Something Interesting This Way Comes

As B.F. Skinner famously advised, when something interesting comes along, the wise person drops everything else and follows it. This advice is the heart and soul of inductive science, but it also applies to clinical practice. My wife, a clinical psychologist and long-time provider of services to children with autism, says that a client session which doesn’t surprise her is a waste of a child’s time. In her view, a routine session may teach the child something but teaches her nothing new about how to help the child. The general point is that both science and practice can benefit the unexpected.

Skinner may have told us how to respond when something interesting comes along, but he was silent on how to recognize when something is interesting. In everyday life, the unexpected often is unwanted, as when your kitchen faucet suddenly starts leaking or when, during a routine long run, your hamstring painfully betrays you. It feels much the same when, during an experiment, apparently stable performance goes haywire or, during a clinical session, never-before-seen behavior erupts.

As an example of the latter, my wife was working on rudimentary communication skills with a young Black girl who had always been a model learner. She was super responsive to contingencies and that day, as in every other session, she was all business … until she wasn’t. In an instant my wife found herself on the floor with a broken pinky and a huge bleeding bite mark. At an emotional level, that moment must have felt as frustrating as a leaky faucet or as scary as an injured hamstring. But it was also something interesting, because the girl had never before been aggressive. The salient thing is how my wife knew what to make of this. She had done her clinical internship in a medical center, where one rotation had focused on managing chronic pain — including from sickle cell disease. From her vantage point on the floor my wife recalled having brushed against the girl’s hip, a classic locus of sickle-cell-related joint issues. What she understood in that moment, for reasons having nothing to do with her specialized training in behavior analysis, is that the girl needed medical attention, not a new behavior plan.

This anecdote illustrates the following unformalized principle: The more stuff you know, the more new stuff you can figure out. Sticking with a medical theme, let’s examine two more examples of this principle in action.

The first example comes from one of my favorite essays of all time, Douglas Root-Bernstein’s “Setting the stage for discovery” in the now-defunct magazine The Sciences. Root-Bernstein described a number of famous “accidental” scientific discoveries as not accidental at all, but rather the result of someone happening to know all kinds of stuff.

Digestion researcher Oskar Minkowski is remembered for “accidentally” discovering that an ablated pancreas results in poor sugar metabolism, an observation which led to the understanding that diabetes is a disease of the pancreas and then to the development of life-saving insulin treatments. What happened specifically is that Minkowski noticed that removing the pancreas caused a formerly-housebroken dog to became incontinent. As the story goes, Minkowski then impulsively tasted the urine to find it was sweet: pancreas, sugar metabolism… diabetes! Eureka! In reality, however, Minkowski was more prepared than impulsive. He loved to play with the dogs in the lab and so knew this particular pooch’s tidy potty habits; that is what made the loss of bladder control stand out. Minkowski had also attended medical school before deciding to go into research. There he learned the symptoms of myriad diseases, and so knew that both urinary urgency and sugary urine were symptoms of diabetes. None of this was necessary to conducting his digestion research, but all of it was necessary to deduce the link between pancreas damage and diabetes.

The second example is from one of my favorite articles, Mark O’Reilly’s description of a toddler who was referred for treatment of self-injurious behaviors (SIB). As O’Reilly wrote:

Mary’s SIB consisted of back banging and ear poking. These behaviors typically occurred simultaneously. Structured interviews with Mary’s mother and general medical practitioner indicated that SIB occurred at high frequencies for approximately 3 to10 days per month (usually in continuous bouts of 2 to 3 days).

A functional behavioral assessment suggested that Mary’s SIB was maintained by sensory reinforcement, and a medical evaluation clarified that this arose only during recurring ear infections lasting 2-3 days. It became obvious that good old antibiotics could short-circuit the conditions occasioning SIB much faster than a behavior plan. The article doesn’t say, but I like to think that the need for the medical evaluation was suggested by life experience: Either O’Reilly or the parent had been around kids enough to know that young ears are an attractive petri dish for microorganisms. You don’t have to know this to conduct a functional behavioral assessment, but you do have to know it to connect the assessment’s results to a medical condition.

Please don’t get too caught up in my medical theme, which I chose strictly for convenience and is incidental to our unformalized principle about “the more you know.” Oskar Minkowski did’t need medical school to become a digestion researcher. My wife didn’t need pain management training to become an applied behavior analyst. And for whoever took Little Mary to the doctor, well, you aren’t required have your own children, with their frequent mundane maladies, to work with other people’s children. What matters here is that “bonus knowledge” can be instrumental in recognizing when the unexpected is, in fact, something interesting.

Another way to say the same thing is that my examples show the importance to discovery of going intellectually off-script, of thinking about more than the central facts of your chosen professional specialization. This in turn raises the question of just how capable we behavior analysts are of going off-script from our carefully planned research programs and clinical protocols. How often do we read outside of our areas of expertise? How often do we change things up just to see what will happen? And how often do we really, when something interesting comes along, drop everything else and follow it?

The truth is that professional contingencies tend to reward what we would describe in a client as stereotypy. The best way to be productive in science, in the sense of generating  the most research from the smallest supply of time and resources, is to stick to a laser-focused agenda in which your studies vary only minimally. I recall in graduate school stumbling across a researcher who’d published 31 papers in about two years. The studies all employed the exact same procedure, but with a different strain of mouse. This may not sound creative or innovative to you, but I’ll bet that investigator got tenure! The world of practice also can reward sticking to a script. Prepackaged protocols require no time to conceptualize, and if I use the exact same protocol with, say, 31 different clients, my odds of achieving acceptable levels of treatment fidelity go way up. But am I learning anything new? Doing my utmost for each client?  Advancing the profession?

The take-home: In behavior analysis we talk a lot about variation and selection, the notion that the more variable behavior is the greater the chances of it bumping into, and being shaped by, contingencies. Yet it has always seemed to me, ironically, that in our discipline we work unusually hard to suppress variability. We have strict standards for how to talk about our subject matter and for what kind of professional sources are deemed respectable and trustworthy. We perseverate on the “right way” to design studies, do clinical assessments, and build interventions. And we exert a lot of social pressure on each another to enforce this homogeneity.

This, my friends, is not a recipe for knowing as much stuff as possible, and I worry about our discipline becoming unduly narrow as a result. The advent of professional certification and graduate-program accreditation only magnifies “standardization” pressures that have been with us for a long time.

As a means of tilting against this particular windmill, the present blog exists solely to be erratic and directionless. It will take what Leonard Mlodinow calls a “drunkard’s walk” through whatever may come up that could be interesting, and useful, to someone at some time, in some way that I may not presently perceive. My hope is to persuade you to not be overly concerned about what you “need to know” and to instead recklessly leap down little rabbit holes that lead to … who knows what? That was Root-Bernstein’s point: Discovery is a hybrid beast, spawned in the intermingling of supposedly unrelated knowledge and expertise. My plan for this blog, therefore, is to not have a plan for what it will cover. I may be as surprised as anyone at what we discover.