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

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.