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Conscience Project Meeting 1-22-11

June 20, 2011

The meeting was conducted at Ethna’s home. Present were Ethna, John, Barb, Sister Mary, Jere, Deb H, Meg , Matt, Deb G, Beulah, Susan and Joe.

The minutes from the previous meeting 9-25-10 were reviewed and accepted.

Matt circulated A. Kaplan (2010): “Morality” professor responsible for research misconduct. Psychiatry Times XXVII (10): 1and 9.

Nota bene: On prior occasions we have discussed Harvard Professor Marc Hauser’s 2007 book Moral Minds: the Nature of Right and Wrong, Harper. The comment by a colleague in the field was reported: “I believe his work on morality is not tainted by this investigation but his work on animals has been, and of course, he is tainted himself by this.”

Ethna provided further update on her efforts in promoting awareness and encouragement for uses of the Deb G’s illustrated version as well as the version of The Lyric of Lafracoth currently available on Conscience Works. Ethna had left an illustrated version with Professor V. Ethna reported very favorable comments regarding both text and illustrations from Professor V, who had given the work two readings and viewings: “The illustrations alone could sell it!” was Ethna’s direct quote from the professor. He encouraged further promotion with prospective publishers. He made the suggestion that the letter to prospective publishers contain a better summary with more material excerpted from the text to present the flavor of the work. He also indicated he could readily envision Lafracoth adapted for the stage. At our last meeting, Ethna had requested an additional hardcopy which she had intended to show Professor B. Matt and Deb G. had prepared the additional hardcopy in the interim and gave it to Ethna at this day’s meeting.

In her turn, Susan shared she had been intrigued by the possibility of rehabilitation of Michael Vick’s dog which had been subjected to the maltreatment entailed by vicious sport. She had learned dogs rescued after experiencing similar adverse life circumstances were divided into groups, adopted into families on the one hand or sent to refuge facilities on the other. Susan drew an analogy to people and inquired, “What prevents a person from being rehabilitated?” In response, Joe commented that pit bulls were biologically susceptible for selection according to their capacity for interspecies aggression. This exchange prompted discussion nature –nurture explanations which moved back and forth from animals traits to applications to human criminality: putative endo-phenotypes and gene-environment interactions. Beulah asked about the number of generations needed to realize changes in phenotypic traits. Joe supplied comments about how very quickly phenotypic changes could sometimes be discerned in breeding. He recalled a study of foxes bred for fur in the Soviet Union. In a single generation, both enlarged size and variations in color were evident from the breeding process. The notion of intended (and unintended) genetic breeding for aggression in species (including humans) was raised. In particular, emerging in discussion was the role of urban adversities and ‘structural’ poverty in establishing criminality.

Matt related how once a year, around the time of the winter holidays in the Conscience Group at Children’s Bureau Retreat, the film version of Lionel Bart’s musical adaptation of Charles Dicken’s Oliver Twist. Oliver! is shown to the youth in residence. Each youth is assigned a character in the film to whom s/he is expected to pay particular attention. Subsequently s/he engages in the task of conducting a conscience sensitive analysis of that character, using the domains of conscience to organize his or her thoughts. S/he then presents his or her theory of that character’s conscience to the entire group for further discussion. Matt indicated that a perennial topic for discussion pertains to the different developmental trajectories of the characters Oliver Twist and Bill Sykes, both of whom are obliged to form their early childhood conscience in adverse circumstances. Apropos Susan’s topic, Matt inquired: what might have differed between the two characters in terms of the modulation of genetic expression by environmental adversity or protective factors that could account for their different outcomes? Matt made passing reference to the work of Caspi et al’s 2002 study on genetic alleles (available in PDF on Google Scholar) seeming to make a difference in whether conduct disorder follows from maltreatment. He also mentioned relevant articles he had recently encountered in the Journal of the Academy Child and Adolescent Psychiatry (JAACAP), given here with full citations:

Caspi A, McClay J, Moffitt T, Mill J, Martin J, Craig I, Taylor A, Poulton R (2002): Maltreated children role of genotype in the cycle of violence. Science 297, 851-853.

Nota bene from the Abstract: “A functional polymorphism in the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA) was found to moderate the effect of maltreatment. Maltreated children with a genotype conferring high levels of MAOA expression were less likely to develop antisocial problems….”

Jonson-Reid M, Presnall N, Drake B, Fox L, Bierut L, Reich W, Kane P, Todd R, Constantino J (2010):The effects of child maltreatment and inherited liability on antisocial development: an official records study. JAACAP 49 (4): 321-332.

Nota bene: Use of a twin registry and court records.

Bagota R, Meaney M (2010): Epigenetics and the biological basis of gene x environment interactions. JAACAP 49 (8): 752-771.

Nota bene: recent review article.

In the context of the capacity for rehabilitation after in some sense ‘being bred’ for aggression or criminality (cf: the conscience domain moral emotional responsiveness, reparation and healing), Meg was reminded of a book: McCall N (1994): Makes Me Wanna Holler, Random House. This is an autobiographical account of how the author’s conscience, shaped by the survivalist values of street and neighborhood as well as his strong sense of foreshortened future, was reformed by the author’s self examination and exercise in moral imagination. In the context of differences in developmental trajectories that seem inadequately accounted for by environment or genes or epigenetic considerations, an anecdote related somewhere in Rabbi Kushner’s writings was recalled: this involved twins who by and large shared environment, one of whom became a generous philanthropist and the other who became a convicted murderer on death row. Both were posed the same question, something like: ‘How do you account for who you have become?’ Both replied, something like: ‘Given that with which I began my life and all that has happened to me since, how could I have turned out otherwise?’

In her turn, Deb G. reflected upon an interview on the news with a spokesperson for ATF whose attribution of motive to—or explanation for the behavior of—the shooter in Tucson AZ, distilled to ‘He was mentally defective.’ Deb G. wondered why this remark so stigmatizing to those struggling with mental illness went unchallenged by the interviewer (cf. conscience domains: moral de-valuation and absent or suppressed moral emotional responsiveness). Matt promised to distribute an article on the subject of stigma of childhood mental illness at the next meeting:

Mukolo A, Heflinger, Wallston K (2010): The stigma of childhood mental disorders: a conceptual framework. JAACAP 49(2): 92-103.

Nota bene: Basically the nature of stigma can be conceptualized at three levels: self, public and institution. Self stigmatization and the stigma that attaches to caregivers and caring professionals are addressed.

As a corollary, Deb H. shared her impression that parents of afflicted children have a tendency to deny the affliction because there is an implication something must also be wrong with them.

There followed a spirited discussion on gun control. Barb remembered how the attempted assassination of Ronald Reagan (1981) added impetus to the fledgling formation of the National Alliance on Mental Illness (NAMI, inception: 1979) as well as to passage The Brady Handgun Violence Prevention Act (signed into law in 1993). She observed, however, that subsequent assassinations and mayhem had not seemed to provide sufficient impetus to build upon these foundations. Joe recalled that Don (of Don’s Guns) had recently remarked he could not keep some form of ordnance in stock, demand being so great following the shootings in Tucson.

‘Defective’ human beings came up again along with the question ‘Who’s entitled to deem the imperfections as making persons more or less worthy?’ As Deb H subsequently put it, “Who decides who can be rehabilitated?” Listening to all the conversations represented in the above account, Sister Mary inquired, “Where does love fit into this- these genetic issues, these ‘imperfect’ [persons] what do we do with ‘them’?” One further question Sister Mary seemed to imply, might be put: ‘Should we be asking what is ‘their’ purpose (Meg’s notes of the meeting reflect a reference was made in the context of “purpose” to C. Gates) or what is ‘ours’?’ (cf. conscience domains: moral emotional responsiveness, moral valuation and moral autonomy).

Matt commented how it seemed to him we were all ‘dross-laden souls’, operating from mixed motives. Even among our worthiest deeds, how many and how much of any can ever be attributed to altruism? In this context we revisited the status of altruism in any given person’s motivational hierarchical arrangement, according to relative goodness and then again according to relative strength (cf. Meg’s application of the British admonition: ‘Mind the Gap’). Barb introduced the phrase ‘strategic altruism’ which takes into account personal financial advantages, such as tax breaks for charitable donations.

The imperfectability of human nature aside, opportunities to purposely nurture giving and giving back do occur. This was evident in Susan’s remarks about plans for students to make a school sponsored trip to the Dominican Republic. Among recommendations for reading that came up in this discussion was Richard Gunderman’s book on the nature of philanthropy: Gunderman R (2008): We Make a Life by What We Give, Indiana University Press, Bloomington, In.

In his turn, John shared reflections on his therapeutic work with veterans, conveying his impression that trauma pushed certain fundamental questions such as ‘purpose’ into the forefront. He subsequently provided the simile: “The trauma is like an earthquake, the flashbacks like aftershocks.” John was reminded of an encounter with a returning warrior who, bewildered by his lack of success in making suicide attempts, began to consider after all if there was some purpose in his life that he had been trying to thwart. John referred to Chaplain Clyde Angel’s group work at VA conducted along themes such as “Search for Meaning” and “Wounding of the Soul.” For background John referred to an article:

Litz B, Stein N, DelaneyE, Lebowitz L, Nash P, Silva C, Maguen S. (2009):Moral injury and moral repair in war veterans. Clinical Psychology Review 29(8): 695-706.

Nota bene, from the front matter: “Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially (what we label as moral injury).

Although there has been some research on the consequences of unnecessary acts of violence in war zones, the lasting impact of morally injurious experience in war remains chiefly unaddressed. To stimulate a critical examination of moral injury, we review the available literature, define terms, and offer a working conceptual framework and a set of intervention strategies designed to repair moral injury.”

John referred to 12 Step programs as well, noting the spirituality inherent in them, their promotion of the project of the examined life, and their emphasis upon the role of suffering for growth.

So much attention to purpose might be what prompted Barb to remark on her priorities and activities now that she is 75. She wants to do things completely enjoyable: some memoir writing, completing her term of office as president of her neighborhood association, volunteering at Spring Mill School, biking, walking ballroom dancing and going off to camp in Vermont in August. Her grandson Glen comes by every Thursday. We appreciated that Barb could acknowledge that one among the enjoyable things, so long as no conflict emerged with other more enjoyable things, was attending Conscience Project meetings.

Matt provided copies of an article in which Jerry Fletcher, Barb and he collaborated last year.

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.

Matt promised not to bother Barb (too much) with any more conscience projects.

Barb provided an anecdote about Glen’s changes in sharing attitudes with respect to chocolate pudding which nicely and humorously illustrated both progressions and vicissitudes.

In July, Ethna, too, turns 75. Joe will soon retire: “Now what will my purpose be?”

No one could say for sure, but Matt indicated there might be purposes at hand for some of the Conscience Project participants. Matt is on the Board of The Indiana Infant and Toddler Mental Health Association (IAITMH) a division of the Indiana Mental Health Association (MHA) IAITMH is developing a means by which early childhood mental health professionals in Indiana could engage in documented study and supervised experiences to receive endorsement. This is already done in Michigan and other states. The endorsement does not substitute for professional training, it is not licensure nor does it provide ‘institutional credentialing or privileging’ of any sort. Part of the process will entail exposure to ethics pertinent to the early childhood fields. In keeping with the mission of IAITMH to promote social emotional and social cognitive development, Matt proposed to the IAITMH Board that a moral psychological approach be made to ethics. He advocated that the approach be interactive as well, beginning with personal conscience before moving onto the professional conscience. Should this proposal be agreeable to IAITMH, the possibility would arise that interested participants in the Conscience Project (CP) might pair with Child Development (CD) Specialists (somewhat akin to the model Meg has promoted in Introduction to Clinical Medicine pairing primary care physicians with psychiatrists and psychologists prepared to lead discussion about development across the life span). The CP and CD specialists would co-facilitate educational groups for learners. The course format would resemble what Meg and Matt did over six sessions in November 2009 at Trinity Episcopal Church for moral educators of various sorts. The CP specialist would need to learn to conduct the educational groups organized around conscience sensitive tasks (see the following paragraph) that reveals the ‘signatures’ of the domains of conscience: conceptualization, attachment, moral emotional responsiveness, moral valuation and moral volition. The CD specialists would make essential teaching points about cognitive, emotional development, attachment, temperament and so forth. Already in process are plans for the 13th annual conference of IAITMH. The conference lasts a day. One or two experts in moral psychology, both at Notre Dame, will be invited to make presentations providing an overview of the field. They are Professors Darcia Narváez and Daniel Lapsley. Meg has agreed to present on ethics and the professional conscience. It is hoped we can inaugurate the collaboration of the first among CP and CD specialists in time for the conference, which will then serve as a model for future courses perhaps held in 1-2 hour sessions and conducted over several weeks.

Meg provided an update on the conscience sensitive course work already established at the medical center: the small group Meg and Matt conduct in the year long ICM I, which on 11/9/10 was graciously hosted at Key School by Susan, the upcoming senior elective in which she engages learners in conscience sensitive tasks such as conscience drawings, moralized genograms, value matrices and harm prevention planning, and the course on conscience and ethics for psychiatry residents, four consecutive sessions which had been moved from August to begin this academic year February 23rd.

Based on the cheating, plagiarism and other violations of age appropriate norms and rules Susan had had occasion to observe in k-12, she advised the educators at the medical center that a train wreck was headed their way. In response to Susan’s dire prediction, surreptitious looks of envy might (or might not) have been cast in Joe’s, Ethna’s and Barb’s directions. An announcement was made about an upcoming Petticrew Faith in Action Program entitled “Leadership, Business Ethics and Faith” featuring Dr. John Lechleiter, Eli Lilly and Co, and Fr. John C. Haughey, SJ Woodstock Theological Center, Washington DC May 3, 2011 9AM-130PM (830 registration, Indpls downtown Marriott, 350 W. Maryland St. co-sponsored by Brebeuf . Deadline for registration: April 26, 2011. No phone number given ( I would go to www.cts.edu/events or contact Brebeuf). $20 for the AM seminar, $40 for AM, lunch and PM, 4320 for a table of 8.

In his turn, Jere produced a rough draft of a bibliography on conscience based on his search of recent literature informed by what he knew were topics of interest to us. His search yielded titles of recent books and articles published between August and December 2010. Subjects included medical ethics, psychology, social issues and philosophy. Jere was thanked and encouraged to put his results on Conscience Chronicles and to continue making this invaluable contribution. There followed discussion about the eventual possibility of a periodic (quarterly?) annotated bibliography organized according to the domains of conscience. Matt said he would send Jere the beginnings of such an annotated bibliography based on something of the kind he had put together for a course.

Lastly, the sad news of the death of Dr. Linda Sue Harrington Stephan was shared by Barb. A one-time participant and ever the friend of the Conscience Project who liked to receive her copy of our meeting summaries and who recommended our work to colleagues and learners, Linda passed away October 22, 2010. She was a loving, kind, brave and memorable soul. Her obituary can be viewed at: http://www2.indystar.com/cgi-bin/obituaries/index.php?action=show&id=121734

Both of our websites have changed URL’s:

Find Conscience Chronicles at: https://iuconsciencenews.org/

Find Conscience Works at: http://shaw.medlib.iupui.edu/

The next meeting of the IU Conscience Project will be hosted by Ethna at her home, on Saturday

4/30/2011at 10:00 AM to noon.

Respectfully submitted,

3-23-11

Edited for Conscience Chronicles 5/31/11

Matthew R. Galvin

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