Different Ways of Knowing; or maybe avoiding knowing anything useful

Hi all,

This week I thought we would touch on one of the more popular lines of thought that is frequently argued by my colleagues. That, is the notion that there are different “ways of knowing” in explaining phenomena. The idea that there are different ways of knowing things is not really new, and forms the basis of any philosophical and epistemological argument, but promoting the verb over the noun (a curiously North American pastime) and the principle that these ways are all equally valid as forms of explanation are more modern ideas, arising from the postmodern movement of the 1970’s.

My thoughts on this were triggered as a few weeks back when in a discussion I heard the trite comment that “…of course  science is only one way of knowing, there are really four different ways of knowing, empirical, ethical, personal and aesthetic.”  What surprised me was that the individual arguing this view made no attempt to justify the classification, but presented this as an established given, simply arguing that this illustrated established ways of knowing in nursing and why we should use a plurality of views in our thinking. So, what is the argument and theory behind this position?

This typology comes from the work of Barbara Carper (1978). Carper’s proposed  a typology of fundamental ways of knowing  that classifies the different sources from which knowledge and beliefs  can be derived. It was specifically applied to nursing knowledge and is seldom used outside of my profession but identified four “patterns of knowing:”

  1. Empirical: Experiential knowledge from scientific inquiry, or other external sources, that can be empirically verified.
  2. Ethical: Attitudes and knowledge derived from an ethical framework, including an awareness of moral questions and choices.
  3. Personal: Knowledge and attitudes derived from personal self-understanding. “Personal knowledge is involved with the knowing, encountering and actualizing of the concrete, individual self.”
  4. Aesthetic: knowledge derived from an appreciation of the nature and art of nursing. “An esthetic experience involves the [immediate] creation and/or appreciation of the situation” This involves  empathic knowledge, including imagining one’s self in the patient’s position, and creativity in the response.

This classification system was really a reaction against empirically derived knowledge, and “scientific” nursing, by emphasising that more personal attitudes and intuitive aspects of knowledge were important too. Well, that certainly sounds reasonable in terms of explaining personal human experience, but let us explore the justification for the typological division further.

Empirical knowledge is easy enough to explain (and also forms the basis for modern scientific argument). It arose in the early-to-mid-17th century  as a response to rationalism (espoused by René Descartes and Benedict de Spinoza). Whilst the rationalists held that knowledge is attained through the operations of the mind, empiricists (such as Francis Bacon, John Locke, George Berkley and David Hume)  argued that knowledge was based on experience and best attained through human perception of the world and phenomena through sensory experience. Isaac Newton was also a key early proponent. I.e. we know things because we have experience of them, or can demonstrate them to be true (or things that we can verify through  experience).

Now here lies the rub; the other three forms, whilst arguably all forms of knowledge generation, can’t be separated so easily and all resort to rationalism. All represent forms of artistic subjective interpretation, and all require us to adopt some form of relativistic thinking. Ethical knowledge, for example, requires us to make judgments on what is right or wrong. This of course varies with different cultures,  and as Roger pointed out in his earlier post, science has very little to say about what is right or wrong. We all possess knowledge of what we consider is right or wrong, but this really comes from our culture or personal beliefs. For example here in North America and in the UK we generally consider eating horse meat, or digging up our dead relatives for a party “wrong,” but in some cultures (such as in Madagascar) they have no problem with those things, and it is a normal part of their everyday cultural life. Hence, ethical knowledge is really a relative form of knowledge.

The same goes for personal knowledge (knowledge of self from personal self-experience). If I see the face of the Madonna in a grilled cheese sandwich and feel it is of religious significance and meaning to me personally, but no-one else sees it or feels that way, then that is my personal experience, and is relative to anyone else’s. Personal self-knowledge is largely subjective (by its very nature) and works as an explanation of the self-perception for the individual. So for explaining why we feel as we do, and react to things it has value. However, for everyday practical issues it is fairly useless in terms of being able to explain any other shared experience or phenomena.

The same also applies to aesthetic knowledge; knowledge of the  immediate or empathic knowing is based on intuitive and abductive reasoning processes, which we know are flawed processes in “truth preserving” rationale, (that is to say useless for any form of general application) and so once again these represent relative and personal ways of knowing. I would also argue empathy is hugely problematic for health professionals, as we are not our patients, and so trying to put ourselves in their position would seem very unwise, as it will reflect what we think we would feel if we were them; not what they actually feel. I also find aesthetic knowing particularly dubious, as I can’t really see how to separate it from personal knowing (apart from the temporal element of immediate appreciation). As there is no clearly identifiable demarcation of one from the other why use these categories to differentiate different forms of knowledge? Knowledge of self, and aesthetic knowledge seem inextricably intertwined.

I also have some concerns that arguing that the way that nurses generate knowledge is somehow fundamentally different from the way other people “know” things is rather an unproductive activity. Suggesting nurses “know” things differently from everyone else, would seem rather a self-defeating argument; so what? I would suggest more usefully, we could consider the following as a simple classification of ways of knowing if we wish to establish the principle that knowledge has individual and subjective components:

1) Empirical Knowledge: a posteriori knowledge derived from experience

2) Intellectual Knowledge; a priori knowledge derived from;

  • Individual cognitive processes
  • Group socio-cultural processes

The terms a priori (“prior to”) and a posteriori (“posterior to”) have long been used to distinguish types of knowledge, justifications or arguments. A priori knowledge or justification is that independent of experience (for example ‘all swans are birds’); a posteriori knowledge or justification is dependent on experience or empirical evidence (for example ‘some swans are black’). There are many points of view on these two types of assertion, and their relationship is one of the oldest problems in modern philosophy. A priori can also refer to an argument made without a logical basis that is without evidence or analysis. Kant’s view of a priori (expressed in his Critique of Pure Reason in 1781) was that it described the underlying mental processes prior to experience. For example, he saw time and space as a priori constructs created by the mind.Kant proposed that whilst we could know particular facts about the world only via sensory experience, their form depended upon “a priori” reasoning, which was a mental construction. He also supported the priority of mind over matter (or physical experience) and this forms the basis for much postmodern thinking.

Aside from that, I would argue if we wish to adopt Carper’s classification, then logically we have to support as many different categories of  “knowing” as we can imagine. My point here is, the arguments used to support Carper’s classification can be equally well used to underpin other creative classifications. So in the spirit of Borge’s fictitious Chinese Celestial Emporium of Benevolent Knowledge (1942) I give you (cue the fanfare) my typology of “Ways of Knowing:”

  1. Empirical Knowing; knowledge derived from empirical sources,
  2. Blessed Knowing; knowledge revealed in sacred ancient texts,
  3. Fabulous Knowing; knowledge derived from fabulous conceptions,
  4. Fanciful Knowing; knowledge derived from dreaming,
  5. Luneful Knowing; knowledge derived from states of madness,
  6. Arcane Knowing; Knowledge of things beyond comprehension,
  7. Spooky Knowing; knowledge derived from magic,
  8. Lupine Knowing; knowledge derived from werwolves,
  9. Satellite Knowing; knowledge of things that, from a great height look like flies, and lastly of course,
  10. Other Knowing; knowing from other than the above.

That should cover it, so please feel free to disseminate and use my typology widely (but please don’t forget to cite your source here on the Real Science blog)!

Lastly, where does this leave us in regard to evidence-based practice (EBP)? Well, in terms of understanding patients (and societies) preferences and the personal acceptability of therapeutic interventions these sort of typologies might seem useful enough. For example, in a paper exploring myths surrounding Evidence-based practice by Professor Hugh McKenna et al. in 1999 the authors cited Carper’s typology as a rationale for  knowledge informing the patient’s choices of therapeutic intervention. Certainly, non-emprical forms of evidence and knowledge are an important part of EBP (EBP includes consideration of acceptability to the patient as a form of evidence). An informed and competent patient can refuse any treatment on the basis of their personal beliefs and preferences, and a nurse should select the best interventions based on this as part of the EBP process. Nevertheless, apart from identifying that people have highly individual knowledge and beliefs that affects their decisions (who would have thought), Carper’s typology is of little practical value in understanding health decisions, as it can be equally well supplanted by any other typology. At the end of the day this leaves us with a lot of arbitrary intellectual nonsense. Amazingly enough, I find this bunk it is still taught as sage wisdom in many PhD nursing programs with no attempt (from what I have seen) to critique it as an alternative or heterodoxical viewpoint.

In considering the merits of Carper’s typology today, maybe we should also consider the 1970’s was the decade of other “bright” ideas such as the Ford Pinto (arguably the worst car ever manufactured), wide lapels, and the heyday of the kipper tie. Maybe it’s time this rather archaic classification of “ways of knowing” should go the same way as them.

As always opinions, critique, vehement disagreement, dissent and argument welcome as commentary.

Bernie

References

Borges J.L. (1942) John Wilkins’ analytical language. In Weinberger E. et al. (Ed.). The total library: Non-fiction 1922–86 (2001) 229–232. London, Penguin Books.

Carper B.A. (1978), “Fundamental Patterns of Knowing in Nursing”, Advances in Nursing Science 1(1), 13–24

Kant, E. (1996). Critique of pure reason (W. Pluhar Trans.). Indianapolis: Hackett.

McKenna H, Cutliffe J, McKenna P (1999) Evidence-based practice: demolishing some myths. Nursing Standard. 14, 16, 39-42.

10 thoughts on “Different Ways of Knowing; or maybe avoiding knowing anything useful

  1. Interesting points here Bernie, although one glaring omission from your typology (and one that forms endless titles for dull research seminars in education) is Knowing knowing. Knowledge derived through knowledge, learnt through learning, considered through consideration…etc…etc…etc… yawn…snore…
    In the meantime, I’ll get working on my ‘typology of wisdom’!

  2. An interesting point, but that would be covered under “Other Knowing” and you are forgetting knowledge through knowing knowing knowing, of course… (ad infinitum).

  3. Interesting attempt to defend the notion of an “objective base” existing in modern scientific methodology. However, your misunderstanding of Kant defeats your attempt. While it is true that Kant shows the a priori nature of our knowledge, he goes onto state that we can not assume that this rationalism, this constructed knowledge represents reality as it is (the thing-in-itself). Rather, it is the only rational way that we can interpret experience. To assume that reality (beyond human observation & understanding) is itself rational, as operating only according to the dictates of Pure Reason, is for Kant a grievous error & folly. We can not ascribe to the workings of the universe the necessities inherent in our reasoning. Yet this is the common understanding of words like “fact” and “truth” when they are appended to scientific knowledge.
    This naive realism is at the heart of the arrogance seen in science (or rather, in so many scientists) and in the bellicose denials of ideas like “God” or in denying the validity of other ways of knowing.

  4. So I take it you like our new typology then? This critique sounds a lot to me like an example of Arcane Knowing to me!

    Firstly, I don’t think I actually make a case for an “objective base for scientific reasoning,” as I include both personal and experiential knowing here. That would be a positivist argument, and I acknowledge that science needs to be creative and use personal knowledge in its process too.

    Secondly, I don’t think I have misunderstood, or misrepresented Kant, as if you read the post carefully you may see I state Kant was interested in the processes that underly reason. Like the empiricists, Kant thought that a priori knowledge was independent of the content of experience; but, unlike the rationalists, Kant suggested that a priori knowledge, in its pure form (that is without any empirical content) is limited to the deduction of the conditions of possible experience.

    Anyhow, you could make a career out of interpreting Kant (and people do). Your point (like most postmodern approaches to epistemology) seems to rely on the age old criticism of science that is reflected in the “problem of induction” which invokes circular logic that is impossible to disprove. I.e. we cannot explain the universe or reality without thinking about it, and as our thoughts are part of the reality we seek to explain, they affect our explanation and understanding of it. Ergo; any explanation or knowledge is somehow subjective. Sure, the universe may operate in any fashion, and is certainly not constrained by our current reasoning, and facts and truths may simply be convenient labels.

    Nevertheless, my point is a practical one and really quite simple. The scientific process offers us explanations that seem to work quite well for explaining the world, knowing and predicting things. To date, it has been much more effective than other proposed forms of knowing (certainly in terms of practical use). Whereas, the arguments you use to support these other forms of knowing (such as Carper’s) resort to relativism in some way or another. So, arguing for other forms of personal knowing is fine, and perfectly valid, but for practical purposes i.e. in nursing, I would argue this type of typology has limited value, other than demonstrating intellectual prowess, or for use in philosophical debates.

    If folks adopting Carper’s knowing can demonstrate knowledge that is actually more useful for managing practical health issues in the real world, then we could reasonably expect this to have subsumed scientific forms of rationale, as it would be superior in terms of its outcomes. So where are the outcomes, and how is Carper’s taxonomy better than any other personal view of knowledge?

    In effect, if Carper’s taxonomy of knowing is acceptable, then so is ours as they both rely on exactly the same arguments in their justification. As to what practical use they are apart from an intellectual exercise is another matter.

    So, given your stated position, just how would you challenge the validity of my taxonomy compared to Carper’s?

    Thanks for reading, and taking the time to post a comment

    Bernie

  5. Absolutely loved it. I am struggling with a paper on Carper and I sooooo agree with you! Your writing is also pretty impressive.

  6. YES! The most logical, well thought out discussion on epistemology in nursing I have come across. I’ll admit, I found myself quite frustrated during my BSN with the use of frameworks such as Carper’s. And again now with my reentry into school for specialty practice. I’ll not deny there is a place for qualitative and/or personal knowledge… however I find a logical positivist perspective to be more useful in most applications.

  7. I teach in a program that uses Carper’s Ways of Knowing and I confess that I find it way too abstract for my pragmatic brain. Sometimes it seems as if academia nurses are trying to show how “smart” they are by inventing different ways of saying the same things…:-)

    diana

  8. Indeed, after 25 years working in nursing education I have come to the same conclusion. Most nursing education textbooks seem to infer nursing education is somehow completely different from any other form of education, and our theories developed independently. Other nursing theories seem to do the same, almost ignoring earlier or parallel work in other fields; relational practice probably being the most recent example, practically ignoring years of psychological and communications theory.

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