Patients confuse fiction and memory due to the complex and sometimes fragile nature of human memory, which is not a perfect recording of events but rather a reconstructive process. Memories are actively rebuilt each time they are recalled, making them susceptible to distortion, blending with imagined details, or incorporating external suggestions. This reconstructive nature means that fictional elements, suggestions, or even dreams can become intertwined with real memories, leading patients to believe in events that never actually occurred.
One key reason for this confusion is that memory does not work like a video playback but more like a puzzle that the brain pieces together from fragments. When some pieces are missing or unclear, the brain fills in gaps with plausible details, which can be influenced by a person’s beliefs, emotions, or external information. For example, during therapy or conversations, suggestions or leading questions can unintentionally implant false details, which the patient later accepts as genuine memories. This phenomenon is often seen in cases involving repressed memories or trauma, where the mind may suppress painful experiences but later reconstruct them inaccurately, mixing fact with fiction.
Another factor is the emotional intensity associated with memories. Strong emotions can enhance the vividness of a memory but also increase the likelihood of errors. Emotional memories are more prone to being reshaped by the brain’s attempt to make sense of the experience, sometimes leading to confabulation—where patients create fabricated or distorted memories without intending to deceive. This is especially common in individuals with memory impairments or neurological conditions, where the brain struggles to differentiate between real and imagined events.
Cognitive biases also play a role. People tend to remember things in a way that fits their current understanding or expectations. Over time, repeated retelling or reflection on an event can alter the memory, making it more consistent with the person’s evolving narrative or identity. This means that fictional elements introduced at any point can become integrated into the memory as if they were always part of it.
Additionally, the brain’s mechanisms for distinguishing between internally generated thoughts (like imagination or dreams) and externally experienced events can sometimes fail. This blurring of boundaries means that imagined scenarios or stories heard from others can be mistakenly encoded as personal memories. This is why some patients report memories of events that others never witnessed or that contradict known facts.
In some cases, the physical state of the brain affects memory accuracy. Conditions such as dementia, brain injury, or acute confusion can impair the brain’s ability to store and retrieve memories correctly, leading to reduplicative paramnesia or confabulation, where patients believe in multiple versions of reality or fabricate memories to fill gaps.
The hypothesis of body memory adds another layer, suggesting that some memories, particularly traumatic ones, might be stored or expressed through bodily sensations rather than conscious recall. While controversial and not fully supported by scientific evidence, this idea reflects how complex and multifaceted memory can be, influencing how patients experience and interpret their past.
Overall, the confusion between fiction and memory arises because memory is a dynamic, reconstructive process influenced by internal cognitive functions, emotional states, external suggestions, and sometimes neurological conditions. This makes it possible for fictional elements to become indistinguishable from real memories in the mind of the patient.
