The Violence of Care is set in a milieu sensitized to feminist critiques of rape as a grave form of gendered violence, recognizing the need to prosecute rapists, and to prevent the revictimization of rape survivors by police and lawyers in interrogation. The criminal prosecution of rape is managed through a well-choreographed state network, including police detectives and rape crisis center advocates, forensic labs, and emergency rooms which provide assistance with injuries and also serve as the primary site of data collection by forensic nurse examiners (FNEs). The focus is on apprehending rapists by following calibrated procedures in proper order, on culling perfectly curated evidence that will best serve prosecution strategies.
Sameena Mulla's empathetic and hard-hitting ethnography of sexual assault interventions in Baltimore reminds us that this concentration on criminal justice procedures is unable to respond to the material or affective needs of rape victims. Mulla brings us into this world through her participant observation as a rape crisis advocate in hospital emergency rooms in Baltimore, supplemented by interviews with rape victims, FNEs, advocates, and related criminal justice professionals. We follow the temporal rhythms of FNEs, advocates, and victims, the travails of transportation, and the affective politics in hospitals where race and class-based determinations cannot quite be named. Vivid instances of humor, spunk, and frustration provide a fuller sense of the personalities and lives of nurses and rape survivors than case details can capture. The book demonstrates an exemplary use of ethnography as a method for witnessing the gaps in the workings of criminal law, as also the critical reflexivity of feminist methodology, framed through the author's account of her own confusion and fumbling maneuvers.
At the center of the ethnography are the FNEs whose very profession came into being as a triumph of feminist intervention: appalled at clumsy, variant, and insensitive administration of rape kits in hospitals by medical professionals, nurses were at the forefront of campaigns to develop training programs, best practices, and protocols for a “more scientific study of forensic practice” (p. 12), forming the International Association of Forensic Nurses and establishing themselves as authorities on sexual assault examinations. As nurses, they are skilled at handling bodies sensitively and putting people at ease, humanizing care; however, as agents of forensics, their primary task is to assemble the best evidence in accordance with protocol.
A critical takeaway of the book is to document that these forensic and caregiving goals tend to be in conflict. FNEs operate under the principle that DNA is “the hand of God,” a favorite phrase one FNE draws from a reality TV show (p. 38). The problem is that this call to a higher order of truth prevails over victims’ needs. FNEs are annoyed by disruptions to mandated routine, such as patients’ urgent need to urinate or leave the hospital to tend to childcare. Documentary procedures often dominate the encounter, further lengthening the process for victims. To produce appropriate abjection in a file, the victim's identifying photograph must be suitably solemn and traumatized: in one of the most poignant vignettes, the nurse who puts a woman at ease during her examination by gentle humor must then redo the photograph, pointing out “Honey, you smiled that time. We need to do it again” (p. 138). Empathy and comfort rare in a rape exam thus has to be erased in order to produce the visage of a victim rather than a woman who had normatively smiled for the camera. Ironically, Mulla points out, nurses append “normal” photographs to evidence reports as a mode of humanization, reasserting the person at the center of the crime, to resist reducing her to a set of reports about fluids and wounds. FNEs pride themselves on photographing wounds for maximum affective impact, even though some prosecutors believe that the lesser verisimilitude of diagrams have more power to persuade juries (p. 146). The book has an admirable light touch in laying out such contradictory impulses, identifying moments at which FNEs experience distance or disgust at victims’ nonnormative responses to standard procedures, such as rejection of emergency contraception, repeat visits to the emergency room, or histories of familial or substance abuse or mental illness.
The Violence of Care is a critical text for reminding us of the wounds produced by the most benevolent of processes through their modes of governance. Documentary regimes to determine sexual assault fail to capture atypical situations such as a young man raped by an older woman, or to accommodate the overlap between domestic violence and rape, or to distinguish between homes as sites of both healing and violence. Structural vulnerabilities which routinely create risk of sexual assault are irrelevant to prosecution, despite the fact that certain forms of vulnerability enabled repeated assaults: hack taxicabs repeatedly feature as sites of rape but have to be used by some women to get to jobs given the lack of other safe and affordable transportation; illegal drug use may expose women to sexual assault; homes and jobs may have to be returned to even as sites of violence.
Sexual assault intervention can only operate in the teleological shadow of the trial, despite the rarity of cases going to court (in Mulla's data, fewer than 3 in 10 cases involving forensic exams went to trial, and FNEs testified in court no more than five times each) (p. 172, p. 222). Mulla contends that such interventions substitute the narrative of victims for the “foundational narrative of the state” (p. 218)—investigations inscribe state power while victims experience alienation. The attention and care of FNEs are often reported as the most positive elements, with “the memory of the forensic nurse (becoming) more idealized and positive as time passed” (p. 220). Mulla thus strongly argues that FNEs would better serve justice if they were to “emphasize their expertise as nurses and seek to provide care rather than to align themselves as agents of the criminal justice system,” and that patients would be better served by “an investment in healing, self-growth and the securing of a livelihood” (p. 220).
