulation, look for evidence of histrionic, borderline or schizotypal personality disorder

28. President Reagan frequently and publicly related stories from his old films roles as his own experiences. Were these confabulations evidence of his early dementia?Should this be a worry?Was it an indicator that he should not have been president?Did it matter?PS. Come back Mr. Reagan. All is forgiven

29. When storytelling conventions are breached, as with the background of Helen Demidenko�s novel, The Hand that Signed the Paper, we are outraged. We are further outraged when we realise that she adopted completely false identify to write it, that of a Ukrainian.

30. We are outraged when confabulation causes harm. The original Marquis de Sade wrote sado-masochistic pornography but laid no pretence to telling the truth We are offended by the recent book, Between a Rock and a Hard Place, the story of Tony, purportedly a sexually abused boy, which turned out to be a fraud, a modern day Justine, passed off as truth, for money or fame. .

31. But this is a new literary genre 'Survivor Literature,' which includes  The Courage to Heal, The Memory Bird,Unchained MemoriesTruth in MemoryAll purport to be reporting memories of being abused as a child, in elaborate prose, some in poetry, all best sellers in Feminist bookshops.Furniture, costume, action are all recalled in greater detail than what you and I can recall of our last but one sexual congress.A study of these texts is a worthwhile exercise .

32. Close examination of this material shows that it is the highly elaborated, detailed product of juvenile �victim� fantasy, a kind of sadomasochistic B&D kiddie porn, which influences our culture with its jargon and models.

33. A text or a story about something does not go to whether or not it happened. No one knows what happened between two people if one of them denies it. However psychiatrists should be able to learn to differentiate a report from a confabulation.  We, indeed anyone literate should be able to differentiate a novel about the French Revolutionfrom an observer�s account of it.

34. More recently, confabulation has been acknowledged in Kaplan and Saddock (APA) to be what �feminist� therapists call �recovered memory� particularly in those cases where it has been recovered in or enhanced by therapy.

35. Can confabulation be differentiated from delusion?It is a narrative, a story and it obeys the narrative conventionsIts text, Its masquerading as memory.Its being more detailed than memory can be. Islands of marooned memory.Inauthentic emotions in the telling and the retelling. Associated phenomenology and personality structure. By reports of what could not be known by the narrator. Such as what others think, or what happened in the next room.

36. The success of confabulations depends on a credulous listener.  Confabulation is nothing like normal memory. It has been described as the 'videotape view of memory', or the 'Hollywood presentation'.Story tellers, novelists and confabulators all follow conventions. They tells us more than that one person can possibly know or remember  more than is possible to know.They tell you what they could not have seen. They tell you what other person in their dramas thought, and they attribute motivation.

37. Confabulated confessions Confabulated confessions by simple minded folk are a major issue on Death Row in the United States as developmentally delayed persons are compliant and prone to confabulate and say what the interviewer wants. Many overturned convictions and releases from death row in recent years are the consequence of Law students checking the details of the crime against confabulated confessions which are unlikely to have been accurate or consistent with the facts.

38. To identify confabulation, Examine statements for the invisible interlocutor who asks Where were you? Describe the room, the furniture? Can you guess at date? What was the weather like? Was it winter or summer? What were you wearing? What was he wearing? What else can you remember? Try to remember.

39. Farrell V the Queen HCA 1998 enables experts to give evidence on the complainant�s reliability.The Cluster B Group are all unreliable in different ways.

40. Histrionic, Hysterical: presents as victimised, manipulated, coerced, physically or psychologically or sexually abused. ' enjoys 'Victim' fantasies.Most likely to dissociateBorderline: experiences psychotic episodes, often erotic in content, whose contents may be recalled as real. Poor autobiographical memory.  Antisocial: is involved in street kid and rent boy allegations against carers, most recently High Court Judge and Archbishop, and he comes up with 'The Abuse Excuse� Narcissistic Personality Disorder: enjoys grandiose fantasies 

41. I will show you a text from a criminal charge which is as yet unresolved. Ten years after the alleged events, Mrs Night accuses her father, Mr Snake, of having had an incestuous relationship with her for two years between when she 17 and 18 when, after her mother�s death, she lived with him in a caravan park.

42. She told her girlfriend about the counsellor she was seeing before she made this report, but his or her name has not been made available to the Defence and she now denies that she saw a sexual abuse counsellor but later denied having done so. Snake has been an alcoholic and had not been known to be sexually active at all for 20 years. He was drunk, on fortified wines, all the time while she was there. 

43. Nonetheless, the prosecution appears to believe that he �did it� to her, all orifices, five times a week for two years. In her narrative, generated by a friendly police person who seems to be guiding her imagery, she describes many episodes, after each of which she says she was �shocked� that her father could do such a thing to his daughter. 

44. Here is the text from her statement about her first ever act of sexual intercourse. Mrs Night claims to have been a virgin when her father had her for the first time. It is unlikely that at such a critical time she could identify certain events. The text suggests Survivor Literature, or Mills and Boon, eroticised accounts of incestuous sexual relationships, assuming submissive girlhood. The Courage to Heal and the Memory Bird are examples of this description of sexual activity and deflowerment. 

45. One night in early November at the nights were getting later (daylight savings, summer) he was staying longer next door with the neighbours drinking cause the van was too hot to stay in. It was like a little oven. I wasn't feeling well this night and I went back to the van early. I remember he came into the van after drinking and it later and fairly late at night. I can't remember. The text here suggests an interlocutor saying 'try to remember' or 'what else do you remember?�She goes onThe main thing I remember about this time is he walking through the door of the caravan and he saying as he walked in through the door, "Here it comes" and "Get ready" or something very much like that, "Here it comes, get ready." "Get ready here it comes."

46. Text refers to eight years before this account of it, yet her inbuilt camera recalls with greater detail than the reader can recall his or her last but one sexual congress or any event in the past week. It is borrowed from erotica and the clinic, not her natural language. It is Hypermnesia or the Hollywood Presentation or sometimes the Videotape View of Memory. It is not memory but guided fantasising and the form is indicative of confabulation. The invisible questioner has been pruned out of the statement.

47. Those words stand out in my mind as being the first time anything ever happened to me like that. He was intoxicated.17. He came through the van to my bed and threw himself on me. I was in limbo half asleep, not really knowing what was happening. I woke up. I struggled with him. I was laying on my back at the time. He pinned my arms back over my head. He had a pack of cigarettes in his left hand as he walked which he threw on the table as he went past it. His upper body was on the top of my upper body and his legs were hanging over the bed at that stage. He was sort of bedding over the bed. I was trying to push up but I was not very strong. The more I struggled the more he seemed to get excited. He was laughing. He said to me, "You know you want it." 

48. By that stage I knew he was wanting to have sexual intercourse with me. By that time he already had the zipper of his shorts undone. He always wore a belt and the shorts had a button on the waist above the zipper. He had undone his belt. The more I struggled the more excited he became and some how he got his legs off the floor and onto the bed. I don't know how he managed it. And that's when it happened. I don't know how he made it possible. He was assaulting me. I was wearing a summer nightie and a pair of underpants. I didn't have a sheet on because it was hot at that stage.18. Can you describe how he was assaulting you?The interlocutor, whom I could sense in this narrative, suddenly makes herself visible.Am I to understand that this was the only question asked for several hou, or perhaps days? This is what Scharnberg calls 'pruning'.

49. He still had hold of my arms. I had got them from above my head but he was still hanging on to them. He was trying to spread my legs with his knees. I was still struggling. I don't know how he removed my underwear. I just know the next minute he was penetrating. He was erect and he was penetrating me down there. He was penetrating my vagina. His penis was erect.This is not memory. This is a romantic novel, full of clich�s19. I know when he got off the bed he didn't have them on. He must have kicked them off at some stage between getting on the bed and being on the bed. He usually wore under pants. They were off as well. I still had my nightie on. He was holding my hands. He muzzled my breasts once or twice but he didn't take his hands off my arms or anything.Can you recall losing your virginity in this detail? Or your last but one sexual congress? This is pornographic literature, not memory.

50. He was accused of 400 instances, charged with 5 then two more after she had some therapy and then the defence sought to exclude the last two.The, after four years of it he was offered to plead to one, with penetration and promised no jail. He was found unfit to plead.He had been drinking three litres daily of port for twenty years

51. 400 acts of sexual intercourse with violence over two years would not be invisible, and would not have remained unheard in a caravan park. This is Spectral evidence.The term originated in Salem after 1692. Twelve year old Abigail Williams and her cousins implicated 61 year old John Proctor and thirty other people in witchcraft which included coming by night in the form of a succubus to copulate, poison and beguile. As more and more people were accused, less and less was actually observed. No one had seen the witch in their vicinity. 

52. The population was intimidated, scared of appearing soft on witchcraft. In that political climate, the disparity between allegation and evidence was not attributed to lying, nor even to hysteria on the part of the accusers. The courts constructed a notion that it was not the person of the witch, but the spectre of the witch, not her body but her ghost, her spectre, that had performed the reported acts. This was termed �spectral evidence�.  It refers events which should have been manifest but remained inconspicuous.

53. Confabulations are generated by reading suggestive booksby suggestionhypnotic techniques fantasising,group therapy with hysterics by credulous police getting a statement guided imagining, EMDR

54. Why do people confabulate? Under different disguises, the 'covering up' or 'gap filling' hypothesis is still going strong.  That is to say, that confabulators include populations who have lost memories through brain damage as well as those who believe that they have lost memories because they have been told they repressed their memories.

55. As such, 'false memory syndrome' can be seen as the hysterical mimic of amnesic confabulation. We have to ask the question for which there is no answer: Does the deception deceive only the listener or is the speaker of this narrative also taken in?Information from so called 'retractors' indicates that some had total belief in their induced confabulations while others say they always had a glimmer of doubt.  Some admit they lied. Self-belief in one�s confabulations will probably a on a continuum, as on the hysteria/ malingering axis.

56. Confabulation about sexual matters is currently being induced by sexual abuse counsellors all over Australia. Treatment for sexual abuse is currently popular in NSW in Department of Health, In women's Refuges by unqualified and untrained counsellors, in DoCS, the Department of Community Services and among RANZCP colleagues in Queensland and NSW who had better remain nameless. And writers of Victims Compensation reportswho might be social workers.It is being taught in Health Department facilities in NSW, in courses advertised to nurses in NSW, Victoria and the ACT 

57. This video contains distressing scenes, and if your daughters have been treated by the Women�s Refuge Movement, please avert your eyes. The six minute video shows Ruth Christie giving a lecture in Queanbeyan Hospital. She advises the ACT police, gives evidence in the Family Court and trains DoCS counsellors and others. The second part shows a DoCs sexual abuse counsellor at work in a DoCS funded women's refuge.