Why do some patients with brain damage construct seemingly false answers to questions, which they believe are true and accurate? Such confabulation is the topic examined in this book. Not only does Dr. Hirstein integrate the anatomical, neurological, and neuropsychological knowledge accumulated thus far on confabulation, but his training as both a neuroscientist and a philosopher provides a unique perspective on confabulation by integrating issues broadly related to the philosophy of the mind. What is also proposed in this well written book is the notion that elements of confabulation can be seen in healthy individuals and in persons with disorders less overtly neurological in nature than those with clearly documented neurological disorder.

In Chapter 1, the author starts with a detailed analysis of confabulation, provides clinical examples from a range of disorders, and then asks questions that prime the reader about factors to be raised and discussed throughout the remainder of the book. Chapter 2 provides information on basic cognitive neuroscience and brain-behavior relations. It serves as an overview for the professional, but is informative for the novice or student. In Chapters 3 and 4, the author provides an in-depth analysis of confabulation and memory disorders, primarily in patients with Korsakoff's syndrome and those with aneurysm of the anterior communicating artery (ACoA), and includes a review of the major theories of memory confabulation. The chapters are rich with neuroanatomical detail and provide a hint of how such neurobehavioral problems may be seen in a less obvious condition, obsessive-compulsive disorder (OCD). I particularly enjoyed Chapter 5 on confabulation from misidentification syndromes (e.g., Capgras, Fregoli syndromes), confabulatory syndromes more traditionally associated with the psychiatric literature, whereas confabulation among Korsakoff and ACoA patients is more traditionally discussed in the neurological literature. Chapters 6 and 7 provide an excellent review of confabulation associated with representations of the body (e.g., asomatagnosia, Anton's syndrome) and among split-brain patients, respectively.

In these first 7 chapters the author provides an easy to read analysis of the current theory that confabulation requires both a “knowledge deficit” and a deficit in “monitoring” or what he calls “checking” the accuracy of one's responses, collectively described as the “two errors.” Regarding knowledge deficits, the author describes the two major categories of confabulation: one involving memory or memory confabulators (e.g., ACoA and Korsakoff's), and the other a specific deficit in perceptual processing, such as Capgras syndrome, Fregoli's syndrome, or reduplicative paramnesia. However, he writes that what is common to both categories of confabulators is the deficit in monitoring (or “checking”) that what is being said is accurate, makes sense, or is otherwise logical (e.g., can one really have two of exactly the same person?), while patients simultaneously do not question the veridicality of their confabulation. Dr. Hirstein also shows how these “knowledge deficits” are associated with specific brain regions, and provides a wealth of integrative analysis arguing that the “checking” difficulties are due to orbitofrontal damage.

While much of the information provided in the first 7 chapters is fairly well accepted in the literature, the presentation and description of the “two errors” required for confabulation is rich with examples and well integrated and conceptualized. The most interesting aspect of this book, however, is the attempt to broaden confabulation to other aspects of the mind's operation, even among “healthy” individuals, which is the focus of the remaining 3 chapters. For example, there is an interesting discussion on the relationship between confabulation and self-deception. It is argued that self-deception also requires the “two errors”: (1) an ill-grounded thought and (2) the failure to reflect or “check” on the thought. As such, he argues that the primary difference between confabulators and self-deceivers is the degree of “tension” caused by the two errors. It is hypothesized that mechanisms associated with clinical confabulation may be the same or similar to those observed in various other conditions such as obsessive-compulsive disorder, autism, and sociopathology. The difference is that clinical confabulators and sociopaths have very little tension when they make their ill-grounded claims, while on the other end of the continuum, those with obsessive-compulsive disorders have extreme “tension.” His thinking and presentation is thoughtful, provocative, and philosophical. However, his ideas clearly require extensive experimental and scientific verification. I felt that in his final chapter (Epilogue), the author could have done a little more to integrate and extend his overall ideas and conclusions in a more focused fashion, although his brief section on “future questions” is indeed provocative.

Overall, the author's goal in writing this book was to show that studying confabulation in clinical settings is relevant to philosophical questions about knowledge and questions related to self-deception, even among healthy individuals. He was successful in achieving this challenging goal. Confabulation provides an excellent forum to address and integrate questions relevant to both neuroscience and philosophy. Brain Fiction: Self-deception and the Riddle of Confabulation provides a detailed and thought-provoking integration of confabulation as part of a philosophy of cognitive science. It deserves a prominent spot on the shelf of every scientist and philosopher interested in the mind and consciousness, both students and professionals alike.