Barbara M. Stilwell

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States

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Publications (20)60.7 Total impact

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    Margaret M. Gaffney · Matthew R. Galvin · Barbara M. Stilwell
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    ABSTRACT: Medicine is a moral enterprise, and medical educators have a primary moral and professional obligation to students to teach, evaluate and nurture this aspect of the curriculum. We assume our students enter medical school as persons of conscience, and that our job as teachers, in addition to helping them master facts, critical and clinical thinking and skills, is to promote their development into professionals of conscience, and eventually, virtuous physicians. 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 moral selves in the face of patients, peers, or teachers who profess divergent values, or request services that jar the young professional’s sense of moral ought-ness. Medical educators readily recognize the moral requirement to teach ethics, but struggle to engage effectively the moral reasoning of students who are inundated with basic science courses and clinical skills training (Self and Baldwin, 1994). Students appreciate hearing case stories, and recognize in the practice of case-based ethical dilemma resolution similarity to other medical problem solving processes, but are impatient with philosophical theory. Most students at our institution were biology or chemistry majors, and few have taken any courses in
    Preview · Article · Dec 2008
  • Barbara M. Stilwell

    No preview · Chapter · Dec 2007
  • Matthew R Galvin · Jerry Fletcher · Barbara M Stilwell
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    ABSTRACT: The Moral Genogram, the Suicide Walk, and the Value Matrix are three conscience-sensitive exercises that lead to increased psychodynamic understanding of moral issues that either promote or protect against suicidality. Their intent is to elicit understanding of how the patient perceives reciprocal moral obligations between herself and her loved ones when choosing to live or die. Although the exercises may be therapeutic in and of themselves, their main intent is to be adjunctive assessment tools to procedures already outlined in the Practice Parameters for assessing suicidality. Their main usefulness is in highlighting morally embedded psychodynamic meaning that should be addressed in psychotherapy. For example, the case presented here highlighted psychodynamic links between Regina's suicidality, conscience functioning, psychopathology, and maltreatment. Addressing the implicated moral plea that her mother protect her from further abuse or neglect would probably decrease her suicidal risk. (A more complete description of this case as well as a model for a Suicidality Prevention Plan that includes these three exercises can be found on the Conscience Works Web site: http://shaw.medlib.iupui.edu/ conscience.) © 2006 by the American Academy of Child and Adolescent Psychiatry.
    No preview · Article · Jul 2006 · Journal of the American Academy of Child & Adolescent Psychiatry
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    M Gaffney · D Litzelman · M Galvin · B Stilwell · A Cottingham
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    ABSTRACT: An I.U. Conscience Project and HELP Collaboration. The presentation 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. Indiana University Conscience Project 1982, Health-professional Ethics Leadership Program (HELP) 1997, Teaching Caring Attitudes (TCA) 1998
    Preview · Article · Jan 2005
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    Margaret Gaffney · Matthew Galvin · B. Stilwell

    Preview · Article · Jan 2002
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    ABSTRACT: To compare moral development and psychopathological interference with conscience functioning (PI) among adolescents exposed to different degrees of earthquake-related trauma and to investigate the relationship of moral development and PI to exposure to trauma, severity of posttraumatic stress disorder (PTSD) symptoms, postearthquake adversities, and extent of loss of nuclear family members. Adolescents (N = 193) from 2 cities at different distances from the epicenter were evaluated. The Stilwell Structured Conscience Interview was used to assess moral development and PI. Structured self-report instruments were used to obtain ratings of severity of earthquake-related trauma, posttraumatic stress symptoms, and postearthquake adversities. Adolescents in the city near the epicenter manifested advanced moral development as compared with their counterparts in the less affected city. Concomitantly, they endorsed responses indicating PI. Levels of PI were significantly correlated with severity of PTSD symptoms. In the aftermath of a catastrophic natural disaster, children assume greater responsibilities and confront a multitude of morally challenging interpersonal situations which may result in an advancement of their moral development. Yet, at the same time, PTSD symptoms and negative schematizations of self and others may give rise to disturbances in conscience functioning. The findings suggest that therapeutic consideration should be given to assisting children in integrating the horror of their traumatic experiences and the harshness of posttrauma adversities into an adaptive schema of good and evil in themselves and the world.
    Full-text · Article · May 1999 · Journal of the American Academy of Child & Adolescent Psychiatry
  • BARBARA M. STILWELL · M R Galvin · S. MARK KOPTA · ROBERT J. PADGETT
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    ABSTRACT: To define discrete developmental levels of understanding of the ways in which normal children and adolescents link autonomy and will to moral obligation and to study the correlation between this progression and previously identified stages of conscience conceptualization. One hundred thirty-two normal volunteers between the ages of 5 and 17 years were individually interviewed using the moral volition section of the semistructured Stilwell Conscience Interview. Analysis of the interviews resulted in five levels of understanding of moral self-evaluation and volitionally chosen behavior. Analyses of variance and covariance showed that the five levels of moral volition had significant correlation with five conceptualization stages, with stage criteria showing a stronger correlation than age. Self-identified tasks of oughtness were hierarchically defined beginning with those defining a morality of restraint followed by moralities of mastery/sufficiency, virtuous striving, idealization, and individual responsibility. Perception of increased independence of self in interaction with conscience was noteworthy at stages 4 and 5. Moral volition is the domain of conscience functioning that defines understanding of moral self-evaluation and volitionally chosen actions; five levels of understanding can be demonstrated in normal children between the ages of 5 and 17 years.
    No preview · Article · Mar 1998 · Journal of the American Academy of Child & Adolescent Psychiatry
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    ABSTRACT: To define discrete developmental levels of understanding regarding the ways in which normal children and adolescents link remembered and current attachment experiences to their moral belief system and to study the correlation between this progression and previously identified stages of conscience conceptualization. Using the moralization of attachment section from the semistructured Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were individually interviewed. Analysis of the interviews resulted in five levels of understanding. By analyses of variance and covariance, the five attachment levels showed significant correlation with the five conceptualization stages. Conceptualization stage showed a stronger correlation than age. In normal development, moralization of attachment is a domain of conscience functioning which follows a five-level hierarchical developmental progression; first, the child's sense of security and empathic responsiveness become paired with a sense of moral obligation; caretaker rules are then incorporated; an understanding of how empathy modifies strict rule-following develops; idols and ideals are chosen that reflect earlier learning in attachment relationships; finally, a visualization of the self as moral standard-bearer or teacher unfolds.
    No preview · Article · Sep 1997 · Journal of the American Academy of Child & Adolescent Psychiatry
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    ABSTRACT: Identify associations among early maltreatment, sufficiencies, and psychopathological interferences in the domains of conscience functioning and low serum dopamine beta hydroxylase activity. Nineteen emotionally disturbed boys screened for maltreatment experiences were compared according to age at onset of maltreatment, enzyme activity, and their conscience functioning in the domain of moral valuation. They were also compared in conscience functions to 19 age and sex matched normal counterparts. Subjects who endured maltreatment prior to 36 months had developmental delays and interferences with functioning in more conscience domains than those who were either spared such experiences or who endured maltreatment later in life. Subjects with low enzyme activity had significantly more interference with authority and peer valuation than subjects with high enzyme activity. Greater interference with valuation was associated with lower enzyme activity and more frequent abuse prior to 36 months. Psychosocial sequelae of early maltreatment have been identified in the domains of conscience. An association has been established between pathological interference in the domain of moral valuation and a putative neurobiologic sequelae of early maltreatment. Implications for future research in the psychobiology of maltreatment are discussed.
    No preview · Article · Feb 1997 · Child Abuse & Neglect
  • Barbara M. Stilwell · Matthew Galvin · Stephen Mark Kopta · Robert J. Padgett
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    ABSTRACT: To assess development of moral valuation in normal children and adolescents, that is, how moral rules for living are derived and justified, and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed. All moral valuation responses were examined within three aspects of social reference: authority-derived, self-derived, and peer-derived. Each aspect was scaled for complexity into six anchored levels. The levels of all three aspects correlated positively with conceptualization stages as well as with each other. When the covariate, age, was taken into consideration, peer-derived valuation was significantly correlated with both age and stage. Moral valuation is a domain of conscience functioning in which moral rules and their justifications are socially referenced in relationship to authority, self, and peers. Anchored levels of these three aspects of moral valuation provide developmental guidelines for mental status examinations in patients between 5 and 17 years of age as well as providing criteria for future comparative studies in various diagnostic categories of psychopathology.
    No preview · Article · Mar 1996 · Journal of the American Academy of Child & Adolescent Psychiatry
  • M Galvin · R Ten Eyck · A Shekhar · B Stilwell · N Fineberg · G Laite · G Karwisch
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    ABSTRACT: Fifty boys, hospitalized on a school-age and an adolescent unit in an intermediate length psychiatric hospital, were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with different childhood maltreatment experiences. Childhood maltreatment was categorized according to onset (before 36 months old, between 36-72 months old and over 72 months old). Childhood maltreatment groups were compared with a group of psychiatrically hospitalized boys who had neither been abused nor neglected. Boys who were younger than 72 months at age of onset of maltreatment had significantly lower DBH activity than those who had experienced maltreatment later in childhood and those who had not been subjected to abuse or neglect. This difference appeared attributable to the DBH activity of school age (but not adolescent) boys who had been abused/neglected before 72 months. Boys with a principal diagnosis of conduct disorder solitary aggressive type had lower DBH activity than boys without this diagnosis regardless of whether or not they had been maltreated. Low serum DBH may be a biological sequela of maltreatment early in life that correlates with the development of conduct disorder solitary aggressive type in boys.
    No preview · Article · Aug 1995 · Child Abuse & Neglect
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    ABSTRACT: Fifty boys, hospitalized on a school-age and an adolescent unit in an intermediate length psychiatric hospital, were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with different childhood maltreatment experiences. Childhood maltreatment was categorized according to onset (before 36 months old, between 36-72 months old and over 72 months old). Childhood maltreatment groups were compared with a group of psychiatrically hospitalized boys who had neither been abused nor neglected. Boys who were younger than 72 months at age of onset of maltreatment had significantly lower DBH activity than those who had experienced maltreatment later in childhood and those who had not been subjected to abuse or neglect. This difference appeared attributable to the DBH activity of school age (but not adolescent) boys who had been abused/neglected before 72 months. Boys with a principal diagnosis of conduct disorder solitary aggressive type had lower DBH activity than boys without this diagnosis regardless of whether or not they had been maltreated. Low serum DBH may be a biological sequela of maltreatment early in life that correlates with the development of conduct disorder solitary aggressive type in boys.
    No preview · Article · Jul 1995 · Child Abuse & Neglect
  • BARBARA M. STILWELL · MATTHEW GALVIN · STEPHEN MARK KOPTA · JAMES A. NORTON
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    ABSTRACT: The purpose of this study was to assess the progression in development of moral-emotional responsiveness in children and adolescents and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed regarding comprehension of their emotional responses to moral stimuli. Rational analysis of the responses identified six items; each item was scaled for complexity into five stages. Factor analysis of the six items revealed two factors: moral-emotional responsiveness 1 contained items relating to external anxiety, internal anxiety, and mood; more-emotional responsiveness 2 contained items relating to the restoration of psychophysiological equilibrium through the processes of reparation and healing. Differences between conceptualization stages, with the moral-emotional responsiveness factors serving as dependent variables, were accounted for by stage differences in age and the positive correlations between the moral-emotional responsiveness factors and age. Moral-emotional responsiveness is a two-factor domain of the conscience. The findings provide additional developmental guidelines for assessing conscience development and functioning both in clinical practice and in research.
    No preview · Article · Feb 1994 · Journal of the American Academy of Child & Adolescent Psychiatry
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    ABSTRACT: Twenty-one psychiatrically hospitalized boys were studied while off psychoactive medication to determine if conduct disorder, solitary type, and abuse or neglect experiences correlated with low levels of dopamine-beta-hydroxylase (DBH) activity. Preliminary results supported earlier findings that undersocialized types of conduct disorder in boys were correlated with low DBH activity. Possible or definite neglect or abuse before 36 months of age was correlated with low DBH activity. Abuse or neglect was not correlated with low DBH activity when time of occurrence was not specified. Low serum DBH may be a biological sequela of seriously disrupted attachment.
    No preview · Article · Nov 1991 · Psychiatry Research
  • BARBARA M. STILWELL · MATTHEW GALVIN · STEPHEN MARK KOPTA
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    ABSTRACT: In order to determine how normal children and adolescents conceptualize their conscience, the Stilwell Conscience Interview was given to 125 normal subjects between the ages of 5 and 17. Responses to questions 1, 2 and 11 (including the drawing of conscience) were empirically analyzed, resulting in a five-stage developmental model. The responses were then randomly presented to two blinded raters to assign them to one of the five stages. Highly acceptable interrater reliability was found, Kappa = 0.90. The relationship of age to stage demonstrated a highly significant positive correlation, indicating that the conceptualization of conscience in normal development follows an invariant, hierarchical pattern of organization. A commentary regarding each stage is presented. The value of this conceptualization model as a comparative standard of normality in the clinical assessment of youngsters suffering from psychopathology is discussed relative to assessment, psychotherapy, and future research.
    No preview · Article · Feb 1991 · Journal of the American Academy of Child & Adolescent Psychiatry
  • Barbara M. Stilwell · Matthew Galvin
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    ABSTRACT: Forty-eight nonpsychiatrically disturbed 11–12-year-olds were asked to describe their conscience, to draw a picture of it, and to describe their internal and external responses to personal transgressions and acts of moral goodness. Three stages of conceptualization emerged, represented by both verbal description and pictorial presentation. The reporting of emotional responses of physiological discomfort, persistent thoughts, and depressive symptoms showed statistically significant variation at the three stages. There were also significant sex differences.Journal of the American Academy of Child Psychiatry, 24, 5:630–636, 1985.
    No preview · Article · Oct 1985 · Journal of the American Academy of Child Psychiatry
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    M Galvin · B Stilwell · M Gaffney · L Hulvershorn
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    ABSTRACT: 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. Conscience Works Theory, Research and Clinical Applications 3(1): 1-36, 2009.
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    Matthew R. Galvin · Barbara Stilwell

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  • M. Gaffney · M. Galvin · J. Abram · M. Srinivasan · B. Stilwell

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    Matthew R Galvin · Margaret M Gaffney · Barbara M Stilwell
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    ABSTRACT: 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 Works: Theory, Research and Clinical Applications, 2005, 1(1): 1-23. Key Words: conscience sensitive, child and adolescent psychiatry, benchmarks for intervention, psycho-educational, group format.
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