Knowledge vs. prejudice

There is often a short distance between knowledge and prejudice with the quickest route being via assumption. We see something we recognise – that we ‘know’ about – and jump quickly to a set of conclusions on the basis of inadequate exploration. However, these conclusions may be entirely unjustified in any one particular instance, being based more on our own filtered experience than on the specifics of the situation at hand. This fine line between knowledge and prejudice is easily crossed, especially when we are under pressure. In our everyday clinical practice, time and resource pressures are universally familiar and increasingly seem to result in short cuts. Of course, short cuts are acceptable, even sensible, if they reliably lead us to the same destination as a longer, more thorough route. Unfortunately so often they do not. They simply lead us to an endpoint that may be unjustified or incorrect and this can be a problem for the individuals with eating disorders and the families we work with. Is there a danger of the gap between knowledge and prejudice reducing further in line with efficiency measures?

There are many definitions of prejudice, mostly referring to unsubstantiated, unjustified, biased or incorrect attitudes and beliefs. I am particularly fond of the definition proposed by Ambrose Bierce, who was born in the United States in the mid-nineteenth century. Bierce was the 10th of 13 children whose parents gave all their children first names beginning with the letter ‘A’. Perhaps this aspect of family life contributed to him becoming a vocal and well-published critic. Bierce put together a satirical dictionary with definitions of common words, in which prejudice is described as ‘a vagrant opinion without visible means of support’ (Bierce, 1911, 2000). I find the image of an idly wandering notion without any obvious tether or anchor, an apt one. So often, it seems to me, that what some clinicians dress up as professional ‘knowledge’ is nothing more than loose opinion, insufficiently grounded in evidence or theory, flapping in the wind.

So how do we guard against knowledge slipping into prejudice? Knowledge is vital. In our field there is much room for more knowledge. Surveys have repeatedly revealed that increased knowledge of eating disorders is put forward as a top priority across a number of key domains, to include improving early identification and tackling stigma. Early identification is essential in facilitating swift access to treatments that have been shown to work. Tackling stigma is essential to decrease the burden of distress and difficulty associated with eating disorders only too commonly experienced by affected individuals. There is no doubt at all that increasing knowledge is important. Yet increased knowledge is insufficient in itself; the process through which we apply our knowledge is just as important and crucial to keeping prejudice out of the picture.

If we are knowledgeable about something, it generally suggests that we are aware of relevant facts and up to date with new information. An individual truly knowledgeable about a certain topic will be able to demonstrate a level of competence in applying what they know to what they see or what they encounter. For example, an individual with an in depth knowledge about butterflies, might know that encountering the rare High Brown Fritillary butterfly (Argynnis adippe) in the East of England would be extremely unlikely. He or she would know that a High Brown looks very similar to a Dark Green Fritillary (Argynnis aglaja) and that the latter, although also quite rare, has a much broader distribution in England and therefore more likely to be encountered in this region. A close inspection of the patterning and hue on the underside of the wing would be required to confirm the butterfly as a Dark Green rather than a High Brown. Knowledge about documented seasonal patterns of the emergence of the adult Fritillary would allow an assessment of how unusual the encounter with the butterfly was. The point being that in order to apply our butterfly expert’s impressive knowledge correctly and usefully, careful inspection and consideration of a number of variables is required.

In clinical practice, the same principles apply. We can and should continually strive to increase our knowledge about eating disorders. Yet we must also be wary of jumping to unwarranted conclusions without proper assessment and sufficiently detailed consideration of what we think we are seeing. Many individuals with eating disorders that we encounter in clinical practice rightly dislike being lumped together as ‘anorexics’ or ‘bulimics’ insisting, again rightly, that they are different to others. If we are to avoid prejudiced attitudes and beliefs getting in the way of our work we must take care not to make assumptions. Discovery is a key component of knowledge acquisition and we should not only know about eating disorders, but also be sure to explore and acquire sufficient knowledge about each individual and their circumstances as this might significantly affect our recommendations. It is well known that ‘knowledge’ can make the holder blind to other possibilities; if we are truly to be of assistance to those struggling with eating disorders we must ensure we work with our eyes and our minds open. After all, if there is an Argynnis adippe for the seeing, you would not want to mistake it for an Argynnis aglaja just because it looks almost identical, would you?