What do we owe to the people we fail to help?

35 years ago, on the outskirts of a small town, lived a young man. After his single father passed away, he lived alone for some time. Nobody knew for how long. He was raised in an insular, isolated home, with no apparent friends or neighbors.

A door-to-door saleswoman met and befriended him. She did what she thought was right: brought him into the community. But he had grown up outside the community, so she helped dress him, helped him socialize, and instructed him on how to fit within the culture.

He’s “strange” of course. Standard social graces are foreign to him. When people ask him to do things, he does them, no matter the request; some take advantage of him. People first embrace him, then quickly turn on him after he breaks social convention too many times.

The saleswoman failed to help. He returned to his home. His name: Edward Scissorhands.

Edward Scissorhands, the character, was Tim Burton’s allegory for growing up isolated in Burbank. The world is bright and conventional, while Edward is dark and…has scissors for hands. You get it.

In the film, Edward is drawn out into the community with the implicit promise of inclusion. Dianne Wiest, as Peg, shows genuine kindness to Edward. She also attempts to change him, so that he might fit in with the community. In fairness to Peg, they try to harness Edward’s skills too – he becomes popular as both hair and topiary stylist. But they dress him in pleated slacks.

For his part, Edward initially seems too good for the community. He’s too unique, too interesting. Ultimately he wants to be a part of the community, falling in love with 90s Winona Ryder. It isn’t forced upon him.

Still, Peg fails, and Edward’s unique qualities eventually draw too much attention, then envy. He never truly fits in, is rejected by a small but vocal minority, and returns to his home. He lives in isolation once more.

The ethics of failure has a sparse literature base. Generally, nobody sets out to fail. Failure is considered, more than anything, a risk. 

Consider the medical perspective: failure is possible in most procedures. But doing nothing is often worse. Failure is an occupational hazard; certain types are accepted.

Dr. Charles Bosk, a professor of medical ethics, wrote a book about errors and failure in surgical training. Entitled Forgive and Remember, he attempted to classify and categorize error types addressed in training: avoidable errors, technical errors, judgment errors, normative errors, quasi-normative errors. In a second edition, his preface notes his regret – people focused on the categories without considering the context of each individual error. 

Nevertheless there are interesting details. Errors caught early and self-reported indicate that the person who made the error is aware of it and had a momentary lapse. But attending physicians judge errors contextually: is this a person who has made many such errors? Technical errors mean that the new physician simply didn’t have the skills required; judgment errors mean that the “right” or “wrong” decision led to a poor outcome; normative errors mean that the decision-maker failed to assume their role – by not attending to a patient, or not respecting medical hierarchy; and quasi-normative errors are those errors that are dependent on an idiosyncratic roles – an attending physician who wants things done “their way.”

Bosk notes that technical and judgmental errors are expected, despite the consequences falling on patients. These are errors that come with learning and practicing a new skill. Normative and quasi-normative errors are judged more harshly, despite not always harming patients, because they are considered to reflect on the character or personality of the trainee. The sentiment here is that anyone can make mistakes, but the best students follow the rules. 

Judgment errors are the most interesting category. The surgeons view successful surgery as dependent on results, and not on technical perfection. In their parlance,

All the best surgeons could agree on the same technically correct decision – and still commit a judgment error.

To be clear, that is but one perspective on the medical model.

The most popular ethics books for behavior analysts, Bailey & Burch’s Ethics for Behavior Analysts, would surely have less to say about Peg’s failure. 

Peg is not competent to offer this kind of help. Bailey & Burch would probably categorize this as a “simple” case. If we hold Peg to professional standards, she behaved unethically.

Peg was not a professional.

In 1985, a law professor named James R. Elkins argued that professionalism is not an answer to a societal problem. 

In fact, professionalism is a framework for maintaining the status quo. Professionals are ethical because they are professionals. Professionalized codes of ethics recuse professionals from thinking about ethics – so long as they stay within their code. No further introspection is necessary.

He proposes abandoning professionalism in favor of craft. Literally the parallel is with artisans who sculpt, paint, or build – key to these are skill, mindfulness, and care. Craft is less about completion per se and more about a process of refinement. Completion without care is pure materialism: an assembly line.

Here lies one answer to failure. A skilled craftsman carefully throws clay on the wheel; she molds it with her hands deliberately; it collapses in the kiln. How do you feel about her failure?

Failure divorced from care, from craft itself, lacks the spirit of ethics. All boxes may have been checked, all professional codes may have been upheld, but a failure without care has failed twice.

Perhaps the clearest parallel to behavior analysis is in the constructional approach first pioneered by Israel Goldiamond, which has appeared to gain popularity in the past several years. The simplest explanation of his philosophy is that traditionally targeting behavior reduction alone is like tearing down a derelict house. You have an empty lot. What had you hoped to build?

Care and skill are both necessary but insufficient. 

Consider that physicians have better patient outcomes if, to simplify things, they are nice. Consider that, in behavior analysis, effective treatment is not enough.

Speed and accuracy are necessary for fluency. Care and skill are necessary for craft.

Care and skill are, to some extent, already written into the BACB ethics code. But referring back to Elkins, perhaps professionalizing care and skill could never work – licensed painters, required to exercise the utmost care in every brush stroke?

Failure is only impossible in a materialist system; where a product definitionally is successful by virtue of its production. Failure of outcome is possible, even when the best judgment is used by the most skillful clinician. 

Failure is only meaningful in a craft.

Epilogue: What about Ed?

The professional perspective is represented here, but what about the perspective of Edward Scissorhands?

There are some studies that examine failure in conventional therapy from the perspective of the client. One representative example: certain negative effects are compounded, but ultimately participants acknowledge some gains. 

Ideally we would have Edward tell his own story, but, uh, he’s not real. Would he feel any positive feelings whatsoever about his experience?

In the final scene, an aged Winona Ryder speculates that Edward still lives, causing the snow that brings her joy. In failure, Edward made one connection.