Mental Deafness: Confabulation, (Mis)Identity, and Reality

This week's readings focused on the theme of confabulation, the accompanying mental scars, and the effects on both the afflicted and their doctors, families, and friends. As Hirstein illuminates in Chapter 5 of Brain Fiction, confabulators display certain traits: orbitofrontal damage, a lack of embarrassment or consideration of others' feelings (edging toward the sociopathic) and a dogged adherence to their claims of "impostors" replacing their loved ones, even in the face of all explanations and facts. (We've all heard about the horrible things that people can do and wondered how someone "normal" could go that badly wrong -- this offers a possibility of argument that sociopaths really do have a different chemical composition, mental defect, or otherwise faulty wiring that leads them to plan and execute acts unfathomable to the average person -- Hitler, Pol Pot, etc.) But while Capgras' syndrome has been meticulously charted in neural terms and doctors can point to the roughly accurate areas of where trauma has occurred, it has also to do with something that cannot yet be fully assembled and picked apart (despite the best efforts of neurologists) -- emotion.

As we've seen in our readings from LeDoux, he is constantly attempting to define emotion solely on the basis of gross neural circuitry and which synapses fire where. While it's true that every operation for humans, consciously or unconsciously, filters back to the "computer in the cranium," this is understandably met with a great deal of resistance when getting into subjects considered more ephemeral, such as emotion, the soul, and innermost fears and desires. As mentioned in The Echo Maker, patients with Capgras have an emotional link severed, and do not automatically access the inherent database of memories, emotions, thoughts, and reactions that, for them, their "real" loved ones would surely activate. As Hirstein explores, the sight of a familiar and much-loved face has much more impact on us than the sight of a stranger. If we see someone we know and care about, our brains activate good memories, pleasant feelings, and the remembrance of experiencing love to reinforce the basic perception of a person that our optic nerves are transmitting: this is a close friend or family member, not an empty automaton, and we know this because we have positive identification and feelings for them. Yet this is precisely what patients with Capgras syndrome lack, and it is this that leaves them to believe they are left alone in a world of impostors.

The Echo Maker explores this issue from both a scientific and humanistic perspective. Unlike Margot Livesey, Richard Powers is clearly writing for both audiences -- scientists and the general public -- and makes sure to enrich his novel with the neuroanatomic prerequisites and manifestations of the syndrome in addition to the effect that his sufferer, Mark Schluter, has on friends and family. We can sympathize with Karin, who is trying desperately to take care of him, and envisioning ourselves in her position is wrenching -- not only has her brother almost lost his life and now requires long-term care, he refuses to even recognize her or be grateful for her presence, because he is convinced that she is someone else. The contortions that our brains can put us through are downright frightening, and yet again raises the question of what reality constitutes. Clearly, Mark has an incorrect idea that Karin is a clone of herself, but for him, it makes perfect and unshakeable sense, and although he might have departed from the mainstream, his life is as informed and his motivations as determined for him as they are for anyone else -- we can only act and react according to what our brains tell us is unshakeably true. Mark cannot live in Karin's reality because he is convinced, on the same level that we are sure of ourselves and who we are, that it is invalid. We can pretend to live in a fantasy world, but quickly run into conflicts with our notions of reality not matching up to everyone else's; besides, it can land us in Bellevue and however much we complain about the food here, it's undoubtedly much worse there.

But that's just the question. We see confabulation as lying; what the patient expresses as reality and what we know from empirical research or evaluation simply do not match up. They will not be convinced otherwise, however; how would you take it if a researcher came up to you and told you that your reality was entirely fabricated and things were much different than you instinctively knew? You'd take it badly, of course, and offer a constant parade of excuses and explanations as to why things were in fact the way you knew them to be. If the patient lacks the awareness or the intention to deceive, and is in fact following their brain's preconceived constructs of reality (as erroneous as they might be) can you really call it lying? Can we even trust our brains? What in the heck are all of us doing? We don't lie about our fundamental surroundings because we have the inherent assumption that they are true, and the same goes for the Capgras' patient. They speak the "truth" for them, which becomes a distortion and paranoia for us because of the different channels mapped by our brains.

Mentally "sound" patients know they are sane because their ideas and precepts match up with everyone else's; that good ol' peer pressure theory back to work. If both you and someone else agree where the wall is, you'll steer your route through your physical space to avoid walking into it; you have the same perceptions and the same mental "channel." The Capgras' sufferer is like that old electronic toy that just kept backing up and hitting the wall again; their reality is out of sync with everyone else's and they are being told that what they know (never mind what subconscious circuits aren't working) is completely wrong. They are in a universe completely different from what they think and perceive to be true, and they are swimming upstream while believing that their real family and friends are being kept from them, most likely through a malicious conspiracy on the part of the doctors -- can they trust these people to heal them? Sounds pretty isolating and frightening to me.

We as readers can sympathize with both the patient and their families/friends, and, like Karin Schluter, we'd be in desperate desire for a cure. Is that what neuropsychology is after all -- altering reality, one brain at a time? Timothy Leary isn't even involved.