Confabulation and delusion: a common monitoring framework

Abstract

Confabulations and delusions both involve the production of false claims. Although they may have different types of content, they share several characteristics. For example, they are often held with considerable conviction and are resistant to counter evidence, they may be acted upon, and they may be accompanied by a lack of concern about the false claim or its implications. Confabulations and delusions may initially arise from failures in different systems (e.g., mnemonic vs. perceptual or affective). However, their shared characteristics raise the possibility that the monitoring deficits involved might be the same, resulting in failure to reject the confabulatory or delusional ideas. In this paper we will focus on the nature of these common monitoring deficits. Critically, we argue that monitoring in confabulation and delusion involves both unconscious and conscious processes. We propose that an unconscious process is responsible for tagging suspect content which needs to be checked for veracity by a separate set of conscious evaluative processes. Failure of these monitoring processes would allow ideas which ought to be checked and rejected to instead be uncritically accepted: This would result in the production of confabulations or delusions. Importantly, inclusion of both unconscious and conscious monitoring stages allows the model to account for both "endorsement" and "explanation" delusions, and both "primary" and "secondary" confabulations. Our hope is that this model may provide a theoretical framework to guide empirical investigation of the commonalities and differences between the conditions.