Political Rights
Slavery
Child
Prostitution Is Sexual Violence
Psychiatric Times October 2004 Vol. XXI Issue 12
Sexology, the study of sexuality, was built on the uncritical acceptance of
prostitution as an institution expressive of both men’s and women’s sexuality.
Alfred C. Kinsey, Sc.D., and his colleagues worked from the 1940s through the
1970s to articulate a sexuality that was graphically portrayed in magazines.
Even today, some assume that prostitution is sex. In fact, prostitution is a
last-ditch means of economic survival or “paid rape,” as one survivor described
it. Its harms are made invisible by the idea that prostitution is sex, rather
than sexual violence.
Prostitution has much in common with other kinds of violence against women.
What incest is to the family, prostitution is to the community. Prostitution is
widely socially tolerated and its consumers (commercial sex customers who are
called johns or tricks by women in prostitution) are socially
invisible.
Herman (2003) polled attendees at a trauma conference, asking how many
currently or previously treated patients who had been used in prostitution.
Three-quarters of the 600 attendees raised their hands. Describing prostitution
as hidden in plain sight, Herman noted that 30 years ago, rape, domestic
violence and incest were similarly invisible.
Prostitution Is Violent
Although clinicians are beginning to recognize the overwhelming physical
violence in prostitution, the internal ravages of prostitution have not been
well understood. Prostitution and trafficking are experiences of being hunted
down, dominated, sexually harassed and assaulted. There is a lack of awareness
among clinicians regarding the systematic methods of brainwashing,
indoctrination and physical control that are used against women in prostitution.
There has been far more clinical attention paid to sexually transmitted diseases
(STDs) among those prostituted than to their depressions, lethal suicidality,
mood disorders, anxiety disorders (including posttraumatic stress disorder)
dissociative disorders and chemical dependence.
Regardless of prostitution’s status (legal, illegal or decriminalized) or its
physical location (strip club, massage parlor, street, escort/home/hotel),
prostitution is extremely dangerous for women. Homicide is a frequent cause of
death (Potterat et al., 2004).
Prolonged and repeated trauma precedes entry into prostitution, with most
women beginning prostitution as sexually abused adolescents (Bagley and Young,
1987; Belton, 1992; Dworkin, 1997; Farley and Barkan, 1998; Silbert and Pines,
1983b, 1981; Simons and Whitbeck, 1991) (Table 1). Homelessness is frequently a precipitating
event to prostitution. Women in prostitution are frequently raped and physically
assaulted (Farley et al., 2003; Hunter, 1994; Miller, 1995; Parriott, 1994;
Silbert and Pines, 1983a).
Prostituted women are unrecognized victims of intimate partner violence by
pimps and customers (Stark and Hodgson, 2003). Pimps and customers use methods
of coercion and control like those of other batterers: minimization and denial
of physical violence, economic exploitation, social isolation, verbal abuse,
threats and intimidation, physical violence, sexual assault, and captivity
(Giobbe, 1993, 1991; Giobbe et al., 1990). The systematic violence emphasizes
the victim’s worthlessness except in her role as prostitute.
Clearly, violence is the norm for women in prostitution. Incest, sexual
harassment, verbal abuse, stalking, rape, battering and torture are points on a
continuum of violence, all of which occur regularly in prostitution. A
difference between prostitution and other types of gender violence is the
payment of money for the abuse. Yet payment of money does not erase all that we
know about sexual harassment, rape and domestic violence.
The experiences of a woman who prostituted primarily in strip clubs, but also
in massage, escort and street prostitution, are typical (Farley et al., 2003).
In strip club prostitution, she was sexually harassed and assaulted. Stripping
required her to smilingly accommodate customers’ verbal abuse. Customers grabbed
and pinched her legs, arms, breasts, buttocks and crotch, sometimes resulting in
bruises and scratches. Customers squeezed her breasts until she was in severe
pain, and they humiliated her by ejaculating on her face. Customers and pimps
physically brutalized her. She was severely bruised from beatings and frequently
had black eyes. Pimps pulled her hair as a means of control and torture. She was
repeatedly beaten on the head with closed fists, sometimes resulting in
unconsciousness. From these beatings, her eardrum was damaged, and her jaw was
dislocated and remains so many years later. She was cut with knives. She was
burned with cigarettes by customers who smoked while raping her. She was
gang-raped and she was also raped individually by at least 20 men at different
times in her life. These rapes by johns and pimps sometimes resulted in internal
bleeding.
Yet this woman described the psychological damage of prostitution as far
worse than the physical violence. She explained that prostitution “is internally
damaging. You become in your own mind what these people do and say with you”
(Farley et al., 2003).
Almost two decades earlier, Norwegian researchers noted that women in
prostitution were treated like commodities into which men masturbate, causing
immense psychological harm to the person acting as receptacle (Hoigard and
Finstad, 1986).
Posttraumatic Stress Disorder
Exposure to paid or unpaid sexual violence may result in symptoms of PTSD.
Most prostitution includes the traumatic stressors that are categorized as
DSM-IV criterion A1 of the diagnosis of PTSD (American Psychiatric
Association, 1994):
Direct personal experience of an event that involves actual or threatened
death or serious injury, or other threat to one’s personal integrity; or
witnessing an event that involves death, injury, or a threat to the physical
integrity of another person.In response to these events, the person with PTSD experiences fear and
powerlessness, oscillating between emotional numbing and emotional/physiologic
hyperarousal. Posttraumatic stress disorder is known to be especially severe
when the stressor is planned and implemented (as in war, rape, incest,
battering, torture or prostitution).In nine countries, across widely varying cultures, we found that two-thirds
of 854 women in prostitution had symptoms of PTSD (Farley et al., 2003) at a
severity that was comparable to treatment-seeking combat veterans (Weathers et
al., 1993), battered women seeking shelter (Houskamp and Foy, 1991; Kemp et
al., 1991), rape survivors (Bownes et al., 1991) and refugees from
state-organized torture (Ramsay et al., 1993).The women were interviewed in a range of contexts (Farley et al., 2003).
Interviewers from supportive local agencies accompanied the researchers, and
agency referrals were given in writing. In some countries, women and girls
were interviewed at agencies that offered services specifically to women and
girls in prostitution (Colombia, Thailand, Zambia). Elsewhere, women were
interviewed in an STD clinic (Germany, Turkey), in the street (Canada, United
States), or in brothels, strip clubs and massage parlors, as well as in the
street (Mexico, South Africa). Women often reported that they prostituted in
both indoor and outdoor locations.The intensity of trauma-related symptoms was related to the intensity of
involvement in prostitution. Women who serviced more customers in prostitution
reported more severe physical symptoms (Vanwesenbeeck, 1994). The longer women
were in prostitution, the more STDs they were likely to have experienced
(Parriott, 1994).It is a cruel lie to suggest that decriminalization or legalization will
protect anyone in prostitution. It is not possible to protect someone whose
source of income exposes them to the likelihood of being raped on average once
a week (Hunter, 1994). One woman explained that prostitution is “like domestic
violence taken to the extreme” (Leone, 2001). Another woman said, “What is
rape for others, is normal for us” (Farley et al., in press).Much of the literature has viewed prostitution as a vocational choice. Yet
the notion that prostitution is work tends to make its harm invisible.
Prostitution is institutionalized and mainstreamed when it is considered to be
unpleasant but legitimate “sex work.” Even organizations such as the World
Health Organization and Amnesty International USA have made the policy error
of defining prostitution as a job rather than as human rights abuse.The solutions are complex. Organizations offering assistance to prostitutes
must be queried about whether they offer not only condoms and unions, but also
options for escape such as housing and job training. It is essential to
abolish not only prostitution, but its root causes as well: sex inequality,
racism and colonialism, poverty, prostitution tourism, and economic
development that destroys traditional ways of living.Despite the illogical attempt of some to distinguish prostitution from
trafficking, trafficking is simply the global form of prostitution. Sex
trafficking may occur within or across international borders, thus women may
be either domestically or internationally trafficked or both. Young women are
trafficked–taken and sold for sexual use–from the countryside to the city,
from one part of town to another, and across international borders to wherever
there are customers.It is a clinical and a statistical error to assume that most women in
prostitution have consented. Instead of the question, “Did she voluntarily
consent to prostitution?” the more relevant question would be, “Did she have
real alternatives to prostitution for survival?” The incidence of homelessness
(75%) among our respondents and their desire to get out of prostitution (89%)
reflect their lack of options for escape (Farley et al., 2003).Until it is understood that prostitution and trafficking can appear
voluntary but are not really free choices made from a range of options, it
will be difficult to garner adequate support to assist those who wish to
escape but have no other economic choices. The conditions that make genuine
consent possible are absent from prostitution: physical safety, equal power
with customers and real alternatives (Hernandez, 2001; MacKinnon, 1993).Just as clinicians now screen for physical and sexual abuse and substance
abuse history, prostitution history should be addressed at intake. It should
be re-addressed after a therapeutic relationship is established, since an
initial denial of prostitution is not unusual (Schwartz, 2000). The questions
“Have you ever exchanged sex for money, drugs, housing, food or clothes?” and
“Have you ever worked in the sex industry: for example, dancing, escort,
massage, prostitution, pornography or phone sex?” are routine in our intake
inquiry. We also recommend asking the question, “Have you ever had sex of any
kind with a professional sex worker [call girl, escort, massage parlor worker
or prostitute]?”In addition to acute and chronic PTSD, comorbid diagnoses may include
generalized anxiety disorder, mood disorders (including depressive and bipolar
disorders), acute suicidality, substance abuse and dependence, personality
disorders, dissociative disorders, and symptoms of traumatic brain injury.
Although special clinics and shelters for women escaping prostitution are
recommended, at this time, services are sometimes accessed at rape crisis
centers, public health agencies, substance abuse treatment clinics, shelters
for battered women and community mental health clinics.Conclusion
Certainly there is an urgent need to address the mental health needs of
women during prostitution and after escape. However, it is equally important
to address men’s demand for prostitution. Acceptance of prostitution is one of
a cluster of harmful attitudes that encourage and justify violence against
women. Violent behaviors against women have been associated with attitudes
that promote men’s beliefs that they are entitled to sexual access to women,
that they are superior to women and that they are licensed as sexual
aggressors (White and Koss, 1993). Customers of prostitutes strongly endorse
these attitudes toward women.Although a statistical minority, the college-aged customers of prostitutes
we surveyed were significantly different from the other young men (Table 2). Those college students who had purchased
women in prostitution were more accepting of prostitution myths and rape myths
than the other students. Chillingly, the college-aged customers of prostitutes
differed from the other students not only in their attitudes but in their
actual behaviors toward women. They acknowledged having perpetrated more
sexually coercive acts with their partners than the other men in the
survey.Those of us concerned with human rights must address the social
invisibility of prostitution, the massive denial regarding its harms, its
normalization as an inevitable social evil, and the failure to educate
students of psychiatry, psychology and public health. Prostitution and
trafficking can only exist in an atmosphere of public, professional and
academic indifference.Dr. Farley is a research and clinical psychologist who has been in
practice for 35 years. She edited the book Prostitution, Trafficking, and
Traumatic Stress, and has authored 24 other publications.References
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