The medical literature about confabulation is extensive but not of much help in accounting for the many cases of political confabulation. It is very unlikely that the late Metropolitan of St Petersburg and Ladoga and the many others peddling the Dulles doctrine and similar conspiracy theories were suffering from vitamin B1 insufficiency. Some undoubtedly did know better but regarded their specific narrative as a useful tool with which to disseminate their ideas. Others may believe that while not everything about their theories or doctrines may be true, they may be partly correct, enough in any case to circulate them widely. Or they may believe that while there is no proof at all that the theories are true, they could be true, or something quite similar could be true.

In any case, there is a striking similarity between clinical and political confabulation: the deep conviction of the confabulators that they are speaking the truth, the elimination of doubt where doubt is called for. It is, to repeat, by no means a specific Russian phenomenon. But it has become particularly widespread in Russia, where it has been embraced not just by the more gullible and less educated section of society but by sections of the intelligentsia, trained not to engage in blind belief but to use a critical approach.

Political confabulation in Russia was first described by the great theologian Vladimir Solovyov more than 100 years ago:

Let us imagine a person healthy in body and strong, talented and not unkind — for such is quite justly the general view of the Russian people. We know that this person (or people) is now in a very sorry state. If we want to help him, we have first to understand what is wrong with him. Thus we learn that he is not really mad; his mind is merely afflicted to a considerable extent by false ideas approaching folie de grandeur and a hostility towards everyone and everything. Indifferent to his real advantage, indifferent to damage likely to be caused, he imagines dangers that do not exist, and builds upon them the most absurd propositions. It seems to him that all his neighbours offend him, that they insufficiently bow to his greatness and in every way want to harm him. He accuses everyone in his family of damaging and deserting him, of crossing over to the enemy camp. He imagines that his neighbours want to undermine his house and even to launch an armed attack. Therefore he will spend enormous sums on the purchase of arms, revolvers and iron locks. If he has any time left, he will turn against his family. We shall not, of course, give him money, even though we are eager to help him, but will try to persuade him that his ideas are wrong and unjustified. If he will still not be convinced and if he perseveres in his mania, neither money nor drugs will help.

Even Solovyov could not offer an explanation, but his amazingly accurate description, written in 1893, seems to be just as valid today. And this will doubtless be investigated for a long time to come.