Reprint of the text from my article in Prospect magazine, 4th July 2009, Issue 160

If someone tells you something that isn’t true, they may not be lying. At least not in the conventional sense. Confabulation, a rare disorder resulting from severe brain damage, causes its sufferers to relentlessly invent and believe fictions—both mundane and fantastical—about their lives. If asked where she has just been, a patient might say that she was in the laundry room (when she wasn’t) or that she’s been visiting Scotland with her sister (who’s been dead for 20 years), or even that she isn’t in the room where you’re talking to her, but in one exactly like it, further down the corridor. And could you fetch her hand cream please? These stories aren’t maintained for long periods, but are sincerely believed.

While it only affects a tiny minority of those with brain damage, confabulation tells us something important: that spontaneous, fluid, even riotous creativity is a natural part of the design of the mind. The damage associated with confabulation—usually to the frontal lobes—adds nothing to the brain’s makeup. Instead it releases a capacity for fiction that lies dormant inside all of us. Anyone who has seen children at play knows that the desire to make up stories is deeply embedded in human nature. And it can be cultivated too, most clearly by anarchic improvisers like Paul Merton.

Chris Harvey John taught me “improv” at London’s Spontaneity Shop. He can step on stage in front of 200 people to perform a totally unscripted hour-long show. There’ll be no rehearsal, no discussion of characters or plot. Instead, he and the other actors invent a play from scratch, based entirely on their unplanned reactions to each other. This seemingly effortless, throwaway attitude is the opposite of what we normally assume about the creative process: that it is hard work. Artists are often talked about in reverent, mystical tones. Art does connect with deep and mysterious human forces, but that doesn’t mean it is only available to a select few who, through luck or special training, are allowed to invent things.

Psychological research increasingly shows that inventiveness is fundamental to the normal operation of the mind. Aikaterini Fotopoulou is a research psychologist at the Institute of Cognitive Neuroscience, London, who specialises in confabulation. She regards it as a failure of the psychological mechanisms responsible for memory. “These inventions are really memory constructions,” she says. “When people confabulate they are failing to check the origin of the material that they build into their memories. You or I can usually tell the difference between a memory of something we’ve done and a memory of something we’ve just heard about, and distinguish both from stray thoughts or hopes. Confabulators can’t do this. Material that, for emotional or other reasons, comes to mind can at times be indiscriminately assumed to be a memory of what really happened.”

There’s a clue to confabulation in the responses of other patients with damage to the frontal lobes. These patients, who may have suffered violent head injuries or damage from illnesses such as strokes or Alzheimers, don’t necessarily confabulate but will often have problems with planning and motivation. They can seem heavily dependent on their external environment. Some, for example, indiscriminately respond to the things they see, regardless of whether it is appropriate in the context. The French psychiatrist L’hermitte demonstrated this “environmental dependency” in the 1980s when he laid a syringe on a table in front of a patient with frontal lobe damage and then turned around and took down his trousers. Without hesitation the patient injected him in the buttocks. This was a completely inappropriate action for the patient, but in terms of the possible actions made available by the scene in front of her, it was the obvious thing to do.

In those patients with frontal damage who do confabulate, however, the brain injury makes them rely on their internal memories—their thoughts and wishes—rather than true memories. This is of course dysfunctional, but it is also creative in some of the ways that make improvisation so funny: producing an odd mix of the mundane and impossible. When a patient who claims to be 20 years old is asked why she looks about 50, she replies that she was pushed into a ditch by her brothers and landed on her face. Asked about his good mood, another patient called Harry explains that the president visited him at his office yesterday. The president wanted to talk politics, but Harry preferred to talk golf. They had a good chat.

Improvisers tap into these same creative powers, but in a controlled way. They learn to cultivate a “dual mind,” part of which doesn’t plan or discriminate and thus unleashes its inventive powers, while the other part maintains a higher level monitoring of the situation, looking out for opportunities to develop the narrative.

Both improvisation and confabulation show that the mind is inherently sense-making. Just as a confabulator is unfortunately driven to invent possible stories from the fragments of their memories and thoughts, so an improviser looks at the elements of a scene and lets their unconscious mind provide them with possible actions that can make sense of it. On stage, this allows them to create entrancing stories. But this capacity for invention is inside all of us. As audience or performers, we are all constantly inventing.