The brain confabulates. It associates diverse sensations, defies contradictions, and creates coherence. It even seeks explanations for its own unfathomable behavior." Those are the words of Dr. Gerald M. Edelman, Nobel laureate in physiology and medicine and author of Wider Than the Sky, talking about the human brain. He tells us that our brains confabulate - unconsciously replacing fact with fantasy when necessary. The brain also defies contradictions-it won't simultaneously believe two ideas that are in direct opposition to each other. The brain even goes so far as to come up with explanations for behaviors that are beyond understanding. All of this is necessary if we're to maintain a sense of coherence, because when the mind isn't logical and orderly anti consistent, we can't function. Without a mechanism to correct incoherence, we would plummet into mental disorder. Our brains literally fill in the gaps for us-even when they have to make things up-so we don't lose equilibrium.
Addiction is not a mental illness (many brain diseases, such as Alzheimer's and Parkinson's, are not mental illnesses), but there was a time when some medical researchers wondered whether alcoholism was related to schizophrenia. Both demonstrate a thought impairment that results in an abnormal interpretation of reality. Like schizophrenics, alcoholics eventually withdraw into delusions and a reality separate from other people. Both disorders appear slowly and affect only some behaviors some of the time. Schizophrenics may continue to appear normal to family and friends well into the earlier stages of the disease, and even once the disease is quite advanced, schizophrenics can seem quite lucid at times. Symptoms aren't consistent and they can change quite radically. Things are very bad and then they get better. Alcoholism has similarly confusing patterns.
A friend of mine was schizophrenic. She resisted treatment, as do alcoholics, and refused medications. She was raised in a family of considerable wealth and fame, and would frequently hallucinate visits with famous friends of her grandfather's who had long since been dead. She'd tell me of these visits in such a sensible and intelligent manner that I would believe her until my brain caught up with the fact that her visitors were no longer living. She once engaged in a knowledgeable discourse on drug trafficking, and her arguments were quite well thought out until she ended with an assertion that Rose Kennedy was the head of the worldwide drug trade. I once tried to evacuate her during a hurricane and she adamantly refused. She believed it was a trick-the CIA was plotting against her. When I turned on the television to show her the weather report, she pointed out that she couldn't trust broadcasters. I telephoned another good friend to try to convince her. She turned and said to me with authority and incredulity, "You know the rules. I can't trust anyone on television or over the phone. Maybe they're really who they say they are, maybe they're not." She was explaining to me how her schizophrenia worked, yet she was still tightly wrapped up in the delusions of the disease. It reminded me of addicts who talk about addiction yet are completely convinced by their altered reality. When I said to my schizophrenic friend, "But you know you can trust me," she replied, "You can't see the truth. You don't know what is really happening." The disease was much more powerful than my relationship with her. Much like the alcoholic, she was quite sure everyone else was wrong. She was incapable of questioning herself. She couldn't say, "A lot of people are telling me something is wrong. Maybe I need to reevaluate my own beliefs." She never agreed to treatment on her own, but family and friends finally took it upon themselves to have her committed to two months of inpatient treatment. She now takes medication and lives a full and normal life.
Even though alcoholism isn't a mental illness and is not related in any way to schizophrenia, it is very helpful to see the similarities between brain diseases and how confusing the symptoms can be. We know addiction hijacks the brain. We've already discussed how it co-opts the survival instinct for its own benefit. But I also think it takes over this mechanism of confabulation for its own purposes. The alcoholic mind makes sense of a disease that doesn't make sense. It seeks out explanations for the unfathomable. When things are going terribly wrong, the disease uses the brain to create alternative realities. The addicted person, like the schizophrenic, can't see beyond the false reality the brain is presenting. The disease tells the alcoholic, You are still in control. You still have more time. Alcoholics, even in the end stage of addiction, believe these thoughts. When we try getting through to the addicted brain, it responds as did my schizophrenic friend: "You don't know what's going on." That's why, one-on-one, we rarely succeed in talking sense to an alcoholic or addict.
Another example of how the brain confabulates is written in the book A Brief Tour of Human Consciousness, by neuroscientist V. S. Ramachandran, M.D., Ph.D. The author tells us about a rare brain disorder called Cotard's syndrome. Patients with this disorder believe they are dead even though they are fully functional human beings. What happens is that all senses become detached from the emotional centers of the brain. As a result, nothing in the person's life has any emotional impact-someone with this syndrome is totally devoid of any emotional response to anything, even the people and things he loves most. These patients' minds translate this emotional emptiness into the belief that they are dead. Dr. Ramachandran explains: "However bizarre, this is the only interpretation that makes sense to them; the reasoning gets distorted to accommodate the emotions... [and] is notoriously resistant to intellectual correction." Ramachandran goes on to explain that if you reason with a Cotard's patient that dead people do not bleed, he will agree that that is true. Then when you prick his arm with a needle and he bleeds, the patient will change his mind and say that dead people do bleed after all. Dr. Ramachandran notes that "once a delusional fixation develops, all contrary evidence is warped to accommodate it." This is also what we experience with addiction. Even when presented with indisputable evidence, the addicted mind will dispute the veracity of the evidence, much to the amazement of family and friends.
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