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:

Laysplainers don’t merely overestimate their own knowledge; they can’t tell the difference between real knowledge and impossible knowledge.

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.

  • Michael Ray Overby

    Well said 🙂

  • rosewater1

    OT update: Niece in law is now officially my niece in law-she and my nephew are married! Insurance issues had a lot to do with it, but they were engaged before all this happened, so it would have happened eventually. She has been working doing what therapy she can at home while they wait for her to get picked up by my nephew’s insurance. That will help a lot.

    She had a real high-she was able to move her left leg and took some steps with a walker. Then another huge low-she is currently hospitalized with blood clots in her leg and her lungs. She’s due to be discharged tomorrow…so we wait and see.

    Great niece is 2 months old and BEAUTIFUL! She had her first 2 shots today-YAY VACCINES!-and handled them like a champ. She is chubby and happy and thriving.

    My dad is set to go to rehab tomorrow. He has a lot of work to do. I still do not think it will be safe for him to live by himself again, and the doctors tend to agree, He is hallucinating at times-he will ask for people who aren’t there, ask me to do things that aren’t connected with reality. I have been told that this may be what is called ICU delirium, and that it may pass. Again, wait and see.

    I’m but nature a type A goal oriented do-er. I don’t lack for things to do, but I also am finding that I’m doing a lot of waiting and being patient.

    • Amazed

      I hope for the best about your dad and now official niece in-law! And I’m thrilled to read about great niece!

      • rosewater1

        Thank you. 🙂 Niece in law is home and, according to my brother, has more movement than before this last hospitaliztion. Dad is in rehab and getting settled in, and I’m running around like a headless chicken doing all the paperwork, etc. that is needed. One day at a time.

  • demodocus

    But they have hundreds of links, Dr. A! Damn, I’m not even confident of my knowledge of history, my own major. Probably because I know just enough to know I know damned little. The only thing I’m reasonably confident are my sewing skills, something I started learning as a small child.

    • BeatriceC

      One of my groups just posted an “ask an expert” thread, basically asking for members who are actual experts in various science and medicine fields to introduce themselves and their area of expertise and allowing members to ask questions in subthreads to those comments. In an earlier thread asking if there as any interest, I said my area of expertise was statistics and probability theory, but prefaced that with “it’s been 20 years since I was in the field, so I’m only comfortable with what I consider the basics; essentially what you’d get in a 200 level university course, maybe a bit beyond that, but not much.” But I still think that some basic information on how statistical analysis works, what the various terms and tests mean, and how to zero in on the design and analysis sections of a study to determine if it’s a solid study, even if you don’t understand the topic of the study, is good, because if you can determine the math is being manipulated or the study design is poor, then you don’t have to worry about understanding the topic enough to determine if it’s bad science.

  • space_upstairs

    Unable to distinguish between knowledge and a feeling of knowledge sounds like Sally on the laysplaining thread to a tee. She apparently believes that the only reliable vaccine science is that tiny minority which says vaccines are bad because…pharma is a big business, and all big businesses are like tobacco in the 60s and are happy to harm people for profit, therefore vaccines, one of pharma’s big mass market products, must be dangerous like cigarettes. Any other science must be pharma-sponsored and therefore illegit, and those of us who believe the other science must be dupes or ignorant or, well, outright shills.

    Most people’s beliefs on hot topics are largely if not entirely a matter of social affiliations and other cornerstones of one’s identity, and most people are unaware of this in themselves. Somehow I ended up aware of it in myself, between watching my political beliefs drift leftward in college and grad school after finding myself conversing and identifying with more left-leaning peers online and off, watching my beliefs in the supernatural fade as I was exposed to more scientific skeptics among my peers, and cutting land-based meats from my diet amidst pescetarian and vegetarian friends and popular articles about the health risks of red and processed meats. All of these changes in belief and practice were slow and conscious since I knew the new peer-based positions were in conflict with the positions of other people in my life who were important to me and to my sense of self, and which had once seemed to make sense to me. Most people who make the kind of changes I did – or opposite ones in the case of people like Sally – would probably say they started thinking for themselves, but between my personal experience and my hobby interest in sociology and psychology, I strongly suspect thinking for oneself does not exist. I will leave it to a psychologist to either confirm this or say otherwise and shame me for being such a hapless follower.

    • rational thinker

      I am starting to think sally may have a problem and I really don’t want to keep at someone with a mental illness so I wont be commenting on that thread anymore. The first guy we got rid of in a few hours other anti vaxers made a few comments. She has been at this for 2 days and a lot of the things she said about herself seems suspect and contradictory.

      • space_upstairs

        She does seem unusually deep down the rabbit hole, too passionate about her cause to consider that maybe we don’t read her links because the very names of the Websites raise red flags of serious agendas for those of us in the “skeptic” community. (If I say anything more to her, it will be that.) The funny thing about inferring more about her well-being from this is that I recently read that small things in psych experiments can make people act and think in ways virtually indistinguishable from madness.

    • fiftyfifty1

      “I strongly suspect thinking for oneself does not exist.”

      Well, it must exist or humans could never have new knowledge, invent things etc. But I would say it occurs much less frequently than we like to think.

      • space_upstairs

        I guess in the sense of making new links between things stored in old knowledge, yeah, it does exist. But like consciously willed actions, it probably represents a tiny portion of thought and needs the infrastructure of what we learned from others to be effective (Newton’s “standing on the shoulders of giants”).