Conscience Works: Theory, Research and Clinical Applications

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A Conscience Sensitive Approach to Moral Injury
(IU Conscience Project, 2021-02-03) Galvin, Matthew R.; IU Conscience Project
Conscience Sensitive Psychiatric Diagnosis of Maltreated Children and Adolescents
(Indiana University Conscience Project, 2001) Galvin, Matthew R.; Stilwell, Barbara; Adinamis, Ann; Kohn, Arlene
The sequelae of maltreatment are conceptualized according to the DSM IV multiaxial system expanded for heuristic purposes. Axis I and Axis IV are expanded to take into account important variables of maltreatment. Differential Axis I diagnoses are identified with special emphasis placed on PTSD, Dissociation, Depression and Disruptive Behavior Disorders. Axes II and III are heuristically expanded to call attention to developmental psychopathology, particularly in the domains of conscience, and associated putative neurobiological sequelae of maltreatment, indicating a pathway to the psychobiology of conscience. Conscience sensitive assessment of maltreated children is illustrated with two case vignettes and selected conscience drawings. A ‘transaxial,’ conscience sensitive approach to DSM nosology is recommended as a corrective. There will likely be additional implications for the psychobiology of conscience as neuroimaging and assessment of conscience functions in health and psychopathology become more refined.
The Conscience-in-Adversity Data Collection for the Further Study of Moral Injury
(IU Conscience Project, 2020) Galvin, Matthew R.
Background. In matters of conscience, we are always learning. When conscience becomes a casualty of adverse life experiences, we are called upon in our healing professions to bind the moral wounds and attend the moral injuries we encounter in the light of whatever knowledge of moral nature and nurture we have acquired, meager as it may be. Objective. To enable further studies of the continuum of casualty in personal conscience that will enlarge and transmit the fund of knowledge in our healing professions. Method. Presentation of a data collection comprised of 125 identity-protected cases, developed from conscience sensitive psychiatric interviews conducted, consecutively, over a three-year period in a residential treatment center which was dedicated to youth who had been reared in adverse life circumstances.
Preliminary Observations and Reflections on Conscience Sensitive Group Therapy
(The Indiana University Conscience Project, 2005) Galvin, Matthew R.; Gaffney, Margaret M.; Stilwell, Barbara M.
Objective: This is the first in a series of articles to characterize and critically consider recently employed forms of conscience sensitive psychiatric treatment of children and adolescents. Method: Modules were designed based upon domains of conscience functioning identified in empirical research and applied to recognized benchmarks for interventions in the treatment of psychopathology. Each module was designed to be sufficiently complete such that full participation from persons entering the cycle of modules at any point would not be compromised. One of the authors paired with interested, experienced therapists in existing programs to conduct and refine interventions in a group psycho-educational therapy format. Results: Over one hundred and fifty hours of conscience sensitive psycho-educational group therapy were conducted in therapeutic loci within a well-established, community-based continuum of care. The therapeutic loci ranged from a child and adolescent psychiatry outpatient clinic to a closed youth residential setting and included adolescent psychiatric intensive outpatient and partial hospitalization programs. Number of participants in any module varied from one in the outpatient locus to fifteen in the intensive outpatient locus. Age of participants varied from school age to late adolescent. Formal intellectual testing was not uniformly available for participants. Most however appeared to be average intellectually. Each participant had, at minimum, an initial assessment by a mental health clinician yielding a DSM IV multiaxial psychiatric diagnosis. No restrictions were placed upon participants in terms of principal or secondary diagnoses or severity of impairment although all had sufficiently severe impairment to be deemed in need of the aforementioned current and standard psychiatric or psychosocial interventions. Length of time for each of the seven modules was permitted to vary according to the stability of the participant population. Individual modules conducted in the adolescent psychiatric intensive outpatient program were limited to one hour each, whereas some modules conducted in the residential and youth day school settings extended over several sessions held once weekly. Seven modules were eventually developed and refined to comprise a full course of conscience sensitive psycho-educational group therapy. Conclusions: Each of the seven modules in its current stage of development and refinement is characterized in terms of praxis, but also considered critically in terms of treatment philosophy. Conscience sensitive group psycho-educational therapy can be conducted in child adolescent psychiatric therapeutic loci ranging from outpatient to closed residential programs. Constraining variables were encountered in the adolescent intensive outpatient program when census became large, and turnover rapid, in consequence of which the full cycle of seven modules conducted at a frequency of one per week could not be completed by many participants. This could be remedied by conducting sessions more frequently, perhaps two to three times per week, and offering a sufficient number of groups to ensure that the number of participants in each group does not exceed eight. In the outpatient setting, there were fewer referrals than had been hoped, perhaps because of limitations upon reimbursement for the total number and/or kind of therapeutic interventions, a condition which, in the local mental health community, favors individual psychotherapy over group psychotherapy. However, the possibility cannot be excluded that there have been referral biases or parental preferences in favor of groups with a more readily recognizable focus such as anger management or social skills over a novel, less familiar approach.
Progress in conscience-sensitive psychiatry: assessment, diagnosis and treatment planning
(IU Conscience Project, 2006) Stilwell, Barbara M.; Galvin, Matthew R.; Gaffney, Margaret M.
Study of the relationship between episodic or continuous moral malfunctioning and psychopathology is an undeveloped field in child and adolescent psychiatry. An empirically derived theory of conscience provides a normative base from which to launch such studies. This work reviews five normative stages of functioning within five domains of conscience: conceptualization, moralization of attachment, moral-emotional responsiveness, moral valuation, and moral volition. Current professional guidelines for the doctor-patient relationship, psychiatric assessment, diagnostic categorization, and treatment planning address conscience functioning sometimes directly, sometimes indirectly, and sometimes not at all. A case report is provided to illustrate progress already made in conscience sensitive clinical psychiatry. Further advances may begin with consideration of proposed hypothetical models, comporting with recent research, which describe progressive impairment involving both delay and deviancy in conscience functioning.
Psychiatric Diagnostic (DSM 5) Contexts of Psychopathological Interference in Conscience Formation and Functioning across the Youth-span: a Guideline
(IU Conscience Project, 2014) Galvin, Matthew R.
Pastoral counselors as well as psychotherapists might readily engage with conscience sensitive psychiatrists at the moral psychological level in understanding psychopathological interferences in conscience formation and functioning. The timeline of conceptual efforts made thus far to chart the course of psychopathological interferences in conscience formation and functioning is demarcated. Conscience sensitive psychiatry requires durable, conceptual tools for organizing bio-psycho-social considerations refined according to current standard diagnostic conventions in order for research to continue but also for the sake of enabling meaningful conscience sensitive contributions to healing. The absence of a designated group of disorders centered upon conscience accentuates the need to provide an up-to-date supplemental typology that will promote conscience sensitivity in diagnostic considerations. A GUIDELINE is provided for considering types of psychopathological interference in conscience formation and functioning in the context of current psychiatric diagnostic conventions.
The Psychobiology of Conscience: Signatures in Brain Regions of Interest
(2009) Galvin, Matthew R.; Stilwell, Barbara M.; Gaffney, Margaret M.; Hulvershorn, Leslie A.
OBJECTIVES: 1) to highlight studies in the last eight years in which functional magnetic resonance imaging or other neuroimaging techniques have been employed in identifying brain activities as putative correlates of various TASKS proposed to represent essential MORAL PSYCHOLOGICAL FUNCTIONS and 2) to consider how NEUROIMAGING STUDIES of CONSCIENCE FUNCTIONAL TASKS might be conducted which provide more depth and meaning in future moral psychobiological investigation. METHOD: Brief descriptions of the principles and caveats of interpreting findings from NEUROIMAGING are provided. A GLOSSARY OF TERMS derived from cognitive sciences including neuropsychology and developmental psychology is presented. These terms, it is suggested, are necessary but not sufficient in understanding the DOMAINS OF CONSCIENCE. Existing NEUROIMAGING STUDIES of putative MORAL PSYCHOLOGICAL FUNCTIONAL TASKS that (at least nominally) address aspects of each CONSCIENCE DOMAIN are reviewed. These STUDIES are organized according to the following subtitles (with the CONSCIENCE DOMAIN of concern identified parenthetically): MORAL COGNITION: MORAL JUDGMENT AND VALENCE (CONSCIENCE DOMAIN: VALUATION), EMPATHY (CONSCIENCE DOMAIN: MORALIZED ATTACHMENT), MORAL EMOTIONS (CONSCIENCE DOMAIN: MORAL EMOTIONAL RESPONSIVENESS), and SELF CONTROL (CONSCIENCE DOMAIN: MORAL VOLITION). No existing NEUROIMAGING STUDIES clearly correspond to the anchor domain, CONCEPTUALIZATION OF CONSCIENCE. The CONSCIENCE DOMAINS are briefly characterized with reference to the empirical research supporting each. CONCLUSIONS: In the last several years, a number of intriguing findings have emerged from NEURO-IMAGING STUDIES relevant to putative MORAL PSYCHOLOGICAL FUNCTIONAL TASKS. However, in addition to caveats attaching to any attribution of activity to neurological structures and their connections based upon signals captured via NEURO-IMAGING, serious concerns also arise regarding the validity of the TASKS currently employed in these studies as truly representative of CONSCIENCE FUNCTIONS. Instruments designed to inquire into relevant CONSCIENCE DOMAINS are put forward. Complementary TASKS more sensitive to each CONSCIENCE DOMAIN are imagined and offered for consideration as ways to provide more depth and meaning to future NEUROIMAGING STUDIES OF CONSCIENCE.
Reconceptualizing Disorders of Conduct
(2015) Stilwell, Barbara M.; Galvin, Matthew R.
Retrieval of Life Affirming Values and their Incorporation into a Suicidality Prevention Plan
(2005) Galvin, Matthew R.; Fletcher, Jerry; Stilwell, Barbara M.
Abstract. This article is intended primarily as a companion piece to provide additional background and illustration for a submission by the same authors to The Journal of the American Academy of Child and Adolescent Psychiatry. It is also the second in a series appearing in Conscience Works to characterize recently employed techniques to render psychiatric treatment of children and adolescents in a conscience sensitive manner. It consists of a progressive Case Presentation interwoven with Discussion points, which together demonstrate the retrieval of life affirming values in the context of suicidality management and the incorporation of these values in an overall suicidality prevention plan.

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