14

Paramnesias and delusions of memory

Ivana S. Marková and German E. Berrios

On occasions, patients may report memories of events that never happened in their
lives, for example, they may claim with conviction to have been in a place before,
or lived through a particular experience, or carried out a deed. During the second
half of the nineteenth century, these clinical phenomena were conceived of as a
form of memory disorder. Changes in the definition of memory occurred during
the 1880s, and this, inter alia, led to their eventual neglect. But they are still met
with in clinical practice and need to be discussed in a book on the neuropsychiatry
of memory complaints. Since most of the interesting clinical descriptions are to be
found in earlier publications, this chapter will perforce have a historical flavour.
In 1886, Emil Kraepelin1 suggested that the term ‘paramnesias’ might be used to
refer to the qualitative disturbances of memory whose study, as opposed to quan-
titative memory disturbances (general and partial amnesias and hypermnesias),
had been confined to a few case reports. Such reports most commonly referred to
what Walter Scott called ‘sentiment of pre-existence’ (and Feuchtersleben called
‘phantasm of memory’, and the French déjà vu) and featured prominently in the
medical work of Wigan, Jensen, Jackson, Sander, Pick and Anjel. But whilst the
former three writers conceived of this phenomenon as a ‘disturbance of perception’
(resulting from a lack of synchrony between the two hemispheres), Sander and Pick
proposed that it was a disturbance of memory.

Paramnesias as ‘disturbances of perception’

Wigan
Wigan (1844) referred to the phenomenon as:
a sudden feeling, as if the scene we have just witnessed (although, from the very nature of
things it could never have been seen before) had been present to our eyes on a former occa-
sion, when the very same speakers, seated in the very same positions, uttered the same
sentiments, in the same words – the postures, the expression of countenance, the gestures,
the tone of voice, all seem to be remembered, and to be now attracting attention for the
second time (p. 84).

313
314 I.S. Marková and G.E. Berrios

Wigan offered the following explanation:

only one brain has been used in the immediate preceding part of the scene, – the other
brain has been asleep, or in an analogous state nearly approaching it. When the attention
of both brains is roused to the topic, there is the same vague consciousness that the ideas
have passed through the mind before, which takes place on re-perusing the page we had
read while thinking on some other subject. The ideas have passed through the mind before,
and as there was not sufficient consciousness to fix them in the memory without a renewal,
we have no means of knowing the length of time that had elapsed between the faint impres-
sion received by the single brain, and the distinct impression received by the double brain.
It may seem to have been many years (pp. 84–5).

Jensen
Jensen (1868) was the first to draw specific clinical attention to these phenomena,
calling them ‘double perceptions’ (Doppelwahrnehmungen):
occasionally, generally only fleetingly, there arises in us a vague awareness that this or other
situation as it is occurring at present, has been experienced in exactly the same way before.
We recall that our friend took exactly that stance, held his hands in that particular way, had
the same expression, spoke the same words, etc. We are almost convinced that we can
predict what he will do next, say next and how we ourselves will respond (p. 48).

Jensen believed that these phenomena were common in healthy individuals and
that their study might throw light on ‘similar’ complaints in the mentally ill.
Like Wigan, he proposed that the experience resulted from a time disparity or
lack of synchrony in the functioning of the cerebral hemispheres. According to
Jensen, the cerebral hemispheres controlled the highest psychical functions, i.e.
perceptions and concepts (Vorstellungen). Nonetheless, he observed, large sectors
of a hemisphere could be ‘absent’ without there being a noticeable loss of function
(i.e. thinking and perceiving were possible in subjects that had only one hemi-
sphere). Like the ‘paired’ sense organs (eyes and ears) that received two images, the
cerebral hemispheres also received two ‘congruent’ perceptions (i.e. normally expe-
rienced as one percept). In abnormal situations, however, there could arise a dis-
parity in the functioning of the cerebral hemispheres akin to squinting of the eyes.
The latter led to double images (double vision), and the former to double percep-
tions, the sole difference being that, in the case of vision, the images were projected
next to each other in space and in the case of the brain the perceptions were pro-
jected one after another in time. Jensen reported four cases showing, arguably, the
same phenomenon. He explained some of the differences between them on the
grounds that some showed the direct expression of the phenomenon and others
showed the effects of modulation by psychological factors.
315 Paramnesias

Jackson
Hughlings Jackson (1932) wrote repeatedly on the ‘sensation of reminiscence’. In
1876, he also indicated that such feelings, primarily seen as the ‘intellectual aura’ of
epilepsy, were ‘not uncommon in healthy people’ (Vol. 1, p. 274). At this stage,
Jackson still believed that Wigan’s ‘double consciousness’ model was a ‘perfectly
accurate account’.
In 1888, Jackson returned to these ‘sensations of reminiscence’ in relation to the
case of a medical colleague who, under the pseudonym of Quærens, had reported
his own temporal lobe epilepsy (Vol. 1, pp. 388–9). To describe his experience,
Quærens quoted from David Copperfield:
We have all some experience of a feeling which comes over us occasionally of what we are
saying and doing having been said or done before, in a remote time – of our having been
surrounded, dim ages ago, by the same faces, objects, and circumstances – of our knowing
perfectly what will be said next, as if we suddenly remember it.

In 1899, Jackson repeated the view that double consciousness or ‘mental diplopia’
was a common accompaniment of the ‘dreamy state’ (pp. 467–8).

Paramnesias as ‘disturbances of memory’

Sander
Sander (1874)2 believed that the ‘double perception’ account did not explain ade-
quately the phenomenon, and reconceptualized it as a ‘memory deception’
(Erinnerungstäuschung). The latter, Sander defined as a sudden impression, in the
course of normal thinking and behaving, that a particular ongoing situation had
been experienced before. Like Jensen, he believed that the phenomenon could lead
to the conviction that the future could be foretold, and that it was common in the
healthy, particularly in the young with a tendency to introspect. He emphasized,
however, that there was an emotional component (a feeling of unease) intrinsically
linked to the memory deception. On occasions this feeling, which was the result of
efforts made to match memories to specific spatiotemporal experiences, could be
distressing and cause marked fear.
Sander reported the case of a 25-year-old man with epilepsy who experienced
this phenomenon on several occasions, each time lasting about two months. In his
account, the patient stated that whilst speaking with someone, or seeing something,
he would suddenly get the feeling that he had experienced the same conversation
or seen a particular object in exactly the same way before. Sander highlighted two
aspects of this case. First was the unusual duration of the memory deception; for,
even when recalling it, the patient was still unclear as to which were real experiences
and which were memories. Secondly, the memory related to all aspects of the
316 I.S. Marková and G.E. Berrios

situation including place, people, things and feelings and not just the event or
object itself. This second feature Sander used to differentiate memory deceptions
from phenomena such as delusions and delusional misidentifications.3
Sander rejected the ‘double perception’ hypothesis on the basis that it was not
simply single objects or perceptions that were involved but the whole situation,
including context and atmosphere. Consequently, memory deceptions could not
be explained just on the basis of anatomical or physiological brain disturbances but
a psychological explanation was needed. He proposed that memory deceptions
arose from similarities to previously experienced events which could trigger the
feelings and contexts associated with a previous experience and lead to the feeling
that that the whole thing had taken place before. With great clinical sense, Sander
placed the abnormality not on the memory itself, but on a mistaken association of
ideas/feelings with the relevant memory. He conceptualized memory deceptions in
the same way as sensory deceptions (Sinnestäuschungen): ‘. . . similarly [to sensory
deceptions] here, it is not the memory that deceives, but memory that is being
deceived through other psychological processes’ (p. 253).

Pick and Anjel

Sander’s paper stimulated others to focus on ‘memory deception’. For example, in
an early paper Pick (1876) reported a patient who as a boy had the feeling that he
had lived through particular situations in exactly the same way as before. Later in
life he developed, in addition, persecutory delusions. This led to an increase in the
frequency of his memory deceptions which in the event became incorporated into
an elaborate delusional system involving the belief that he had a ‘double life’
(Doppelleben). Pick distinguished between simple memory deceptions (i.e. déjà vu
experiences as conceptualized by Sander and – arguably – Jensen) and delusional
interpretations based on these experiences – as shown by his patient. Pick pro-
pounded that the memory deception was the basic or primary phenomenon.
Although Anjel (1878) used the term ‘memory deception’, he returned to a
version of the ‘perceptual’ hypothesis. Noticing an association between memory
deceptions and tiredness and stress, he proposed that physiological processes were
slowed down by fatigue thus leading to a prolongation of the time lapse between
the sensory and the cerebral perception of an object. This led to an incongruence
between the sensory system and the cerebral processes that elaborated sense data
into subjective representations. Thus Anjel’s hypothesis differs from the view pro-
posed by Wigan and Jensen according to which the disparity was between the
images generated by the two cerebral hemispheres.
317 Paramnesias

Other paramnesias

Apart from the déjà vu-like phenomena, other types of paramnesias were discussed
in the literature prior to Kraepelin’s synthesis. Of note amongst these are the so-
called obsessions, hallucinations and illusions of memory, respectively.

Eyselein
Though claiming to describe a form of memory deception in Sander’s sense,
Eyselein (1875) reported the case of a patient with mnestic obsessions who was per-
sistently preoccupied with the need to recall things from her past. The patient,
however, did not seem to be aware of having experienced the same things before.
Eyselein focused more on the accompanying feeling of unease and distress than the
feeling of recognition.

Kahlbaum
By ‘hallucinated memories’ (hallucinirte Erinnerungen), Kahlbaum (1866) referred
to hallucinations of false past events.4 He reported the case of a young Catholic
female inpatient who complained at a ward round that the priest (accompanying
the doctors during this activity!) was confusing her with his notions. She stated that
she was a Catholic and did not want to turn Protestant. It turned out that the priest
had only recently started working at the institute, and had not seen her or any other
patient in her ward before. Therefore, remarked Kahlbaum, the patient was either
lying, which seemed unlikely, or had recently experienced hallucinations whose
content related to the religious debate. Kahlbaum went on to question what sort of
hallucinations might these be, i.e. were they auditory hallucinations, or facial
(visual) hallucinations, or both? It had been noticed that whilst the patient fre-
quently made such complaints, talking about conversations which she had appar-
ently experienced in the recent past, no one had actually observed her as appearing
to be experiencing hallucinations at any time.
To conceptualize her symptom as a ‘hallucination of memory’, Kahlbaum pro-
posed that perception resulted from an interplay between the functional activity of
peripheral and central organs of perception. The central organs of perception were
of two types: (i) organs of perception proper that converted the physical stimuli
into a ‘psychical form’, and (ii) organs of ‘apperception’, responsible for comparing
current input to past impressions and endowing percepts with the knowledge that
they had been perceived before.
In the case of his patient, Kahlbaum noted firstly that the dysfunction had to be
in the central organs of perception. Consequently there were two options: one that
her experiences resulted from pathology in the organs of perception proper in
which case pathways subserving vision and hearing were affected. However, it was
318 I.S. Marková and G.E. Berrios

not simply the case that she was ‘hearing a vision’ but that the patient was involved
in a dialogue and therefore would have had to have spoken to her hallucination or
have hallucinated her own words. Since she had never been observed participating
in imaginary dialogues, it seemed more likely that the abnormality lay in the organs
of apperception, where the psychical representations were contextualized and
grounded as memories. Kahlbaum thus concluded: ‘we are dealing here not with a
memory of a real hallucination, but with a hallucinated memory, with the halluci-
natory process involving the act of remembering itself ’ (p. 41).

Sully
‘Illusion of memory’ was defined by Sully (1895/1881)5 as:
a false recollection or a wrong reference of an idea to some region of the past. It might,
perhaps, be roughly described as a wrong interpretation of a special kind of mental image,
namely, what I have called a mnemonic image . . . Mnemonic illusion is thus distinct from
mere forgetfulness or imperfect memory (pp. 241–2).

He identified three components in accurate recollections: ‘When I distinctly recall

an event, I am immediately sure of three things: (i) that something did really
happen to me; (ii) that it happened in the way I now think; and (iii) that it hap-
pened when it appears to have happened. I cannot be said to recall a past event
unless I feel sure on each of these points.’ (p. 242). Based on these components, he
suggested three types of illusions of memory: ‘(i) false recollections, to which there
correspond no real events of personal history; (ii) others which misrepresent the
manner of happening of the events; and (iii) others which falsify the date of the
events remembered.’ (p. 243). Using the analogy of ‘visual illusions’, Sully suggested
a mechanism for each: ‘Class (i) may be likened to the optical illusion known as
subjective sensations of light, or ocular spectra. Here we can prove that there is
nothing actually seen in the field of vision . . . similarly, we shall find that there is
nothing actually recollected . . . such illusions come nearest to hallucinations in the
regions of memory . . . Class (ii) has its visual analogue in those optical illusions
which depend on effects of haziness and of the action of refracting media . . . in like
manner we can say that the images of memory often get obscured, distorted, and
otherwise altered . . . Finally, class (iii) has its visual counterpart in erroneous per-
ceptions of distance . . . It will be found that when our memory falsifies the date of
an event, the error arises much in the same way as a visual miscalculation of dis-
tance’ (pp. 243–4).
Sully focused on the first group (the ‘hallucinations’ of memory):
what . . . are these false and illegitimate sources of mnemonic images, these unauthorized
mints which issue a spurious mental coinage, and so confuse the genuine currency?6 They
consist of two regions of our internal mental life which most closely resemble the actual
319 Paramnesias

perception of real things in vividness and force, namely, dream-consciousness and waking
imagination (p. 273).

Later on, Sully added a third mechanism:

Modern science suggests another possible source of these distinct spectra of memory. May
it not happen that, by the law of hereditary transmission, which is now being applied to
mental as well as bodily phenomena, ancestral experiences will now and then reflect in our
mental life and so give rise to apparently personal recollections? (pp. 280–1).

Based on his interesting interactional model of the self, Sully went on to suggest
that the notion of personal identity might, in part, be constituted by illusory or false
memories.
Sully’s functional classification of false memories and his emphasis on mnestic
(as opposed to perceptual) function constitute an advance in regards to the old
‘brain disparity’ theories. However, he made little effort to test his views in the clin-
ical field as Jensen, Sander, Pick and others had done (he does not quote their
work). Nonetheless, his views were to influence Kraepelin.

Kraepelin and the new classification

Under ‘paramnesias’, Kraepelin (1886) brought together the ‘qualitative’ memory

disturbances. He expanded Sander’s concept of memory deceptions by including
other ‘falsification of memories’ (Erinnerungsfälschungen). Using a modified
version of Sully’s classification, he subdivided the entire group into ‘partial’ phe-
nomena, i.e. falsifications or distortions of true memories analogous to illusions
(conflating two of Sully’s groups); and ‘complete’, i.e. ‘false’ experiences expressed
as memories, and viewed as analogous to hallucinations. Focusing on the second
group, Kraepelin believed complete falsifications of memory should be viewed as
memories which did not correspond to ‘real’ past experiences, in the same way that
hallucinations were considered as perceptions without a corresponding ‘real’
object. The content of such false memories or ‘pseudoreminiscences’ consisted of
elements of past experiences, combined according to patterns other than the orig-
inal ones.
Based on the clinical analysis of personal and borrowed case histories, Kraepelin
subdivided pseudoreminiscences into: (i) simple (einfachen Erinnerungsfälschung),
(ii) associating (associirenden Erinnerungsfälschung), and (iii) identifying
(identificirenden Erinnerungsfälschung). The first group included any image that
arose spontaneously in the mind, of whatever content, as long as it was experienced
as a memory. The second type referred to apparent memories which were evoked
by association with a currently perceived object, i.e. the perception of such partic-
ular object/event would trigger the false memory whose content, in turn, would
320 I.S. Marková and G.E. Berrios

involve the object in a specific role. The third type, Kraepelin identified with
Sander’s ‘memory deceptions’ (equivalent to the current definition of déjà vu), and
consisted of the feeling that the current situation with all its details had been expe-
rienced in exactly the same manner at some time in the past.

‘Simple falsification of memory’

Simple pseudoreminiscences occurred both in health and illness. Healthy subjects
could fantasize about fictional characters and on occasions take on their personal-
ities and experiences. Similarly, patients in whose minds the distinction between
truth and fantasy, and even the initial intention to deceive, had become blurred
could experience these phenomena. Severer forms of simple pseudoreminiscences
occurred in pathological conditions, e.g. General Paralysis of the Insane (GPI) and
dementia, and also in paranoid and affective psychoses. In GPI, such pseudo-
reminiscences were often colourful and ‘fantastic’, and patients would ‘recall’
amazing adventures, fantastic journeys and meeting and identifying with famous
people. Kraepelin’s case 1 referred to a 42-year-old man with GPI who claimed that
he had built, inter alia, beautiful ships for Russia and a castle in Nüremberg. He was
‘Frederick the Great’s twin brother’, he ‘had been with Christ on the cross’, he ‘was
Adam in Paradise’ and ‘Hercules and Alexander in the battle of Gaugamela’, etc.,
recounting such historical events as being his memories. His ‘recollections’ were
easily guided to other areas by asking him about such new events. His memory for
‘real’ past experiences as well as for recent events was relatively preserved. Another
patient with GPI (Case III) claimed that he had created 76618 planets, and that
everything there was better, more colourful: ‘. . . whilst the camel here is brown,
there it is a wonderful sky blue with white and gold splashes . . .’ (p. 836). He had
also built, in different colours, all the churches in Germany and had led all wars, etc.
Somewhat less fantastic falsification of memories occurred in other organic
states such as idiocy/dementia (Blödsinn). Kraepelin observed that, in these cases,
the immediate or recent past was also invented, and his clinical descriptions are
redolent of what nowadays is termed ‘confabulations’.7 These patients would
(falsely) report receiving letters or visitors and other events in a convincing manner
and in full detail. In some cases, whole days might be reconstructed out of pseudo-
reminiscences. Such patients tended to have relatively good memory for events in
the distant past, but poor memory for recent events. Kraepelin described a 74-year-
old man (Case X) with intellectual and memory deficits who had become childish
and irritable, not doing anything, irresponsibly borrowing money, and eating
greedily. He was disorientated in time and place and unable to recall recent events
or to retain information for any length of time. In place of real memories, he
reported detailed false apparent memories although on occasions he would hesi-
tate exclaiming that he was going mad.
321 Paramnesias

Less frequently than in GPI, simple falsifications of memory with fantastic

content could also occur in paranoia (Verrücktheit).8 Kraepelin’s case V concerned
a 26 year-old chronically ill patient who one day claimed that a prince was coming
to fetch her. She believed herself to originate from different parents, and would no
longer recognize her relatives. She then recalled having lived on earth before, rec-
ognizing coetaneous people who had lived in Spain more than 1000 years earlier.
On being asked how she knew this, she would respond that this was her recollec-
tion: ‘. . . from memory, one doesn’t forget what one has experienced in life . . .’ (p.
842).
Yet another chronically psychotic patient (case VII) recounted, in detail, mem-
ories involving fantastic and impossible contents. He had taken part in duels, ended
wars through his bravery, a bullet had passed through his head and 50 more
through his chest – requiring several operations though the scars had all dis-
appeared. His head had been torn off but replaced with an iron one. He believed
that people around him, whom he saw for the first time, were actually known to
him from earlier times. He described life on the sun, moon and Mars. He was con-
vinced of the truth of his experiences and regarded with suspicion anyone who did
not believe him. His mood was changeable but mostly pleasant and friendly. Later,
he developed even more grandiose delusions, claiming that his castles and palaces
were to be found on the stars, that he had placed kings in charge of these and put
the Pope on the moon so that he could bless everything. He had married 1000 times
but, becoming tired of his wives, he had married them off to the sovereigns of the
stars. He had 100 sons. In hospital, he had been given new lungs and testicles, etc.
The patient’s memory for true events was intact, but quickly lapsed into his fantas-
tical recollections. Some years later, his delusions receded and he became apathetic,
neglecting his appearance, speaking little, and spending a lot of time sitting still in
his room. Later on, the old grandiose and persecutory delusional ideas reappeared.
These, and other such case descriptions, were grouped by Kraepelin as chronic
insanities (chronische Wahnsinns). In some, onset was in childhood; in others as late
as in their 40s. Many also had sensory deceptions (hallucinations) which tended to
be unpleasant and related to persecutory delusions. In contrast, the content of
grandiose delusions was considered by Kraepelin to be related to falsification of
memories, not because the latter were the origin of the former but both, he
believed, arose from the same pathological source.9
Patients thus affected were also given to misidentifying people
(‘Personenverkennung’). For example, new people around them would be
identified with those populating their old memories, and considered as acquain-
tances who had shared with them journeys or experiences. In the course of one
conversation, the same person could be ‘identified’ with any one of a number of
earlier protagonists in the patient’s recollections. Generally, these patients had good
322 I.S. Marková and G.E. Berrios

memory for true events, leading Kraepelin to believe that true and the false mem-
ories ran independently in their minds. Showing subjective certainty about the
truth of their false memories, such patients were unaware that they clashed with
their true memories.
Pseudoreminiscences also occurred in Melancholia and Mania. The melancholic
mood, by affecting patients’ views and perspectives of their past, gave rise to both
partial and complete memory falsifications such as ‘depressive delusions’ of evils or
sins committed; for example, one patient claimed that in her youth, she had
deceived her parents and chased after men; another patient claimed that he had
stolen everything, and yet another had betrayed Germany, etc.10 Similar paramne-
sias also developed out of obsessional thoughts. Initially resisted, these experiences
later dominated over healthy memories. Sometimes pseudoreminiscences would
start with a vague feeling11 that something terrible had been committed and then
would crystallize into a specific ‘recollection’. Kraepelin also observed that the
content of pseudoreminiscences in Melancholia was more uniform and less colour-
ful than that of pseudoreminiscences in GPI or chronic insanities. On the other
hand, the simple pseudoreminiscences of Mania, a mixture of truth and fantasy,
were similar to those seen in GPI. Rightly, Kraepelin noted that it was difficult to
determine whether such experiences were true pseudoreminiscences (i.e. experi-
enced as recollections) or the grandiose exaggerations of Mania.
In summary, simple pseudoreminiscences were heterogeneous phenomena
found both in health and disease and corresponding to experiences variously
classified in current terminology as delusions, delusional memories and confabula-
tions. Kraepelin attempted to delineate them further.
(a) They had to be experienced as actual memories. This differentiated them
from lying or deliberate deceptions and exaggerations, as well as from hallucina-
tions and simple delusional ideas referring to past events. In regards to the latter,
for example, a patient might infer ‘information’ from a hallucination concerning a
past event; this was not a simple pseudoreminiscence for he would not experience
it as an actual recollection with its accompanying antecedents and contexts.
(b) The ‘falsification’ referred to the recollecting process itself and not to the
original ‘memory’ or experience. It was this falsification of the activity of recollect-
ing that distinguished ‘true’ pseudoreminiscences from hallucinatory reminis-
cences and delirious reminiscences, which superficially might present in a similar
way. In the latter, the reported past event was also false in the sense that it did not
correspond to a ‘real’ event in the past; however, it could be true or ‘real’ in the sense
that it was an actual pathological representation in the patient’s mind. This would
subsequently be copied by the normal recollecting processes. In other words, for
Kraepelin, it was not just the discrepancy between a reported past event and an
actual event that constituted a falsification of memory, but the discrepancy had to
323 Paramnesias

be manifested through the processes of recollection which in turn (and following

the literal definition of ‘hallucination’ – without a corresponding object), could not
be based on any object, real or pathological.
(c) Differentiating between hallucinatory or delirious reminiscences and true
pseudoreminiscences might be difficult. Kraepelin suggested that it helped to focus
on the content of the experience which was more constant in the case of hallucina-
tory and delirious reminiscences (because the memory processes were relatively
intact and there was the same original representation in the mind caused by the
pathology). In the case of true pseudoreminiscences, however, it was less constant
as it was not based on any specific representation in the mind and could thus be
triggered and/or shifted by skilful questioning.
(d) With respect to mechanisms underlying paramnesias, Kraepelin was less
clear. He mentioned ‘alterations of consciousness’ (Bewusstseinstrübung) which
occurred with varying severity and caused a reduced capacity to differentiate
between reality and fantasy. He made analogies with the ‘dream state’ (also a form
of altered consciousness) where fantasies and real experiences were likewise mixed
and indistinguishable.
(e) It was also unclear what sort of process constituted the simple paramnesia.
Although accepting that it arose from the same pathological source as the grandiose
delusion, Kraepelin believed that the two phenomena were distinct. Because of
their relationship to past experiences, he attached greater pathological significance
to paramnesias. Following Sully, he based his reasoning on the fact that it was easier
for most people (healthy or otherwise) to lose objectivity when evaluating future
or present situations for this was coloured by their ongoing mood. In contrast,
evaluation of past events was, he believed, less affected by such moods, wishes and
biases. Hence, distortions in this sphere betrayed more serious pathology. Because
Kraepelin viewed the past as a sum of all past experiences and the foundation of the
personality or the self (unseres Ich), its pathological evaluation would also imply a
significant disturbance of the person’s individuality or self.

‘Associating falsification of memory’

Kraepelin defined ‘associating’ pseudoreminiscences as those triggered by a current
perception. The patient believed that there was a link between his (supposed) past
and current perception, and constructed a false relationship between the two.
Kraepelin gave the example of a 33-year-old merchant (Case XIV) who 12 years
earlier had complained to the police that he was being followed. At that time, he
also believed that people were looking and talking about him. He had continued to
function relatively well until his psychosis became florid. He started to believe that
the newspapers were publishing descriptions of his clothes, the food he ate, what
he paid for things, etc. A few weeks prior to his hospital admission, he claimed that
324 I.S. Marková and G.E. Berrios

he had read in the paper that he was the Royal Pretender and that he would be
enthroned within the year. Although he ‘remembered’ reading these things and
‘knew’ the exact pages on which they had appeared, he was never able to find the
places again. Consequently, he became convinced that the particular articles were
being deliberately removed and replaced. On closer questioning, it also emerged
that at the time of reading the paper he had not been struck by any articles about
him. It was only a few hours or days later that he would suddenly realize that arti-
cles were referring to him, at which point he could then recall in detail their con-
tents.
On admission to hospital, he was calm, showed no behavioural disturbance, and
his memory seemed excellent. His pseudoreminiscences became apparent when he
started talking about another patient. He denied being acquainted with this person
prior to his admission, but recalled having heard that he would be meeting him in
hospital. Further questioning revealed that he had similar beliefs about other
patients and events, for example, remembered having read about the organization
of the hospital prior to admission and now knew all details concerning this. Thus,
he seemed to link each pseudoreminiscence to a current impression – people, fur-
niture, or conversation around him. News events which occurred whilst he was an
inpatient, he likewise claimed to have read/heard about some months previously.
Every occurrence was already known to him. He also exhibited an extensive delu-
sional system which appeared to originate in part from sensory deceptions and in
part also from simple pseudoreminiscences. He had auditory hallucinations saying
that he could hear the hospital director telling another patient his whole history;
such hallucinations, however, were infrequent, never hostile, and their contents
were interwoven with his ideas and delusions. Kraepelin called them ‘apperceptive
hallucinations’ (Apperceptionshallucinationen). As his illness progressed, the
pseudoreminiscences shown by this patient became pervasive and he found that the
views he had expressed earlier about other things, e.g. the Pope, social reforms etc.,
were now being printed in the papers, almost word for word. Similarly, jokes he had
recounted were also being printed. Finally, it became clear to him that a number of
thoughts he had seemingly developed whilst in hospital, he had already had earlier.
This case showed all the features Kraepelin considered as typical of associating
pseudoreminiscences. First, particular objects seemed to trigger paramnesias and,
as the disease progressed, more and more objects became triggers. Secondly, objects
were integrated into the contents of the paramnesia. Kraepelin observed that there
was a delay in time between the perception of the object and the construction of
the memory which to him suggested that the object alone might not be the sole
trigger. Likewise, the content of the pseudoreminiscence was far more detailed than
that found in a normal recollection. In addition to real objects, hallucinations could
also act as triggers of paramnesias, and, as an example, he reported the case of a
325 Paramnesias

patient who developed a chronic insanity following alcoholic delirium tremens and
who heard the voices of his sisters talking to him, and through their ‘questions’, he
came to realize that he had committed a number of wrong doings in the past.
The distinction between simple and associating paramnesias thus hinged on the
presence in the latter of a trigger which could be a real or a pathological perception.
The aetiological or prognostic significance of the trigger itself, however, is unclear.
Furthermore, Kraepelin’s view that the patient could be aware of the trigger ‘by
apperception’12 makes it difficult to distinguish between the associating and simple
forms. Nonetheless he analysed in detail the nature of the link between a current
perception and a recollection in order to differentiate between associating
paramnesias and other phenomena in which such a link might appear to exist, e.g.
the misidentification phenomena.13 In these clinical phenomena, however, the link
between present and past impressions was, according to Kraepelin, in the opposite
direction, and hence they were the converse of the paramnesias. In the latter it was
the current impression that led to the construction of the recollection and was
incorporated into it; on the other hand, in the misidentification the past experience
gave rise to the construction and meaning attached to the current perception; hence
the misidentification was not simply a perceptual disturbance but a complex
process resulting from the activity of memory, imagination, judgment, etc.

‘Identifying falsification of memory’

Kraepelin observed that this was commoner than the ‘associating’ type of paramne-
sia and corresponded to Sander’s ‘memory deceptions’ (déjà vu experiences).
Kraepelin likewise emphasized that what was perceived as ‘re-experienced’ was the
whole situation rather than some of its features. He stressed also that the situation
was experienced as identical in every respect (not just similar) and, furthermore,
the person was convinced of his experience even if the ‘earlier’ experience could not
be clearly located. For Kraepelin, this ‘feeling of identity’ suggested an involvement
of the self in the deception and was essential to the definition of the phenomenon;
it therefore differentiated the identifying from the simple paramnesias. Crucially,
for Kraepelin, the ‘self’ that was involved in the ‘identifying’ paramnesias related to
a ‘second-order’ disturbance in contrast to the ‘self ’ that was involved in the simple
paramnesias which reflected a disturbance of the actual structure of the self.
These phenomena were, however, fleeting. Kraepelin argued that this made
Sander’s ‘similarity’ hypothesis implausible as this predicted a longer-lasting
paramnesia. Kraepelin’s views, however, seem to have been based on borrowed
cases and a few reports by healthy people. Because of this he mostly iterated earlier
descriptions (feelings of unease, premonition, etc.), although he suggested ‘per-
ceptual change’ (environment seen as dark, shadowy) and a ‘temporary halt in
thought flow’ as additional features. Kraepelin found all earlier explanatory
326 I.S. Marková and G.E. Berrios

theories unsatisfactory but limited himself to favouring the mechanism of ‘altered

consciousness’ on the grounds that these paramnesias tended to be associated with
fatigue (known to cause attention to shift from the outside to the self) and epilepsy.
The ‘paramnesias’ as a unified class encompassing Kraepelin’s manifold qualita-
tive memory disturbances did not appear to survive for long. Instead, focus on par-
ticular subgroups falling within the paramnesias resulted in the delineation of
phenomena which became conceptualized as independent entities. Very broadly,
this fragmentation seemed to develop along two main lines, namely: (i) paramne-
sias as false recognitions (i.e. déjà vu phenomena and subsequently jamais vu,
misidentifications and reduplicative paramnesias) and, (ii) paramnesias as false
recollections (subsequently confabulations, delusional memories).

Paramnesias as ‘false recognitions’

In France, interest in the paramnesias peaked in the 1890s as illustrated by the

famous debate in the journal Revue Philosophique between Lalande, Dugas, Lapie,
Le Lorrain and others where these experiences were viewed in the specific and
narrow sense of false recognition, i.e. in the déjà vu sense (equivalent to Sander’s
memory deceptions and Kraepelin’s identifying pseudoreminiscences). Lalande
(1893) expressed this directly when he proposed that the term ‘paramnesias’ should
be exclusively reserved for such experiences and reiterated the clinical character-
istics described by Sander. Dugas (1894), who followed in the debate, made a dis-
tinction between the ‘impression of déjà vu’ and paramnesia or false memory
proper. He conceived the former as a type of confusion, a partial illusion, where
false ‘recognition’ of a situation occurred on the basis of actual similarities to pre-
vious experiences and hence was explicable by analogy. Paramnesia, by contrast,
was a total illusion in that a new situation was experienced as identical to a previ-
ous one. Not based on any similarity, it was therefore inexplicable, and this resulted
in the accompanying affective state. The impression of déjà vu, he noted, was com-
moner and involved single objects or groups of things. Paramnesia, on the other
hand, related to a situation in its totality: ‘a current section of life (‘tranche de vie’),
cut out and transported into the past’ (p. 39). Dugas also differentiated between
paramnesias with (complete) and paramnesias without (simple), the feeling of
premonition and proposed different mechanisms for each. On the other hand, Le
Lorrain (1894) argued that paramnesias with premonition should not be classed as
paramnesias but as telepathic phenomena. Lapie (1894) proposed that imagination
created situations that were then stored and that, on occasion, coincided with real-
life perceptions and hence gave rise to false recognition.
The Revue Philosophique debate was not satisfactorily resolved. However, it nar-
rowed and reconceptualized the paramnesias as disorders of recognition which
327 Paramnesias

were due to multiple disturbances involving sensory/perceptual/cognitive pro-

cesses (e.g. telepathy, hypnosis, imagination, dreams, double personality) rather
than memory disturbances per se. (Those who did concentrate on the memory
model (e.g. Bourdon, 1893; Le Lorrain, 1894), tended to conceptualize the
paramnesias as the false recognition of single objects or groups of objects rather
than the false recognition of the total experience.) This shift in focus was made
explicit by Arnaud (1896) at a meeting of the Société Médico-Psychologique: ‘I
believe that it would be better to abandon these words false memory and paramne-
sia which have the double disadvantage of being vague and inexact – since it is not
certain whether the phenomenon in question is in fact associated with memory.
Thus, to keep things clear and avoid theoretical assumptions, I suggest the term
illusion of déjà vu’ (p. 455).
After briefly referring to Wigan, Jensen, Sander, Pick, Anjel, Forel, Kraepelin,
Ribot, Lalande, Dugas and Sollier, Arnaud claimed (as had earlier French authors)
that the prevalence of the déjà vu illusion had been exaggerated and confused with
analogous states such as vague memories. He pointed out that déjà vu had two
fundamental characteristics: intensity of the feeling – which bordered on convic-
tion, and identity of the subjective current state with the ostensible past situation.
He further distinguished between a ‘mild’ form of déjà vu, a ‘normal’ experience of
short duration, which ceased abruptly and was rectifiable; and a ‘severe’ form, a
pathological phenomenon which lasted much longer and was rarely susceptible to
rectification. As an example of the severe form, Arnaud (1896) reported the case of
Louis, a 34-year-old graduate from Saint Cyr (the French Military Academy) who
had experienced déjà vu as a child. After developing cerebral malaria, he was found,
in 1891, also to be suffering from anterograde and retrograde amnesia. After 7
months, he improved from his malaria but his memory remained poor. In 1893,
Louis showed ‘the first symptoms characteristic of déjà vu’ when he started claim-
ing that he could recognize certain newspaper articles which he said he had read
previously. He even claimed to have written many of them himself. At the marriage
of his brother, he insisted that he had attended the same ceremony a year before, in
identical conditions and he couldn’t understand why everything was happening
again. On admission to hospital, he immediately ‘recognized’ everything he saw,
including the rooms, the park outside, the staff, their words and gestures and his
own responses. He also claimed to recognize all great public events and this led him
to make errors in dates saying the year was 1895 since newspapers were dated 1894.
He felt that he was re-doing and re-perceiving the same things and re-experiencing
the same emotions, mental states and dreams. He summarized this as ‘I am living
two parallel years’ (p. 460).
Arnaud explored the nature of this severe form of déjà vu arguing that, although
the phenomenon appeared to be experienced as a memory, it was not in fact a true
328 I.S. Marková and G.E. Berrios

disturbance of memory. First, the ‘recognition’ in déjà vu, in contrast to the

recognition in true memories, was unstable; for example, in the case of Louis, when
his environment was manipulated, his ‘recognition’ adapted correspondingly to the
changes without apparent loss of vividness. In other words, the localization of the
experience in space was in reality always that of the present perception. Similarly,
the specific localization in time to one year previously was simply the result of rea-
soning by the patient. Secondly, a true memory consisted of a situation evoking a
network of related recollections acting as its context. The illusory memory or déjà
vu consisted only of the current situation: ‘consisting of nothing more, nothing less
than the contents of the present perception’ (p. 466). For example, when Louis saw
someone from behind, he claimed to ‘recognize’ them, but on further questioning,
he could not provide any information other than the description afforded by the
back view. Thus, the illusion of déjà vu was simply the current perception projected
into the past or a retrospective perception (une perception rétroactive/rétrospective).
Arnaud’s case shows singular features that differentiate it from the usual form of
déjà vu: (i) it had a surprising specificity of localization in time (to one year earlier),
(ii) it combined both false recognition and false recollection, e.g. Louis ‘recognized’
articles in newspapers but also insisted that he had written some himself, and
claimed to be living parallel lives (i.e. there was a duplication of experiences), (iii)
the affective component seemed at times incongruent with his experiences (e.g.
smiling at his recognition of the doctor). All these features suggest alternative
(current) clinical diagnoses such as a delusional state or a delusional
misidentification or reduplication. Furthermore, by focusing on particular aspects
of the case, Arnaud concluded that Louis had a perceptual rather than a memory
disorder (hence his proposed change in terminology). Arnaud’s perceptual view
was touched upon by subsequent participants in the debate such as Pierre Janet,
who in the main agreed, and Paul Garnier who advocated the continuous use of the
term ‘false memory/paramnesia’ for it drew attention to the fact that the phenom-
enon occurred predominantly in those with memory impairment.
Arnaud’s paper marks a turning point in the conceptualization of ‘false recogni-
tions’. Two years later, and based on the results of a postal survey, Bernard-Leroy
(1898) tried to re-categorize false recognition/déjà vu as a memory disturbance
(Berrios, 1995). Later writers, however (e.g. Dromard & Albès, 1907), continued
the drift away from the ‘memory’ explanation.

Dromard and Albès

These writers made a further distinction between déjà vu (or déjà éprouvé) and false
recognition (fausse reconnaissance), defining the former as a simple, normal, and
transient phenomenon in which the subject felt as if he were re-experiencing a
section of his life, and which involved no impairment of judgment. False recogni-
329 Paramnesias

tion, on the other hand, they viewed as a false, pathological and persistent belief
involving an alteration of judgment (Dromard & Albès, 1907). Instead of relating
to a ‘section of life’ or the ‘totality of an experience’, false recognition related to
single things or groups of things or people (falsely) recognized in isolation.
Dromard and Albès introduced a new explanatory element by expanding upon
Janet’s idea that false recognition resulted from a loss of the ‘feeling of (present)
reality’ (which like Janet, they conceived as a specific mental function). Patients
experiencing false recognition were thus unable to distinguish the real from the
unreal. As an example, Dromard and Albès (1907) reported the case of a man with
a past history of hallucinations and persecutory ideas who had been admitted to
hospital following arrest by the police. He was picked up outside the Ministry of
the Interior where he had been demanding a full review of the birth certificates of
those born after 1870. He said that people were confused and needed to know
definitively who they were and where they came from. On admission to hospital,
he claimed to ‘recognize’ amongst the patients, people he knew (e.g. a previous
boss) and expressed surprise at seeing so many familiar people in the hospital.
By reconceptualizing false recognition as a misidentification of specific objects
rather than as a ‘false recognition’ of a particular experience, Dromard and Albès
came close to describing the phenomenon of delusional misidentification,
specifically, the Capgras symptom, the Frégoli symptom and intermetamorphosis
(Marková & Berrios, 1994); and by viewing the phenomenon of false recognition
as an impairment of judgement, they reconceptualized false recognition and false
non-recognition as being the positive and negative poles of a common process.

‘Reduplicative paramnesia’

Of all the group of phenomena that originally were called paramnesias, the redu-
plicative paramnesia is the only one to have survived, at least in name. It is still occa-
sionally conceived as a qualitative memory disturbance.

Pick
After reporting at least one earlier case,14 Arnold Pick (1903) coined the term ‘redu-
plicative paramnesia’ to refer to
a continuous series of events in the patient’s remembrance, subsequently fall into manifold
occurrences; the isolated events, though they remain pretty clearly in his memory, are
impressed on him as repetitions thereof (p. 261).

Pick’s first case had been of a patient with GPI who claimed that there were two
clinics exactly alike in which he had been, two professors of the same name were at
the head of these clinics, etc. Pick’s second case was of a 67-year-old lady with senile
330 I.S. Marková and G.E. Berrios

dementia/presbyophrenia15 who again showed marked memory impairment and

disorientation in time. She had fluctuations in mood and various fleeting delusions
changing in content and relating to numerous ‘illusionary’ phenomena. She also
confabulated. In contrast to the first patient, her reduplicative paramnesia was
more selective, i.e. she only claimed that she was in the ‘same clinic’ (as the one in
Prague) but that this was situated elsewhere. She did not, however, duplicate the
professor (and assistants) insisting instead that the same professor was head of both
(identical) clinics and the assistants also worked in both clinics. In addition, the
patient expressed the (false) belief that she had experienced the same situation
before: ‘This is already the second time that I have had the advantage of your valued
treatment’ (p. 264).
The ‘duplication’ in reduplicative paramnesia could thus relate not only to places
and people but also to time. Again, this shows similarity to the false recogni-
tion/déjà vu phenomena described above. In his initial explanation for reduplica-
tive paramnesia, Pick had suggested that the clinical phenomenon was a
disturbance of the ‘sense of familiarity’ (Bekanntheitsgefühl). Subsequently,
however, he proposed that the basic disturbance was a loss of continuity between
consecutive mental impressions. The latter, in turn, resulted from mental and
memory disturbances caused by the background disease (e.g. GPI/dementia, etc.).
Thus patients ‘cannot identify one situation from the other, which become dupli-
cated and eventually divided into a multiplicity of events’ (p. 267). Pick also
believed that the selectivity of reduplicated ‘objects’ observed in his second patient
was the result of a relatively greater preservation of intellect.

Coriat
Coriat (1904) reviewed Pick’s cases and reported further examples occurring in
patients with Korsakov’s psychosis, alcoholic deterioration and general paralysis.
According to this author, reduplicative paramnesia could be explained by a
combination of dissociation and disturbance of the sense of familiarity
it is the inability to bridge over the dissociated memory images, associated perhaps with a
feeling of having experienced certain events . . . before, and being unable to connect or
correct this sense of familiarity with previous or present experiences on account of these
gaps (p. 653).

Coriat’s interest in the ‘sense of familiarity’ biased his recognition of the disorder
and it is questionable whether his second case is actually an instance of reduplica-
tive paramnesia. It concerned a 40-year-old labourer with a long history of heavy
alcohol intake. A few months prior to hospital admission, he stopped working and
began accusing his wife of infidelity. His memory seemed to be deteriorating in that
he failed (spontaneously) verbally to recall places he had been to before. He became
331 Paramnesias

increasingly flat and apathetic and was admitted to hospital whereupon he

expressed his concerns about his wife’s infidelity. Otherwise he was well orientated
and showed no deficits in recent memory. He claimed, however, that he had been
in the hospital 1 year previously and subsequently added that, at that time, he had
been seen and treated by the same doctors and in the same room. Some days later,
he stated that he had been in the hospital 2 years previously. Later still, he men-
tioned that he had been in the hospital four times in as many years, undergoing
similar treatments and seeing the same people on each occasion. It is thus appar-
ent that, in contrast to the ‘classic’ description, his ‘reduplication’ related only to
time and not to places or people. Remarking on the similarity between Coriat’s and
Arnaud’s case, Rosenberg (1912) considered that both showed pathological forms
of déjà vu in the context of paranoid psychoses. He argued that since Coriat’s
patient remained orientated and showed no evidence of impaired memory for
recent events, he did not experience any loss of continuity in his mental impres-
sions and thus was not predisposed to reduplication of his experiences. Rosenberg
went on to stress that organic memory disorder was a necessary condition for the
development of reduplicative paramnesia.
During the late nineteenth century, the paramnesias conceived, in general terms,
as mere ‘false recognitions’ became fragmented. For example, paramnesias were
classified according to: (i) their object, i.e. whether the recognition related to a par-
ticular experience in its entirety (‘section of life’) or to a single object
(persons/places/things); this favoured the differentiation between déjà vu/jamais
vu phenomena and misidentification/reduplication phenomena, respectively; (ii)
the duration of the false recognition, i.e. whether it was fleeting or persistent,
leading to their grading as mild and severe; relevant to the latter was whether or not
the underlying process was delusional; (iii) type of recognition, i.e. relationship to
normal recognition processes, thus stimulating the debate on the nature of the
underlying process, i.e. whether it involved memory, perception or other functions;
(iv) the presence/absence of an organic-memory deficit influenced whether the
phenomenon was conceptualized as ‘neurological’ or ‘psychiatric’, respectively.
More recently, attempts have again been made to seek a common mechanism, par-
ticularly in respect to delusional misidentification and reduplicative paramnesia
(Alexander et al., 1979; Joseph, 1986; Röhrenbach & Landis, 1995).

Paramnesias as ‘false recollections’

In general, less work has been focused on paramnesias as ‘false recollections’, i.e.
referring to ‘memories’ of events that have not in reality taken place (conflation of
Kraepelin’s simple and associating falsification of memories). This view was spon-
sored by Korsakoff.
332 I.S. Marková and G.E. Berrios

Korsakoff
Korsakoff (1891) described two forms of memory disturbance in patients with
‘polyneuritic’ psychosis (polyneurotischer Psychose). First, patients suffered from
amnesia for recent events whilst retaining relatively good memory for distant
events. Secondly, patients suffered from pseudoreminiscences or falsification of
memory (gefälschten Erinnerungen). Following earlier writers, Korsakoff sub-
divided the second group (Erinnerungstäuschungen) into: (i) sudden feeling of
having experienced a particular situation in exactly the same way before, including
having the same thoughts, speech, etc. (i.e. equivalent to Kraepelin’s ‘identifying
memory deceptions’), and (ii) real or true pseudoreminiscences (eigentlichen
Pseudoreminiscenzen) whereby an event never experienced by the patient, simply
entered his mind and was believed by him as being a true past experience. In such
cases,
a patient might claim that he was Alexander of Macedonia, that he had taken the trip to
India. He would claim to recall how everything happened and could relate all sorts of details
about the trip as if he had actually experienced it (p. 391).

Korsakov believed that analysis of this second group revealed the kernel of the
pseudoreminiscence to be a true memory; hence, they corresponded to Kraepelin’s
partial falsifications of memory or illusions of memory. (His case descriptions,
however, are more suggestive of Kraepelin’s complete falsifications of
memory/hallucinations of memory.)
In addition to polyneuritic psychosis, pseudoreminiscences also occurred in
paranoia, melancholia, mania, GPI, and senile dementia. He described patients
with polyneuritic psychosis: ‘on being questioned about how they spent their day,
often gave detailed accounts of trips, meetings, etc. detailing these as if they had
truly had the experiences.
. . . In most cases, the patient will change his account of such fantastic memories, e.g. one
patient who had just reported that he had driven to hospital, forgot this in the next minute
and subsequently gave an account of having gone hunting and shooting ducks’ (p. 392).16

In some patients, the false content of their memories persisted and gave rise to delu-
sional ideas.
Following some detailed case descriptions (Korsakoff, 1891), Korsakoff con-
cluded that polyneuritic psychosis was often accompanied by memory deceptions
as well as delusions based on the latter. He described such delusions as commonly
relating to themes of death and funerals. With time, pseudoreminiscences became
stronger and, from these, delusional ideas gained their force, resulting in a picture
of partial insanity. Korsakoff claimed that in polyneuritic psychosis, pseudo-
reminiscences were almost always based on a true/real memory, and likely to arise
from the linking of memory traces into fairly constant associations. Such associa-
tions were, in turn, more likely to form if there was a pre-existing disorder of the
333 Paramnesias

mechanism involved in the association of ideas, such as was found in some psy-
choses.

Wernicke
Wernicke (1906) contributed to the understanding of the paramnesias by making
a further distinction between delusional misinterpretation of memories (retrospec-
tiven Beziehungswahn) and falsification of memories (Erinnerungsfälschungen).
The former consisted of real memories being delusionally misinterpreted, e.g. a
patient with grandiose delusions remembered being spoken to by an Officer when
he was a young boy; only later did he ‘realize’, on the basis of certain similarities,
that this Officer, was actually Kaiser Wilhelm or Kaiser Friedrich or some equally
high-ranking personality. At the same time, he had been asked at school by his
teacher whether he still had a father or grandfather; this question, he also came to
realize, related to this high-ranking personality and he subsequently knew where to
look for his father or grandfather. The objection that this could have been a
‘neutral’ question was dismissed by the patient on the grounds that the teacher had
given him a meaningful glance and a hand signal.
It was important, Wernicke claimed, to differentiate this delusional misinter-
pretation of memory from a falsification of memory which presented in a positive
and a negative form. The positive form or ‘confabulation’ consisted of the appear-
ance of memories of experiences which had never actually occurred; the content of
these confabulations was generally in keeping with the rest of delusions (Wahn).
For example, patients with persecutory delusions related (confabulated) adven-
tures in which they had supposedly been followed. Wernicke believed that there was
a link between confabulations and disturbances of memory and that this was
further confirmed clinically by the fact that confabulations were seen particularly
in mental illnesses accompanied by memory deficits such as hebephrenia, pres-
byophrenia and GPI. He considered that the fantastic content of some confabula-
tions resembled that of dreams and that (once lying was excluded), such
confabulations represented true memories of dreams.
On the other hand, Wernicke defined the negative form of ‘falsification of mem-
ories’ as consisting of the appearance of circumscribed deficits or gaps in an other-
wise well-retained memory database and when there was no reason to suspect a
disturbance of the senses or of attentional loss at the time of the particular experi-
ence. This was necessary since it would not be surprising to observe memory gaps
in patients with meningitis, epilepsy or delirium tremens who, at the time, would
have suffered from disturbed attention. In negative falsification of memories,
however, single or individual events taking place in full consciousness became lost
whilst attending (surrounding) events were remembered. Two elements helped
explain negative falsifications of memory, namely, presence at the time of (i) a par-
ticularly strong affect, and (ii) an overvalued idea (überwerthigen Idee). Hence, this
334 I.S. Marková and G.E. Berrios

clinical phenomenon was common in chronic partial psychoses: for example, a

patient under the influence of an overvalued idea, believed that a particular official
was his personal enemy and insulted him. He subsequently denied that he had done
so (i.e. he showed a memory gap for the event).
According to Wernicke, delusional interpretation of memories were to be con-
sidered as qualitative falsifications of memory whilst the positive and negative
forms were quantitative falsifications of memory. The latter, he suggested, were
better termed additive and subtractive forms, respectively. All three forms shared
an underlying mechanism, namely a disconnection (Sejunction). For example, in
confabulation (additive form) there was a disconnection between the recollected
experience (whether this was real, imagined or a dream) and time. It is thus clear
that Wernicke’s classification was different from Kraepelin’s who had considered all
‘false memories’ as qualitative memory disturbances. Wernicke’s contribution led
to a further narrowing of the falsifications of memories. Thus, he conceived qual-
itative memory falsification as extrinsic to the memory or recollecting process itself;
in other words, memory is intact but the quality of the recollection, as manifest by
the different colouring or significance, is altered by the delusional process. In con-
trast, quantitative memory falsifications are intrinsic to the recollection itself in the
sense that there is either an increase in (false) memories or a decrease in (true)
memories.

After Wernicke
In historical terms, Wernicke’s view marks the final split of the false recollections
into delusions (both delusional notion and delusional perception/interpretation à
la Kurt Schneider) and confabulations. Fundamental to this division is the putative
link of confabulations with a real memory deficit. Indeed, this became the main
criterion as for example used by Chaslin (1912) (see also Berrios 1999b). But this
also means that the crucial question, namely whether delusional memories and
confabulations are differentiable on phenomenological grounds alone, was left
unanswered.
Jaspers’ (1948/1913) classification of memory falsifications was also unclear on
phenomenological grounds. He distinguished between false memories
(Trugerinnerungen) on the one hand and other memory falsifications
(Erinnerungsfälschungen) on the other. Conceptualizing the former as ‘hallucina-
tions of memory’ (following Kahlbaum, 1866), he nevertheless did not make clear
how these differed from delusional ideas (Wahnvorstellungen). The other memory
falsifications were further divided into (i) pathological lying, (ii) attribution of new
meanings to past (true) events (i.e. delusional misinterpretation) and, (iii)
confabulation. Again, however, it would appear that the main distinction between
false memories (Trugerinnerungen) and confabulation is the presence, in the latter,
335 Paramnesias

of an organic memory impairment. Schneider (1959) viewed memory falsification

as resulting from delusional processes, either in the form of delusional perception
or as sudden delusional ideas: ‘qualitative disturbance of memory in schizophrenia
and cyclothymia are, however, not really disturbances of memory but delusional
elaboration of memory and spontaneous delusional notions’ (pp. 125–6). Current
textbooks (e.g. Gelder et al., 1996) and standardized interview schedules (e.g. PSE,
Wing et al., 1974) continue to use the term ‘delusional memories’ to refer to ‘false
memories’ reported by psychotic patients but they do not always indicate what the
exact distinction is between these experiences and conventional delusional percep-
tion or delusional interpretation of memories. Lastly, others have concentrated on
whether the distinction has any diagnostic significance (Buchanan, 1991).

Conclusions

During the nineteenth century, the generic term paramnesia was used to refer to a
group of clinical phenomena amongst which déjà vu, confabulations, and delu-
sions and hallucinations of memory remain the more salient. These phenomena
had been known since earlier but it was only after the work of Sander that they
began to be considered as ‘memory’ disorders. In Kraepelin’s taxonomy the
paramnesias are included as ‘qualitative’ disorders of memory affecting either
recognition or recollection. However, towards the turn of the century, the concept
of memory was noticeably narrowed down and the paramnesias were set asunder.
They have been neglected since. Déjà vu remains a curiosity seen in some forms of
epilepsy and occasionally in the normal affected by fatigue. Delusions of memory
are occasionally mentioned in the literature but hallucinations of memory have dis-
appeared altogether.
And yet these phenomena need explanation. It has been suggested in this chapter
that their study may force upon us a broader definition of memory than the one
currently in play and one which may prove to be more useful to neuropsychiatry.
Because these phenomena do not figure as ‘symptoms’ in most current nosologies,
they are no longer searched for, and hence their incidence and prevalence in clin-
ical populations (let alone their epidemiology in the community) are unknown.
However, the conceptual, historical and clinical information provided in this
chapter suggests that it might be clinically worthwhile to return to these phenom-
ena not only in relation to patients explicitly complaining of memory disorders but
also in subjects with functional psychosis as they might provide the clinician with
new phenomenological markers.