Original Article
Video Gaming and Sexual Violence: Rethinking Forensic Nursing in a Digital Age Dave Mercer, PhD, MA, BA (Hons), RMN, PGCE, and Denis Parkinson, MSc, RN
ABSTRACT This article reports findings from a qualitative study into how forensic nurses, and male personality disordered sexual offenders, talked about “pornography” in one U.K. high-security hospital. Research rationale was rooted in current professional and political debates, adopting a discourse analytic design to situate the project in a clinical context. Semistructured interviews, as co-constructed accounts, explored talk about sexual media, offending, treatment, and risk. Data were analyzed using a version of discourse analysis popular in healthcare research, identifying discursive repertoires, or collective language use, characteristic of the institutional culture. Findings revealed that masculine discourse marginalized female nurses and contradicted therapeutic goals, where men’s talk about pornography, sex, and sexual crime represented discriminatory and gendered language. Nursing definitions of pornography were constructed in the context of the client group and an organizational need to manage risk. In a highly controlled environment, with a long-stay population, priority in respondent talk was given to mainstream commercial sexual media and everyday items/ images perceived to have embedded sexual meaning. However, little mention was made of contemporary modes of producing/distributing pornography, where sex and sexual violence are enacted in virtual realities of cyberspace. Failure to engage with information technology, and globally mediated sex, is discussed as a growing concern for forensic health workers. KEYWORDS: Cyberspace; discourse; forensic nursing; games; pornography; sexual violence
he research question developed from outraged professional and political debate that greeted publication of the Fallon Inquiry in the United Kingdom, documenting serious irregularities in the personality disorder unit of a high-security hospital (Fallon, Bluglass, Edwards, & Daniels, 1999). These centered on underground trading in sexual media and unregulated patient access to video-cassette recorders and information technologies (IT), which permitted downloading/copying of illicit sexual media. In contrast to a large body of experimental
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Author Affiliation: University of Liverpool, United Kingdom. The authors declare no conflict of interest. Correspondence: Dave Mercer, PhD, MA, BA (Hons), RMN, PGCE, University of Liverpool, The Whelan Building, The Quadrangle, Brownlow Hill, Liverpool L69 3GB, England. E-mail: [email protected]. Received August 29, 2013; accepted for publication November 27, 2013. Copyright © 2014 International Association of Forensic Nurses DOI: 10.1097/JFN.0000000000000017
Journal of Forensic Nursing
studies, striving to establish a cause–effect link between pornography and male sexual violence (e.g., Malamuth, Feshbach, & Jaffe, 1977; Malamuth & Huppin, 2005), less attention has been paid to how perpetrators talk about pornography and sexual offending. Forensic mental health nurses have a professional role in the care/treatment of sexually abusive men, part of which might involve managing sexual media in clinical environments. Institutional vigilance, restriction, and searching might fulfill the function of security but take little account of individualized care planning (Mercer, 2012). With regard to sexual crime, an important issue relates to the use and circulation of legally available materials with sexually explicit content or mundane products featuring sexualized images of women and children (Kelly, 1992). Hynes and colleagues (2007) note the recent involvement of mental health professionals in assessing and treating individuals entering services as a result of Internet use for sexual purposes. Recognizing the expanding medicalization and criminalization of emerging modes of sexual activity, it www.journalforensicnursing.com
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Original Article is suggested that a spectrum of practitioners, including nurses, need better preparation to undertake highly specific roles. Legal frameworks in the area are complex because online sexual activity is a relatively novel phenomenon embracing disparate activities that “parallel offline, or ‘real world,’ sexual behavior” (Hynes et al., 2007, p. 20). The research project outlined here is an attempt to develop the knowledge base of a relatively new branch of nursing science by focusing on the discourses/ talk of staff and offender patients in relation to pornography and sexual crime.
Cybertechnology and Sexual Violence Debates about the societal role of pornography have a long history (Hunt, 1993; Kendrick, 1987), embracing written and pictorial representations of human sexuality, where language is culturally and politically located. With ever-expanding and sophisticated technologies, commentators describe the contemporary world as postmodern pastiche of imagery with multiple messages (McNair, 1996), with “sexual stories” as a specific set of discourses typifying western industrial society, from television chat shows to psychotherapy (Evans, 1993; Plummer, 1995; Simon, 1996). The pornography industry has long invested in masscommunication systems and global media to manufacture and distribute products (Cole, 1989). Illicit use of Internet technology as “deviant technicways” (Durkin & Bryant, 1995) provides unregulated marketplaces for a “culture of sex talk,” blurring boundaries between private and public spheres (Wallace & Mangan, 1996). An alternative approach to the vexed issue of pornography, and effects of viewing it, is contained in a critique of new cultural forms, fragmentation, and breakdown of established categories of meaning, where personal narratives are transformed into public property (Moorti, 1998). Pornography is cited as a prime example of a genre constructed specifically by the erotic, discussed not as reified commodity but as discourses that invite interpretation. Relationships between “pornography” and “user” become more complex than traditional “cause–effect” models influential in social science research, and attention is directed toward the meaning of media images of sex and context in which they are used (Benwell, 2005; Wilkin, 2004). Massive growth, and commercial success, of “cyberporn” is a recent development in the pornography industry, with uptake rivaling travel/business sites (Stack, Wasserman, & Kern, 2004), and addictive use of Internet pornography is diagnosed as a variant of pathological sexuality (Stein, Black, Shapira, & Spitzer, 2001). Particular concern is expressed about visual depictions of real or simulated rape. Gossett and Byrne (2002), investigating “rape depictions” on Internet sites, comment on ease of access, range of choices, and interactive options, enabling viewers to “see through the eyes of the rapist” and manipulate 28
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content. Pornography sites, conventionally referred to as “infotainment,” are described by feminist theorists and activists as hate speech, harassment, and sexual aggression against women. Tate (1990) offered an early challenge to the stereotypical “child molester,” as alienated outcast, drawing attention to worldwide trade in sexualized images of children. These concerns remain central to debates about sexual trafficking (Chase & Statham, 2005) with two developments contributing to global abuse of children: affordable holiday destinations where boys/girls are sexually available and digital technology permitting production/cross-border distribution (Alexander, Meuwese, & Wolthuis, 2000). Internet child pornography has many forms: pictures, “anime” (cartoons), video, sound files, and stories (Burke, Sowerbutts, Blundell, & Sherry, 2002). Quayle and Taylor (2005) note that, before the IT revolution, pedophiles were relatively isolated but now form “virtual communities” with minimal external controls, a phenomenon referred to as “cyber-pedocriminality” (Webb, Craissati, & Keen, 2007). The complexity of defining “child pornography” creates problems, and a singular focus on illegal materials ignores how “seemingly innocent” pictures function for offenders (Zurbriggen, Pearce, & Freyd, 2003). Early feminist literature identified rape as a “terrorist weapon” in national conflicts (Brownmiller, 1975; Vogelman, 1990), but contemporary cultural critics refer to “pornography of war” (Baudrillard, 2005). Associating pornography with “pathological sexuality,” in nonsexual contexts, includes erotic objectification of human suffering such as genocide (Dean, 2003). Morrison (2004) and Bovens (1998) note resemblances between photojournalism and pornography, focusing on “bad consequences,” diminished empathy, and misuse/misappropriation of images. Technology has made systematic rape, as ethnic cleansing (Hynes, 2004; Price, 2001; Seifert, 1996), available via the Internet, with female victims reporting the filming of sexual atrocities (MacKinnon, 1994).
Video Games and Sexual Violence Video games are becoming increasingly graphic, incorporating violent and disturbing imagery (Kierkegaard, 2011). In 2007, the industry generated over $26.5 billion dollars in worldwide sales (Dines, 2010). Despite this trend, sexual violence within video games is not a new development. The 1980’s game “Custer’s Revenge” is described as pornographic (Donovan, 2010; Dworkin, 1981) for translating rape of Native American women into competitive entertainment. In the same decade, “Night Life” included explicit sexual images that contributed to the development of Japanese “bishojo” games. These typically focus on schoolage girls, influenced by sexually graphic manga comics. Extreme examples, known as “eroge,” depict sexual fantasies including violent rape and pedophilia. “Lolita Syndrome” Volume 10 • Number 1 • January-March 2014
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Original Article involves removing clothing from prepubescent girls by knife throwing, “177” allows rape of teenage girls, and “RapeLay” is essentially a rape simulator (Donovan, 2010). Although banned internationally, the latter is easily obtainable from the Internet and has gained popularity (Beck, Boys, Rose, & Beck, 2012). Numerous video games allegedly containing explicit sexual materials are available in Japan, but domestic child pornography laws do not apply (Kierkegaard, 2011). Many easily accessible video games contain sexual violence toward women. An example is the recently rebooted “Tomb Raider” franchise, which has reimagined the main character as a sexual assault survivor. Attempted rape, and murder, makes Lara Croft vulnerable and needing protection by (male) players (Penny, 2012). Video games in the successful series “Grand Theft Auto” (GTA) include violence, rape, and criminality (Kierkegaard, 2011). Dines (2010,) notes that, when “GTA IV hit the market in April 2008, on its first day of release, it sold a record 2.5 million units in North America ( p. 62).” An infamous “Hot Coffee” game segment, when unlocked, allows sex between two characters, where players control movements/sexual positioning. In “GTA Vice City,” male characters get money refunded for “killing” prostitutes (Dill, Brown, & Collins, 2008). Biever (2006) suggests that virtual rape may not constitute a problem in the erotic games “Red Light Center” and “Sociolotron,” with users consenting to being “raped” before signing up. Whitty, Young, and Goodings (2011) examine taboo elements of “massive multiplayer online roleplaying games,” where multiple players interact online simultaneously. Many games contain components that would constitute criminal behaviors if committed offline, including torture, violence, and cannibalism. Rape is possible in “Phantasmagoria,” incest is implied in “House of the Dead–Overkill,” and “Battle Raper” allows sexual assault/rape of defeated female opponents. Young and Whitty (2010) discuss “Pangea,” a Korean production, with female characters losing clothes when hurt and being fully naked when killed. Beck and colleagues (2012) suggest that recent developments in video game technology have led to more realistic representations of virtual worlds and increased interactivity with the game and other players. Xbox Kinect allows games to be played without a controller, as body movement influences play. It is not unreasonable to imagine future games allowing players to physically act out violent, and sexually violent, behaviors.
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Study Aim
The aim was to explore different ways pornography was spoken about in the institutional environment where nursing staff and patients shared space and time. It offered a Journal of Forensic Nursing
challenge to a dominant social science research tradition, which uncritically accepts particular versions of “truth,” and objects/subjects of scientific knowledge are assumed to have a prediscursive existence (Hardin, 2001; Rolfe, 2000).
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Design and Method Discourse Analysis Discourse analysis (DA) is a heterogeneous range of social science research (Silverman, 2001) prioritizing language to explore social voices as interwoven discourses, emphasizing multiple truths and competing realities (Cameron, 2001). A constructivist version of DA (Potter & Wetherell, 1987) prominent in critical research (e.g., Crowe, 2005; McCloskey, 2008) was adopted. It focuses on variability in accounts and performative aspects of language as social practice, providing a link between culture and self. Like critical DA, it permits interrogation of ideological assumptions and power inequities (e.g., Fairclough, 2001, 1995), a strategy suited to researching disciplinary apparatus of high-secure psychiatry (Mercer, 2013b; Pilgrim, 2007).
Recruitment and Data Collection Access to the research site and potential participants proved challenging, but the project gained approval from a local research ethics committee and hospital/directorate governance committees (Mercer, 2009). Interviews were undertaken with 18 nurses (13 men and five women) and nine personality disordered sexual of fenders,recruited from the personality disorder unit of one high-secure hospital. Initially, consent from responsible medical officers was required to approach potential patient participants, followed by opportunistic sampling according to approved inclusion/ exclusion criteria (see Table 1). These were constructed to ensure boundaries between research and therapy were delineated. Interactive episodes provided a reciprocal exchange of ideas, and respondents became active participants (Kvale, 1996). In-depth, semistructured interviews took place on hospital wards at a time convenient for respondents. Ethnographic observations and field notes complemented data collection and informed avenues of inquiry.
Data Analysis In DA, accounts rather than speakers represent units of analysis, focused on language use, not on language users (Wood & Kroger, 2000). Interviews were audio-taped and transcribed to capture nuances of meaning (Coates & Thornborrow, 1999; Edwards, 2004), a process that represented first-stage analysis. Attention was given to function, construction, and variability (Potter & Wetherell, 1987). Selective coding initiated immersion in data as a meditative, rather than mechanical, exercise. A “discourse analytic frame of mind” (Wood & Kroger, 2000) enabled www.journalforensicnursing.com
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Original Article
TABLE 1. Inclusion and Exclusion Criteria Inclusion criteria Patient population
Staff population
Male patients
Registered mental health nurses
Patients with a diagnosis of personality disorder and a recorded sexual offense
Staff with clinical and/or therapeutic experience of working with a sexual offender client group
recognized, or rebuffed, the idea of socially negative effects resulting from violent mediated entertainment. Gendered knowledge and experience, again, informed discussions; men focused on risk within the unit, and women located their ideas in a sociological context. One female nurse talked about sexualization of cyberspace and technology in pursuit of profit. Damage and social harm extended to those involved in the manufacture of exploitative sexual media:
Exclusion criteria Patient population
Staff population
Female patients
Staff without clinical, or therapeutic, experience of working with a sexual offender client group
Patients with an index offense of sexual offending and a diagnosis of mental illness or learning disability
Nursing staff with direct clinical, or therapeutic, responsibility for individual patients consenting to take part in the research study
identification of interpretive repertoires, ideological dilemmas, and subject positioning (Wetherell, 1998), and themes and concepts that organized the presentation of findings in report form.
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Findings Gendered Discourses and Gendered Experiences The study identified a series of discursive repertoires that positioned speakers within the institutional culture and informed the practice of nursing. These are summarized below: 1. Talk constructed the hospital ward as a physical, symbolic, and masculine territory. 2. Gendered construction of secure care defined male nurses in terms of physicality and female nurses in terms of sexuality. 3. Language use embodied gendered knowledge and experience mediated by institutionalized sexism. 4. Talk about pornography and sexual offending framed ideological distancing and discourses of dangerousness.
Discussion below focuses on a small subset of data pertaining to respondent talk about technology and mediated representation of sex and violence.
Sexual Violence and Violence as Sexual Few respondents made reference to digital pornography in general or video gaming specifically. A distinct discourse 30
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Women who want to say this [the sex industry] is the work I choose to do and I want to get paid for it.... I think they’ve just bought into that system really...a bit like you can buy into systems it doesn’t matter what your gender is [pause] I think it’s damaging for people who produce it…never mind the people who consume it [pause] I think it is so prevalent…and of course we wouldn’t have an Internet were it not for pornography.... it’s amazing and always has been at creating its own means of distribution” (female nurse 13). Technologies of cyber communication made the pornographic marketplace less clearly defined, with the Internet described as a major provider of mediated sexual representations. Global access meant purchasing pornography, previously transacted in public domains, shifted to the private sphere of home. Encountering cyber-sexual entertainment did not require web searching. Rather, it constantly threatened to intrude into the online lives of computer users, requiring installation of defenses, presenting a confusing interplay of sex/gender. Limited experience, recounted with reticence, connoted pornography as something pervasive and invasive, ultimately cloaked in the mystery of how men “have sex with themselves”: I’m on the Internet…isn’t everyone? And they flash up don’t they…these things…. I’ve got a little firewall now…before that it was like oh my god and y’know the little pictures at the top.... Nikki says hi there…watch me with me lesbian thing…. it’s women as well as men [pause] but men mainly use it to [pause] I don’t know...to have sex with themselves I suppose” (female nurse 12). “Dangerousness” as a dominant strand in male staff accounts framed wider talk about how sexual media should be managed at ward level. “Risk” was an abstract, ill-defined concept, and overt sexual content was only part of risk calculation. One patient’s fascination with recordings of war crimes reconstructed archival Volume 10 • Number 1 • January-March 2014
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Original Article film footage as eroticization of torture and death. Images were not specifically about sexual abuse, but suffering inflicted on women victims was (re)interpreted as a vehicle for sexual excitement: When you look at things that are clinically inappropriate for somebody to have [pause] we found him with.... it was actually Nazi videos which y’know…war [pause] to most people it’s nothing...no great shakes...but to him it really was because he got a kick from watching the torture scenes in them…and the women that were abused in them...physically abused...but to him that was sexual” (male nurse 3). Given that commercial pornographic materials had been largely removed from the wards and were seen as a clinical concern about only sex offenders, nurses became involved in searching for and censoring any items that could be associated with risk. Attention was devoted to a plethora of mundane images/texts seen as “dangerous” if accessed by pedophiles. Such included children’s clothing catalogues/television programs, National Geographic magazines, newspaper items, photographs, and postcards. This seemed to consume considerable time and effort for no tangible benefits. One finding related to video entertainment, films and games, was apparent lack of understanding by care teams relating to potential risk issues and artificial codification of physical violence and sexual violence as distinctly different behaviors. Demonstrating a clinical rationale for withdrawing violent video games was only one stage in the decision-making process of the clinical team. The data extract below illustrates these tensions, where there was confusion over Pan European Game Information ratings, whether games were designed for young or adult audiences, and the actual aim/goal of the game(s): There are broad policies that say that they can’t have Playstation games in their own room [pause] oh they can have Playstation 1 but not Playstation 2 because there’s a portal...you can get onto the Internet...but there’s no restriction on games...you could take it to the care team… but not that many people know what’s going on in a Playstation game…not in detail...and we do stop violent video games for example...would they take it [video-game] off him? Perhaps [pause] there would be a humorous conversation that surrounded all of that [pause] laughing and joking…and then perhaps get them more sober… and they may or they may not take it off him… and one of the issues they would cite is it’s an eighteen [pause] I don’t think it’s about being eighteen Journal of Forensic Nursing
[break] Grand Theft Auto...what it’s about is robbing cars...it’s an 18 is a recommendation…if they’re over 18 to play these things [pause] you go round driving a car and you can knock people over…and I know people who can’t wait to play that…to go and hit the women [break] but it tells you that they’re not engaging with Grand Theft Auto in the way it was meant to be played.... I don’t think [pause] if it is the way it’s meant to be played then of course you’ve got thirteen…fourteen…fifteen year olds right… throughout the country playing this game which is a top selling game.... It then becomes socially acceptable for you to hit women…on a computer” (male nurse 1). The policy on sexually explicit materials was interpreted to include a range of commercially available media not ordinarily considered pornographic but deemed inappropriate in the context of sex offender treatment. The dilemma of imposing controls was discussed by a patient who ordered a number of digital versatile discs (DVD) movies, which were withheld because of violent/ sexually violent content. The films had previously been broadcasted on terrestrial television and watched by non-sexoffenders on the ward, reinforcing institutional discourses that used sexual offending to symbolize dangerousness. If staff had little difficulty in recognizing violent sexual crime, it was proposed that they had less awareness of how physical violence could be sexualized: They said in one of them there’s an explicit rape scene [Once Upon a Time in America] and the other two the amount of violence in Natural Born Killers and Reservoir Dogs is…give reason for concern... but what I’ve seen on here...right psychopathic films…sadistic films [pause] maybe not sexual…but sadistic [pause] and these are lads who are…they’re in for murders or killings [pause] I’m not… although I did commit horrific violent sexual acts…. I didn’t go over to the fact that I sadistically tortured…or used any sort…. I didn’t even hit them…and I didn’t get off on that [break] they [nurses] tend to think it’s alright to… for [laughs] I don’t know why killers and people who’ve taken life…they can have these sadistic violent films…but there’s always words of concern and caution over giving them to sexual offenders” (patient 9). Another patient questioned staff abilities to accurately predict risk, making an association between violent video games and potential reoffending. The account paralleled nurse observations about the influence of computer-generated www.journalforensicnursing.com
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Original Article imagery, with Lara Croft assuming iconic status as amalgam of sex and violence. Describing risk as subjective interpretation, he remarked on excessive levels of enjoyment fellow inmates derived from violent games, at the same time distancing himself from other sexual offenders on the unit: The other one [patient] down here…killed [pause] a member of his family…sexually [pause] will tell me that he’s no longer violent…but he plays the most violent games he can pick on the computer which are all shoot ’em up games [pause] I mean I have a PS1…I have a couple of shoot ’em ups…. I have a couple of drivers…a couple of Lara Croft [pause] the usual cross section…and I hardly ever play ’em anyway [pause] this guy lives on the computer…sniping…killing…stabbing…hacking… whatever…loves it and gets a real…you know he’s getting a buzz” (patient 3). Given the shared masculine language, male nurses similarly deployed linguistic repair devices (Auburn, 2005) to set themselves apart from men defined as other (Lacombe, 2008; Peternelj-Taylor, 2005, 2004); talk about pornography, simultaneously, constructed ideas about normality, deviance, and dangerousness.
I’ve played violent video games.... I’ve watched pornography...watched violent films on the telly [pause] I haven’t killed anyone and I haven’t sexually assaulted anyone...in fact I’m here treating people who do” (male nurse 6).
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Discussion
The last 4 decades have witnessed a burgeoning volume of social science inquiry attempting to establish a correlation between certain forms of pornography and abusive attitudes, or aggressive behaviors, in male consumers (e.g., Donnerstein, Linz, & Penrod, 1987; Malamuth & Huppin, 2005). Typically, these adopt experimental designs with student volunteers being tested after exposure to violent/subordinating sexual imagery. Outcomes remain equivocal and contested, with debate marked by sociological and ideological positioning. Much work is remote from clinical or custodial environments where men, convicted of sexual crimes, are contained and/or treated. Findings discussed in this article, in contrast, have drawn on qualitative investigation (Mercer, 2013a) into the practice domain of forensic mental health nursing, where 32
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meaning took precedence over measurement. Acknowledging pioneering work undertaken in the U.S. correctional system (Scully, 1990; Scully & Marolla, 1984), it embraced contemporary interest in language as a way of understanding sexual crime, sex offender treatment, and construction of masculinities (Auburn, 2005; Cowburn & Pringle, 2000). In this article, we have reviewed a body of literature specifically related to growing concerns about increasingly violent, sexually graphic content of Internet pornography and video games. In the context of longstanding debates about pornography as a contributory factor in male sexual violence, attention has shifted to a new population, or generation, of consumers. In this sense, we need to consider the implications of new technologies for forensic mental health practice in the future. However, data derived from the study suggest that these issues are not part of the construct or vocabulary of forensic nursing. Accounting for this can only be speculative: it might be an artifact of the research site, that respondents were within a mature age range, or possibly, because the patient group had no Internet access, it was not considered problematic. This highlights current worries of global social saturation of imagery and ideas that normalize pornography in the everyday world. Our argument is sympathetic with the work of Dines (2010) about how the “porn” industry has “hijacked” contemporary culture. In this context, pornography is likely to replace conventional ways of learning about sex and relationships, where young men and women (as oppressor and oppressed) are likely to be casualties of distorted and damaging versions of masculinity/sexual identity. Revolutionary advances in communication and IT and worldwide popularity of social-networking sites mean that young people and children live in an image rather than a print culture (Dines, 2010). Despite positive aspects and political benefits, there are antisocial consequences to unlimited ease of access to images purveying dehumanizing abuse of women, sex, and violence, more than ever before, defining popular culture. As noted, criminality can be enacted in cyberspace with little risk of detection. It is proposed (Gunter, 2013) that forensic practitioners consider examination of Internet/social media data in psychiatric assessment and treatment. Despite massive challenges, in terms of nursing practice, there are considerations that could help frame proactive and prosocial approaches (see Table 2). Nursing has long been a target of mediated representations that construct the “sexy nurse” as staple feature of pornographic fantasy and fetish (Orr, 1988). We suggest that individual nurses and professional bodies embrace struggles against exploitative and discriminatory media promoting gender hatred. Paraphrasing the campaigning slogan of 1970’s/1980’s antipornography activists, the “Personal is the political,” so too is the “Professional the Volume 10 • Number 1 • January-March 2014
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Original Article
TABLE 2. Confronting Pornography As a Personal and Public Health Problem • Active, meaningful participation of forensic nurses in offender treatment programs where pornography is critically addressed. • Recognition that management/restriction of sexual media in patient/prisoner populations is broader than treatment programs/facilities for sex offenders. • Clear policy guidelines to inform decision making in relation to sexual media in secure settings based on a philosophy of harm reduction. • Promotion of a clinical culture premised on antioppressive and antidiscriminatory practice/praxis. • Managerial and clinical leadership that takes seriously and tackles gendered inequalities within health and criminal justice organizations. • Incorporating assessment of pornography use in the context of individualized care planning for offender patients. • In-service training and development for clinicians. • Involvement in/initiation of educational outreach programs targeted at young people, parents, teachers, and youth workers. • Formulation and conduct of nursing research projects focused on pornography as a health concern in forensic practice. • Engagement with activist/academic groups working to oppose powerful interests in the pornography industry.
political.” One of our objectives in writing this article was to situate the concept of pornography in the vocabulary of forensic nurses. Hitherto, this has been largely ignored in the professional press, and those contributions, which do exist (e.g., Drake, 1994; Duff, 1995), are dated in the context of an industry noted for its entrepreneurial media adaptability. Of the literature discussed about gaming and sexual violence, none appeared in a health-related journal. Arguably, it is forensic nurses (community, mental health correctional, or sexual assault nurse examiners ) who will be in the front line of managing abusive attitudes or behaviors associated with a “porn culture.” The contribution of Gail Dines has been central to our argument, and it is fitting to close with some cautionary words: “One thing is certain: we are in the midst of a massive social experiment, only the laboratory here is our world and the effects will be played out on people who never agreed to participate” (Dines, 2010, p. ix).
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References
Alexander, S., Meuwese, S., Wolthuis, A. (2000). Policies and developments relating to the sexual exploitation of children: The legacy of the Stockholm Conference. European Journal on Criminal Policy and Research, 8, 479–501.
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Auburn, T. (2005). Narrative reflexivity as a repair device for discounting “cognitive distortions” in sex offender treatment. Discourse and Society, 16(5), 697–718. Baudrillard, J. (2005). Pornography of war. Cultural Politics, 1(1), 23–26. Beck, V. S., Boys, S., Rose, C., Beck, E. (2012). Violence against women in video games: A prequel or sequel to rape myth acceptance? Journal of Interpersonal Violence, 27(15), 3016–3031. Benwell, B. (2005). “Lucky this is anonymous”: Ethnographies of reception in men’s magazines: A “textual” approach. Discourse and Society, 16(2), 147–172. Biever, C. (2006). Fantasy or violation? New Scientist, 190(2556), 68–68. Bovens, L. (1998). Moral luck, photojournalism, and pornography. The Journal of Value Inquiry, 32, 205–217. Brownmiller, S. (1975). Against our will: Men, women and rape. New York, NY: Simon & Schuster. Burke, A., Sowerbutts, S., Blundell, B., Sherry, M. (2002). Child pornography and the Internet: Policing and treatment issues. Psychiatry, Psychology and Law, (1), 79–84. Cameron, D. (2001). Working with spoken discourse. London, UK: Sage. Chase, E., Statham, J. (2005). Commercial and sexual exploitation of children and young people in the UK: A review. Child Abuse Review, 14, 4–25. Coates, J., Thornborrow, J. (1999). Myths, lies and audiotapes: Some thoughts on data transcripts. Discourse and Society, 10(4), 594–597. Cole, S. G. (1989). Pornography and the sex crisis. Toronto, ON: Amanita. Cowburn, M., Pringle K. (2000). Pornography and men’s practices. The Journal of Sexual Aggression, 6(1/2), 52–66. Crowe, M. (2005). Discourse analysis: Towards an understanding of its place in nursing. Journal of Advanced Nursing, 51(1), 55–63. Dean, C. J. (2003). Empathy, pornography and suffering. Differences: A Journal of Feminist Cultural Studies, 14(1), 88–124. Dill, K. E., Brown, B. P., Collins, M. A. (2008). Effects of exposure to sex-stereotyped video game characters on tolerance of sexual harassment. Journal of Experimental Social Psychology, 44(5), 1402–1408. Dines, G. (2010). Pornland: How porn has hijacked our sexuality. Boston, MA: Beacon Press. Donnerstein, E., Linz D., Penrod S. (1987). The question of pornography. New York, NY: Free Press. Donovan, T. (2010). Replay: The history of video games. Lewes, UK: Yellow Ant. Drake, R. E. (1994). Potential health hazards of pornography consumption as viewed by psychiatric nurses. Archives of Psychiatric Nursing, 8(2), 101–106. Duff, A. (1995). Pornography and censorship: The problems of policy formation in a psychiatric setting. Psychiatric Care, 2(4), 137–140. Durkin, K., Bryant, C. (1995). “Log onto sex”: Some notes on the carnal computer and erotic cyberspace as an emerging research frontier. Deviant Behaviour: An Interdisciplinary Journal, 16(3), 179–200. Dworkin, A. (1981). Pornography: Men possessing women. London, UK: Women’s Press. Edwards, J. A. (2004). The transcription of discourse. In D. D. H. E. (Eds.), The handbook of discourse analysis. Oxford, UK: Blackwell.
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Original Article Evans, D. (1993). Sexual citizenship: The material construction of sexualities. London, UK: Routledge. Fairclough, N. (1995). Critical discourse analysis: The critical study of language. London, UK: Longman. Fairclough, N. (2001). Critical discourse analysis as a method in social scientific research. In R. M. (Eds.), Methods of critical discourse analysis. London, UK: Sage. Fallon, P., Bluglass, R., Edwards, B., Daniels, G. (1999). Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital (Cm 4194). London, UK: HMSO. Gossett, J. L. Byrne, S. (2002). “Click here”: A content analysis of Internet sites. Gender and Society, 16(5), 689–709. Gunter, T. D. (2013). Social media in the practice of forensic psychiatry evaluation and management. Abstracts of the XXXIIIrd International Congress on Law and Mental Health, Amsterdam, pp. 219–220. Hardin, P. K. (2001). Theory and language: Locating agency between free will and discursive marionettes. Nursing Inquiry, 8, 11–18. Hunt, L. (1993). The invention of pornography: Obscenity and the origins of modernity, 1500–1800. New York, NY: Zone Books. Hynes, F., Taylor, N., Lenihen, F. (2007). The role of the mental health professional in cases of online sexual activity. The British Journal of Forensic Practice, 9(3), 19–23. Hynes, H. P. (2004). On the battlefield of women’s bodies: An overview of the harm of war to women. Women’s Studies International Forum, 27, 431–445. Kelly, L. (1992). Pornography and child sexual abuse. In: C. Itzin (Ed.), Pornography: Women, violence and civil liberties. Oxford: Oxford University Press. Kendrick, W. (1987). The secret museum: Pornography in modern culture. New York, NY: Viking. Kierkegaard, S. (2011). POSTAL 2 plays in US court—Schwarzenegger v. Entertainment Merchants Association. Computer Law & Security Review, 27(3), 278–290. Kvale, S. (1996). Inter-views: An introduction to qualitative research interviewing. London, UK: Sage. Lacombe, D. (2008). Consumed with sex: The treatment of sex offenders in risk society. British Journal of Criminology, 48, 55–74. MacKinnon, C. A. (1994). Only words. London, UK: Harper-Collins. Malamuth, N., Huppin, M. (2005). Pornography and teenagers: The importance of individual differences. Adolescent Medicine, 16, 315–326. Malamuth, N. M., Feshbach, S., Jaffe, Y. (1977). Sexual arousal and aggression: Recent experiments and theoretical issues. Journal of Social Issues, 33(2), 110–133. McCloskey, R. (2008). A guide to discourse analysis. Nurse Researcher, 16(1), 24–44. McNair, B. (1996). Mediated sex: Pornography and postmodern culture. London, UK: Arnold. Mercer, D. (2009). Research in state institutions: A critical issue for nursing practice. Journal of Forensic Nursing, 5, 107–108. Mercer, D. (2012). Policing pornography in high-secure care: The discursive construction of gendered inequality. In D. T. A. (Eds.), (Re)Thinking violence in health care settings: A critical approach. Surrey, UK: Ashgate. Mercer, D. (2013a). Girly mags and girly jobs: Pornography and gendered inequality in forensic practice. International Journal of Mental Health Nursing, 22, 15–23.
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Mercer, D. (2013b). Sex offender therapy: Collusion, confession and game-playing. In D. J. D. A. (Eds.), Power and the psychiatric apparatus: Repression, Transformation and Assistance. Surrey, UK: Ashgate. Moorti, S. (1998). Cathartic confessions or emancipatory texts? Rape narratives on the Oprah Winfrey Show. Social Text, 16(4), 83–102. Morrison, W. (2004). “Reflections with memories”: Everyday photography capturing genocide. Theoretical Criminology, 8(3), 341–358. Orr, J. (1988). The porn brokers. Nursing Times, 84, 22. Penny, L. (2012). The trouble with Lara Croft. New Statesman, 141(5111), 14–14. Peternelj-Taylor, C. (2004). An exploration of othering in forensic psychiatric and correctional nursing. Canadian Journal of Nursing Research, 36(4), 130–146. Peternelj-Taylor, C. (2005). Engaging the “other.” Journal of Forensic Nursing, 1(4), 179–191. Pilgrim, D. (2007). Ashworth in context. In D. (Ed.), Inside Ashworth: Professional reflections of institutional life. Oxford, UK: Radcliffe. Plummer, K. (1995). Telling sexual stories: Power, change and social worlds. London, UK: Routledge. Potter, J., Wetherell, M. (1987). Discourse and social psychology: Beyond attitudes and behaviour. London, UK: Sage. Price, L. S. (2001). Finding the man in the soldier-rapist: Some reflections on comprehension and accountability. Women’s Studies International Forum, 24(2), 211–227. Quayle, E., Taylor, M. (2005). Paedophiles, pornography and the Internet: Assessment issues. British Journal of Social Work, 32, 863–875. Rolfe, G. (2000). Research, truth and authority: Postmodern perspectives on nursing. London, UK: Macmillan. Scully, D. (1990). Understanding sexual violence: A study of convicted rapists. London, UK: Routledge. Scully, D., Marolla, J. (1984). Convicted rapists’ vocabulary of motive: Excuses and justifications. Social Problems, 31, 530–544. Seifert, R. (1996). The second front: The logic of sexual violence in wars. Women’s Studies International Forum, 19(1/2), 35–43. Silverman, D. (2001). Interpreting qualitative data: Methods for analysing talk, text and interaction (2nd ed.). London, UK: Sage. Simon, W. (1996). Postmodern sexualities. London, UK: Routledge. Stack, S., Wasserman, I., Kern, R. (2004). Adult social bonds and use of Internet pornography. Social Science Quarterly, 85(1), 75–88. Stein, D. J., Black, D. W., Shapira, N. A., Spitzer, R. L. (2001). Hypersexual disorder and preoccupation with Internet pornography. American Journal of Psychiatry, 158(10), 1590–1594. Tate, T. (1990). Child pornography: An investigation. London, UK: Methuen. Vogelman, L. (1990). The sexual face of violence: Rapists on rape. Johannesburg, South Africa: Ravan Press. Wallace, J., Mangan, M. (1996). Sex, laws, and cyberspace: Freedom and censorship on the frontiers of the online revolution. New York, NY: Henry Holt. Webb, L., Craissati, J., Keen, S. (2007). Characteristics of internet child pornography offenders: A comparison with child molesters. Sexual Abuse, 19, 449–465.
Volume 10 • Number 1 • January-March 2014
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Original Article Wetherell, M. (1998). Positioning and interpretive repertoires: Conversation analysis and post-structuralism in dialogue. Discourse and Society, 9, 335–356. Whitty, M. T., Young, G., Goodings, L. (2011). What I won’t do in pixels: Examining the limits of taboo violation in MMORPGs. Computers in Human Behaviour, 27(1), 268–275. Wilkin, P. (2004). Pornography and rhetorical strategies—The politics of public policy. Media, Culture and Society, 26(3), 337–357.
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Wood, L. A., Kroger, R. O. (2000). Doing discourse analysis: Methods for studying action in talk and text. London, UK: Sage. Young, G., Whitty, M. T. (2010). Games without frontiers: On the moral and psychological implications of violating taboos within multi-player virtual spaces. Computers in Human Behaviour, 26(6), 1228–1236. Zurbriggen, E. L., Pearce, G. E., Freyd, J. J. (2003). Evaluating the impact of betrayal for children exposed in photographs. Children and Society, 17, 305–320.
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Video Gaming and Sexual Violence: Rethinking Forensic Nursing in a Digital Age Dave Mercer, PhD, MA, BA (Hons), RMN, PGCE, and Denis Parkinson, MSc, RN
ABSTRACT This article reports findings from a qualitative study into how forensic nurses, and male personality disordered sexual offenders, talked about “pornography” in one U.K. high-security hospital. Research rationale was rooted in current professional and political debates, adopting a discourse analytic design to situate the project in a clinical context. Semistructured interviews, as co-constructed accounts, explored talk about sexual media, offending, treatment, and risk. Data were analyzed using a version of discourse analysis popular in healthcare research, identifying discursive repertoires, or collective language use, characteristic of the institutional culture. Findings revealed that masculine discourse marginalized female nurses and contradicted therapeutic goals, where men’s talk about pornography, sex, and sexual crime represented discriminatory and gendered language. Nursing definitions of pornography were constructed in the context of the client group and an organizational need to manage risk. In a highly controlled environment, with a long-stay population, priority in respondent talk was given to mainstream commercial sexual media and everyday items/ images perceived to have embedded sexual meaning. However, little mention was made of contemporary modes of producing/distributing pornography, where sex and sexual violence are enacted in virtual realities of cyberspace. Failure to engage with information technology, and globally mediated sex, is discussed as a growing concern for forensic health workers. KEYWORDS: Cyberspace; discourse; forensic nursing; games; pornography; sexual violence
he research question developed from outraged professional and political debate that greeted publication of the Fallon Inquiry in the United Kingdom, documenting serious irregularities in the personality disorder unit of a high-security hospital (Fallon, Bluglass, Edwards, & Daniels, 1999). These centered on underground trading in sexual media and unregulated patient access to video-cassette recorders and information technologies (IT), which permitted downloading/copying of illicit sexual media. In contrast to a large body of experimental
T
Author Affiliation: University of Liverpool, United Kingdom. The authors declare no conflict of interest. Correspondence: Dave Mercer, PhD, MA, BA (Hons), RMN, PGCE, University of Liverpool, The Whelan Building, The Quadrangle, Brownlow Hill, Liverpool L69 3GB, England. E-mail: [email protected]. Received August 29, 2013; accepted for publication November 27, 2013. Copyright © 2014 International Association of Forensic Nurses DOI: 10.1097/JFN.0000000000000017
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studies, striving to establish a cause–effect link between pornography and male sexual violence (e.g., Malamuth, Feshbach, & Jaffe, 1977; Malamuth & Huppin, 2005), less attention has been paid to how perpetrators talk about pornography and sexual offending. Forensic mental health nurses have a professional role in the care/treatment of sexually abusive men, part of which might involve managing sexual media in clinical environments. Institutional vigilance, restriction, and searching might fulfill the function of security but take little account of individualized care planning (Mercer, 2012). With regard to sexual crime, an important issue relates to the use and circulation of legally available materials with sexually explicit content or mundane products featuring sexualized images of women and children (Kelly, 1992). Hynes and colleagues (2007) note the recent involvement of mental health professionals in assessing and treating individuals entering services as a result of Internet use for sexual purposes. Recognizing the expanding medicalization and criminalization of emerging modes of sexual activity, it www.journalforensicnursing.com
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Original Article is suggested that a spectrum of practitioners, including nurses, need better preparation to undertake highly specific roles. Legal frameworks in the area are complex because online sexual activity is a relatively novel phenomenon embracing disparate activities that “parallel offline, or ‘real world,’ sexual behavior” (Hynes et al., 2007, p. 20). The research project outlined here is an attempt to develop the knowledge base of a relatively new branch of nursing science by focusing on the discourses/ talk of staff and offender patients in relation to pornography and sexual crime.
Cybertechnology and Sexual Violence Debates about the societal role of pornography have a long history (Hunt, 1993; Kendrick, 1987), embracing written and pictorial representations of human sexuality, where language is culturally and politically located. With ever-expanding and sophisticated technologies, commentators describe the contemporary world as postmodern pastiche of imagery with multiple messages (McNair, 1996), with “sexual stories” as a specific set of discourses typifying western industrial society, from television chat shows to psychotherapy (Evans, 1993; Plummer, 1995; Simon, 1996). The pornography industry has long invested in masscommunication systems and global media to manufacture and distribute products (Cole, 1989). Illicit use of Internet technology as “deviant technicways” (Durkin & Bryant, 1995) provides unregulated marketplaces for a “culture of sex talk,” blurring boundaries between private and public spheres (Wallace & Mangan, 1996). An alternative approach to the vexed issue of pornography, and effects of viewing it, is contained in a critique of new cultural forms, fragmentation, and breakdown of established categories of meaning, where personal narratives are transformed into public property (Moorti, 1998). Pornography is cited as a prime example of a genre constructed specifically by the erotic, discussed not as reified commodity but as discourses that invite interpretation. Relationships between “pornography” and “user” become more complex than traditional “cause–effect” models influential in social science research, and attention is directed toward the meaning of media images of sex and context in which they are used (Benwell, 2005; Wilkin, 2004). Massive growth, and commercial success, of “cyberporn” is a recent development in the pornography industry, with uptake rivaling travel/business sites (Stack, Wasserman, & Kern, 2004), and addictive use of Internet pornography is diagnosed as a variant of pathological sexuality (Stein, Black, Shapira, & Spitzer, 2001). Particular concern is expressed about visual depictions of real or simulated rape. Gossett and Byrne (2002), investigating “rape depictions” on Internet sites, comment on ease of access, range of choices, and interactive options, enabling viewers to “see through the eyes of the rapist” and manipulate 28
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content. Pornography sites, conventionally referred to as “infotainment,” are described by feminist theorists and activists as hate speech, harassment, and sexual aggression against women. Tate (1990) offered an early challenge to the stereotypical “child molester,” as alienated outcast, drawing attention to worldwide trade in sexualized images of children. These concerns remain central to debates about sexual trafficking (Chase & Statham, 2005) with two developments contributing to global abuse of children: affordable holiday destinations where boys/girls are sexually available and digital technology permitting production/cross-border distribution (Alexander, Meuwese, & Wolthuis, 2000). Internet child pornography has many forms: pictures, “anime” (cartoons), video, sound files, and stories (Burke, Sowerbutts, Blundell, & Sherry, 2002). Quayle and Taylor (2005) note that, before the IT revolution, pedophiles were relatively isolated but now form “virtual communities” with minimal external controls, a phenomenon referred to as “cyber-pedocriminality” (Webb, Craissati, & Keen, 2007). The complexity of defining “child pornography” creates problems, and a singular focus on illegal materials ignores how “seemingly innocent” pictures function for offenders (Zurbriggen, Pearce, & Freyd, 2003). Early feminist literature identified rape as a “terrorist weapon” in national conflicts (Brownmiller, 1975; Vogelman, 1990), but contemporary cultural critics refer to “pornography of war” (Baudrillard, 2005). Associating pornography with “pathological sexuality,” in nonsexual contexts, includes erotic objectification of human suffering such as genocide (Dean, 2003). Morrison (2004) and Bovens (1998) note resemblances between photojournalism and pornography, focusing on “bad consequences,” diminished empathy, and misuse/misappropriation of images. Technology has made systematic rape, as ethnic cleansing (Hynes, 2004; Price, 2001; Seifert, 1996), available via the Internet, with female victims reporting the filming of sexual atrocities (MacKinnon, 1994).
Video Games and Sexual Violence Video games are becoming increasingly graphic, incorporating violent and disturbing imagery (Kierkegaard, 2011). In 2007, the industry generated over $26.5 billion dollars in worldwide sales (Dines, 2010). Despite this trend, sexual violence within video games is not a new development. The 1980’s game “Custer’s Revenge” is described as pornographic (Donovan, 2010; Dworkin, 1981) for translating rape of Native American women into competitive entertainment. In the same decade, “Night Life” included explicit sexual images that contributed to the development of Japanese “bishojo” games. These typically focus on schoolage girls, influenced by sexually graphic manga comics. Extreme examples, known as “eroge,” depict sexual fantasies including violent rape and pedophilia. “Lolita Syndrome” Volume 10 • Number 1 • January-March 2014
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Original Article involves removing clothing from prepubescent girls by knife throwing, “177” allows rape of teenage girls, and “RapeLay” is essentially a rape simulator (Donovan, 2010). Although banned internationally, the latter is easily obtainable from the Internet and has gained popularity (Beck, Boys, Rose, & Beck, 2012). Numerous video games allegedly containing explicit sexual materials are available in Japan, but domestic child pornography laws do not apply (Kierkegaard, 2011). Many easily accessible video games contain sexual violence toward women. An example is the recently rebooted “Tomb Raider” franchise, which has reimagined the main character as a sexual assault survivor. Attempted rape, and murder, makes Lara Croft vulnerable and needing protection by (male) players (Penny, 2012). Video games in the successful series “Grand Theft Auto” (GTA) include violence, rape, and criminality (Kierkegaard, 2011). Dines (2010,) notes that, when “GTA IV hit the market in April 2008, on its first day of release, it sold a record 2.5 million units in North America ( p. 62).” An infamous “Hot Coffee” game segment, when unlocked, allows sex between two characters, where players control movements/sexual positioning. In “GTA Vice City,” male characters get money refunded for “killing” prostitutes (Dill, Brown, & Collins, 2008). Biever (2006) suggests that virtual rape may not constitute a problem in the erotic games “Red Light Center” and “Sociolotron,” with users consenting to being “raped” before signing up. Whitty, Young, and Goodings (2011) examine taboo elements of “massive multiplayer online roleplaying games,” where multiple players interact online simultaneously. Many games contain components that would constitute criminal behaviors if committed offline, including torture, violence, and cannibalism. Rape is possible in “Phantasmagoria,” incest is implied in “House of the Dead–Overkill,” and “Battle Raper” allows sexual assault/rape of defeated female opponents. Young and Whitty (2010) discuss “Pangea,” a Korean production, with female characters losing clothes when hurt and being fully naked when killed. Beck and colleagues (2012) suggest that recent developments in video game technology have led to more realistic representations of virtual worlds and increased interactivity with the game and other players. Xbox Kinect allows games to be played without a controller, as body movement influences play. It is not unreasonable to imagine future games allowing players to physically act out violent, and sexually violent, behaviors.
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Study Aim
The aim was to explore different ways pornography was spoken about in the institutional environment where nursing staff and patients shared space and time. It offered a Journal of Forensic Nursing
challenge to a dominant social science research tradition, which uncritically accepts particular versions of “truth,” and objects/subjects of scientific knowledge are assumed to have a prediscursive existence (Hardin, 2001; Rolfe, 2000).
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Design and Method Discourse Analysis Discourse analysis (DA) is a heterogeneous range of social science research (Silverman, 2001) prioritizing language to explore social voices as interwoven discourses, emphasizing multiple truths and competing realities (Cameron, 2001). A constructivist version of DA (Potter & Wetherell, 1987) prominent in critical research (e.g., Crowe, 2005; McCloskey, 2008) was adopted. It focuses on variability in accounts and performative aspects of language as social practice, providing a link between culture and self. Like critical DA, it permits interrogation of ideological assumptions and power inequities (e.g., Fairclough, 2001, 1995), a strategy suited to researching disciplinary apparatus of high-secure psychiatry (Mercer, 2013b; Pilgrim, 2007).
Recruitment and Data Collection Access to the research site and potential participants proved challenging, but the project gained approval from a local research ethics committee and hospital/directorate governance committees (Mercer, 2009). Interviews were undertaken with 18 nurses (13 men and five women) and nine personality disordered sexual of fenders,recruited from the personality disorder unit of one high-secure hospital. Initially, consent from responsible medical officers was required to approach potential patient participants, followed by opportunistic sampling according to approved inclusion/ exclusion criteria (see Table 1). These were constructed to ensure boundaries between research and therapy were delineated. Interactive episodes provided a reciprocal exchange of ideas, and respondents became active participants (Kvale, 1996). In-depth, semistructured interviews took place on hospital wards at a time convenient for respondents. Ethnographic observations and field notes complemented data collection and informed avenues of inquiry.
Data Analysis In DA, accounts rather than speakers represent units of analysis, focused on language use, not on language users (Wood & Kroger, 2000). Interviews were audio-taped and transcribed to capture nuances of meaning (Coates & Thornborrow, 1999; Edwards, 2004), a process that represented first-stage analysis. Attention was given to function, construction, and variability (Potter & Wetherell, 1987). Selective coding initiated immersion in data as a meditative, rather than mechanical, exercise. A “discourse analytic frame of mind” (Wood & Kroger, 2000) enabled www.journalforensicnursing.com
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Original Article
TABLE 1. Inclusion and Exclusion Criteria Inclusion criteria Patient population
Staff population
Male patients
Registered mental health nurses
Patients with a diagnosis of personality disorder and a recorded sexual offense
Staff with clinical and/or therapeutic experience of working with a sexual offender client group
recognized, or rebuffed, the idea of socially negative effects resulting from violent mediated entertainment. Gendered knowledge and experience, again, informed discussions; men focused on risk within the unit, and women located their ideas in a sociological context. One female nurse talked about sexualization of cyberspace and technology in pursuit of profit. Damage and social harm extended to those involved in the manufacture of exploitative sexual media:
Exclusion criteria Patient population
Staff population
Female patients
Staff without clinical, or therapeutic, experience of working with a sexual offender client group
Patients with an index offense of sexual offending and a diagnosis of mental illness or learning disability
Nursing staff with direct clinical, or therapeutic, responsibility for individual patients consenting to take part in the research study
identification of interpretive repertoires, ideological dilemmas, and subject positioning (Wetherell, 1998), and themes and concepts that organized the presentation of findings in report form.
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Findings Gendered Discourses and Gendered Experiences The study identified a series of discursive repertoires that positioned speakers within the institutional culture and informed the practice of nursing. These are summarized below: 1. Talk constructed the hospital ward as a physical, symbolic, and masculine territory. 2. Gendered construction of secure care defined male nurses in terms of physicality and female nurses in terms of sexuality. 3. Language use embodied gendered knowledge and experience mediated by institutionalized sexism. 4. Talk about pornography and sexual offending framed ideological distancing and discourses of dangerousness.
Discussion below focuses on a small subset of data pertaining to respondent talk about technology and mediated representation of sex and violence.
Sexual Violence and Violence as Sexual Few respondents made reference to digital pornography in general or video gaming specifically. A distinct discourse 30
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Women who want to say this [the sex industry] is the work I choose to do and I want to get paid for it.... I think they’ve just bought into that system really...a bit like you can buy into systems it doesn’t matter what your gender is [pause] I think it’s damaging for people who produce it…never mind the people who consume it [pause] I think it is so prevalent…and of course we wouldn’t have an Internet were it not for pornography.... it’s amazing and always has been at creating its own means of distribution” (female nurse 13). Technologies of cyber communication made the pornographic marketplace less clearly defined, with the Internet described as a major provider of mediated sexual representations. Global access meant purchasing pornography, previously transacted in public domains, shifted to the private sphere of home. Encountering cyber-sexual entertainment did not require web searching. Rather, it constantly threatened to intrude into the online lives of computer users, requiring installation of defenses, presenting a confusing interplay of sex/gender. Limited experience, recounted with reticence, connoted pornography as something pervasive and invasive, ultimately cloaked in the mystery of how men “have sex with themselves”: I’m on the Internet…isn’t everyone? And they flash up don’t they…these things…. I’ve got a little firewall now…before that it was like oh my god and y’know the little pictures at the top.... Nikki says hi there…watch me with me lesbian thing…. it’s women as well as men [pause] but men mainly use it to [pause] I don’t know...to have sex with themselves I suppose” (female nurse 12). “Dangerousness” as a dominant strand in male staff accounts framed wider talk about how sexual media should be managed at ward level. “Risk” was an abstract, ill-defined concept, and overt sexual content was only part of risk calculation. One patient’s fascination with recordings of war crimes reconstructed archival Volume 10 • Number 1 • January-March 2014
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Original Article film footage as eroticization of torture and death. Images were not specifically about sexual abuse, but suffering inflicted on women victims was (re)interpreted as a vehicle for sexual excitement: When you look at things that are clinically inappropriate for somebody to have [pause] we found him with.... it was actually Nazi videos which y’know…war [pause] to most people it’s nothing...no great shakes...but to him it really was because he got a kick from watching the torture scenes in them…and the women that were abused in them...physically abused...but to him that was sexual” (male nurse 3). Given that commercial pornographic materials had been largely removed from the wards and were seen as a clinical concern about only sex offenders, nurses became involved in searching for and censoring any items that could be associated with risk. Attention was devoted to a plethora of mundane images/texts seen as “dangerous” if accessed by pedophiles. Such included children’s clothing catalogues/television programs, National Geographic magazines, newspaper items, photographs, and postcards. This seemed to consume considerable time and effort for no tangible benefits. One finding related to video entertainment, films and games, was apparent lack of understanding by care teams relating to potential risk issues and artificial codification of physical violence and sexual violence as distinctly different behaviors. Demonstrating a clinical rationale for withdrawing violent video games was only one stage in the decision-making process of the clinical team. The data extract below illustrates these tensions, where there was confusion over Pan European Game Information ratings, whether games were designed for young or adult audiences, and the actual aim/goal of the game(s): There are broad policies that say that they can’t have Playstation games in their own room [pause] oh they can have Playstation 1 but not Playstation 2 because there’s a portal...you can get onto the Internet...but there’s no restriction on games...you could take it to the care team… but not that many people know what’s going on in a Playstation game…not in detail...and we do stop violent video games for example...would they take it [video-game] off him? Perhaps [pause] there would be a humorous conversation that surrounded all of that [pause] laughing and joking…and then perhaps get them more sober… and they may or they may not take it off him… and one of the issues they would cite is it’s an eighteen [pause] I don’t think it’s about being eighteen Journal of Forensic Nursing
[break] Grand Theft Auto...what it’s about is robbing cars...it’s an 18 is a recommendation…if they’re over 18 to play these things [pause] you go round driving a car and you can knock people over…and I know people who can’t wait to play that…to go and hit the women [break] but it tells you that they’re not engaging with Grand Theft Auto in the way it was meant to be played.... I don’t think [pause] if it is the way it’s meant to be played then of course you’ve got thirteen…fourteen…fifteen year olds right… throughout the country playing this game which is a top selling game.... It then becomes socially acceptable for you to hit women…on a computer” (male nurse 1). The policy on sexually explicit materials was interpreted to include a range of commercially available media not ordinarily considered pornographic but deemed inappropriate in the context of sex offender treatment. The dilemma of imposing controls was discussed by a patient who ordered a number of digital versatile discs (DVD) movies, which were withheld because of violent/ sexually violent content. The films had previously been broadcasted on terrestrial television and watched by non-sexoffenders on the ward, reinforcing institutional discourses that used sexual offending to symbolize dangerousness. If staff had little difficulty in recognizing violent sexual crime, it was proposed that they had less awareness of how physical violence could be sexualized: They said in one of them there’s an explicit rape scene [Once Upon a Time in America] and the other two the amount of violence in Natural Born Killers and Reservoir Dogs is…give reason for concern... but what I’ve seen on here...right psychopathic films…sadistic films [pause] maybe not sexual…but sadistic [pause] and these are lads who are…they’re in for murders or killings [pause] I’m not… although I did commit horrific violent sexual acts…. I didn’t go over to the fact that I sadistically tortured…or used any sort…. I didn’t even hit them…and I didn’t get off on that [break] they [nurses] tend to think it’s alright to… for [laughs] I don’t know why killers and people who’ve taken life…they can have these sadistic violent films…but there’s always words of concern and caution over giving them to sexual offenders” (patient 9). Another patient questioned staff abilities to accurately predict risk, making an association between violent video games and potential reoffending. The account paralleled nurse observations about the influence of computer-generated www.journalforensicnursing.com
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Original Article imagery, with Lara Croft assuming iconic status as amalgam of sex and violence. Describing risk as subjective interpretation, he remarked on excessive levels of enjoyment fellow inmates derived from violent games, at the same time distancing himself from other sexual offenders on the unit: The other one [patient] down here…killed [pause] a member of his family…sexually [pause] will tell me that he’s no longer violent…but he plays the most violent games he can pick on the computer which are all shoot ’em up games [pause] I mean I have a PS1…I have a couple of shoot ’em ups…. I have a couple of drivers…a couple of Lara Croft [pause] the usual cross section…and I hardly ever play ’em anyway [pause] this guy lives on the computer…sniping…killing…stabbing…hacking… whatever…loves it and gets a real…you know he’s getting a buzz” (patient 3). Given the shared masculine language, male nurses similarly deployed linguistic repair devices (Auburn, 2005) to set themselves apart from men defined as other (Lacombe, 2008; Peternelj-Taylor, 2005, 2004); talk about pornography, simultaneously, constructed ideas about normality, deviance, and dangerousness.
I’ve played violent video games.... I’ve watched pornography...watched violent films on the telly [pause] I haven’t killed anyone and I haven’t sexually assaulted anyone...in fact I’m here treating people who do” (male nurse 6).
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Discussion
The last 4 decades have witnessed a burgeoning volume of social science inquiry attempting to establish a correlation between certain forms of pornography and abusive attitudes, or aggressive behaviors, in male consumers (e.g., Donnerstein, Linz, & Penrod, 1987; Malamuth & Huppin, 2005). Typically, these adopt experimental designs with student volunteers being tested after exposure to violent/subordinating sexual imagery. Outcomes remain equivocal and contested, with debate marked by sociological and ideological positioning. Much work is remote from clinical or custodial environments where men, convicted of sexual crimes, are contained and/or treated. Findings discussed in this article, in contrast, have drawn on qualitative investigation (Mercer, 2013a) into the practice domain of forensic mental health nursing, where 32
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meaning took precedence over measurement. Acknowledging pioneering work undertaken in the U.S. correctional system (Scully, 1990; Scully & Marolla, 1984), it embraced contemporary interest in language as a way of understanding sexual crime, sex offender treatment, and construction of masculinities (Auburn, 2005; Cowburn & Pringle, 2000). In this article, we have reviewed a body of literature specifically related to growing concerns about increasingly violent, sexually graphic content of Internet pornography and video games. In the context of longstanding debates about pornography as a contributory factor in male sexual violence, attention has shifted to a new population, or generation, of consumers. In this sense, we need to consider the implications of new technologies for forensic mental health practice in the future. However, data derived from the study suggest that these issues are not part of the construct or vocabulary of forensic nursing. Accounting for this can only be speculative: it might be an artifact of the research site, that respondents were within a mature age range, or possibly, because the patient group had no Internet access, it was not considered problematic. This highlights current worries of global social saturation of imagery and ideas that normalize pornography in the everyday world. Our argument is sympathetic with the work of Dines (2010) about how the “porn” industry has “hijacked” contemporary culture. In this context, pornography is likely to replace conventional ways of learning about sex and relationships, where young men and women (as oppressor and oppressed) are likely to be casualties of distorted and damaging versions of masculinity/sexual identity. Revolutionary advances in communication and IT and worldwide popularity of social-networking sites mean that young people and children live in an image rather than a print culture (Dines, 2010). Despite positive aspects and political benefits, there are antisocial consequences to unlimited ease of access to images purveying dehumanizing abuse of women, sex, and violence, more than ever before, defining popular culture. As noted, criminality can be enacted in cyberspace with little risk of detection. It is proposed (Gunter, 2013) that forensic practitioners consider examination of Internet/social media data in psychiatric assessment and treatment. Despite massive challenges, in terms of nursing practice, there are considerations that could help frame proactive and prosocial approaches (see Table 2). Nursing has long been a target of mediated representations that construct the “sexy nurse” as staple feature of pornographic fantasy and fetish (Orr, 1988). We suggest that individual nurses and professional bodies embrace struggles against exploitative and discriminatory media promoting gender hatred. Paraphrasing the campaigning slogan of 1970’s/1980’s antipornography activists, the “Personal is the political,” so too is the “Professional the Volume 10 • Number 1 • January-March 2014
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Original Article
TABLE 2. Confronting Pornography As a Personal and Public Health Problem • Active, meaningful participation of forensic nurses in offender treatment programs where pornography is critically addressed. • Recognition that management/restriction of sexual media in patient/prisoner populations is broader than treatment programs/facilities for sex offenders. • Clear policy guidelines to inform decision making in relation to sexual media in secure settings based on a philosophy of harm reduction. • Promotion of a clinical culture premised on antioppressive and antidiscriminatory practice/praxis. • Managerial and clinical leadership that takes seriously and tackles gendered inequalities within health and criminal justice organizations. • Incorporating assessment of pornography use in the context of individualized care planning for offender patients. • In-service training and development for clinicians. • Involvement in/initiation of educational outreach programs targeted at young people, parents, teachers, and youth workers. • Formulation and conduct of nursing research projects focused on pornography as a health concern in forensic practice. • Engagement with activist/academic groups working to oppose powerful interests in the pornography industry.
political.” One of our objectives in writing this article was to situate the concept of pornography in the vocabulary of forensic nurses. Hitherto, this has been largely ignored in the professional press, and those contributions, which do exist (e.g., Drake, 1994; Duff, 1995), are dated in the context of an industry noted for its entrepreneurial media adaptability. Of the literature discussed about gaming and sexual violence, none appeared in a health-related journal. Arguably, it is forensic nurses (community, mental health correctional, or sexual assault nurse examiners ) who will be in the front line of managing abusive attitudes or behaviors associated with a “porn culture.” The contribution of Gail Dines has been central to our argument, and it is fitting to close with some cautionary words: “One thing is certain: we are in the midst of a massive social experiment, only the laboratory here is our world and the effects will be played out on people who never agreed to participate” (Dines, 2010, p. ix).
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References
Alexander, S., Meuwese, S., Wolthuis, A. (2000). Policies and developments relating to the sexual exploitation of children: The legacy of the Stockholm Conference. European Journal on Criminal Policy and Research, 8, 479–501.
Journal of Forensic Nursing
Auburn, T. (2005). Narrative reflexivity as a repair device for discounting “cognitive distortions” in sex offender treatment. Discourse and Society, 16(5), 697–718. Baudrillard, J. (2005). Pornography of war. Cultural Politics, 1(1), 23–26. Beck, V. S., Boys, S., Rose, C., Beck, E. (2012). Violence against women in video games: A prequel or sequel to rape myth acceptance? Journal of Interpersonal Violence, 27(15), 3016–3031. Benwell, B. (2005). “Lucky this is anonymous”: Ethnographies of reception in men’s magazines: A “textual” approach. Discourse and Society, 16(2), 147–172. Biever, C. (2006). Fantasy or violation? New Scientist, 190(2556), 68–68. Bovens, L. (1998). Moral luck, photojournalism, and pornography. The Journal of Value Inquiry, 32, 205–217. Brownmiller, S. (1975). Against our will: Men, women and rape. New York, NY: Simon & Schuster. Burke, A., Sowerbutts, S., Blundell, B., Sherry, M. (2002). Child pornography and the Internet: Policing and treatment issues. Psychiatry, Psychology and Law, (1), 79–84. Cameron, D. (2001). Working with spoken discourse. London, UK: Sage. Chase, E., Statham, J. (2005). Commercial and sexual exploitation of children and young people in the UK: A review. Child Abuse Review, 14, 4–25. Coates, J., Thornborrow, J. (1999). Myths, lies and audiotapes: Some thoughts on data transcripts. Discourse and Society, 10(4), 594–597. Cole, S. G. (1989). Pornography and the sex crisis. Toronto, ON: Amanita. Cowburn, M., Pringle K. (2000). Pornography and men’s practices. The Journal of Sexual Aggression, 6(1/2), 52–66. Crowe, M. (2005). Discourse analysis: Towards an understanding of its place in nursing. Journal of Advanced Nursing, 51(1), 55–63. Dean, C. J. (2003). Empathy, pornography and suffering. Differences: A Journal of Feminist Cultural Studies, 14(1), 88–124. Dill, K. E., Brown, B. P., Collins, M. A. (2008). Effects of exposure to sex-stereotyped video game characters on tolerance of sexual harassment. Journal of Experimental Social Psychology, 44(5), 1402–1408. Dines, G. (2010). Pornland: How porn has hijacked our sexuality. Boston, MA: Beacon Press. Donnerstein, E., Linz D., Penrod S. (1987). The question of pornography. New York, NY: Free Press. Donovan, T. (2010). Replay: The history of video games. Lewes, UK: Yellow Ant. Drake, R. E. (1994). Potential health hazards of pornography consumption as viewed by psychiatric nurses. Archives of Psychiatric Nursing, 8(2), 101–106. Duff, A. (1995). Pornography and censorship: The problems of policy formation in a psychiatric setting. Psychiatric Care, 2(4), 137–140. Durkin, K., Bryant, C. (1995). “Log onto sex”: Some notes on the carnal computer and erotic cyberspace as an emerging research frontier. Deviant Behaviour: An Interdisciplinary Journal, 16(3), 179–200. Dworkin, A. (1981). Pornography: Men possessing women. London, UK: Women’s Press. Edwards, J. A. (2004). The transcription of discourse. In D. D. H. E. (Eds.), The handbook of discourse analysis. Oxford, UK: Blackwell.
www.journalforensicnursing.com
Copyright © 2014 International Association of Forensic Nurses. Unauthorized reproduction of this article is prohibited.
33
Original Article Evans, D. (1993). Sexual citizenship: The material construction of sexualities. London, UK: Routledge. Fairclough, N. (1995). Critical discourse analysis: The critical study of language. London, UK: Longman. Fairclough, N. (2001). Critical discourse analysis as a method in social scientific research. In R. M. (Eds.), Methods of critical discourse analysis. London, UK: Sage. Fallon, P., Bluglass, R., Edwards, B., Daniels, G. (1999). Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital (Cm 4194). London, UK: HMSO. Gossett, J. L. Byrne, S. (2002). “Click here”: A content analysis of Internet sites. Gender and Society, 16(5), 689–709. Gunter, T. D. (2013). Social media in the practice of forensic psychiatry evaluation and management. Abstracts of the XXXIIIrd International Congress on Law and Mental Health, Amsterdam, pp. 219–220. Hardin, P. K. (2001). Theory and language: Locating agency between free will and discursive marionettes. Nursing Inquiry, 8, 11–18. Hunt, L. (1993). The invention of pornography: Obscenity and the origins of modernity, 1500–1800. New York, NY: Zone Books. Hynes, F., Taylor, N., Lenihen, F. (2007). The role of the mental health professional in cases of online sexual activity. The British Journal of Forensic Practice, 9(3), 19–23. Hynes, H. P. (2004). On the battlefield of women’s bodies: An overview of the harm of war to women. Women’s Studies International Forum, 27, 431–445. Kelly, L. (1992). Pornography and child sexual abuse. In: C. Itzin (Ed.), Pornography: Women, violence and civil liberties. Oxford: Oxford University Press. Kendrick, W. (1987). The secret museum: Pornography in modern culture. New York, NY: Viking. Kierkegaard, S. (2011). POSTAL 2 plays in US court—Schwarzenegger v. Entertainment Merchants Association. Computer Law & Security Review, 27(3), 278–290. Kvale, S. (1996). Inter-views: An introduction to qualitative research interviewing. London, UK: Sage. Lacombe, D. (2008). Consumed with sex: The treatment of sex offenders in risk society. British Journal of Criminology, 48, 55–74. MacKinnon, C. A. (1994). Only words. London, UK: Harper-Collins. Malamuth, N., Huppin, M. (2005). Pornography and teenagers: The importance of individual differences. Adolescent Medicine, 16, 315–326. Malamuth, N. M., Feshbach, S., Jaffe, Y. (1977). Sexual arousal and aggression: Recent experiments and theoretical issues. Journal of Social Issues, 33(2), 110–133. McCloskey, R. (2008). A guide to discourse analysis. Nurse Researcher, 16(1), 24–44. McNair, B. (1996). Mediated sex: Pornography and postmodern culture. London, UK: Arnold. Mercer, D. (2009). Research in state institutions: A critical issue for nursing practice. Journal of Forensic Nursing, 5, 107–108. Mercer, D. (2012). Policing pornography in high-secure care: The discursive construction of gendered inequality. In D. T. A. (Eds.), (Re)Thinking violence in health care settings: A critical approach. Surrey, UK: Ashgate. Mercer, D. (2013a). Girly mags and girly jobs: Pornography and gendered inequality in forensic practice. International Journal of Mental Health Nursing, 22, 15–23.
34
www.journalforensicnursing.com
Mercer, D. (2013b). Sex offender therapy: Collusion, confession and game-playing. In D. J. D. A. (Eds.), Power and the psychiatric apparatus: Repression, Transformation and Assistance. Surrey, UK: Ashgate. Moorti, S. (1998). Cathartic confessions or emancipatory texts? Rape narratives on the Oprah Winfrey Show. Social Text, 16(4), 83–102. Morrison, W. (2004). “Reflections with memories”: Everyday photography capturing genocide. Theoretical Criminology, 8(3), 341–358. Orr, J. (1988). The porn brokers. Nursing Times, 84, 22. Penny, L. (2012). The trouble with Lara Croft. New Statesman, 141(5111), 14–14. Peternelj-Taylor, C. (2004). An exploration of othering in forensic psychiatric and correctional nursing. Canadian Journal of Nursing Research, 36(4), 130–146. Peternelj-Taylor, C. (2005). Engaging the “other.” Journal of Forensic Nursing, 1(4), 179–191. Pilgrim, D. (2007). Ashworth in context. In D. (Ed.), Inside Ashworth: Professional reflections of institutional life. Oxford, UK: Radcliffe. Plummer, K. (1995). Telling sexual stories: Power, change and social worlds. London, UK: Routledge. Potter, J., Wetherell, M. (1987). Discourse and social psychology: Beyond attitudes and behaviour. London, UK: Sage. Price, L. S. (2001). Finding the man in the soldier-rapist: Some reflections on comprehension and accountability. Women’s Studies International Forum, 24(2), 211–227. Quayle, E., Taylor, M. (2005). Paedophiles, pornography and the Internet: Assessment issues. British Journal of Social Work, 32, 863–875. Rolfe, G. (2000). Research, truth and authority: Postmodern perspectives on nursing. London, UK: Macmillan. Scully, D. (1990). Understanding sexual violence: A study of convicted rapists. London, UK: Routledge. Scully, D., Marolla, J. (1984). Convicted rapists’ vocabulary of motive: Excuses and justifications. Social Problems, 31, 530–544. Seifert, R. (1996). The second front: The logic of sexual violence in wars. Women’s Studies International Forum, 19(1/2), 35–43. Silverman, D. (2001). Interpreting qualitative data: Methods for analysing talk, text and interaction (2nd ed.). London, UK: Sage. Simon, W. (1996). Postmodern sexualities. London, UK: Routledge. Stack, S., Wasserman, I., Kern, R. (2004). Adult social bonds and use of Internet pornography. Social Science Quarterly, 85(1), 75–88. Stein, D. J., Black, D. W., Shapira, N. A., Spitzer, R. L. (2001). Hypersexual disorder and preoccupation with Internet pornography. American Journal of Psychiatry, 158(10), 1590–1594. Tate, T. (1990). Child pornography: An investigation. London, UK: Methuen. Vogelman, L. (1990). The sexual face of violence: Rapists on rape. Johannesburg, South Africa: Ravan Press. Wallace, J., Mangan, M. (1996). Sex, laws, and cyberspace: Freedom and censorship on the frontiers of the online revolution. New York, NY: Henry Holt. Webb, L., Craissati, J., Keen, S. (2007). Characteristics of internet child pornography offenders: A comparison with child molesters. Sexual Abuse, 19, 449–465.
Volume 10 • Number 1 • January-March 2014
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Original Article Wetherell, M. (1998). Positioning and interpretive repertoires: Conversation analysis and post-structuralism in dialogue. Discourse and Society, 9, 335–356. Whitty, M. T., Young, G., Goodings, L. (2011). What I won’t do in pixels: Examining the limits of taboo violation in MMORPGs. Computers in Human Behaviour, 27(1), 268–275. Wilkin, P. (2004). Pornography and rhetorical strategies—The politics of public policy. Media, Culture and Society, 26(3), 337–357.
Journal of Forensic Nursing
Wood, L. A., Kroger, R. O. (2000). Doing discourse analysis: Methods for studying action in talk and text. London, UK: Sage. Young, G., Whitty, M. T. (2010). Games without frontiers: On the moral and psychological implications of violating taboos within multi-player virtual spaces. Computers in Human Behaviour, 26(6), 1228–1236. Zurbriggen, E. L., Pearce, G. E., Freyd, J. J. (2003). Evaluating the impact of betrayal for children exposed in photographs. Children and Society, 17, 305–320.
www.journalforensicnursing.com
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