The Violence of Care: Rape Victims, Forensic Nurses, and Sexual Assault Intervention

Sexual violence has recently received considerable media attention, featuring stories of campus rape in the U.S., and sexual assault in other parts of the world. While the media attention is needed, scholars should additionally welcome increasing number of anthropologists that take the problem of sexual assault to be a worthy topic of study. It also means that the pioneering work of Peggy Reeves Sanday from nearly three decades ago is finally receiving the citations it deserves. The latest offering in the growing field of the anthropology of gender-based violence is Sameena Mulla’s masterful ethnography, The Violence of Care: Rape Victims, Forensic Nurses, and Sexual Assault Intervention. Mulla’s work lays bare the tension between medical and legal interventions in sexual assault and rape cases, and exposes how inadequate the U.S. response to assault continues to be, nearly four decades after the country began treating rape as a serious crime with negative health consequences.

Mulla’s ethnography is an inspired addition to what might be broadly termed problem-based ethnography: where the focus is less on a particular cultural group or place, and instead identifies a problem to analyze from an anthropological perspective. Unlike other attempts at problem-based ethnography, where the fieldsite serves as a shadowy backdrop to the topic being address, Mulla fleshes out Baltimore, the city where she undertook her work, and readers get a sense of the neighborhoods, the hospital buildings, and even the interior spaces the victims in her book occupy.  The description is rich and vivid, and readers are immediately pulled into the victims’ lives and the traumas they confront.  This book is not for the faint of heart.

Mulla, in a duel role as researcher and sexual assault advocate, draws her data from observations of 44 sexual assault examinations in the emergency room, interviews with nurses, law enforcement and other officials, as well as in-depth interview with the victims.  She also attended grand jury orientations to observe how they received sexual assault training, in addition to conducting extensive archival work. The research was carried out over a four-year period, from 2002-2006, and Mulla provides a detailed account of the methods she utilized.

Mulla’s book takes readers through the myriad medical and legal contexts, and barriers, the victims encounter as they are treated for sexual assault.  Mulla painstakingly describes the forensic process that has become commonplace as a part of the sexual assault forensic examination.  Specially trained nurses (commonly referred to as FNE—forensic nurse examiners) follow a specific protocol to ensure supposedly objective collection of forensic data that can be used to determine the extent of the crime.  It is from the description of this encounter between victim and nurse that Mulla builds her argument in the book: that the purported antiseptic response to the assault is another form of violence enacted upon the victim.

To build her case Mulla takes readers through richly descriptive and beautifully written chapters.  She explores the way DNA has become sacrosanct in medico-legal contexts, the concept of time (a particularly sophisticated chapter), the professionalization of care, the documentation required to make a rape case, as well as the various categories victims are assigned based on their race, class, education, drug use and medical status. Mulla brings a deft eye to the intersectional issues of victims’ lives, and she is careful to maintain individual features while still making broader claims about the way victims are treated.

One of the best features of Mulla’s book is the care with which she writes about the victims themselves.  The interviews and observations presented from her ethnographic work are sensitive to the trauma of what the victims experience, but also provide the information necessary for those who are unfamiliar with the issue of sexual assault to gain a sympathetic understanding of what the victim went through. Mulla does this without resorting to voyeurism or gratuitous descriptions of violence.  The writing is raw, but it captures elegantly the voices of those willing to share their experiences with Mulla. In many respects, the interviews are a testament to how carefully Mulla approached her subjects, and the trust she gained in order to tell these stories.

This isn’t a hopeful book. In the conclusion Mulla reiterates her case regarding the way institutional structures and modalities produce new forms of violence against victims, and for society—she details the miniscule chance that a perpetrator will be brought to justice—and reaffirms the evidence that the system doesn’t work.  Victims do not receive the care they deserve, nor the justice they are owed, and nurses, acting in good faith, are unwittingly reproducing trauma in their attempt to objectively neuter it.  While she clearly outlines the barriers to care and the problems produced by a system designed to respond to sexual violence, it doesn’t appear to be much in the way of a will to change the status quo. This is probably the most important takeaway from the book. Mulla provides scholars with the theoretical tools and data to convince others there is a problem. The question remains, though, as to how applied, engaged, and activist anthropology will respond to her assessment and move forward?

This book is easily accessible by undergraduate students, and for students who are not anthropology majors. It could be used in classes covering such topics as global public health, social science methods, sexual violence, legal and medical institutions, as well as more obvious anthropology courses. It would be useful to complement the findings with readings that present the perspectives of nurses and other frontline workers in the field of gender-based violence to fill the gaps left in the wake of the book. For example, Mulla’s own position as a sexual response advocate is undertheorized in the book.  Mulla doesn’t engage with the extensive literature on frontline workers and this would have enhanced her overall argument.  A course instructor could use research like Wies and Coy’s (2013) analysis of the vicarious trauma nurses experience as a part of their forensic labor, published in Human Organization, to usefully complement and complicate the perspectives presented in Mulla’s book.

Despite these few shortcomings, this is overall a beautifully written and urgently needed book. As Mulla makes clear, the problem of sexual assault is not going away, and it is not being prosecuted, nor treated medically in a way that is beneficial to the victims or to society.

Hillary J. Haldane, Quinnipiac University

Mulla, Sameena. The Violence of Care: Rape Victims, Forensic Nurses, and Sexual Assault Intervention. New York University Press, 2014. Read more at NYU Press 

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