In the late 1990s, when I was both a new anthropology graduate student and an experienced gynecological nurse practitioner, I underwent a week of intensive training to become a Sexual Assault Nurse Examiner, or SANE. On our first day, we were asked to share our reasons for being there and, though the details of the other participants’ stories have since escaped me, I recall being the only one in the room to connect my interest in being a SANE with my commitment to feminist health care, i.e., care rooted in the recognition of a patriarchal social order that registers its bodily impacts along gendered lines.
Though surprising at the time, the ill-fit between (my) feminism and the discipline of forensic nursing resonates all too well with the situation described by Sameena Mulla in her important new book The Violence of Care. Indeed, the absence of feminism from these nurses’ respective worldviews, though not explicitly noted by Mulla, is evident throughout the text, depicted across a variety of verbal and behavioral exchanges through which rape victims are rendered other by the nurses charged with their care. One of the more glaring examples involves the behavioral insistence, on the part of some nurses, on keeping sexual assault victims formally draped, even when victims themselves attempt to shift their drape sheet and gaze back at the nurse conducting the exam. Having performed pelvic exams on thousands of women, I found this to be both disturbing and strange, as my practice was to always adjust the drape sheet in a way that allowed my patient and I to look at one another.
My manipulation of the drape sheet, rather than an idiosyncratic innovation, was attached to a host of practices and patient orientations derived from the 1960s-70s era women’s health movement (WHM) in the United States. Many of the practices associated with the WHM, e.g., clinicians asking permission from, or narrating their exams to, patients (“I’m touching your leg now,” “Okay if we go ahead with the speculum”?), are so commonsensical in contemporary gynecology that it was surprising to read about nurses dispensing with one so central to feminist health care. This made me curious about how the nurses themselves understood this act, one that Mulla rightly describes as distancing.
One clue can be found in Mulla’s astute analysis of the feminized nature of nursing, and of forensics as a mode via which some nurses have pursued greater institutional authority. Though made up almost entirely of women, the profession has largely avoided examining itself with the tools of feminist analysis. It is also true that the WHM’s reach did not fully extend to nurses; physicians, and the unquestioned power they wielded over women’s bodies, were the targets of activists’ initial interventions. This awkward relationship—between nursing, feminism, and feminized labor—makes the authority with which forensic nurses are currently invested situational rather than durable. It also indexes how nurses have adapted to shifting gender roles, both in and outside of health care settings.
Indeed, and as Mulla demonstrates throughout the book, forensic nurses hover between a myriad of binarized spaces, including gender roles (masculine vs. feminine), the type of care they deliver (medical vs. nursing), its location (emergency room vs. bedside) and aims (legal vs. therapeutic), and their relationship to physicians (autonomous vs. subservient). Moreover, their propensity to identify with victims as nurses rather than women (p. 79) suggests an inability to relate to victims via a mode of solidarity rather than hierarchical authority or medical distance. In sum, The Violence of Care raises a novel and intriguing set of questions about the relationship between forensic nursing and the feminist movement(s) responsible for putting sexual assault on the institutional map.
Mulla expresses concern that forensic nurses “relinquish their role as care providers” in their quest to secure evidence-based rape convictions and that, in doing so, they “lose out on an important opportunity to reframe sexual violence as a gendered health-related issue” (p. 226). And though I too worry about the relative lack of gender analysis within and around the forensic encounters she describes, Mulla and I may disagree regarding nurse’s relative capacities to generate this institutional shift. The standard curricula for two- and four-year degree programs leave little room for nursing students to learn about feminist thought or gender analysis, a set of skills that require their own cultivation. Trained to work in a system through which care is distributed in profoundly uneven ways, nurses often survive as professionals by adapting to rather than challenging this order. But even these realities do not fix nursing as any one kind of institutional actor—nurses’ heterogeneous backgrounds predispose them to any number of social projects, including those of healing and justice that Mulla invokes. The complicated “care” administered via contemporary modes of sexual assault intervention may rely on nursing’s complicity with state projects that cast gendered violence as exception rather than rule. But it may also depend on the still undeveloped relationship between nursing and feminism, a project around which more gender theorists and medical anthropologists may wish to converge.
Moreover, Mulla worries that forensic nurses exchange “the kindness” (p. 214) with which patients associate them for a “cool affect” (p. 227) and techno-scientific expertise, a formulation that may limit our definitions of both nurse and care. In feminist-informed abortion clinics in the US, for example, counselors act as patient advocates, physicians expertly perform a procedure, and nurses attend to the entire process, being both kind and technically proficient. I wonder if there is room in Mulla’s analysis for a more distributed model of care, one that can include the specialized and technical skills of a clinician, working in tandem with other affective laborers to remedy, or at least ameliorate, an urgent (medical) situation. Mulla’s book makes it eminently clear that “’warm and fuzzy’” (p. 212) care has a place in sexual assault interventions. I suggest that we use this insight to carefully delineate what we mean by, and whose job it is to administer, such care.
Christine Labuski is an anthropologist and an assistant professor of Women’s and Gender Studies at Virginia Tech, where she also directs the Gender, Bodies & Technology initiative. Her book, It Hurts Down There: The Bodily Imaginaries of Female Genital Pain, is forthcoming from SUNY Press.