Knowing certain things is straight forward — like recognizing a friend’s house or remembering how to do a procedure we’ve done hundreds of times. But we’ve all met patients who are sure there is something wrong with them — they know it — despite all evidence to the contrary. Neurologist Robert Burton suggests that current neuroscience shows that knowing is a primary feeling, derived from unconscious processes beyond conscious scrutiny (On Being Certain: Believing You are Right Even when You’re Not, 2008).

Memory research shows this clearly. In one study, subjects were asked to write down their recollections of what they were doing when they heard about the explosion of the Challenger spacecraft, soon after the event. They were subsequently tested at various intervals. Although their memories changed, many participants felt that the most recent version was the “right” one even though the original journal entry contradicted what they now said. When confronted with his journal, one student said: “That’s my handwriting, but that’s not what happened.” The feeling of knowing can be persistent and impervious to reason.

Burton says that feelings such as certainty, conviction, faith, rightness, wrongness and clarity arise out of involuntary and unconscious mental systems that are integral components of the thoughts they qualify. Once a feeling of rightness becomes part of a thought, it becomes very difficult to change it. He concludes that isolated rational thought is a myth, since no part of the brain works free of involuntary and undetectable influences. The feeling that something is right comes out of unconscious processes that fit whatever is being considered, and previous patterns and sentiments. When the resulting calculation of probability of correctness reaches a certain level, we become aware of a feeling of knowing. (Einstein is said to have struggled with this: contemplating the implications of his theories, he said he could not believe that God would “play dice with the universe”).

Tapping into knowledge

Psychologist Timothy Wilson suggests that our minds have evolved to operate largely outside of conscious awareness. Much of our thinking involves “simulating” a situation to see what feelings it draws forth. Our feelings contain dense information from experience about things and this system is a quick way to tap into all that knowledge. Wilson points out several common errors in this process (Science 2008;321:1046-7). The simulation may choose an unrepresentative memory to compare with; it may leave out nonessential details that might have a large effect on the outcome. Thus, recalling a memory of an accident when you were in a car becomes incorrectly generalized to future times in a car, with the attendant associations of fear and avoidance. Antonio Damasio suggests that “gut feelings” begin with thought about a potential action; then an activation of memories of emotional states in similar circumstances which then activates a conscious memory and gives rise to awareness of a feeling: “I have a bad feeling about this.”

Sometimes the evidence on which we come to a feeling of knowing is (or seems) clear; other times it’s much less available and we’re only aware that something feels right. Burton reminds us of the need for humility, as we can never be certain exactly how the feeling of knowing is created.

Back to Jerry

Jerry wasn’t interested in psychotherapy; he was just sure there was a problem. His family physician offered reassurance and was willing to repeat liver function tests at 6-week intervals for awhile, so Jerry would feel that his concerns were taken seriously without leading to unnecessary investigations.