The Conscience Celebration: A Story About Moral Flourishing

This is a serialized book with a new episode appearing approximately every two months. Neither morally didactic (i.e. it is not a book of virtues); nor a "How To" book about moral reasoning with Kohlbergian dilemmas; nor a workbook on values clarification. This book is intended to be informative to children about what they and their peers are experiencing, in common and diverse experiences, as their consciences develop. It is a secular, psychoeducational book about conscience development and functioning. As such, it provides tools to discuss moral development the way educational videos assist teacher, parent and child with discussion of sexual development and sexuality

A Conscience Sensitive Approach To Ethics and Teaching Caring Attitudes

An I.U. Conscience Project and HELP Collaboration. The article describes models for teaching ethics and caring attitudes to undergraduate medical students in both formal and informal medical education curriculum. Competency based curriculum is discussed

Retrieval of Life Affirming Values and their Incorporation into a Suicidality Prevention Plan

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

Preliminary Observations and Reflections on Conscience Sensitive Group Therapy

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

Conscience Sensitive Psychiatric Diagnosis of Maltreated Children and Adolescents

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.Support for this and other work by the I.U. Conscience Project conducted in collaboration with Pleasant Run Inc. has been generously provided by Mr. and Mrs. Jim Irsay and The Indianapolis Colts, The Moore Foundation and other individual anonymous donors

Progress in conscience-sensitive psychiatry: assessment, diagnosis and treatment planning

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

Conscience Sensitive Medical Education

Medicine is a moral enterprise, and young people who enter professional school are presumed to be morally astute, as well as intellectually capable. Thoughtful students quickly grasp the fact that what we can do in medicine usually outpaces the consensus of what we ought to do, and one of the earliest questions these students ask is how they should go about honoring their individual consciences in the face of patients, peers or teachers who profess divergent values, or request services that jar the young professional’s sense of ought-ness. Medical educators readily acknowledge the need, indeed the moral requirement, to teach ethics, but struggle to ascertain the most effective, efficient and compelling way to present the material and engage the moral reasoning of students who are already inundated with basic and advanced science studies (Self & Baldwin, 1994). Students appreciate hearing about case stories, but do not want much in the way of philosophical theory. Most students at our institution have backgrounds in biology or chemistry; few have taken any courses in literature, philosophy, religion, ethics or other humanities. The handful of lectures and small-group case-based discussions related to ethical dilemmas in medicine offered in the curriculum are helpful, but often fail to prepare the young physician adequately for a life in which moral questions daily will present themselves. We are piloting an approach to moral teaching in medicine based on an examination of conscience formation and functioning, and the understanding of the intersection of personal conscience with professional medical and ethical values. We believe that conscience theory and language may be a useful addition to the traditional approaches to dilemma resolution that involve principles, theories, and case based reasoning. In this paper we will explore traditional ethical resolution methods, give a brief history and overview of Conscience Theory, and then show through case example how using Conscience Theory may allow a richer examination of the most poignant and troubling dilemmas physicians face

The Psychobiology of Conscience: Signatures in Brain Regions of Interest

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