Victimless Prostitution? Think Psychiatric Victims

She was 38 and attractive, by any measure, but she was manic. Sleeping was a problem, despite some pretty high doses of prescription drugs.  She was open about her past; surprisingly.  She had been recently dismissed from her eleventh hospitalization.  She was 10 days out, and would have been living on the street if the county had not sprung for accommodations in a less than glamorous motel.  She had not a penny to her name.  She was in the area where I was only because she had once had some friends there.  Now all her friends were either gone or dead.

Her teeth were mostly missing.  I did not ask her to remove her ill-fitting wig, for I wanted her to keep whatever pride she had been able to preserve.Her face was worn, but her cheekbones proud and high.

She had not expected a female physician.  She said she always got tired old men with white beards.  She said I was too attractive to be a psychiatrist.  That I probably could have done well in her profession, had I dared too.  I thanked her for what I took as an amazing compliment; what else could I do?

Her clothes were over-sized discards from a pool at the hospital.  She talked fast as was not much on topic, as one would expect from a manic.  I did my best to take a medical history.

She had been the child of a prostitute.  It was not too surprisingthat she did not have a clue who her father was.   She said that her mother had “given” her to a man to obtain drugs when she was age 12. Her rape by this man was not something I wanted to push her to describe.  She told me only that she had required a surgical repair, that took 28 stitches.  The “repair” could not repair her ability to have children, something that she said had been emotionally as well as physically painful.  Now she rattled off her story like an automaton. I had assisted a little gynecological surgery in the course of my training.  It was nowhere near enough for me to begin to imagine the kind of injury she was describing.

She had intrusive thoughts of that event, and avoided, as best she could, everything that could possibly remind her of it.  And she was high-strung, telling me that she jumped in the air with any kind of a noise that could surprise her.

It was easy to confirm the diagnosis of post traumatic stress disorder.  This is the same thing that veterans bring back from combat experience, at least the ones for whom life does not seem as it will ever be the same again.  She wasted no time in telling me she had worse traumas,physical ones.    I had noticed her limping into the office, but it seemed slight.  She told me that she was not only in constant pain, but had a number of surgeries.  All of her medical difficulties were the results of beatings by pimps. She could not count how many.  She said many things were still broken, and could never be fixed.  In her left leg and ankle, she said there were more screws and nails than she could count, and three plates. In her right wrist, some smaller rods and some nails.  She went on to show me that she had plenty of old fractures that had ot healedcorrectly.  Her right collarbone, for example. Her left shoulder.  She rattled them off faster than I could write.  She had told this before. All these injuries, she told me, were from beatings from various pimps.  She still had thoughts of them, had tried to avoid the places or streets where they had happened, let alone the people.  And she was high-strung.  I did not plan the train sound that startled her beyond description. More post traumatic stress disorder. The surgeries she described were complex.  There were over thirty. All at the same large, famous, Los Angeles teaching hospital.  It occurred to me that given the incredibly long period this woman had lived “on the street,” from age 12  through age 38 we were talking 26 years.  Among other things, this woman had clearly served as a teaching case for many generations of orthopedic residents.Maybe neurology residents, too, but no neurosurgeons.  She had a lot of losses of consciousness and a lot of seizures, which the county had already gotten her a couple of medicines for, from elsewhere.  Maybe observation by some neuro traumatologists, but nobody had been inside her skull.  She insisted all her cat scans and MRIs (she had been through the change in technologies) had been normal.

Her brain was not normal.  She had someone drive her to the clinic, so she knew the date.  She had a lot of trouble with what we call a “mental status exam.”  She couldn’t add or subtract much in her head; She couldn’ think of the capital of the state of California (Sacramento) or of the United States.  I named three objects and she could not remember any of them after five minutes, something normal folks do easily.
I have to admit I was a little surprised she mentioned the Bible to me.  Like a lot of people who have been involved in illegal and/or “sinful” activities, she saw her life in black and white.  She was either good or bad.  She had been bad and wanted to be good. I only know one place in the Bible where this sort of thing is discussed; in Deuteronomy there is 21:10-14, about the treatment of “captive” women.

This passage was quoted and studied by medieval Jewish commentators. Known as the “pretty woman” law, it has been credited evidence that “taking” a woman captive, as part of the spoils of war, meant either marrying her or dishonoring her..Imuset has been interpreted as meaning something about “rape” being an act of not sex but of violence.

I told her that she could find solace anywhere she wanted, and religion had comforted many.  I told her that forgiveness had to be essence of the situation.  That I had seen people who had turned their lives around from some very serious situations.  I was not the expert on the financial concerns, or the education she wanted.  She told me
her goal was to somehow teach or counsel and tell people that the life of prostitution was the most horrible life in the world, but that it is possible to get out of it, but even easier to avoid it, if people only knew.  She had the spirit.  I would come up with a therapist for her horrible post traumatic stress disorder, the incredible amounts of medication she needed to sleep, according to her hospital discharge summary and the bottles in her trembling hands. Maybe her suffering WAS of Biblical proportions. I tried to remember positive things I had been told about the “world’s oldest profession.”

A one time friend and associate was, and still is, a therapist with a period of time spent as a sex-worker in her past.  She believed that treating the “sex industry” as something legitimate would help people get better, and even had a compendium of first person stories about prostitutes on the net.  It now seems to have disappeared. I remember some kind of work to determine the rights of prostitutes, to somehow unionize them.  Now all that is pretty much distilled into an archive on women’s history–at Harvard, of all the delightful places.  But this still a fantasy for many, I think.  I remember when the movie “Pretty Woman” came out, some young girls seemed to believe that being a prostitute was somehow one way to get to the fairy tale ending.  This disturbed a lot of people.

The Mayflower Madam served only to reinforce the dream with an idea of wealth, exclusivity, and glamour.  Sidney Biddle Barrows by name, she has since emerged as quite an able businesswoman. Of course I turned to the fields of psychology and psychiatry and such, where the overwhelming lack of useful information about the women whom, by either coercion or chose choose this life; is overwhelmingly amazing.

The study of prostitution seems to have been at its height when psychoanalysis was in bloom.  I can’t even link you to page 768 of the December 1, 1945 issue of the British Medical Journal that features a review of a pamphlet,

“Psychology of the Prostitute,”  Basically, Dr. Edward Glover,”one of the foremost exponents in this country of Freudian psychology,” gave a lecture where he explained that prostitution is a “two sided” problem involving psychopathology in both prostitutes and their customers, both of whom were obviously fixated at less than normal adult sexual development.  The section Medicine: Psychology and Prostitution of Time Magazine–Monday, March 3rd 1958-is on line.

Manhattan Psychoanalyst Harold Greenwald; came out with a book called “The Call Girl;”  which dealt with the elite upper crust precursors of Mayflower Madam’s group, several of whom were his own analysands.  He found that for the most part they had miserable childhoods, deep insecurities, and increased self worth from the fact that people thought they were worth paying for.  Some were frigid.  Some needed debasement to reach orgasm.  They could and did move on to marriage and to other professions.  Still, an elite crew. I believe that the attempts to glamorize prostitution in any way shape or form are doomed to fail, because of the horrible, demeaning, inhuman reality of that situation.

I finally realized that the reason I had not seen anyone like the experienced prostitute I describe here earlier in my career, was simply that they do not usually live that long. I had pretty much convinced myself by this time that the prostitutes of Los Angeles (and other large cities, I expect) did such a good job of passing under the radar that most academic and public institutions could not count them, let alone describe them.  The internet is as close as we can get to an institutionalized anarchy open to all, so I was able to find a little more information on a few amazing websites. Founded by Dr. Melissa Farley, a research and clinical psychologist, this is a very “academic” site, with lots of information as well as ongoing research projects.  Dr. Farley, who founded the site in 1995, is to be congratulated; this is a professional woman seriously committed to social change, who has said and done a lot to improve women’s rights.  No “Pretty Woman” stuff here. The one page to hit, if there is time for no others, is the fact sheet.  

If anyone is not yet convinced that all the movies and books that give women the idea that the “fairy tale” road through prostitution is wrong, this cutting narrative has the ring of truth that nobody, but my dear patient, has ever given me squarely. But an academician, even a practical-minded one, can not be expected to express the personal toll on the women who go through this.

The most powerful expressions I found of the actions involved with this “profession,” from the psychological description of what this interaction is like for both women and the men who “buy” them, is something I found at a site with the unlikely name of “menstrual poetry.”

Basically, the thesis here is that male-female relationships are so complex that men are supposed to somehow reciprocate when wives “give” them sex, and the simple financial transaction associated with prostitution.  Surprisingly, the discussion and the other articles on the site were a literate discussion of something rarely discussed in a literate manner on the internet; sex and sexuality, from a feminist point of view.

Prostitution is indeed not only the “oldest profession,” but it may predate the evolution of man.  There is an amazing story that has surfaced in a few academic studies, about a Yale study where Capuchin monkeys were made to use a token economy in various ways.   One of the first things they did was use the tokens, which they were supposed to use for food, for sexual favors.

It has even been suggested that all simian “grooming” behaviors,  well-studied indicator of social position in any simian group I ever heard about in research, are in effect currency of a monkey-sort to obtain sexual favors. But something being old does not make it right. I remember years ago, in an undergraduate college sociology course about criminology, prostitution was categorized as a victimless crime. It isn’t.  In the kind where the woman is the commodity, there is no doubt in my mind that the woman is the victim. I will do I know how to do to help my patient.  I am about things like ethics and hope and doing the right thing.   I strongly suggest this list of organizations that help prostitutes leave prostitution.

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