How important is DNA collection after all? A look at Sameena Mulla’s ‘Violence of Care’

Earlier this month I posted a reading list that I’ve been working on, which included Sameena Mulla’s The Violence of Care. I want to focus on one particular chapter from that book that really resonated with some other things I’ve been reading and re-watching, namely the Netflix mini-series Unbelievable and the nonfiction reporting the series was based on.

CW: this post refers to depictions and trauma of sexual violence, injury, forensic exams, and policing.

First, this book is difficult to read because of its subject matter, but as a critical text* about the medical-judicial response to victims of sexual assault it is both valuable and very accessible. Mulla’s autoethnographic approach to the topic mediates the difficult content and complex concepts effectively. Mulla is a good writer, and she balances multiple discourse levels effortlessly (for the reader). For example, she can weave difficult theoretical concepts from Jacques Derrida together with the technical jargon of medical exam forms and the anecdotal stories from nurses, victims, and cab drivers.

[* The term “critical” used in this blog refers to “analysis” and “critical thinking,” not “fault-finding.” The word “critical” and its variations — like “criticism” and “critique” — are used heavily in academic and cultural analysis discussions because the work that academics do is primarily analysis, and theorizing derived from analysis. So when I say “critical text” I don’t mean that this is a text that just bashes something. I mean this is a text that analyzes something and offers discussion with an aim of developing (new) understanding.]

Sameena Mulla is a social scientist, trained in anthropology, who studies the intersections of law, medicine, philosophy, and sexual violence, especially in the U.S. context. Her book, The Violence of Care: Rape Victims, Forensic Nurses, and Sexual Assault Intervention, was published in 2014 and makes use of her first-hand work as a volunteer rape crisis volunteer in Baltimore, Maryland. In that position, she was able to document the procedures, beliefs, reactions, stories, and feelings that take place in, and are shaped by, the sexual assault examination context. Mulla was in the waiting rooms and in the examination rooms of the City Hospital with sexual assault victims and advocating on their behalf, communicating with nurses, staff, and others while the individual navigated these processes. She was also, I assume, in the break rooms and hallways with the nurses, hospital staff, family-members, loved ones, and police personnel.

Book cover,

Through this study, we can better see how different sets of language, perspectives, institutional knowledges, motivations, and cultural narratives converge and clash in the aftermath of sexual assault to shape not just the immediate experience of a victim, but the identity-formation of a victim as a victim.

For example, in the introduction to the study, Mulla points out that police, forensic nurses, and the hospital personnel who work with them use the acronym “ASA” (“alleged sexual assault victim”) to refer to a patient who has come to the hospital to receive a forensic exam. However, as a rape crisis volunteer advocating for the patient, Mulla would avoid this term:

“The rape crisis center had cautioned us to reject this moniker; as rape crisis advocates, we did not have to qualify our clients as “allegedly” victimized. We, unlike the law enforcement personnel who saw them during the course of rape crisis intervention, were free to believe them and to aid their recovery to the best of our abilities.” (2)

This early example demonstrates a kind of struggle between law enforcement, hospital staff, nurses, patients, and crisis volunteers at the level of language to label and catalog a person according to policing and legal requirements, on one hand, or to treat a patient in distress, on the other. This language practice in the hospital inevitably influences the interactions between people: is the person a victim or not? Why might that matter? For whom might that matter? And who or what should we prioritize in this situation? What is lost or gained with the institutionalization of language in this way?

Mulla’s subsequent comment is also a good illustration of the “autoethnography” at work in the study:

“I and the other rape crisis advocates frequently wondered why nurses continued to adopt this moniker since their other patients weren’t treated as if they ‘allegedly’ had stomach pains or any other health complaints.” (2)

Here, Mulla interjects a question that is afforded by her particular perspective as a rape crisis advocate and as a cultural studies analyst: the statement comments on the language use and, rather than simply describing it as a transparent or natural term, interrogates its institutional and cultural implications from a personal perspective.

Mulla’s questions have a practical purpose: she often frames each chapter in terms of lessons for amending or transforming the practices of forensic intervention.  So her study is not simply philosophical in an abstract sense but rather aims to identify and understand problems that can be addressed, for the sake of both patients and professionals.

As I mentioned, I’d like to focus on one specific chapter for this post: Chapter 1: “The Hand of God”: DNA and Victim Subjectivity in Sexual Assault Intervention.  Especially given the popularity of forensics in the cultural imagination of the “CSI” and “true crime” media era, this chapter was particularly impactful in terms of the discrepancies between “cultural imagination” about legal, scientific, and police procedures and the realities of the U.S. justice system when it comes to sexual assault and “evidence.”

So here I’d like to simply pull some highlights from the chapter, adding minimal commentary.  I hope that it both offers some useful information and perspectives and encourages you to read more.

Mulla begins the chapter by referencing the Locard “exchange principle,” which is a kind of fundamental basis for forensics (and something I’ll post about separately later this week).  This principle establishes the protocols of examining a “crime scene.” In the case of sexual assault, however, the victim’s body becomes a crime scene. That means that nurses become forensic detectives of a crime scene:

“In a sexual assault case, the victim’s body is treated as part of the crime scene, and thus, forensic nurses must find the evidence using the right techniques and expertise” (37-38).

This already raises the potential for many different identity-, legal-, and medical-based conundrums and paradoxes for the patient and the medical treatment of the patient. What Mulla emphasizes in this chapter, however, is that both nurse examiners and patients often proceed under culturally-influenced notions of forensics rather than fact-based, empathetic, or practical considerations.

For example:

“In a 2003 interview with a forensic nurse examiner, here called “Emma,” the significance and presumed capacity of DNA identification as a magic bullet in rape investigations was conveyed through Emma’s sharing a quote from one of her favorite on-air forensic profilers from the reality television show, Forensic Files. Emma quoted this line to me, a line she often repeated to other nurses and medical personnel who were often under her proctorship during their training: ‘DNA is like the hand of God pointing down and say- ing, “It’s you!”’ This was said with a dramatic emphasis and an accompanying gesture in which Emma’s hand was transfigured: tense, strong, and pointing at a hypothetical rapist invisibly hovering before her and no longer able to hide. The gesture was arresting, especially to me, as I occupied the seat of the hypothetical called-out rapist being accused by Emma’s pointing finger.” (38)

This anecdote about the forensic nurse who quotes a true crime show to train other forensic medical staff suggests that there is an odd feedback loop between true crime media and forensic professionals working in the field and training others. It reminds me of a kind of hall of mirrors situation: which is the original? Which is real? 

Well, in this case, Mulla drops some reality via statistics that demonstrate that the so-called “DNA evidence” collected during these post-assault forensic exams isn’t really all-powerful or a magic bullet:

“Of the more than 300 evidentiary examinations she had performed in her 11 years as a forensic nurse examiner, she was subpoenaed fewer than five times, testified perhaps three times, and did not know (or remember) the outcomes of those trials. The state’s attorney did not communicate with her regularly, and though she had a very good relationship with the head of the local crime lab, she received only very intermittent follow-up. There is a wide gap between the confidence forensic nurse examiners place in the DNA evidence they collect and the reality of what happens to DNA evidence in the United States.” (38)

What’s so striking about this section is that the nurse examiner should know this information because it’s her record. And yet, rather than relying on her own professional experience as an intermediary between the hospital and the courtroom, she returns again and again to the true crime show with the catchy “God” line.

As someone who studies narrative theory, I’m reminded that humans create and choose narratives to understand their experiences, to explain their experiences, and also to avoid or manufacture experiences and identities as they see fit to best serve their emotional or material needs.

Perhaps this is an example of the nurse examiner, “Emma,” needing to believe that she is part of a justice paradigm that transcends her (unremarkable) “justice” record. Has she really “assisted justice” in these 300+ examinations? Maybe not as much as she likes to tell herself.

It also makes me wonder: if Emma looked at her work through a different lens, a different paradigm, might she need to rely on the silly “God” line from a true crime show? For example, if she prioritized other parts of her professional identity or duty, such as medical “care,” could she draw on other kinds of intimate and real exchanges with her patients as evidence that she had done her “job”?

Mulla also points out that in many (if not a majority) sexual assault cases, “DNA identification is often irrelevant” because the assailant is already known by the victim: “In these cases, the defense does not deny that sexual contact has taken place, and typically argues that sexual intercourse was not assault because it was consensual. DNA findings do very little to resolve questions of consent” (39).

Nevertheless, in all forensic examinations, the importance of DNA evidence collection tends to dominate the experience:

“For many sexual assault victims, it is the forensic nurse examiner with whom they spend the most time, and who represents their entree into the criminal justice system. Forensic nurse examiners in Baltimore, Maryland, like those across the country, expend a great deal of their energy and resources collecting evidence that will never be processed. DNA collection and wound documentation account for most of the forensic examination, an ordeal lasting a minimum of two hours for those sexual assault victims reporting to law enforcement.” (40)

And this part of the discussion reminds me of the scenes in Netflix’s Unbelievable, the drama miniseries based on the reporting by ProPublica and The Marshall Project about a particular serial rapist case in Washington and Colorado between 2008-2011. Of course, in that case, the assailant was unknown and it was crucial to the investigation to try to find any identifying information about the assailant.

Screenshot from Netflix's 'Unbelievable.' Marie sits in an exam room at a hospital with a hospital gown on. She looks both vulnerable and disconnected from her own situation at the same time.
Screenshot from Netflix’s ‘Unbelievable.’ Marie sits in an exam room at a hospital with a hospital gown on. She looks both vulnerable and disconnected from her own situation at the same time.

But what I think Mulla’s book helps me think more about is what’s happening in those scenes in terms of the victims’ identification with the investigative process, their identification as victims, and their identification as crime scenes.

In the case of Marie, for example, the 2008 victim who was a product of the foster care system in Washington and who had already experienced multiple kinds of abuse throughout her life starting at a young age, the forensic examination process is a pivotal point for her social formation.  She had recently moved into a transition program for those aging-out of the foster system and was working on establishing herself as an autonomous adult, someone with control over her life for the first time.

The scenes of Marie telling and re-telling her narrative about the assault to first a uniformed police officer, then a detective, then a nurse examiner while being prodded, swabbed, photographed, and given the morning-after pill and a list of crisis numbers to call illustrate the institutional pathways that all of these individuals are expected to walk. Marie thinks that she is doing her duty as a responsible adult, while at the same time she is infantilized by some of the professionals she encounters, and at other times she is dehumanized by the exchanges.

Is she a victim or isn’t she a victim? Is she a victim or a crime scene? Is she an autonomous adult or helpless girl? These are questions that destabilize Marie’s identity, and probably make it easier for the institutional actors and mechanisms to script her (or “interpellate” her, as Mulla frames it) according to whatever is most convenient for the legal-medical construct.

Marie is at an important crossroads in these scenes: she’s becoming an adult and a victim and also a criminal when her ex-foster mom suggests to the investigating officer that Marie might be making the story up for attention, setting in motion a tragic and infuriating spiral of events that result in Marie’s being charged with the offense of filing a “False Report.”

Mulla describes the particular identification process that occurs through the forensic exam as a kind of “embodied training” in which the patient learns what their place is in the medical-legal context:

“The forensic examination serves as another type of institutional interpellation in which its subjects, both victims and perpetrators, are interpellated into an idealized configuration of these roles. By delving into the intersection of nursing protocols and victim experiences of forensic examination, particularly those protocols and experiences linked to the pursuit and recovery of DNA, this chapter gives an account of the social, material, and representational practices that contribute to the contingent configuration of the victims’ and perpetrators’ bodies and subjectivities within forensic intervention.” (41)

This framing by Mulla really crystallized things for me: the forensic examination establishes a specific social and cultural narrative that casts the various players into specific scripted roles: the victim, the assailant, the law, the evidence, the courtroom, . . . and how could we forget about God, right? Isn’t there always the spectre of an ultimate judge lurking within the exam room, hovering over the questionnaires and medical examination forms?

But Mulla’s discussion also points to the ways that individuals slip between and through these various categories, and that some of these roles  . . . never really materialize.

Mulla summarizes her findings about priorities and roles that are established through the sexual assault intervention in terms of evidence gathering:

“If we think about a sexual assault intervention as an emergency and question the source of urgency that calls for an emergency intervention, it becomes clear that there are two objects of care: the patient herself, and the fragile organic matter that may yield DNA. The timing and resources of the sexual assault intervention are deeply invested in both stabilizing and treating the traumatized patient, and reducing the vulnerability of the organic evidence being collected. The victim is expected to facilitate this process by tolerating pain, discomfort, hunger, cold, and shame, and perhaps delaying her need to urinate or defecate. For the sustenance and preservation of perfect evidence, a victim must be willing to offer herself up to the forensic nurse examiner’s scrutiny and ministration.” (42)

In a twist, Mulla explains that Emma winds up being kind of right about DNA and the hand of God:

“Whether or not the search for these materials comes to fruition in the form of positive identification of DNA evidence, moot in cases in which the parties are known and simply dispute the consensual nature of a sexual encounter, the expectation that such evidence will be present, and can be destroyed or obfuscated, animates the victim’s experiences of assault, and the ensuing progression of intervention. In this sense, DNA proves to be the hand of God, acting through the nurse’s hand, manipulating the victim’s body and shaping the victim’s subjectivity as she is interpellated into the forensic intervention and oriented toward a particular expectation of what healing or justice may follow.” (56)

In other words, the “hand of God” is real because the forensic nurse believes the narrative. As a result, she directs the emotional and physical outcomes of the patient according to that narrative. This places a “victim” along a specific social spectrum created through a combination of popular and institutional language, true crime media, and cultural assumptions about justice.

There is so much more that is raised in this chapter and this book, and I hope to return to this text and topic in a podcast in the near future (stay tuned!). For the meantime, however, let’s turn to Meena’s closing take-aways and questions for this chapter on evidence collection:

“As forensic nurses work with sexual assault victims, they might question the lessons they impart in this work. What do victims perceive as the priorities of the sexual assault intervention? Is the emphasis on DNA-evidence collection warranted, or can we achieve a better balance of the needs of victims with the needs of the criminal investigation? Taking these dynamics into consideration, we must remember that such lessons are not inscribed through a disembodied pedagogy, but rather are etched on the “canvasses” of victims’ bodies and spirits.” (56)

[Note: I’ve linked to the book through my affiliate link, which means I will receive a small percentage of the purchase price if you buy the book through the link. Thank you for supporting this blog and public humanities projects!]

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