Short answer
Feeling confused is a common and normal experience that typically resolves quickly. However, in certain conditions like delirium, psychosis, or dementia, confusion can persist for extended periods. The brain is constantly at work, filtering, selecting, and organising the information we perceive. When these systems are overwhelmed or disrupted, confusion can occur – sometimes briefly, other times for longer durations.
Longer answer
Picture by Richard Duijnstee from Pixabay
Confusion is a common and normal experience. Our brains excel at predicting what will happen next, so when something unexpected occurs, it can disorient us. For example, it can be confusing when someone says something that doesn’t align with your current understanding or when trying to grasp a particularly complex explanation. Additionally, sudden, emotionally charged events, such as losing someone close to you, can create confusion. While confusion can be mentally exhausting, it is usually short-lived. Most of the time, clarity can be restored by seeking additional information, adjusting to the new situation, or focusing on familiar aspects of your life that provide stability.
However, some forms of confusion are more persistent. For instance, severe physical illness can lead to delirium, a state where concentrating becomes difficult, you may lose track of your surroundings, and you might even experience hallucinations. Psychosis, another form of confusion, involves losing touch with reality, often accompanied by a sense of detachment. This condition can be triggered suddenly, especially in individuals who are predisposed to it or as a result of drug use. Similarly, people with dementia may frequently experience episodes of confusion. To make things even more ‘confusing’ (😉), some people are labelled as confused despite feeling perfectly clear-headed. This highlights the complexity of the term, as explored with a playful twist in a Radio 1 column (Dutch): https://www.youtube.com/watch?v=AWdSYg5mYZI.
How the brain responds to different types of confusion likely varies, but one thing they all share is the loss of a normal sense of stability. When confused, you may struggle to focus, determine what’s important, or maintain control over your thoughts and actions. Several brain systems are involved in this process. Specific ‘messenger molecules’ play a key role in transmitting information between different brain areas (such as dopamine, noradrenaline, and serotonin). These molecules help your brain react to important external signals, guide your attention, and decide whether to take action. Your brain has a sort of filter to focus on the ‘most important’ things. This filter is associated with the striatum, a part of the brain, and relies on dopamine. If this filtering system doesn’t work correctly, you can become confused and overwhelmed by stimuli.
Yet another brain system is responsible for your ability to retrieve important memories, plan, prioritise, start, switch, and stop tasks. This system is located in the frontal lobe and is connected to other areas of the brain. Disruption of this system can also lead to confusion in both feelings and behaviour. This ability to manage behaviour effectively is known as executive functioning.
In essence, our brains are constantly working to prevent confusion by selecting and organising what we perceive (such as sights, sounds, touch, and smells) and what we think, feel, want, remember, and plan to do. When you think about it, it’s impressive how often this process runs smoothly despite the many distractions in the world.
This response was written by Dirk Geurts, a psychiatrist at Radboudumc Nijmegen.
For further reading on this topic:
Everything about psychosis (Dutch): https://www.psychosenet.nl/psychose/
What is delirium? (Dutch): https://www.nvvp.net/website/patinten-informatie/aandoeningen-/delier
The difference between delirium and dementia (Dutch): https://www.alzheimer-nederland.nl/delier-en-dementie