In The Violence of Care: Rape Victims, Forensic Nurses, and Sexual Assault Intervention, Sameena Mulla focuses her attention and research on victims/patients of sexual assault as they come to the emergency room at a Baltimore hospital. Working as a rape crisis advocate Mulla gains insight into how patients are treated, how nurses cope with their responsibilities of being both care-givers and evidence collectors, and how blending both the medical and legal professions ultimately shapes the way in which patients are labeled (as compliant, non-compliant, ideal or not ideal victims, as repeat offenders, high risk patients and so on), how their actions are viewed in the system, and ultimately, how these women and men manage their own experiences and definitions of being both a victim and a patient.

Mulla’s approach is both that of a researcher and anthropologist, studying and observing the interactions between victims and nurses, victims and law enforcement and victims and families, but her role is also that of a rape crisis advocate, a person who listens to, responds to, and assists the women and men seeking medical assistance. Therefore, Mulla both tells her own story with the book as much as she re-tells the stories of the women and men she met during her four years of engaging in participatory research. The result is a book that is both personal, critical, profound and at times difficult to read. As Mulla describes and sets the scene for many sexual assaults, and the processes in which forensic examinations occur, readers may find certain aspects of the book problematic or difficult to read. Even though the title of the book certainly warns readers about its context, a trigger warning might be appropriate.

Mulla’s main points in The Violence of Care is that the operation mode of both the medical and legal aspects of care imposes “… a particular violence on victims of sexual assault. This violence is born not from the intentions of individual forensic nurses who consciously set out to alienate the victim-patient with whom they are working, but rather from the particular institutional, professional, and historical location of forensic sexual assault intervention” (p. 217). In each chapter, Mulla describes the practices developed from such contexts. For example, DNA testing has become the norm in cases of sexual assault and forensic nurses often spend the majority of the examination time looking for traces of DNA on victim’s bodies, even as most sexual assault/rape cases do not go to trial, as rape kit backlogs are numbered in the thousands, and as DNA does not resolve the question of consent. Even so, the presence of (and subsequently the lack of) DNA is highly important, and victims often suffer through hours of examinations in the hopes of recovering DNA.

Similarly, Mulla also discusses many other aspects of care and practices that can lead to re-victimization and the belief in a certain type of, or even “ideal” victim as part of forensic examinations. These aspects include the time line of processing victims (as well as the time victims wait before seeking medical assistance), the methods by which forensic nurses are trained, how to deal with patients not willing to consider emergency contraceptives, to the documentary style, and photographic evidence of injury, as well as other controversial topics, such as acquaintance rape and victims being under the influence of drugs, alcohol or medications.

The Violence of Care provides systematic research into the practices of forensic nurses as they provide care to sexual assault victims. This care does however lend itself to problematic assumptions as the medical and legal fields are intersected, as Mulla notes. The book is certainly of interest to those who have had contact with sexual assault intervention, and it can also be of importance to forensic nurses and others in the medical and legal fields when discussing possible policy changes. At the same time, given that Mulla is an anthropologist, the book can be used in the classroom in certain anthropology courses, but also in disciplines such as criminology and women’s studies.   

© 2015 Hennie Weiss

Hennie Weiss has a Master’s degree in Sociology from California State University, Sacramento. Her academic interests include Women’s studies, gender, sexuality and feminism.