When George Washington wrote in his copy book as a schoolboy that “Labor to keep alive in your breast that little spark of celestial fire called conscience” (see Schlafly, 2002 ), it showed he was born, as all true social leaders, to understand both the divine nature of Conscience and the obligation of following its commands. But with this sentence he also transmitted—however unknowingly—a challenge to the neuroscientists of future: the challenge of exploring and understanding the neural blueprint of Conscience.

This was a tall order. The monumental two volumes of The Principles of Psychology by the father of American psychology, William James ( James, 1890 ), didn’t even have the word “conscience” in its subject index. Perhaps Sigmund Freud was the first to pay attention to the problem. The below passages from Chapter III of his classic “The Ego and the Id” ( Freud, 1962 )—originally published in 1923—summarized his opinion:

“It is easy to show that the ego ideal answers to everything that is expected of the higher nature of Man…it contains the germ form which all religions have evolved… As a child grows up, the role of father is carried on by teachers and others in authority; their injunctions and prohibitions remain powerful in the ego ideal and continues, in the form of conscience, to exercise moral censorship… Social feelings rest on identifications with all other people on the basis of having the same ego ideal.” (p. 27).

Scientific investigations of the 21^st century opened new windows to this recognition. According to Schalkwijk, three subsystems participate in the functioning of ego ideal, also called as Super-Ego by Freud. These subsystems are: “…the capacity for empathy, the proneness to experience self-conscious emotions, such as shame, guilt, and pride, and the capacity for logic, moral thinking” ( Schalkwijk, 2018 , Abstract). Others pointed out that “cognitive neuroscience investigations have begun to reveal the distributed neural networks which interact to implement moral judgement and social decision-making, including systems for reward learning, valuation, mental state understanding, and salience processing…”, all fundamental to morality ( Yoder & Decety, 2017 , Abstract).

Finally, Patricia S. Churchland, founder of neurophilosophy, produced a comprehensive book on Conscience ( Churchland, 2019 ). She dedicated a full chapter, Chapter 6 titled “Conscience and Its Anomalies”, to discuss the overlaps of these anomalies with psychopathy, sociopathy and obsessive-compulsive disorders. At the same time, her book concluded that “If we seek a precise explanation of why a seemingly decent person acted against conscience by taking a bribe or molesting a child or lying under oath, we have to acknowledge that neuroscience cannot yet provide such a precise neurobiological answer.” (p. 187).

The aim of this article is to move science and philosophy a step closer to that neurobiological answer by looking at the anomalies of Conscience. Specifically, the article focuses on the anomaly that can be called Conscience Dysfunction Syndrome.

The thesis of this paper is that the prefrontal cortical neural circuitry of Conscience, as defined and fine-tuned for this paper by the author, can often undergo pathophysiological changes even in highly successful politicians and businessmen, resulting in the Conscience Dysfunction Syndrome of which profound social impacts justify its scientific examination.

The referred definition of Conscience is that it may be the cosmically originated evolutionary product of a both genetically and environmentally regulated domain within the prefrontal cortical neural supercircuitry of Self-Ken—that highly evolved self-awareness/self-knowledge system forming the central medium of the human Soul—where this domain, interacting with the other Self-Ken domains of Mission, Will and Identity, develops during early childhood in response to the care experienced in this period to assure a lifelong drive to reciprocate these early experiences with the right acts of social goodness and love instead of the wrong acts of social harm and hate whenever the challenge of this choice—indeed, the choice between right and wrong – is encountered ( Ludvig, 2022a, 2022b ).

This definition is consistent with Churchland’s opinion that “Conscience is an individual’s judgement about what is morally right or wrong, typically, but not always, reflecting some standard of a group to which the individual feels attached.” ( Churchland, 2019 : p. 5). Though the addition that Conscience may be a cosmically originated function of the human Soul is a—good or bad—cosmological neuroscientific suggestion.

Obviously, since neural circuitries in brain can work abnormally in neurological and psychiatric patients, the prefrontal cortical neural circuitry of Conscience can also work abnormally in affected individuals, leading to the mentioned Conscience Dysfunction Syndrome.

These thoughts are illustrated in Figure 1 .

The existence of a God-sensing neural circuitry in the cognitive system is consistent with Freud’s opinion that the ego-ideal/Super-Ego—can relay religious thoughts ( Freud, 1962 : p. 27). Though the addition that this ego-ideal/Super-Ego is associated with the prefrontal cortical neural supercircuitry of Self-Ken, central medium of the human Soul, is another cosmological neuroscientific suggestion. This suggestion is not an alternative to the concept of the evolutionary development of morality, it just expands that concept with the reasonable thought that the essence of evolution itself must have come from a higher organizing system, perhaps the one Alfred Russel Wallace, co-discoverer of the evolution of life by natural selection, attributed to “a superior intelligence” guiding the “development of man” and his noblest faculties ( Wallace, 1870 : p. 359).

Nevertheless, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition, Text Revision, DSM-5-TR ( American Psychiatric Association, 2022 ), lists 919 different, ICD-10-CM-coded psychiatric diagnoses with not a single one including the term “conscience”. Indeed, the Manual’s 45-page Subject Index doesn’t even have the word “conscience”.

But Conscience is clearly a manifestation of the human psyche, and its possible dysfunctions have been recognized by thinkers since ancient times.

According to the New Testament, St. Paul warned in his 1^st letter to Timothy about the “insincerity of liars whose consciences are seared”. Canto XI of Dante’s Inferno describes the “…sycophants, hypocrites, falsifiers, thieves…pimps and all such filthy cheats…” punished for their lives led by “fraud, which is the canker to every conscience”. Shakespeare’s Richard the Third couldn’t avoid the recognition in Act 5, Scene 3, of the play that “My conscience hath a thousand tongues, And every tongue brings in several tales, And every tale condemns me for a villain.”

Hitler’s architect and Minister of Armaments and War Production from 1942 to the end of World War II, Albert Speer, admitted after 20 years in Spandau’s prison and 10 more years of thinking in the renewed Germany that “…a quarter of century after these events, it is not only specific faults that burden my conscience, great as these may have been. My moral failure resides in my active association with the whole course of events. I had participated in a war which…was aimed at world dominion.” ( Speer, 1979 : p. 523). Apparently, Speer’s Conscience didn’t function normally when he worked for Hitler. Conscience Dysfunctions exist.

The books shown in Figure 2 were used as the major inputs to this study. Churchland’s “Conscience” was a guiding material as the first comprehensive book dedicated specifically to this mental phenomenon ( Churchland, 2019 ). Freud’s classic “The Ego and the Id” helped to see Conscience in the context of conscious and subconscious brain events ( Freud, 1962 ). The DSM-5-TR ( American Psychiatric Association, 2022 ) was used partly as a reminder of the need of integrating the phenomenon of Conscience into the awareness of psychiatrists, while it was also used to learn about their likely view on the relationship between Conscience and the variety of personality disorders.

To provide good examples for the suggested Conscience Dysfunction Syndrome, this article presents the modern cases of Donald Trump, Vladimir Putin, Elon Musk and Bernard (Bernie) Madoff.

The case of Donald Trump was primarily examined with the book of his niece Mary L. Trump ( Trump, 2020 ). The case of Vladimir Putin was primarily examined with his own book ( Putin et al., 2000 ). The case of Elon Musk was primarily examined with the world-renowned Walter Isaacson’s biography of him ( Isaacson, 2023 ). And the case of Bernard Madoff was primarily examined by the unbiased book of Andrew Kirtzman titled “Betrayal: The Life and Lies of Bernie Madoff” ( Kirtzman, 2010 ).

Besides, I used my MD and PhD in neuroscience background (see https://orcid.org/0000-0002-6782-4253 ) to evaluate the virtually unceasing flood of information pouring from the entire spectrum of digital media on Trump, Putin and Musk in the last 10 years and the somewhat less but still enormous amount of data on Madoff from his arrest in 2008 through his death in 2021.

It is argued here that Conscience Dysfunction Syndrome ( Figure 1 ), seemingly affecting many successful politicians and businessmen ( Figure 2 ), is manifested in abnormal Conscience and the associated symptoms of abandoned Mission, abused Will and deformed Identity.

This section was inspired by Reviewer 2 of the paper’s manuscript, as he or she asked me to propose observations and tests that “…could be used to identify or measure Conscience Dysfunction Syndrome.” The below Figure 7 is an initial sketch of my proposal.

The first step of diagnosing Conscience Dysfunction Syndrome would be to categorize the subjects of this mental problem. The key here is to accept the inclusion of powerful political and business figures, if appropriate. This would be helped by Robert Jay Lifton’s published argument that in the Trump-era “…we must recognize the urgency of the situation in which the most powerful man in the world is also the bearer of profound instability and untruth.” ( Lifton, 2017 , Foreword).

The second step would be the process of differential diagnosis, as Conscience Dysfunction Syndrome can certainly be dominated by mental diseases like Antisocial Personality Disorders with or without psychopathic features or Narcissistic Personality Disorder. If these latter conditions are clearly identified, then the examined subject should be transferred to the experts of these disorders. Thus, his/her case severity and treatment options are no longer applicable, N/A, to the immediate general strategy for Conscience Dysfunction Syndrome, though consultation with the psychiatrists and/or psychologists who take up the case will be important.

The third step is the assessment of the severity of the case of the now diagnosed subject of Conscience Dysfunction Syndrome. I believe severe, dominating cases are characterized by the lack of self-criticism and remorse however the subjects are confronted with their actions betraying the rejection of conscience. During these therapeutic confrontations, wearable EEG devices this author recommended to capture the unique electrophysiology of religious inspirations and creative acts ( Ludvig, 2023a, 2024 ) might also be useful to capture the likely abnormal prefrontal cortical EEG signs as objective measurements. People with mild cases, on the other hand, are probably responding to such confrontations by showing some signs of self-criticism and remorse.

The fourth and final strategic step is to devise the right therapeutic option for the subject. Mild cases can hopefully be treated with psychotherapy as much including traditional procedures as analyzing with the subject such genius insights into human conscience as Shakespeare’s “Macbeth”, Pasolini’s “The Gospel According to St. Matthew”, Mozart’s “Don Giovanni” and other works of this kind. However, treating the severe cases of Conscience Dysfunction Syndrome, like those presented in this article, is problematic. The option of removing the affected subject from his or her social leadership position is too naïve to consider. This author believes that the only realistic therapeutic solution is the preventive one, to introduce into elementary and high school education the new subject of Mental Health Science (along with the also new subject of Physical Health Science) letting the students understand, more and more deeply and among other key neuroscientific facts—the superiority of life guided by Conscience.

The 2024 edition of the Stanford Encyclopedia of Philosophy emphasized in its entry on Conscience that this mental phenomenon “…can only find its proper place in philosophical and in public discussion if its philosophical and psychological aspects are teased out, defined and addressed.” The present article intended to contribute to this intellectual process by (1) including a refined, cosmological neuroscientific definition of Conscience in the Thesis section, and (2) elaborating the idea of Conscience Dysfunction Syndrome within the text and figures of the entire paper. Both are concepts not yet mentioned or alluded to in the above Encyclopedia.

The article specifically examined some key features of the political and business lives of Donald Trump, Vladimir Putin, Elon Musk and Bernard Madoff. The virtually continuous presence of the lives of the first three and the last 12 years of the fourth in every form of media for most of humankind made not just feasible this examination for a medically educated neuroscientist like this article’s author ( Moshé & Ludvig, 1988 ; Ludvig & Kovacs, 2002 ; Ludvig et al., 2004 ), but it was also an intellectual obligation due to the global impacts of these four lives.

It seemed that all of these individuals developed the similar mental alteration here called as Conscience Dysfunction Syndrome. Thus, their partly hereditary and partly acquired difficulties in operating a healthy Conscience had the severe consequence of impairments in the Mission, Will and Identity domains of their Self-Ken, central medium of the human Soul. The hereditary component could be the best recognized in Madoff’s life: “Illegal activities were taking place inside the Madoff home,” as Madoff’s parents, Ralph and Sylvia, and apparently Bernie, “were running rogue stock trading operations out of their living room.” ( Kirtzman, 2010 : p. 34). On the other hand, the acquired component was clearly present in the life of Trump, grown up in the family atmosphere of competition favoring winning at all costs in business over following the guidance of Conscience ( Trump, 2020 ).

Indeed, the dysfunction of Conscience was observed by close family members in the case of Trump, reflected in imprisonment in the case of Madoff, expressed in assassinations and wars in the case of Putin, and revealed in the lack of self-criticism after SpaceX failures and aggressive interferences with the federal government in the case of Musk.

That this dysfunction of Conscience was accompanied with abandoned Mission, abused Will and deformed Identity in all four examined individuals justified the addition of the term “Syndrome” to this condition. Though this term belongs to the vocabulary of medicine, whether the described Conscience Dysfunction Syndrome can be considered as a mental disease depends on how we define the biological malfunction of “disease”. If we define it as a condition causing such a suffering to the affected individual that he/she looks for treatment, then the described syndrome is not a disease, as none of the individuals examined here has ever looked or sounded in any media as a sufferer from Conscience-related problems. If we define “disease” as a condition that can also cause such a suffering to the affected individual’s social environment that the people of that environment look for treatment for the individual, then the described syndrome might be considered as a psychiatric entity.

One counterargument might be that Conscience Dysfunction Syndrome is just a version of Antisocial Personality Disorder with or without psychopathic features. But these disorders are characterized with such failures to conform social norms that they often lead to arrests (American Psychiatric Association, p. 748, 884-885). This is not just absent in the lives of people like Trump, Putin or Musk, but their character’s key feature is the exact opposite: the overwhelming drive to social success and popularity. And Madoff’s life didn’t lack social success either as a member of various boards of directors and country clubs.

Another counterargument might be that this syndrome is just a symptom of Narcissistic Personality Disorder. But the humanity of the admirable lives of such artists as Pablo Picasso, Herbert von Karajan, Leonard Bernstein, Maria Callas and the likes, however not without narcissism, cannot be compared with the approach to the world of those examined in this article.

Yet another counterargument might be that the pathophysiology responsible for Conscience Dysfunction Syndrome is unrelated to prefrontal cortical functions as indicated in Figure 1 . However, the fact that patients with prefrontal cortical lesions undergo significant personality changes including changes in their Conscience supports the crucial role of prefrontal cortex in this mental phenomenon. Even in describing the famous case of the prefrontal cortically damaged Phineas Gage, John Harlow noted that the patient “…will not yield to restraint when it conflicts with his desires” ( Harlow, 1868 ). Prefrontal cortical involvement in this patient’s symptoms was later confirmed by neuroimaging studies ( Damasio et al., 1994 ).

Whether Figure 1 is correct in indicating the association of Conscience Dysfunction Syndrome with the lack of sensing God is difficult to prove, as this sensation is among the most private and closed mental phenomena. But certainly, using Presidential power to separate immigrant parents from their children (Trump), ordering the assassinations of political opponents (Putin), stealing billions of dollars from unsuspecting clients (Madoff) or willfully ruining others’ business and livelihood (Musk)—are not performed by people following the basic, however differently worded, commands of the Torah, Gospels, Quran, Bhagavad Gita, Tao Te Ching or the Sermon at Benares.

This article cannot be finished without the lesson Conscience Dysfunction Syndrome teaches us via the modern cases of Trump, Putin, Madoff and Musk. It teaches us that the similar historic cases of Crassus, once the richest man in Rome; Mehmed II, destroyer of Constantinople; Trotsky, Lenin’s superintelligent comrade or Charles Ponzi, role model of fraudsters, are not simply cases of the past, but ever-renewing social threats unless their control will be learned. And to learn it, Mary L. Trump’s lesson about his uncle Donald must be absorbed: “The deafening silence in response to such blatant display of sociopathic disregard to human life… fills me with despair and reminds me that Donald isn’t really the problem after all. That is the end result of Donald’s having continually been given a pass and rewarded not just for his failures but for his transgressions against tradition, against decency, against the law, and against fellow human beings.” ( Trump, 2020 : pp. 204-205).

How did Patricia S. Churchland finish her profound book on Conscience? She finished it with these words: “None of us are morally perfect, but the level of dishonesty and the lack of shame among many of our leaders predicts disorder and heightened conflict. Norms are being shifted away from virtue and toward greed and hard-heartedness. There are many exceptions to this trend at all age levels, and the courage of such people is admirable.” ( Churchland, 2019 : p. 191).

The hope of this article is that the people of this courage will once form their alliance—NOT AGAINST the world of Trumps, Putins, Madoffs and Musks, BUT FOR the alternative world of freedom and decency.

In the human brain, distinct neural networks can undergo specific pathophysiological changes, like the changes of the nigrostriatal network in Parkinson’s Disease, the changes of the association cortical network in Alzheimer’s Disease, or the changes of the hippocampal network in Mesial Temporal Lobe Epilepsy. Thus, the neural supercircuitry of the prefrontal cortical Self-Ken, central medium of the human Soul, can also undergo pathophysiological changes. One of these pathophysiological changes may be the Conscience Dysfunction Syndrome introduced in this article. The four symptoms of this syndrome seem to be: Abnormal Conscience, Abandoned Mission, Abused Will and Deformed Identity. That this syndrome often appears in highly successful politicians and businessmen, like in those examined in this article, shouldn’t cause fear in the interested neuroscientists and neurophilosophers, rather it must inspire them so that they can help to design the future led by as morally right as intellectually capable representatives.

Every human being I have encountered in life, friend or enemy, helped me to conceive this article.