Thursday, September 18, 2014

Confabulation, Conflation & the ACC thinking process

The mental processes of those with ACC, can more often that not manifest behaviors seen in childhood, but these will persist into adulthood.  While not all with ACC have issues with confabulation it is nonetheless a common enough occurrence in our thinking processes, which if not understood by those around him or her can lead to blame, anger, accusation and false judgement of the child or adult with ACC.

Confabulation  is a memory disturbance that is the production of fabricated, distorted or misinterpreted memories about oneself or the world, without the conscious intention to deceive. Confabulation is distinguished from lying as there is no intent at deception and we are unaware the information is false. Although we can present blatantly false information, confabulation can also seem to be coherent, internally consistent, and relatively normal. Those of us who confabulate present incorrect memories ranging from "subtle alterations to bizarre fabrications"  and we have no doubts as to our  recollections, despite evidence to the contrary.

These event can be provoked or spontaneous. A provoked confabulation represents a normal response to a faulty memory, and can become apparent during memory testing, where a spontaneous  confabulation does not occur in response to a cue and seems to be involuntary. These are relatively rare, but are more common in cases of ACC and may result from the interaction between frontal lobe pathology and temporary global amnesia.

The majority of research on confabulation centers around children. NT children as well as ACC are particularly susceptible to confabulations based on their high suggestibility. When forced to recall confabulated events, children are less likely to remember that they had previously confabulated these situations, and they are more likely than their adult counterparts to come to remember these confabulations as real events that transpired...accept in the case of Agenesis of the Corpus Callosum. Research suggests that this inability to distinguish between past confabulatory and real events is centered on developmental differences. Due to underdeveloped encoding and critical reasoning skills, an ACC person's ability to distinguish real memories from false memories can be impaired. 

When this thinking process is not expected or understood, parents of ACC children and friends and family of ACC adults can react in a negative, dismissive or accusatory manner.  Needless to say, that does wonders to destroy self esteem and confidence in those of us afflicted in this way.  Not everyone with ACC confabulates, but it has been a major part of my life for as long as I can remember.  Because of it I was bullied, beaten and blamed for so much that was not my fault.

I usually give the following example, because in retrospect, when I learned of my ACC it jumped out at me and made itself really obvious:

Mother would ask "did you take out the garbage?"  In that instant I would have a visual memory of my taking out the trash and would tell her "yes I did."  She would look and see the trash was still full to the top (even in the same room.)  I could have been remember another time I took out the trash, or simply confused the image in my head with reality.

This also happened (in retrospect) when I was asked to brush my teeth, and "did you do it?"  Thing is, they never really checked to see if I had indeed done it.  I have never, to this day established a consistent habit of teeth brushing.

This sort of thing still happens to me today.  The difference is I've been able to educated people around me, and they can see what is actually happening, and it diffuses an often terrible situation.

Today I have memory issues that look a bit different but are nonetheless still really troubling.  I can think about preparing a meal to eat, and think I've already eaten it. I've done this, and not eaten anything until 5 or 6 in the afternoon, because all of the sudden I was sick with a headache and stomach ache, the only clues that I haven't really eaten.

Likewise you and I can have a face to face conversation, and if asked to recall it just a few minutes later, you might find a strikingly different conversation than what you remember us talking about...this leads into explaining conflation:

Conflation occurs when the identities of two or more individuals, thoughts, concepts, or places, sharing some characteristics of one another, seem to be a single identity; the differences becoming lost.  Conflations are of two types "congruent" and "incongruent."

Congruent conflations are the more commonly used in everyday life in speech and language, for example: "look who's calling the kettle black?"  The two ideas "look who is talking" and "calling the kettle black" are blended together to mean the same thing.  This type of conflation is more "normal" and understood in context.

On the other hand incongruent conflation occurs when the two thoughts or concepts do not mean the same thing, but share a common word or theme. For example, "a bull in a candy store" can be formed from the expressions "a kid in a candy store" and "a bull in a china shop". The former expression paints a picture of someone who is extraordinarily happy and excited, whereas the latter one brings to mind the image of a person who is extremely clumsy, indelicate, not suited to a certain environment, prone to act recklessly, or easily provoked. The conflation expresses both of these ideas at the same time. Without context, the intention is not entirely clear.  Yet for someone with ACC, we may not be aware we are doing this, and yet the concept or thought or memory we hold in mind makes complete sense to us, even if it confounds the listener.

Idiomatic conflation has been used as a source of humor in certain situations. For example, "A bird in the hand will get the worm...no, wait...The early bird is worth two in the bush...no... well, that's the idea" by combining two popular expressions.

Yet with ACC not only is there confabulation, but these confabulated memories conflate with actual events or legitimate memories.  And this could be pointed out to the person or child with ACC and we just cannot accept it, even if you present "proof" to us that we are "wrong." 

Think of it this way, what if your very thoughts were constantly challenged and you were told they were unreal? This likely would be no less anxiety provoking for an NT than someone with ASD or ACC.  We start to believe we are less than other people, and it is drilled into our heads that we "are liars" (or worse, my own father calling me a psychopathic liar) and being beaten and abused because of it.  

Recently, I have come to the conclusion that I had confabulated and conflated events in a dear friends life.  Perhaps with something I was told or explained, the memories I had whether real or false blended with real life events.  This lead me to accusing a friend's spouse of abuse.  And to this day, I'm absolutely sure she told me what she did.  But she has no reason to lie.  This caused us a real tension in our friendship, that I doubt we'll ever recover from.  Yet, even now, I could swear to what "I was told", but several sources have assured me the information is incorrect.

Now, for the NT out there, or the parent of an ACC or ASD child that confabulates and conflates, please, just imagine for one moment what it must be like to live with this day in and day out.  A few adults with ACC that I know, we call this the "dirty little secret of ACC" because there is so much shame and invective poured on us by others because of this, we internalize the shame and beat ourselves up.

I'm still researching ways to "disarm" this phenomenon.  I know that it will always occur, and that stress brings it on more readily, but I can't help thinking there must be a way to bring it to our attention where we can actually do something to correct it.  My closest friends that are aware of this tendency in me, I have given them free reign to point out to me when, in their eyes, this seems to be happening.  It can be frustrating for the NT, because they will present to us "evidence" of our misthinking, but we cannot accept it.  WHO can accept that they cannot always trust there thoughts and memories.  So, parents of, and friends of those with ACC, please be kind...please be careful when wanting to blame and accuse us of something that we clearly do not understand is occurring.

It is one thing talking about this subjectively, but even today, I am mostly completely unaware when confabulation occurs, until I run into the "brick wall" of facts given me by situations or peoples....I am grateful for those in my life that have come to understand and work with me and not reject me because of these differences in my thinking process.

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