Critical Care

Sameena Mulla’s remarkable new book about rape victims and forensic nursing is tightly woven, compelling in its ethnography, and so carefully thought and cumulative in its analytic structure (resituating in turns questions of time, body, care, gender, photography, kinship, home, self and state) that for me reading it felt like one extended epiphany. It also left me with a profound respect for Mulla’s work as a rape crisis counselor and an anthropologist. Rarely do we see participant observation on this order of participation, rarely do we see a writer strike such a perfect tone when addressing such deeply fraught material.

Talk of sexual assault is everywhere right now. From public outrage in the aftermath of a brutal gang rape in Delhi in 2012 that drew the world’s attention, to the ongoing scandal of sexual assaults in the US military, to the politicized sexual assaults in Tahrir Square, to the revelation that some 400,000 rape kits remain unprocessed in the US, to the highly publicized failure of US colleges and universities to adequately respond to the problem of rape on their campuses, such talk turns quickly to the law. If the law is meant to protect the population and to bring justice to the victim, then it is against these ends that its shortcomings of practice are judged. But in Mulla’s careful hands we are led to ask what other effects does it bear? The Violence of Care, set in a Baltimore hospital, focuses close attention on the micropractices of the law on narrative and the body and the attendant regimes of evidence that structure forensic nursing. It shows how powerfully perceived imperatives of the law violate possibilities for care of the individual, even within a space geared towards critical care. Such a dynamic is only intensified by the structural violence of poverty, gender, age, and race that animate the dynamics of sexual assault in Baltimore and elsewhere. Is the rape kit here the equivalent of public health’s magic bullet? The narrow technological solution to the complex political, economic, and social problem of sexual violence?

Scholars of medicine have long been interested in the law as a particular dimension of state power. Important work has pursued the intersection of the medical and the legal through questions of intellectual property (drug patents and pricing), the tension between personal liberties and public health (compulsory vaccination, quarantine, immigration, sterilization etc), tort law (malpractice, injury), and questions of legal protection for patients as human subjects (informed consent, patient autonomy etc). But Mulla’s subject is not the legal as a constitutive domain of medicine. She is concerned here with medical relationships and technologies used for legal ends in the immediate aftermath of traumatic injury. As she so carefully and methodically uncovers when the medical profession is recruited to the legal, something disturbing happens to medicine, its promise of care, and its imperative of psychic and bodily healing. I was left wondering if a person can be a crime victim and a patient at the same time? What kind of healing, if any, could or should the law offer?

Some piece of the answer lies in the sexually assaulted body as simultaneous site of injury (and therefore potential care) and source of truth. Mulla shows how forensics renders the victim’s body a crime scene, with rape perverting the social dimension of the body, such that in its aftermath there is a mingling of two bodies (perpetrator and victim) on and inside of one (victim). Such a doubled body is ripe with rapidly deteriorating evidence of interest to the state. In this way the violence of care resonated with other clinical contexts in which the wellbeing or care of the patient is subsumed under the name of a larger collective – the population (for research or biopolitical purposes). The violence of care here works alongside what Lisa Stevenson has recently called the “anonymity of care,” and Miriam Ticktin’s mapping of the “casualties of care” to situate the vulnerable body in relationship to the state. Sameena Mulla’s powerfully intelligent book reminds us that for individuals caught up in these relationships, care as healing is elusive, even as care as institutional practice is formidable.

Julie Livingston is Visiting Professor in the Department of Social and Cultural Analysis and the Department of History at NYU. Her most recent book is Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic (Duke University Press, 2012).



Margaret Lisa Stevenson, Life Beside Itself: Imagining Care in the Canadian Arctic (Berkeley: University of California Press, 2014)

Miriam Ticktin, Casualties of Care: Immigration and the Politics of Humanitarianism in France (Berkeley: University of California Press, 2011).