'Confabulation' in narrative disclosure by Schizophrenic patients

Confabulation has been defined in numerous ways. Most authors have distinguished between two types of confabulation, although they emphasise that these may not be completely distinct. In ‘momentary confabulation’ the person fabricates a past event in direct response to a probe of his memory. This frequently consists of ‘real’ memories displaced in their temporal context (Korsakoff 1889, Victor et a1 1971, Berlyne 1972). In contrast, ‘fantastic confabulation’ involves the person spontaneously generating false memories, and behaving as though they are true. This latter type of confabulation is frequently grandiose and wide ranging (Berlyne 1972). Theories as to the mechanism for confabulation can be artificially divided into five groups, although most support is found for confabulation as a reflection of a memory deficit, and/or a frontal lobe/executive function deficiency. Following many clinical reports of phenomena resembling confabulation in schizophrenic patients Nathaniel-James and Frith (1996) studied 12 schizophrenic subjects, matched with 12 volunteers (including nine healthy subjects and three depressed patients). They showed that confabulation was present. They suggested that it was the result of a memory deficit. However, there are as yet no formal reports of confabulation by schizophrenic patients in tasks which do not require memory. The present study demonstrated that ‘confabulation’ occurs in schizophrenic patients in similar tasks but where memory is not required. The adoption of a linguistic analysis to describe confabulations was suggested by a consideration of the nature of confabulations and possible assessment methods. As Rochester (1980) notes with reference to thought disorder, a speech/language sample is being evaluated and the thought is merely inferred as it cannot be accessed directly. The use of linguistic analysis as advocated by Ebert (1991) and Thomas (1997) to describe discourse disturbances in schizophrenia makes ‘no presupposition about the focus of the disturbance, which can then be regarded form a variety of perspectives ...’ (Thomas 1997, p. 33). Narrative discourse involves the production of a story based on characters or events or the relating of an event. An adequate narrative requires that the speaker consider the environmental context includmg the listener’s perspective, knowledge of the world, shared knowledge, conventions etc. Assumptions regarding thls information are based on several factors. As with other forms of discourse, speaker contributions are assumed to follow Grice’s (1975) maxims: try to be relevant, informative (conveying new information), truthful, and appropriate in manner (clear, brief and orderly). This necessitates ensuring that all parts of the story must be consistent with the earlier parts of the story and the larger environmental activity, whilst providing the context for what follows in the story. This study was designed to elicit connected discourse in reasonably natural situations, whilst providing a context against which to check verbal output for comparative data. This makes it more probable that the assessment is measuring general process rather than a special skill that is not habitually used by language users. Additionally, it is probable that this is the level at which people with schizophrenia experience communication difficulties, as suggested by McGhie’s (1970) studies of patients’ subjective reports and by Dawson et a1 (1980) in their discussion of the various analytic approaches available. In this study a six picture sequence was used to obtain the narrative. This remained in front of the subject throughout the task to eliminate the memory component previously involved in tasks eliciting confabulation in schizophrenic subjects. Any ‘spontaneous,grandiose confabulations’ would be analysed in terms of the requirements of a description of extraordinary events as described by Jefferson (1984) for example.