Civilizing the ‘Barbarian’: a critical analysis of behaviour modification programmes in forensic psychiatry settings



    1. Professor and University Research Chair in Forensic Nursing, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada and Visiting Professor, Faculty of Health & Social Care, University of Chester, Chester, UK
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    1. Associate Professor of Rhetoric, Department of English, Ryerson University, Toronto, ON and Assistant Professor, Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Dave Holmes
University of Ottawa
Faculty of Health Sciences
451 Smyth Road
Canada K1H 8M5


holmes d.&murray s.j. (2011) Journal of Nursing Management 19, 293–301
Civilizing the ‘Barbarian’: a critical analysis of behaviour modification programmes in forensic psychiatry settings

Aim  Drawing on the works of Erving Goffman and Michel Foucault, this article presents part of the results of a qualitative study conducted in a forensic psychiatry setting.

Background  For many years, behaviour modification programmes (BMPs) have been subjected to scrutiny and harsh criticism on the part of researchers, clinicians and professional organizations. Nevertheless, BMPs continue to be in vogue in some ‘total’ institutions, such as psychiatric hospitals and prisons.

Method  Discourse analysis of mute evidence available in situ was used to critically look at behaviour modification programmes.

Results  Compelling examples of behaviour modification care plans are used to illustrate our critical analysis and to support our claim that BMPs violate both scientific and ethical norms in the name of doing ‘what is best’ for the patients.

Conclusion  We argue that the continued use of BMPs is not only flawed from a scientific perspective, but constitutes an unethical approach to the management of nursing care for mentally ill offenders.

Implications for Nursing Management  Nurse managers need to be aware that BMPs violate ethical standards in nursing. As a consequence, they should overtly question the use of these approaches in psychiatric nursing.