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Adolescent Psychiatry

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ISSN (Print): 2210-6766
ISSN (Online): 2210-6774

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Clinical Perspective

Conscience Relevance and Sensitivity in Psychiatric Evaluations in the Youth-span

Author(s): Matthew Galvin*, Leslie Hulvershorn and Margaret Gaffney

Volume 9, Issue 3, 2019

Page: [167 - 184] Pages: 18

DOI: 10.2174/2210676609666190415142734

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.

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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.
Bowlby, J. (1988). A secure base.. New York: Basic Books.
Coles, R. (1997). The moral intelligence of children.. New York: Random House.
Damasio, A. (1999). The feeling of what happens.. New York: Harcourt Inc..
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
Flew, A. (Ed.). (1979). A dictionary of philosophy (Rev. 2nd ed.). New York: St. Martin’s Press.
Frijda, N. (1986). The Emotions.. Cambridge, UK: Cambridge University Press.
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]
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
Kerns, M. (Ed.). (1995). Efficacy, agency and self-esteem.. New York: Plenum.
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.
LeDoux, J. (2000). Emotion circuits in the brain. Annual Review of Neuroscience, 22, 153-184.
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.
Mautner, T. (Ed.). (1996). A dictionary of philosophy. Oxford: Blackwell Reference.
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]
Webster’s New Universal Unabridged Dictionary.. (1996) New York: Random House Value Publishing.
Wittgenstein, L. (1965). The blue and brown books, preliminary studies for the philosophical investigations.. New York: Harper Torchbooks. (Original work published 1958)
Yehuda, R., & Flory, J. (2018). Considering the genetic and epigenetic signature of early adversity within a biopsychosocial framework. American Journal of Psychiatry, 175(6), 491-492.

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