Abstract
Background: While practice parameters recommend assessment of conscience and values, few resources are available to guide clinicians.
Objective: To improve making moral inquiry in youth aged 15 to 24. Methods: After documenting available resources for behavioral health clinicians who are inquiring about their patient’s moral life, we consider our studies of conscience development and functioning in youth. We align descriptions of domains of conscience with neurobiology. We compare youth reared in relative advantage, who have fairly smooth functional progressions across domains, with youth reared in adverse circumstances. We offer the heuristic conscience developmental quotient to help mind the gap between conscience in adversity and conscience in advantage. Next, we consider severity of psychopathological interference as distinct from delay. A case illustration is provided to support the distinction between conscience relevant and conscience sensitive approaches to psychiatric assessments. Results: Our findings support the hypotheses that youth who experience adverse childhood experiences show evidence of fragmentation, unevenness and delay in their conscience stage-attainment. We demonstrate proof of concept for conscience sensitive psychiatric assessment in the youth-span. Conscience sensitive inquiries improve upon merely conscience relevant interpretations by affording better appreciation of moral wounding, in turn setting the stage for moral-imaginative efforts that elicit and make the latent values of the youth more explicit. Conclusions: A conscience sensitive approach should be part of both psychiatric and general medical education, supported explicitly by clinical guidelines recommending conscience sensitive interview techniques that aim to acquire information aligned with current neurobiological terminology.Keywords: Adolescent development, conscience developmental quotient, conscience domains and stages, conscience in advantage and adversity, conscience, moral development.
Achenbach, T., & Edelbrock, C. (1983). Manual for the child behavior checklist revised child behavior profile.. Burlington, VT: University Associates in Psychiatry.
Alegria, A., Radua, J., & Rubia, K. (2016). Meta-analysis of fMRI studies of disruptive behavior disorders. American Journal of Psychiatry, 173(11), 1119-1130.
Ali, S., & Nussbaum, A. (2018). Inpatient psychiatry. In: J.R., Peteet, M.L., Dell, and W.L.A., Fung, (Eds.), Ethical considerations at the intersection of psychiatry and religion. (pp. 125-137). New York: Oxford University Press.
American Academy of Child and Adolescent Psychiatry. (1997). Practice parameters for the psychiatric assessment of children and adolescents. Journal American
Academy of Child and Adolescent Psychiatry,, 36(10) (Supplement.), 4S-20S.
American Psychiatric Association (2013a). Diagnostic and statistical manual of mental disorders. (5th ed., pp. 750-757). Washington, DC: American Psychiatric Publishing, Inc..
Bauer, W., Arndt, W., Gingrich, F., & Danker, F. (1979). Greek-English lexicon of the new testament and other early christian literature. (2nd ed.). Chicago: The University of Chicago Press.
Baron-Cohen, S. (1995). Mindblindness: an essay om autism and theory of mind.. Cambridge, MA: MIT Press.
Blair, J. (2016). The neurobiology of disruptive behavior disorder. American Journal of Psychiatry, 173(11), 1073-1074.
Davidson, R. (2006). Neural substrates of affective style and value. In: J., Changeux, A., Damasio, W., Singer, & Y., Christen, (Eds.), Neurobiology of human values. (pp. 67-90). New York: Springer-Verlag.
Encyclopaedia Brittanica. (1999). Peter Lombard, French
bishop. Retrieved from
https://www.britannica.com/ biography/Peter-Lombard
Gaffney, M., & Galvin, M. (in press). The Indiana University
Conscience Project 1982-2014: director’s report
to the dean of the school of medicine 5.15.2014. (Update
through 2018 to be published in Conscience
Works.)
Gaffney, M., & Galvin, M. (2012). Techniques in conscience
sensitive medical education. MedEdPORTAL.
Retrieved from
www.mededportal.org/publication/9166
Gaffney, M., Galvin, M., Abram, J., Srinivasan, M., & Stilwell, B. (2005).Trying on the rings of Glaucon: conscience
centered medical ethics. Conscience Works:
Conscience and Ethics, 2(2): 1-21. Retrieved from
https://scholarworks.iupui.edu/handle/1805/16470
Gaffney, M., Galvin, M., & Stilwell, B. (2002). Conscience
sensitive medical education. Conscience Works: Conscience
and Ethics, 1(1): 1-17. Retrieved from
https://scholarworks.iupui.edu/handle/1805/16416
Gaffney, M., Galvin, M., & Stilwell, B. (2007). A conscience
sensitive approach to ethics and teaching caring
attitudes. Conscience Works: Conscience and Ethics,
3(1): 6-20. Retrieved from
https://scholarworks. iupui.edu/handle/1805/450
Galvin, M. (2014).Psychiatric diagnostic (DSM5) contexts
of psychopathological interference in conscience formation
and functioning across the youth-span: a
guideline. Conscience Works: Theory, Research and
Clinical Applications, 4(1): 1-40. Retrieved from
https://scholarworks.iupui.edu/handle/1805/6583
Galvin, M., Fletcher, J., Stilwell, B. 2005 Conscience sensitive
psychiatry: clinical applications: retrieval of life
affirming values and their incorporation into a suicidality
prevention plan. Conscience Works: Theory,
Research and Clinical Applications, 2005, 2(2): 24-
33. Retrieved from:
https://scholarworks.iupui.edu/ handle/1805/16298
Galvin, M., Fletcher, J., & Stilwell, B. (2006). Assessing meaning of suicidal risk behavior in adolescents; three exercises for clinicians. Journal American
Academy of Child and Adolescent Psychiatry, 45(6), 745-748.
Galvin, M., Gaffney, M., & Stilwell, B. (2005) Preliminary
observations and reflections on conscience sensitive
group therapy. Conscience Works: Theory, Research
and Clinical Application, 2(2): 1-23. Retrieved from
https://scholarworks.iupui.edu/handle/1805/16296
Galvin, M., Gaffney, M., Stilwell, B., Abram, J., & Altmeyer, L. (2002) Conscience centered psychiatric
ethics: a course. Conscience Works: Conscience and
Ethics. Retrieved from
https://scholarworks.iupui.edu/ handle/1805/16469
Galvin, M., & Stilwell, B. (2003) Conscience in the mental
health professional. Conscience Works; Conscience
and Ethics. 2(1): 1-104. (Original work published
1997) Retrieved from
https://scholarworks.iupui.edu/ handle/1805/16468
Galvin, M., Stilwell, B., & Fletcher, J. (2010). Conscience sensitive psychiatry: clinical applications: retrieval and incorporation of life affirming values in a personalized suicidality management plan. Annals of the
American Psychotherapy Association., 13(3), 14-23.
Galvin, M., Stilwell, B., Gaffney, M., & Hulvershorn, L. (2009) The psychobiology of conscience; signatures
in brain regions of interest. Conscience Works: Theory,
Research and Clinical Applications, 3(1): 1-36.
Retrieved from
https://scholarworks.iupui.edu/handle/1805/16300
Galvin, M., Stilwell, B., Shekhar, A., Kopta, M., & Goldfarb, S. (1997). Maltreatment, conscience functioning and dopamine beta hydroxylase in emotionally disturbed boys. Child Abuse and Neglect., 21(1), 83-92.
Galvin, M., Ten Eyck, R., Shekhar, A., Stilwell, B., Fineberg, N., Laite, G., & Karwisch, G. (1995). Serum dopamine β hydroxylase and maltreatment in psychiatrically hospitalized boys. Child Abuse and Neglect., 19(7), 821-832.
Gemelli, R. (2008). Normal child and adolescent development. In: R., Hales, S., Yudofsky, & G., Gabbard, (Eds.), The Textbook of Psychiatry. (5th ed., pp. 245-300). Washington, D.C.: American Psychiatric Publishing, Inc..
Greer, E. (2017). “A many-sided substance”: the philosophy of conversation in Woolf, Russell, and Kant. The
Journal of Modern Literature, 40(3), 1-17. Retrieved
from: http://www.jstor.org/stable/10.2979/jmodelite.40.3.01
Goenjian, A., Stilwell, B., Fairbanks, L., Galvin, M., Karayan, I., & Pynoos, R. (1999). Moral development and psychopathological interference in conscience functioning among adolescents after trauma. Journal
American Academy of Child and Adolescent Psychiatry, 38(4), 376-384.
Hulvershorn, L., Cullen, K., Francis, M., & Westlund, M. (2014). Developmental resting state functional connectivity for clinicians. Current Behavioral Neuroscience
Reports, 1(3), 161-169. https://scholarworks.iupui.edu/handle/1805/8388
[http://dx.doi.org/10.1007/s40473-014-0020-3]
[http://dx.doi.org/10.1007/s40473-014-0020-3]
Indiana University Conscience Project. (1998-2008). Conscience
Works: Conscience Sensitive Moral Education.
Retrieved from: http://shaw.medlib.iupui.edu/ conscience/ and
https://scholarworks.iupui.edu/handle/ 1805/484
Indiana University Conscience Project. (2007). A guide to
conscience. Conscience Works: Conscience and Ethics,
3(1) pp.6-20. Retrieved from
http://shaw.medlib. iupui.edu/conscienceguide2-20-07.pdf
Indiana University Conscience Project. (2011a): The value
matrix. Conscience Works: Conscience and Ethics.
Retrieved from
https://scholarworks.iupui.edu/handle/ 1805/17197
Indiana University Conscience Project. (2011b): Demoralization
and harm prevention planning. Conscience
Works: Conscience and Ethics. Retrieved from
https://scholarworks.iupui.edu/handle/1805/16478
Kandel, E. (2018). The disordered mind; what unusual brains tell us about ourselves.. New York: Farrar, Strauss and Giroux.
Kahneman, D., & Sunstein, C. (2006) Cognitive psychology of moral intuitions. In J.-P. Changeux, A. Damasio,
W. Singer, & Y. Christens (Eds.), Neurobiology of
human values (pp.91-105). New York: Springer
Kochanska, G., Forman, D., Askan, N., & Dunbar, S. (2005). Pathways to conscience; early mother-child mutually responsive orientation and children’s moral emotion, conduct and cognition. Journal of Child Psychology and Psychiatry, 46(1), 19-34.
Lewis Fernandez, R., Aggarwal, N., Hinton, L., Hinton, D., Kirmayer, L &. American Psychiatric Association
(2016): DSM5 Handbook on the Cultural Formulation
Interview. Washington DC: American Psychiatric
Publishing, Inc.
Marzi, S., Sugden, K., Arsenault, L., Belsky, D., Burrage, J., Corcoran, D. ...Caspi, A (2018): Analysis of DNA methylation in young people: limited evidence for an association between victimization stress and epigenetic variation in blood. American Journal of Psychiatry, 175(6), 517-529.
Nozick, R. (1981). Philosophical explanations. (pp. 311-314). Cambridge, MA: Belknap Press, Harvard University.
Odell, J. (Ed.). (2013-2014): Conscientious objection in the
healing professions; a reader’s guide to the ethical
and social issues. Conscience Works: Conscience and
Ethics. Retrieved from https://scholarworks.iupui.edu/ handle/1805/3844
Odell, J. & Galvin, M. (Eds.). (2014, Mar 23). Conscience
project meeting 6.1.13 minutes: recent activities: conscience
sensitive education: is it possible? Moderator:
S. Laramore; Panel: S. DiMicco, J. Bradshaw, M.
Gaffney, M. Galvin, & J. Odell University of Indianapolis,
Indianapolis, IN. Conscience Chronicles.
(Original panel conducted 2013, April 10) Retrieved
from:
https://iuconsciencenews.org/
Odell, J., & Galvin, M. (Eds.). (2013, March 9). Conscience
project meeting 5. 5. 12 minutes. Conscience Chronicles.
Retrieved from,
https://iuconsciencenews.org/
Posner, M., & Rothbert, M. (2000). Developing mechanisms of self -regulation. Development and. Psychopathology, 12, 427-441.
Quinn, J. (1998) Saint Bonaventure, Italian theologian. In
Encyclopaedia Brittanica. Retrieved from:
https: //www.britannica.com/biography/Saint-Bonaventure
Rizzolatti, G., & Craighera, L. (2005). Mirror neurons: a neurobiological approach to empathy. In J. Changeux,
A Damasio W, Singer & Y. Christen (Eds.), Neurobiology
of Human Values (pp.107-121). New York:
Springer.
Siegel, D. (2001). Memory: an overview, with emphasis on development, interpersonal, and neurobiological aspects. Journal American Academy. Child and Adolescent Psychiatry, 40(9), 997-1011.
Stanford Encyclopedia of Philosophy. (2015). Medieval
theories of conscience. (Original work published
1998) Retrieved from:
https://plato.stanford.edu/ entries/conscience-medieval/
Stilwell, B. (2002a). Trauma, moral development, and conscience
functioning. Conscience Works, Theory, Research
and Clinical Application, 2(1): 1-4 Appendix
A: The Stilwell Conscience Interview (Original work
published 1994, November 5).
https://scholarworks. iupui.edu/handle/1805/15746
Stilwell, B. (2002b): Prototypical vignettes of stages in normal
conscience development Conscience Works, an
On-line Periodical, Theory, Research and Clinical
Application, 2(1): 1-4 Appendix E
scholar works.iupui.edu/handle/1805/15742
Stilwell, B., & Galvin, M. (1985). Conceptualization of conscience in 11-12-year olds. Journal American Academy Child Psychiatry, 24(5), 630-636.
Stilwell, B., Galvin, M., & Kopta, M. (1991). Conceptualization of conscience in normal children and adolescents ages 5 to 17. Journal American Academy. Child and Adolescent Psychiatry, 30(1), 16-21.
Stilwell, B., Galvin, M., & Kopta, M. (2000). Right vs. wrong: raising a child with a conscience.. Bloomington: Indiana University Press.
Stilwell, B., Galvin, M., Kopta, M., & Norton, J. (1994). Moral-emotional responsiveness: a two-factor domain of conscience functioning. Journal American. Academy
Child and Adolescent Psychiatry,, 33(l), 130-139.
Stilwell, B., Galvin, M., Kopta, M., & Padgett, R. (1996). Moral valuation: a third domain of conscience functioning. Journal American Academy. Child and Adolescent Psychiatry,, 35(2) 230239
Stilwell, B., Galvin, M., Kopta, M., & Padgett, R. (1998). Moral volition: the fifth and final domain leading to an integrated theory of conscience understanding. Journal American Academy
Child and Adolescent. Psychiatry,, 37(2), 202-210.
Stilwell, B., Galvin, M., Kopta, M., Padgett, R., & Holt, J. (1997). Moralization of attachment: a fourth domain of conscience functioning. Journal American Academy Child and Adolescent. Psychiatry, 36(8), 1140-1147.
Stilwell, B., Galvin, M., & Gaffney, M. (2006) Progress in
conscience sensitive psychiatry: assessment, diagnosis
and treatment planning. Conscience Works: Theory,
Research and Clinical Application, 2(1): 5-30.
Retrieved from
https://scholarworks.iupui.edu/handle/ 1805/16235
Sullivan, J. (2007). The Indiana University conscience autobiography
for health care professionals completed
with commentary pertinent to Islam. Conscience
Works: Conscience and Ethics, 3(1): 6-20. Retrieved
from https://scholarworks.iupui.edu/handle/1805/16471
Vinten, R. (2017). Revolution of the ordinary by Toril Moi. Nordic Wittgenstein Review, 6(2), 99-103.
[http://dx.doi.org/10.15845/nwr.v6i2.3460]
[http://dx.doi.org/10.15845/nwr.v6i2.3460]
27