Sameena Mulla’s The Violence of Care: Rape victims, forensic nurses and sexual assault intervention highlights the consequences of reductionism in the medico-legal world. She focuses on the ways that legal requirements shape the interactions between victim, Forensic Nurse Examiner (FNE) and Victim Advocate, and in particular the temporal aspect of these interactions (e.g. the requirement to collect trace material within a particular timeframe post-assault in order to increase the potential for recovering DNA evidence, or the collection of information related only to the events of the assault), and also the ways in which they serve to separate the attack from the rest of the victim’s biography. The assault becomes a ‘zero-hour’ from which all future decisions evolve along a designated timeline. Of course, some of this separation is performed with the best interests of the victim and her case in mind, and there is a belief that the less information recorded about the complainant’s behaviour, dress etc., the better; however, potentially problematic information re-enters the recording for supposedly scientifically important reasons (e.g. recent sexual partners in order to distinguish between different semen found in the body, any intoxicants recently consumed), resulting in the medical recording of potentially harmful information.
Mulla draws the reader’s attention to a couple of major points: first, that this presumed separation not only fails to fit with the complainant’s sense of self (for instance, one of the case studies emphasised the fact that the assault was the third horrible thing to have happened recently), and secondly, the important, far-reaching and problematic repercussions of treating the victim in a way that emphasises the importance of the rupture. For instance, Mulla’s ethnographic data problematizes the presumed belief (held by many FNEs) in the home as a place of safety and recuperation; proper consideration of the biography of the incest victim would construct the home as a place of harm rather than safety. Likewise, other cases demonstrated the ways FNEs vilified some victims as ‘repeat customers’ or as demonstrating ‘drug-seeking behaviour’; in these cases, the FNEs focused upon the fact that the victim had been revictimised, which they understood as a result of risk-taking behaviours rather than the complex biographies that resulted in their revictimisation. Examples such as these draw attention to the extent to which the reduction to the rupture also serves to reinforce particular understandings of the victim of rape and rape itself. Mulla identifies the ways that documentary technologies reinforce normative expectations of whether someone counts as a victim/offender, and the examples further demonstrate the extent to which the legitimate victim is one who does not put themselves at unnecessary risk. In attempting to improve the potential for convictions, the forensic technologies necessarily reproduce ideologies that make it harder for women and men to achieve justice.
The reduction of the victim’s biography to the temporality of the assault is certainly one of the violences of care towards which Mulla draws attention; however, while she explicitly focuses on the temporal aspect, I felt the work spent as much time emphasising the spatial. Clearly, there is much discussion of the inter-relationship between the medical space of the Emergency Room and the juridical space of the police station, courthouse etc. and the ways that both interact in order to construct the ‘Forensic’ modality, but there is also much within the text and the case studies that represents the spatial construction of Baltimore. For instance, in the introductory chapter, Mulla recognises that her own sense of the city has altered as a response to an awareness of the hotspots for violent activity. This is later emphasised by a discussion of crime-mapping data and websites; as the author states, such medico-legal constructions of the city impact on the ways that FNEs interact with their victims. Given that much of the book engaged so richly with the spatial aspects of FNE work, it left me wondering why the temporal was given so much prominence in the introduction. I was also intrigued by her decision to use the term ‘victim’ and eventually ‘victim-patient’ rather than the more regularly used ‘survivor’ to denote the harmed party. However, as Mulla very cogently argues, the term survivor connotes the same biographical rupture that she is attacking, emphasising the extent to which a person has moved on from a particularly troublesome point in time, while the term ‘victim-patient’ instead highlights the importance of both the medical and the legal registers in forensic examination work.
Mulla’s identification of the reductionism of the victim’s biography, implicit in the forensic medical examination, as well as the implications of that reduction, is fascinating and wholly troubling; through her ethnographic observations as a victims advocate she is able to identify a deeply entrenched problem, well-disguised within the more traditional debates in this area over the primacy of the medical or the legal or the importance of professionalism and evidence-based practice. Using an ethnographically-rich approach, focusing upon the temporal and indeed the spatial, Mulla sophisticatedly expresses the violence of reductionism.
Gethin Rees is a Lecturer in Criminology at the University of Southampton. He is interested in the use of medical evidence in the criminal justice system, especially in rape and sexual assault cases, and the treatment of victims. Previously he has been funded by the United Kingdom’s Economic and Social Research Council and his current work on the medico-legal and popular narratives of the sexsomnia defence is being funded by the Socio-Legal Studies Association.