Dear laysplainer, spare me your impossible knowledge!

Black cubes with word IMPOSSIBLE on light background

Many years ago I received an urgent gynecology question at 11 PM. I was the OB-GYN Chief Resident on call that night so any outside calls came to me.

The middle aged woman on the phone told me she was desperate for help. She needed to know if her son’s girlfriend had come to the hospital to have an abortion. I repeatedly explained to her that I didn’t know, wouldn’t find out and was constrained by patient confidentiality from telling her in any case. I thought we were having a conversation about abortion and patient privacy. But then she said something that changed everything:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Laysplainers don’t merely overestimate their own knowledge; they can’t tell the difference between real knowledge and impossible knowledge.[/pullquote]

Please, you must let me know if she had an abortion at your hospital, because I hear the baby calling to me from a jar: Grandma, Grandma, come get me!

I realized then that we were having a conversation about mental illness.

I didn’t understand what was going on until the moment the woman offered impossible knowledge. Impossible knowledge is what people believe they know but couldn’t possibly be true because it is literally impossible (as in this case) or because it doesn’t exist.

Many people with mental illness believe they are in possession of impossible knowledge. The woman I spoke with believed with every fiber of her being that her putative aborted grandchild was telling her to come get him. But you don’t have to have to be mentally ill to claim you have impossible knowledge. Laysplainers offer it all the time to “prove” whatever it is they believe.

As I wrote last week, a laysplainer is a layperson (typically an anti-vaxxer or alternative health advocate) who “explains” disease, prevention or treatment to a medical professional in a condescending, overconfident, oversimplified and inaccurate way. And they don’t restrict themselves to false claims. They freely (and irritatingly) offer impossible knowledge.

In 2015, Dr. David Dunning, of the Dunning Kruger effect, published a paper on impossible knowledge.

At times, people even claim knowledge they cannot possibly have, because the object of their knowledge does not exist, a phenomenon known as overclaiming. For example, in the late 1970s, nearly a third of American respondents expressed an opinion about the “1975 Public Affairs Act” when asked about it directly, even though the act was a complete fiction. Approximately a fifth of consumers report having used products that are actually nonexistent …

Impossible knowledge looms large in the anti-vaccine movement. Many rabid anti-vaxxers assert confidently that there is a secret world-wide conspiracy of nearly all doctors, immunologists and public health officials to promote vaccines that don’t work and actually cause injuries to innocent children. That’s impossible knowledge because there is no such conspiracy and it couldn’t possibly be secret if you learned about it from a YouTube video.

The shill gambit, beloved of anti-vaxxers and lactivists, is often a form of impossible knowledge. Accusing me of being a shill for big Pharma or Big Formula is definitely impossible knowledge since I don’t get paid by any pharmaceutical or formula company. It is also impossible knowledge since you can’t possibly know it unless you have examined my finances and/or the finances of drug and formula companies.

Claiming that I “hate” breastfeeding is another variation of impossible knowledge since I breastfed my four children and both I and they enjoyed it and thrived.

So why do people claim knowledge they couldn’t possible have because it didn’t happen or it isn’t true?

According to Dunning and colleagues:

A sizable body of work on how people evaluate their own knowledge suggests that they rely not only on a direct examination of their mental contents but also on a feeling of knowing. Notably, a feeling of knowing is often only weakly predictive of actual knowledge and appears to be informed, at least in part, by top-down inferences about what should be or probably is known. We theorized that such inferences are drawn from people’s preconceived notions about their expertise, inducing a feeling of knowing that then prompts overclaiming.

In other words, anti-vaxxers and other alt-health aficianados don’t merely overestimate their own knowledge as the Dunning Kruger effect predicts (those with the least knowledge tend to think they know the most). They aren’t capable of telling the difference between real knowledge and a “feeling” of knowing.

The authors note:

It is easy to imagine how a tendency to overclaim, especially in self-perceived experts, could have adverse consequences. Self-perceived experts may give bad counsel when they should give none. For instance, an individual considering a financial decision may consult a friend who expresses confidence in her financial knowledge. That friend may provide inappropriate advice because she fails to recognize her insufficient familiarity with the question. Further, a tendency to overclaim may discourage individuals from educating themselves in precisely those areas in which they consider themselves knowledgeable and that may be important to them. In other words, over-claiming may hinder people from truly achieving a valuable level of genuine knowledge.

Similarly, self-perceived vaccine experts (anti-vaxxers) give bad counsel when they should give none. The typical anti-vaxxer provides inappropriate advice because she fails to recognize her insufficient knowledge. Moreover, because she “feels” like she knows all she needs to know, she doesn’t seek education in immunology, science and statistics. Offering impossible knowledge marks her not as knowledgeable, but as ignorant and gullible.

So, laysplainers, spare me your impossible knowledge!

Don’t tell me what doctors do or don’t learn in medical school; I went to medical school and you didn’t.

Don’t tell me how many “unhindered” vaginal births obstetricians have seen; I’m an obstetrician and you’re not.

Don’t tell me vaccines cause autism; I’ve read the vaccine literature and you haven’t.

Don’t tell me the Fed Is Best Foundation is shilling for formula companies; their financial forms make it clear that they aren’t.

When you assert impossible knowledge you are like the woman who told me she heard her aborted grandchild calling her. You indicate that you have lost touch with both knowledge and reality.