In Memory of Lynn Wasnak

April is Sexual Assault Awareness Month

In Memory of Lynn Wasnak
(AKA: Lynn Iverne Koehler - Wasnak)

1945 - May 14, 2013

Lynn Wasnak (AKA: Lynn W.) has been a pioneer in self-help / anti-rape movement since 1989.  After a group called Speaking For Ourselves closed (which was the first newsletter for individuals with dissociative disorders) –– Lynn Wasnak picked up where they left off and she founded  the organization "Many Voices", which offers a bi-monthly newsletter, information and resources for survivors with dissociative disorders.

Lynn was a phenomenal writer and author of several books on dissociation.  Her books include "Mending Ourselves: expressions of healing & self-integration" and "Multiple Personality Disorder from the Inside Out".  

Lynn has been a loved and cherished friend to many for over a quarter of a century.

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“Lynn Wasnak died May 14, 2013 in her home in Cincinnati.” Lynn would have approved of that factual lead, believing it was better to come out and write what you mean rather than dance around a subject or doll it up. The problem is, that those who are her friends know that Lynn left a legacy that is truly alive, and will be as long as those who need her wisdom and help choose it to be, as long as there is a community of survivors willing to share.

The last few decades of Lynn’s life were focused on the organization for which she became executive director (and every other title at Many Voices Press). Certainly she continued her successful freelance writing career, but even the money earned from that went to subsidize her advocacy for those who suffer from abuse and trauma. At one point she decided to master the complicated world of nonprofits, and struggled to keep the organization financially afloat by using her own funds and those of special friends. A post office box full of reader submissions, and email overflowing with expressions of thanks and a need for information kept her going because it was confirmation that her efforts were needed.

Later, when Lynn was stunned to discover she had stage four breast cancer, she fought harder and more self-sacrificingly than anyone should be asked to do. But, she did so because Lynn really was the embodiment of “many voices.” When a friend commented that she couldn’t understand why Lynn fought so hard to live when she was suffering so much, daughter Diane had the answer: “She was unselfish.” 

Lynn was a voice for living life with passion. She was a voice for the oppressed and suffering. She was an advocate for Alzheimer’s research after losing both her mother and sister to the disease. (Following her mother’s death, Diane was determined to navigate a complicated research donor process to honor Lynn’s desire to have her brain donated to Alzheimer’s research.)

While she was in the throes of a particularly difficult physical and mental period, Lynn amazed everyone by taking on the cause of a senior center that was closing in her area. (This was an organization she had no connection with previously.) She was tireless in her giving.

Lynn’s voices – all of them— resonated with both brilliance and passion. She tackled each challenge armed with reams of research and documentation. What must her oncologist have thought when she would arrive at each appointment armed with the latest studies and knowledge of all the intricacies of what she was experiencing! 

Now Lynn’s voice has been silenced by a body that simply could not keep up with her mind and her epic efforts. That is where the rest of the world must take up the songs she sung so eloquently and the debates she fought so well. While there will be no more newsletters, books or postings from this prolific writer, the issue of dissociative disorders and abuse remains. The suffering remains. Lynn was a conduit for disseminating information from those who survived abuse. It was her wish that someone would continue that role; but even without it, each and every one of those she touched can keep Lynn’s voice for healing alive. ManyVoicesPress.com will remain online. We hope you will write and create and share through this and the Many Voices Press Facebook page. The greatest gift to Lynn would be to know that she created a community that is united and able to sustain itself. 

Even if you are not comfortable posting anything, please visit these pages periodically to read messages from others and to see if Many Voices Press has found a new conduit leader. It’s the most meaningful way to honor the voice she used for so many so passionately. 

A special note: Lynn died without a will, believing her body would be disposed of after her brain was removed. Unfortunately, the way things work is that the body of the deceased research victim is returned to the family. Diane, who is struggling with the loss of her mother and financial shortages herself, asks anyone who would like to contribute to these arrangements to please send a check to her at Many Voices Press, Many Voices, PO Box 2639, Cincinnati Oh 45201

Dissociative Disorders in Women: Long-Term Consequences of Violence Against Children

Dissociative Disorders in Women:
Long-Term Consequences of Violence Against Children

By KAREN HOPENWASSER, MD 


Dissociative disorders, diagnosed as much as nine times more frequently in women than men, are poorly under- stood. The mosaic symptomatology often leads to misdiagnosis or incom- plete assessment. Despite substantial research indicating the probable etiol- ogy as severe childhood abuse, many clinicians do not recognize the rela- tionship between violence and dissoci- ation. An emerging body of research indicates that post-traumatic memory can be distinguished neurobiologically from other forms of memory. While clinical research has given us tools for evaluating dissociative symptoms, neurobiological research is clarifying the relationship between brain devel- opment in children and adult dissocia- tive symptoms. Once the diagnosis is made, many patients report feeling understood for the first time in their lives. This allows for stronger thera- peutic alliances and the use of com- plex treatment techniques to manage pain and increase a sense of safety. 

Everyday physicians examine women who have experienced violence as an ordinary occurrence. The awareness that they have been physically beaten and/or sexually abused is silenced in some women by unbearable shame, while for others, the context of violence within the family camouflages their awareness altogether. As children these women used methods of coping that allowed them to manage the pain, maintain emotional connec- tions, and survive into adulthood, albeit with multiple physical and psychological problems. Few physicians have been trained to recognize the long-term conse- quences of early childhood abuse and Dr. Hopenwasser is a clinical assistant professor of psychiatry at Cornell University Medical College and is in practice in New York City. 

dissociative disorders, in particular. While the dissociative disorders are weighted with great controversy, this controversy has propelled much-needed research and scientific interest.

The concept of dissociation put forth within the medical community dates back to the late 19th century with the work of Jean-Martin Charcot and Pierre Janet.1 These Salpêtrière physicians had a major influence on Sigmund Freud, who more fully developed the concept of hysteria.2 As psychoanalytic thinking moved from a trauma theory of dissocia- tion to a seduction theory of hysteria, interest in dissociation faded. Although clinicians recognized the phenomenon of “battle fatigue”3 in soldiers during both World Wars, a renewed interest in disso- ciation did not emerge until the late 20th century. Currently, dissociation is recog- nized as a neurophysiological phenome- non that develops in response to envi- ronmental influences and manifests itself in distinct physical and psychological symptoms. Recent research on the neu- robiology of post-traumatic stress disor- der (PTSD) and dissociation4-8 has sup- ported the distinct categorization of dissociative disorders and chronic post- traumatic states. We are becoming increasingly aware that extreme stress, particularly in the form of interpersonal mistreatment, has a profound psycho- physiological impact on the developing child. As we understand more about these consequences, we need to reevaluate some fundamental theories about the structure of the mind, the phenomenology of psychiatric diagnosis, and the impact of environment on brain development after birth. 


Dissociation, though, remains an elu- sive concept. Frank Putnam defines it as:

a process that produces a discernible alteration in a person’s thoughts, feel- ings, or actions so that for a period of time certain information is not associated or integrated with other information as it normally or logically would be.9 

Bessel van der Kolk, et al subdivide dissociation into three categories: primary, secondary, and tertiary.10 Primary refers to sensory and emotional elements dur- ing a traumatic experience that may not be integrated into memory. Secondary refers to the separation of the experienc- ing and observing self, such as the feeling of floating above oneself and observing from a distance. Tertiary refers to the development of distinct identity states, characterized by particular thoughts, feel- ings, and behaviors. This tertiary form— the dissociative disorders—is the main subject of this paper. 


Dissociation will be seen in primary care practice as a symptom of other major psychiatric illness, such as major depressive disorder, bipolar disorders, and substance abuse or withdrawal; as a psychological defense; as a psychiatric ill- ness; and, at times, as a nonpathological experience, including its manifestation in certain non-Western rituals. It will also be seen in a variety of medical condi- tions, such as toxic reactions to chemi- cals, medication reactions, and metabolic disturbances. As a symptom of illness, there is no evidence of a sex difference in prevalence. As a Diagnostic and Statistical Manual (DSM-IV) diagnostic category, however, dissociative identity disorder (DID), formerly multiple personality dis- order, is diagnosed three to nine times more often in women.9,11,12


The dissociative disorders masquerade as a variety of illnesses and somatic disor- ders. A 1991 literature review found an average of seven years between a patient’s entry into treatment and a diagnosis of DID, and that each patient accumulated an average of three to four different diag- noses along the way. The author con- cluded that “clinicians’ general lack of familiarity, . . . skepticism, and low indices of suspicion play important roles in their failure to make the diagnosis in a timely manner.”13 The development of such research-based instruments as the Structured Clinical Interview for Dissociative Disorders,14 the Dissociative Disorders Interview Schedule,12 and the Dissociative Experiences Scale15,16 helps clinicians to make the diagnosis more quickly. 

With increased recognition of dissocia- tive disorders, clinicians find that patients feel better understood, sometimes for the first time in their lives. This enhances the sense of trust vital to the therapeutic relationship and increases the sense of safety essential for healing. 

Despite some methodological limita- tions, studies on long-term outcome indicate that symptoms and the cost of treatment are both reduced when patients are correctly diagnosed with DID.17,18 Ellason and Ross looked at 54 inpatients with DID over two years and found that with treatment, both Dissociative Expe- riences Scale and Dissociative Disorders Interview Scale scores decreased signifi- cantly, and other symptoms improved.17 The purpose of this review is to help clinicians understand the dissociative disorders in both individual and larger social contexts. The relationship between dissociation as a psychological defense and as a psychiatric illness affords us insight into what can be called a post- Cartesian neurophilosophy of mind/ body unity.19,20 This shift from dualism, the separation of physical and mental, to an appreciation of the material compo- nents of consciousness, helps us to understand dissociative disorders. The nexus of symptom presentation will begin to make sense as we understand the neurophysiology of consciousness and the developmental integration of physical and psychological self. 



Relationship Between Dissociation and Violence The dissociative disorders are:

a psychobiological response to a relatively specific set of experiences occurring within a circumscribed developmental window . . . the most compelling and clinically useful model [of the genesis of DID] is based on evidence that repeated childhood trauma enhances normative dissocia- tive capacities, which in turn provide the basis for the creation and elabora- tion of alter personality states over time.21 

Repeated childhood trauma can occur within the context of such large scale social violence as the holocaust or war, or within the individual family. The overwhelming majority of US women who suffer from chronic dissociative disorders were victims of childhood physical, emotional, and/or sexual abuse starting between the ages of 2 and 12 years old.22-25 This abuse includes the repetitive exposure to violence against a parent or sibling as well as that experi- enced directly. 

A recent epidemiological study in Ontario, Canada of nearly 10,000 resi- dents age 15 and older found that 31.2% of men and 21.1% of women reported a history of childhood physical abuse. Childhood sexual abuse was reported by 12.8% of women and 4.3% of men. Severe physical abuse (based on the Child Maltreatment History Self-Report) was reported nearly equally by men and women (about 10%), while nearly three times as many women as men reported severe sexual abuse (11.1% versus 3.9%).26 These findings support the national consensus that domestic violence against children is common, and that severe sexual abuse is more common in girls than boys and has a prevalence of more than 10%. 

While not all abused children develop dissociative disorders, studies have shown a high rate of dissociative disorders in women who identify themselves as sur- vivors of sexual abuse.24,27-29 One study of 98 female psychiatric inpatients found that 83% had dissociative symptom scores above what would be considered median for normal adults, and those with a history of childhood sexual abuse had the highest dissociative experience scale scores. In addition, a history of childhood sexual abuse seemed to double the risk of concurrent physical and sexual abuse in adult life.24 

Some clinicians have speculated that men with DID are found more often in the criminal justice system than the men- tal health system.21,30 An example can be found in the work of James Gilligan, a forensic psychiatrist, who noted case after case of severe early childhood maltreat- ment among male murderers in prison.31 In a review of records of 11 men and one woman who had committed murder, clinical researchers were able to establish a link between early severe abuse and DID. They were able to rule out malin- gering, while the evidence of early abuse was based upon corroborating informa- tion from family members, neighbors, court and hospital records. Most of the subjects had at least partial amnesia for the abuse.32 

Neurobiology of Dissociation
When abused children grow up, they often have fragmented memories of their childhood experience of violence. While physicians are aware that domestic violence is a nationwide “serious public health problem,”33 adults with inconsis- tent recall are often greeted with skepti- cism. A number of studies of “normal” college students and untraumatized children have demonstrated that children are suggestible, and that memory is unreliable.34,35 These studies have been used in a media campaign that has created excessive doubt in the minds of both clinicians and patients. 
  
The encoding of memories of trauma is subject to stress hormone influences that are different from those of nontrau- matic memory. Neurobiological research, as opposed to laboratory cognitive psy- chological research, has demonstrated that intense overstimulation of the amyg- dala (as a result of a terrifying stimulus) interferes with hippocampal function. As a result, registration of sensorimotor per- ception may occur without symbolic or semantic coding.36 The increased firing of hypothlamic-cortical pathways under stress may lead to increased facilitation of long-term memory. This could account for the eidetic (photographic) nature of flashbacks. Overstimulation may also lead to decreased sensitivity of receptors, leading to decreased registration, consoli- dation, and integration of memory. This accounts for both the “black holes”37 of dissociation as well as errors of recall. 

In a study looking at brain activity during flashbacks, positron emission tomography showed increased activity in right limbic, paralimbic areas and visual cortex, while activity was remarkably decreased in left inferior frontal (Broca’s area) and medial temporal cortex, the brain areas necessary for one to find words to describe these experiences.38 In addition, neuroendocrinological alter- ations lead to a failure in the develop- ment of a conventional linear sense of time. Instead of steady forward move- ment there are gaps in continuity.39 Fail- ure to experience time in a linear fashion can lead to a blurring together of memo- ries, not unlike what would happen if several transparencies were projected on top of one another.40 We would not be able to distinguish one from the other. Thus, the phenomenon of delayed recall will not be understood without further research in the neurobiology of traumatic stress and dissociative adaptation. 

While research is clarifying the mecha- nisms of PTSD, much less is understood specifically about the neurophysiology of dissociation. The thalamus plays a crucial role in dissociative states, serving as a sensory gate to modulate information between brain stem, cortex, amygdala, and hippocampus.41 One current theory of the biological basis of conscious awareness is that it is dependent on oscil- lating connections between the thalamus and cortex.42 The organization of con- sciousness is dependent on integrated corticocortical function. Certain drugs that produce dissociation interfere with cortical integration. Much laboratory research is now focused on various neuro- transmitters, including the excitatory transmitter glutamate and the NMDA (N-methyl-D-aspartate) receptor. There is hope that the study of these transmit- ters and receptors will someday give us insight into the pharmacologic manage- ment of severe dissociative states.41 



Clinical Picture of Dissociative Disorders
The DSM-IV divides dissociative disorders into five diagnostic categories: dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder, and dissociative disorder not otherwise specified (DDNOS). DDNOS includes many women who were severely abused as children but have not devel- oped distinct “alter” identities. The tran- sition from the old concept of multiple personality disorder to DID represents an attempt at conceptual advancement. Alter identities are not personalities at all, but could be thought of as uninte- grated or partially integrated pathways of neural networks regulated by neurotrans- mitters and neurohormones.40 As chroni- cally traumatized children mature, they may fail to integrate affectively charged memory with cognitive functioning, and as a result, dissociated alter states (or what Putnam calls “discrete behavioral states”)39 may emerge. This accounts for the classic symptom of “lost time” or memory lapses. In other words, DID is a disorder of consciousness and identity integration over time.40 One of the major tasks of psychotherapeutic treatment is the development of an integrated, sub- jective sense of past and present so as to distinguish between then and now. 

It is my belief that this failure to dis- tinguish between past and present is probably responsible for some of the range of psychiatric symptoms we see in dissociative patients, such as panic attacks, phobias, cycling mood changes, suicidal depression, paranoia, and even attention deficit type symptoms. The physical manifestation of this failure is seen in flashback states and somatic memory. Both somatic memory and somatic symptoms bring these patients into the primary care physician’s office. 

The multitude of symptoms associated with these disorders often leads to confusion about diagnosis. Many symptoms play together to create a unique picture, while individual symptoms overlap with those of other diagnoses: panic disorder, rapid cycling mood disorders, PTSD, and eating disorders.12 There is also a certain amount of co-morbidity, particularly with chemical dependency prob- lems, borderline personality disorder, PTSD, and mood disorders.28,43 Confu- sion between the Axis II diagnosis borderline personality disorder and Axis I diagnosis dissociative disorder is striking. The two can certainly coexist, while at times one is misdiagnosed for the other. Research on borderline personality disorder has shown an impressive correlation with early childhood abuse,44-46 and diagnostic criteria (identity disturbance, poor impulse control, self-mutilation) clearly overlap. One prospective study found that 38.6% of 44 children diagnosed with borderline personality disorder had abuse histories, compared to only 9% of 100 controls with a range of other diagnoses.45 

Failure to recognize or appreciate a history of severe early trauma can hinder understanding of such extreme behaviors as self-mutilation, which is often a pain management technique used in the ser- vice of emotional survival rather than of self-destruction.47 When done in a state of post-traumatic numbness it can be particularly alienating for the helping professional to watch. Both clinician and patient are caught in the eddy of forgetting the function of this behavior. 

Dissociative Disorders in Medical Practice
Women with dissociative disorders fre- quently report somatic complaints;12,48-50 the list is lengthy, with headache, body pain, gastrointestinal and gynecological complaints particularly common. Miller found significant variability in visual functioning, with measurable changes in refraction between alter states in two studies comparing DID patients with simulated controls.51,52 Electromyographic studies indicate there may be marked changes in muscle tension as switches among conscious states are made.53 One recent example encountered personally was a woman who developed blisters on her feet wearing shoes that were already broken in and previously quite comfort- able. A switch into another conscious state (sometimes called a part) led to a shift in posture and manner of walking. 

Fluctuations in sensitivity to medica- tions and differential expression of allergic reactions, which can be problematic for the physician prescribing medication, have been found. Clinicians should not assume the patient is misleading if she gives a history of erratic reactions to medication or is confused about whether she has had allergic reactions. In the presence of a history of early trauma, this may be indicative of dissociative state changes.

Both electroencephalographic and thyroid studies can be inconsistent.54 In a prospective, longitudinal study of girls age 8 to 15 years, 14 sexually abused girls were compared with 13 control subjects. The sexually abused girls had twice the frequency of positive plasma antinuclear antibody titers when compared with matched controls, suggesting the possi- bility of alteration in immune function.55 

It is a common clinical observation that the patient with severe dissociation seems different from visit to visit. The emotional tenor, quality of voice, body posture, and affect state may change markedly.9,12,21 The patient may well not report awareness of any difference, unless asked directly: Do you have clothing in your closet you don’t remember buying? Does your handwriting change dramati- cally? Do people seem to know you that you do not recall meeting? A rather sub- tle but serious problem is the change in cognitive ability across altered states.56

A highly educated, intellectually capable patient may on a specific occasion not understand directions for further medical treatment and use of medication, and she may not acknowledge it because she is either ashamed or too confused to say that she does not understand. Cogni- tive changes will alter the relationship between doctor and patient. It can be bewildering to find that the trusting relationship one had developed with a patient is ruptured inexplicably. 

Women severely abused as children frequently develop chemical dependency problems.57 One study found that 73% of 55 women being treated for chemical dependency in an inpatient facility had been victims of sexual or physical assault, while those with concurrent PTSD were more likely to have been victims of childhood sexual abuse.58 


The Gap Between PTSD and Dissociative Disorders
Most clinicians have treated women victims of violence. PTSD syndromes are common following rape, battering, random crime, and accidents.59,60 Disso- ciation during a traumatic event increases the likelihood of ongoing post-traumatic symptoms.10 This observation has led to the development of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ),61 an instrument that has been used primarily to predict PTSD follow- ing natural disasters. While some trau- matized children develop chronic PTSD and others develop clear DID, there is a vast overlap of symptoms, and probably a majority do not strictly meet the crite- ria for either. Some have suggested com- plex post-traumatic stress disorder62 or disorders of extreme stress63 as diagnoses  for adults who were victims of repeated violence in childhood. These are not yet DSM-IV diagnoses, although the criteria were used during some of the PTSD clinical field trials. These proposed diag- noses take into consideration that pro- longed, repeated trauma in childhood (what Lenore Terr has called Type II trauma)64 disrupts subsequent matura- tional processes and leads to a plethora of symptoms in adult life,65 including failure to self-regulate affect, inability to comfort oneself, impaired attachment (both clinging and fear of intimacy), impaired interpersonal functioning, and mistrustful attitude toward the world. 

Use of a diagnosis like disorders of extreme stress would allow us to identify a group of patients who are otherwise misdiagnosed and, consequently, some- times treated inappropriately. It would facilitate a view of the patient as a whole person with a disorder of adaptation, rather than fragmented diagnoses to match the fragmented sense of self. 

Treatment Considerations
No controlled studies have addressed the treatment of DID. Perhaps the greatest benefit of the controversy around DID has been the development of treatment guidelines. The International Society for the Study of Dissociation released Guidelines for Treating Dissociative Identity Disorder in Adults in May 1994. Revised in 1997 based on the available clinical and research literature, the guide- lines cover diagnostic procedures, treat- ment planning, and an outline for psychotherapy.66 While there are a vari- ety of treatment approaches, the many clinicians with extensive experience seem to agree that an emphasis on pain man- agement and creation of a sense of safety are necessary regardless of approach.67,68 Building the trust essential for a sense of safety starts with clearly defined bound- aries within the therapeutic relationship.69 

Because symptoms are broad and mul- tisystem, an informal treatment team— psychotherapist or psychiatrist, primary care physician and/or gynecologist, and adjunctive social supports—is most productive. Someone who is chemically dependent cannot learn to manage intense affect and integrate this with cognitive function, so the use of 12-step programs is essential to maintain sobriety. While numerous inpatient programs around the country treat adults with the dual diag- nosis of chemical dependency and disso- ciative problems, the majority of treat- ment occurs in an outpatient setting. Even severe symptoms can be managed on an outpatient basis with pharmaco- logical agents, within the context of psy- chotherapeutic support. Antidepressants relieve some depressive symptoms, though alter switching may create the impression that medication has stopped working.70 Flashbacks can often be man- aged with the long-acting benzodiazapine clonazapam. Anecdotal reports indicate that the alpha adrenergic agonists cloni- dine and guanfacine diminish flashbacks, while case reports have shown the efficacy of propanolol.39 Because propanolol can have substantial side effects and drug- drug interactions, I have tried the beta blocker pindolol, also useful in treating resistant depression, with some success. Carbamazepine, valproic acid, and low- dose new generation neuroleptics have also been helpful. As mentioned above, neurobiological research on dissociation suggests a theoretical role for anti-gluta- mate drugs, yet to be developed. 

Psychotherapeutic treatment requires flexibility and versatility. Cognitive restructuring, the modification of long- held beliefs,71 must be done within a care- ful exploratory context. This is usually facilitated through the use of such adjunc- tive therapeutic tools as journal writing, art work, poetry, yoga, meditation, and sometimes body work. In addition to traditional individual and group psycho- therapy, many adult victims of child- hood abuse benefit from nonverbal treatment approaches, such as art and movement therapy.72 

How much one has to remember in order to heal is a matter of debate, but it appears that one must remember enough to validate one’s experience and to mourn what was lost by or stolen from the trau- matized child.67,68 Speaking the unspeak- able and having others bear witness to it has allowed many women to move on
in their lives. The process is exquisitely painful, and we have few tools to amelio- rate that pain. I approach dissociative symptoms as a form of memory. Treat- ment needs to support the integration of these memories as long as they persist, especially since dissociation seems to increase the risk of revictimization, described by Kluft as a “sitting duck syndrome.”73 When dissociation dimin- ishes and no longer interferes with func- tioning, then remembering is determined by individual strengths and other subjec- tive traits. Many women find that spiri- tual connection is the only way to hold and tolerate their memories of utter helplessness and despair. 

One very new therapeutic tool for diminishing fear, enhancing safety, and decreasing pain is eye movement desensi- tization and reprocessing (EMDR).74 Originally developed to treat PTSD, it can be incorporated into the overall treatment of dissociative disorders.75,76 Clinical evidence indicates that EMDR allows the patient to downregulate the intensity of affect and process traumatic memories in clusters, rather than indi- vidually. It also allows for the processing of somatic memory in the absence of visual images. EMDR is not a hypnotic technique and does not involve sugges- tion. In the course of an EMDR session, the brain is stimulated through alternating left and right perception either through eye movement, auditory or tactile stimu- lation. Prior to the eye movements, the patient is encouraged to generate an authentic, positive cognition, even if it is difficult to believe in the thought. The alternating stimulation seems to allow for the rapid integration of cognitive and emotional information. While research has not yet explained the mechanism or efficacy of EMDR, “the absence of theory or a conceptual foundation is not suffi- cient to dismiss totally the preliminary findings of the technique.”77 In the hands of a skilled and competent thera- pist, EMDR can be an additional useful tool. The use of hypnosis in treatment and the risks of suggestibility have generated considerable controversy. 

In response to concerns about pseudo- memories, the American Society of Clinical Hypnosis released a 1995 task force report concluding that memories may be recovered later in life, that hyp- nosis may facilitate recovery of memo- ries, and that pseudo-memories may occur in and out of therapy, with or without hypnosis.78 Dissociation is a

form of auto-hypnosis, and it is impossible to avoid auto-hypnotic states in treating dissociative patients. The use of hypnosis allows for carefully controlled manage- ment of severe symptoms.79,80 

Conclusion

In summary, dissociative disorders are almost always a result of severe, repeated childhood maltreatment. They appear much more commonly in women, possi- bly because of the higher incidence of sexual abuse in girls than boys, and pos- sibly because they are recognized more in women than men. 

Many patients with dissociative disor- ders are misdiagnosed and mistreated by clinicians who misunderstand their dis- guised and multifarious symptoms. As Judith Herman says,

The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable.67(p1) When we recognize and identify dissociative disorders in our patients we are forced to acknowledge the consequences of chronic violence on individuals and families. Clinicians who allow patients to speak about atrocities they have experi- enced are challenged to hold the aware- ness that this suffering was inflicted by other human beings and not a random act of nature. While dissociation helps children to survive, in adults it interferes with mature adaptation. 

The clinical presentation of dissocia- tive disorders needs to be taught to every medical student, every health profession- al in training, and every mental health trainee. While the fractured bones and the bruises of physical abuse in child- hood are no longer obvious in adult women, the symptoms of dissociation are carried into adulthood and seen by medical professionals routinely. 

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184 JAMWA Vol.53, No.4

How Prostitution Works

How Prostitution Works

By Joseph Parker, Clinical Director

The Lola Greene Baldwin Foundation - Feb. 26, 2004

INTRODUCTION

Prostitution, pornography, and other forms of commercial sex are a multibillion dollar industry. They enrich a small minority of predators, while the larger community is left to pay for the damage.

 

People used in the sex industry often need medical care as a result of the ever-present violence. They may need treatment for infectious diseases, including AIDS. Survivors frequently need mental health care for post-traumatic stress disorder, psychotic episodes and suicide attempts. About a third end up chronically disabled and on Social Security.

 

The sex trade plays an active role in promoting alcohol and drug problems. Pimps also use prostituted women in forgery and credit card fraud. The community must pay for chemical dependency treatment, insurance costs and incarceration.

 

In addition to these costs, the community loses the contributions which might have been made to legitimate community productivity by those used up in the sex industry.

 

The operators of sex businesses not only do not pay for these expenses, many manage to avoid paying taxes at all.

 

THE JOHNS

No business can afford to create a product for which there are no buyers. The first step in understanding the sex industry is to understand the customers, the johns.

 

Real sexual relationships are not hard to find. There are plenty of adults of both sexes who are willing to have sex if someone treats them well, and asks. But there lies the problem. Some people do not want an equal, sharing relationship. They do not want to be nice. They do not want to ask. They like the power involved in buying a human being who can be made to do almost anything.

 

The business of prostitution and pornography is the use of real human beings to support the fantasies of others. Anyone working in prostitution who tells a john too much about who they really are, interferes with the fantasy. They risk losing a customer, and may get a beating as well. In real relationships with real people, you are stuck with the limitations of who you are, who your partner is, and what you can do together without hurting each other.

Some people do not want real relationships, or feel entitled to something beyond the real relationships they have. They want to play "super stud and sex slave" or whatever, inside their own heads. If they need to support their fantasies with pictures, videotapes, or real people to abuse, the sex trade is ready to supply them. For a price, they can be "a legend in their own minds."

 

The most common type of prostitution customer is the user. He is quite self-centered, and simply wants what he considers to be his needs met.

 

The user would deny any intent to harm anyone, and might even claim some empathy for the sex workers he uses. However, his empathy does not extend to discontinuing his using behavior, nor to helping anyone escape from the sex industry. He does not care whether the person he is using is unwilling or unusually vulnerable. He simply feels entitled to whatever he wants, whenever he wants it. If someone is hurt, that is not his problem. He feels that the fee he pays covers any damages.

 

He sees himself as a respectable person, and works to protect that appearance. Users provide a large, safe, and steady income for the pimps and other "businessmen," of the sex industry.

 

Sadists are people who have the ability to take pleasure in another person's fear, pain, or humiliation. They constitute about ten percent of the population. Sadists vary in severity, ranging from those who just make you feel bad, on up to those who do torture murders. There is a definite practice effect. If allowed to hurt people often, their sadism gets worse.

Physical, sexual, and emotional abuse by sadists drives their child victims from their homes into the street, trying to escape. The pimps and "chickenhawks" take it from there.

 

Sadists are attracted to prostituted women and children because they are willing to get into a car or come to a place where the sadist can be in control. Sadism is about control. Hurting people who cannot stop them is their most intense and pleasurable form of control.

Sadists play close attention to matters of power. They are most brutal with small women and children, and are more careful with larger women and men. They avoid people who may have someone to protect them, or someone who may take revenge on the victim's behalf.

 

There are pimps who specialize in supplying victims to sadists, and who base their fees on the amount of damage done to the victim.

 

Sadists are found at all levels of society, including the respected and powerful. They often use this, saying, "You are just a whore, nobody is going to believe you." If they do kill someone, they are very aware that, to some extent, the effort society puts into finding the killer will reflect the value placed on the victim. People working in prostitution are safe victims.

 

Necrophiles are people who can take pleasure in filth, degradation, and destruction. They are the users of the sick, the old, the psychotic, the brain damaged, the "tracked" and tattooed casualties of the sex industry, in the end stages of their lives. For necrophiles, broken bodies and broken minds are a turn on. They glory in their superiority over ruined human beings, and feel entitled to express their contempt in every way.

 

Necrophiles must keep their perversion secret from their friends and families, both to protect their social standing, and to protect their fantasies of superiority. Normal people just would not understand.

 

Child molesters participate in the sex industry in several ways. Some have been aware of a sexual attraction to children, often of a particular age and sex, from some time in late childhood. They then make the choice to act on it.

 

Some have sadistic characteristics. Children are easier than adults to control. The molester's own children, in his own home, are the easiest of all to control.

 

Necrophilic child molesters enjoy the knowledge that, when the molesters are finished with them, the children's lives will never be the same. They enjoy the fact that the children may later self-destruct in addiction, prostitution or suicide. It proves that they were right.

 

Sex offenders against children operate with varying degrees of sophistication. Some do careful "grooming." They use pornography to break down resistance, and supply drugs, alcohol, and money. Others just start out with forcible rape. Many claim unusual "love" for children. They claim that sex between adults and children is not harmful, and should be legalized. Pedophiles actually teach children that they are helpless, hopeless, worthless, and only good for sex and hurting.

 

A large portion of workers in the sex trade started out as sexually abused children. Some were even "broken in" by being shared with or rented out to others by their own families.

There are specialist pimps who provide children to johns. The fees vary depending on the age, sex and appearance of the child, as well as the amount of damage the child has already incurred.

 

When caught, the pimps and johns claim not to have known the child's real age. There is a market for small adults made up to look like children, both for direct sex and for pornography. But the truth is in the fees: real children sell for more than fake ones.

 

Prostitution buffs are like police and fire buffs, that is, people with an intense interest in those occupations even though they do not belong to them.

 

Prostitution buffs are people with a morbid fascination for or obsession with prostituted persons and their activities. Some characterize themselves as "researchers", and amass hundreds of pages of notes and photographs, that somehow are seldom published.

 

Others claim to be intent on religious redemption of "sinners", and spend huge amounts of time in vice areas, but never quite manage to offer anyone practical help.

 

A third group consists of "community livability" activists, who blame the people being prostituted for the behavior of the johns, pimps, and drug dealers.

 

As with any obsession, with some people it may get out of control. Police buffs may take unlawful police action, and some fire buffs eventually set fires.

 

Each type of prostitution buff strongly believes his or her rationalizations for their activities, and would vehemently deny any personal sexual interest. The trouble is, it is obviously there. They show a lot of subtle signs, which, to someone working in prostitution, indicate that they may be potential customers.

 

When a prostituted person approaches the buff to offer their services, the response may be unpredictable and dangerous. Sometimes the buffs will accept their services, and the worker may never realize that they are anything but a normal trick. At other times, they will be met with rage, as if they are making a hetero- or homosexual attack on the buff. They may be beaten, knifed, or thrown out of a moving vehicle.

 

Most of the "research" and "religious" buffs are men, and spend enough time studying their subject that their identifications of who is and is not prostituting are fairly accurate.

 

Many of the "community livability" activists are women. Some may pepper spray or draw weapons on young people who are in no way involved, but who fit whatever stereotype the activist has for what a prostitute should look like.

 

CUSTOMER STREAMS

Three forces generate streams of customers for prostitution: Isolation, sexual abandonment, and unusual interests. Prostituted people are used to service populations which are physically isolated from the life of their communities. These customers come from military bases, logging or mining camps, and from farm labor camps. Operators of these facilities are often involved in arranging for services through local pimps.

 

Other customers are isolated by travel, such as seamen, truckers, and traveling businessmen. Hotels and motels, bars and other businesses providing support services for travelers also participate in arrangements for sexual services.

 

In some religious cultures, and some individual family cultures, sex is regarded as an unpleasant duty of marriage, and once the childbearing years are over, one partner may cut the other off from sexual activity. The sex industry does not reach out to middle-aged women, so their only choice is to have affairs. This may be morally unacceptable to them, or eligible partners may not be available. For them, there may be no solution.

 

For men, prostitution is quite available, and many men may see it as less wrong than having affairs, or as requiring less effort. These men provide a large and steady income for the sex industry.

 

Most of these johns would be classified as "users", and an unclear proportion of them might not be prostitution customers if they were not isolated.

 

Customers who remain in or near their home communities are more likely to use prostituted people due to unusual interests, such as sadism, pedophilia, or sexual addiction. They are isolated by the nature of their desires, rather than their location. For example, men who prefer sex with boys, but who do not view themselves as homosexual, support a whole segment of the industry involving prostituted males. It is unclear whether local law enforcement efforts, or the openness and aggressiveness with which with the sex industry is allowed to operate in a community, affects the stream of "special interest" customers.

 

A large portion of prostituted people are also used in and around the communities where they grew up. The fact that survivors often meet previous tricks in local grocery stores and other random places can be a considerable problem for their recovery.

 

For those whose special interests place them at serious legal risk in their own community, there is sex tourism. Some cities in the US are well known to run more 'wide open' than others, that is, there are fewer and weaker laws on the books, and police and other officials are discouraged from enforcing them. These conditions are often the result of cooperation between business and elected officials, who are repaid by the sex industry in various ways.

 

THE PIMPS

No one really wants to have sex with five, ten, or twenty strangers a day, every day. Besides the sheer numbers involved, some of those strangers are going to use a person in ways that are bizarre, painful, disgusting, and occasionally fatal.

 

When people who have worked in prostitution call it repeated rape, they are not exaggerating or being "hysterical." They are being legally precise. Rape is sexual intercourse, against the will of the victim, carried out by threat or force.

 

In prostitution, the john performs the sex act with the unwilling victim, but subcontracts the intimidation and violence to another man, the pimp.

 

The john would like to believe he is paying for sex, but the person he has sex with gets little or none of the money. The money goes to the pimp to pay for the force needed to keep prostituted women and children working. It goes to the drug dealer who provides whatever it takes to keep the workers from becoming psychotic or committing suicide. It goes to pay the businessmen who provide the real estate, support services, and legal protection for the trade.

 

Pimps come in three general types.  

Media pimping, like other kinds, involves selling fantasies that ultimately hurt people. Two of their central lies are that women are only good for sex, and men are only good for violence.

 

They claim that they produce sex and violence because that is all that sells. In fact, many other things sell as well or better. (For example, Walt Disney and Steven Spielberg productions often are very successful.) Media pimps often have a tremendous sense of superiority over "common" people, yet lack the intelligence and creativity to do high quality work. They very much enjoy selling a degraded view of the human race.

 

Advertisers often implicitly promise that buying their products will bring happiness, power, and sexual success. After spending their money, the victims of this "bait and switch" scam find that they get only a pack of cigarettes, a bottle of shampoo, or a magazine full of dirty pictures. They are just as lonely and unhappy as before, but their money is gone.

 

Media pimps perform another "bait and switch" function, in cooperation with business level pimps. They attract young people hoping for fame and fortune in the legitimate entertainment business, and manipulate them into the lower levels of the sex industry.

 

They degrade ordinary people living ordinary lives, by showing only idealized characters with perfect bodies, high powered jobs, and plenty of money. The characters' problems are always solved in an hour or two, with a liberal application of sex and violence.

 

Real people, whose lives cannot hope to measure up to these "ideals", are made to feel inferior and worthless. The media pimps work to divert people from the ups and downs of real life, into dependence on the fantasy worlds that they sell. The sex industry, above all, sells fantasy regardless of who gets hurt.

 

The media pimps have a lot of money. They own magazines and newspapers, and produce movies and television programs. They can afford to hire law firms and advertising agencies to further their interests. Their money can buy access to political officials, and special treatment for their businesses. In return they offer favorable media exposure, and large campaign contributions.

 

Their money often goes to support various front organizations, which work to direct public discussion toward "free speech rights," and away from the damaging effects of the sex industry on the women and children used in it.

 

Business level pimps extract profits from the sex industry in ways that minimize the risk of public exposure or criminal prosecution.

 

They own the bars and strip clubs, which attract concentrations of potential johns. They offer jobs as dancers and hostesses to vulnerable young people who are potential candidates for more direct use in the sex trade. They own the adult bookstores, massage parlors, motels, and legal brothels.

 

They posture as legitimate businessmen, conceal their ownership behind corporations and front men, and deny knowing that their property is being used in the sex industry. They charge sex businesses far higher rents and fees than they could get from legitimate tenants, which indicate they know what the businesses are doing.

 

Through contacts in the business community, they arrange for sexual services for visiting businessmen, politicians, celebrities, and sports teams. By keeping these arrangements secret, business pimps insure a degree of protection for their other activities from their customers in high places.

 

Business level pimps separate themselves from the "dirty workers" of the sex trade by treating them as independent contractors rather than employees. This enables them to avoid having to pay taxes, overtime pay, health insurance, and workmen's comp. If one of the workers is arrested, the businessman is protected from any legal involvement. They subcontract any violence needed to the street level pimps.

 

With support from elements of the "legitimate" entertainment industry, as well as street level pimps, they produce and distribute commercial pornography.

 

They support and have the support of "civil liberties" advocates, who oppose censorship regardless of the harm done to the people used in making the pornography. They disclaim any responsibility for the actions of potentially violent sex offenders who use pornography to "fuel" their fantasies until they are ready to commit actual violence.

 

Business pimps often join civic organizations, make highly public contributions to charity, and play a role in local politics. They continually assert their identity as legitimate businessmen. When threatened, they call on the support of the real, legitimate, non-sex business community, often successfully.

 

Unlike street level pimps, the businessmen usually manage to hold onto their profits. They have investment skills, can afford lawyers, seldom are addicted, and rarely take the risks involved in garden variety crime. Often the greatest danger they face is from the Internal Revenue Service, not from the police.

 

Street level pimps are the foot soldiers of the sex industry. Typically, they are small time criminals, who have a high need for sadistic gratification.

 

The johns and business level pimps subcontract to these men the brainwashing, terror, beatings, and the occasional murder needed to keep prostituted women and children working.

 

Pimps are part of the business even where prostitution is legal. Brothels do not run employment ads. The brothel owners require that any new "employee" be "referred" by someone ready to supply whatever force is necessary to control the woman.

 

Street pimps learn the business from friends and relatives already in the business, from other criminals in jails and prisons, and from other pimps they meet hanging out in the bars and clubs. Occasionally, someone especially talented in greed and cruelty learns the trade solely by practicing on available victims.

 

Pimps tend to avoid identifying themselves as such, except to other pimps. They like to present themselves as husbands, boyfriends, or protectors. When caught in acts of violence, they try to prevent outside interference by claiming that it is "only a domestic matter." In fact, the pimps themselves are the greatest danger to those they exploit. The johns and the police are lesser hazards.

 

Street pimps pride themselves on their finesse, on controlling their victims by psychological manipulation. They claim that prostituted women and children give their money to the pimps because they "love" them. (In criminal language, "She loves me" means "I can control her.") Street pimps try to play down their use of threats and violence, despite the fact that it is their biggest contribution to the sex industry.

 

Throughout human history there has been the kind of greed that takes the form of wanting to own other human beings. Slavery died out in most areas because it was unprofitable compared to more modern methods of production. The one trade where the would-be slaver can still find success is in the sex industry. For many pimps, the gratification of owning slaves is as important as the drugs and the money.

 

Contrary to the images in the media, most pimps exploit members of their own race. Many are nearly the same age as their victims.

 

Most pimps are male. Women are becoming more and more involved as active operators in the sex industry. Some are involved in helping a male pimp to control his "stable," or act as madams in brothels owned by someone else. Some run "escort" or out-call services themselves, but maintain relationships through which they can call on male enforcers when needed.

 

Occasionally women are involved in supplying their own children to pedophiles, pornographers, or others in the sex industry. The mother's own addiction is the usual cause. Plain greed for money, and the mother's own sexual perversities are less common motivations.

 

Street level pimps usually spend their money on clothes, jewelry, cars, and especially on their own addictions. They often are involved in other types of crime, especially drug dealing, and may go to prison for those. Successful prosecution for pimping itself is quite unusual.

It is rare for a street pimp to hold onto his money and make the transition to a business level operator, but there always are a few at the business level who got their start as street pimps.

 

WHERE THE WORKERS COME FROM

The sex industry ultimately is about power. This is best demonstrated by the care with which the industry takes to ensure that those it uses are powerless. The predators are neither irrational nor stupid. They watch carefully for a kind of "victim profile," and avoid anyone who may be uncontrollable or dangerous.

 

They focus on young people coming out of families that are abusive, disorganized, or non-existent. One fundamental function of the family is protection of its members, especially its children. The family also is a team, and all players must do their jobs. If a member is lost or disabled, others in the extended family or community must step in to carry on. When one or more adults in a family are absent, addicted, mentally ill, or severely demoralized, the children are in danger.

 

When the family is poor, or part of a devalued minority group, and opportunities for education and good jobs are limited, some members of those families may be willing to take risks. If the young people are being terrorized, beaten, or sexually abused by the very people who should be protecting them, many are going to take their chances on the street. For some, nude dancing or even prostitution may look better than no job at all.

 

If they are under age, have no address, or cannot afford to have their parents involved, most social service agencies will not help them. Children are still treated as some adults' property.

 

The juvenile system has little interest in noncriminal runaways or "throwaways." There are age requirements for normal jobs, usually between 14 and 18 years of age. The very young are practically forced into the sex industry, even before the pimps and johns get involved. They may have to do prostitution from age 12 or 14, until they turn 18, and can get a "better job" such as nude dancing.

 

There are three general patterns for "breaking" someone into prostitution.

 

In slave taking, a young male predator "befriends" a victim long enough to be sure she is not dangerous herself, nor protected by anyone who is. He manipulates her into a situation where she can be kidnapped and held in isolation in a place the slaver and his friends control. Over a prolonged period, she is terrorized, tortured, and gang raped. She is threatened with her own death, and that of anyone she loves.

 

Once she is convinced that her only chance of survival is to do exactly as she is told, she is "turned out." Her first "trick" may in fact be a member of the prostitution organization, set up to make sure she performs as directed. After she has been properly "seasoned," she is put to work for her captors, or sold to another pimp.

 

The domestic violence transition targets young people coming out of abusive homes who are emotionally needy, and have no real idea of what a normal love relationship looks like. They become involved with a "boyfriend" who initially treats them better than they have ever experienced before. The boyfriend gradually becomes extremely controlling, and eventually violent. He introduces commercial sex in terms of his pressing need for money, and "If you love me, you will do this." He quickly transitions from "just this once" into "You are just a whore, my whore!" and requiring daily prostitution. He continues controlling the victim with alternating emotional manipulation and explosive violence, while living on her earnings, for as long as she lasts.

 

The "grooming" process is used by older and more sophisticated predators, and is especially used on younger children. These perpetrators become adept at identifying abused, neglected, and depressed children, and "befriending" them. They develop a "special" relationship, one that isolates the child from others, and makes the child feel indebted to the groomer.

 

Slowly, resistance is broken down, using gifts, money, alcohol, drugs, and pornography. In the sex industry, pornography is not only a profitable product, it also is a working tool.

 

They engage the child in progressively more direct sex, and begin to merge the abuse into the child's identity: "You want this", "You like this", "You make it happen", "Now you are dirty, perverted, queer". These predators often are only interested in children of a specific age or appearance. When they develop beyond that, the kids may be passed off to pedophiles interested in older children. Being suddenly "dumped" for no understandable reason often is very painful for the child.

 

Over a lifetime these predators may victimize an incredibly large number of children. The emotional damage they do leaves a child even more isolated and vulnerable to further involvement in the sex industry.

 

GENDER DIFFERENCES

The experience of prostitution is remarkably similar for males and females, but there are some differences.

 

Most young men used in prostitution are heterosexual. They are drawn into the sex industry by many of the same forces as women. Many johns consider themselves straight, and claim that only the prostituted young male is gay. Those used in male-on-male prostitution often are left with tremendous confusion about their actual sexual orientation. When trying to escape "the life", they may encounter all the prejudices encountered by gays, in addition to the stigma of prostitution. They are at higher risk of HIV than prostituted women.

 

Rape and sexual slavery are common in jails and prisons. There is considerable public support for it as a normal part of the punishment. Some of those who run institutions do their best to maintain a safe and controlled environment. They may be hampered by outdated, hard to supervise buildings and lack of staff. Others may care very little about what inmates do to each other.

 

Inmates who go to staff for protection often end up in protective custody. Thismis practically the same as disciplinary isolation. The response of convicts toward "snitches" ranges from abusive to deadly.

 

Almost all of these traumatized men eventually are released. Many dissolve into alcohol and drug dependence, or are disabled by psychological symptoms. Others wander the streets, intoxicated, armed, and ready to react explosively to any threat of harm or humiliation.

 

Women used in prostitution usually have children sooner or later. Mothers who cannot protect themselves rarely can protect their children. In the endless whirl of sex, drugs and violence, the children may be neglected, traumatized, or even become merchandise in the sex industry themselves. One of the most painful events in the life of prostitution is losing custody of children, regardless of how good the reasons for that loss may be.

 

Most prostituted women want very much to be good mothers, often trying to give their children the love and care they never received themselves. The birth of a "trick baby", that is, one fathered by some unknown john, produces very complicated feelings. Some mothers can separate their feeling for the baby from the anger at the way the baby was conceived, but others cannot. Some "trick babies" are given up for adoption by mothers who fear that they otherwise might abuse them.

 

If the baby was fathered by a pimp, or is at least claimed to be in official records, the courts may fail to recognize, or ignore, the real nature of the relationship. The pimp may be given visitation rights or even custody. This gives the pimp a new person to threaten and a new means of controlling the mother. It makes escaping from the sex industry even harder than it already is.

 

Both male and female survivors of prostitution usually develop a tremendous hatred of men, especially those in authority. They hate both for the actual harm done, and for the help that was not given when it was terribly needed.

 

SOCIETY'S ROLE

The larger society provides the pimps with a very powerful weapon. It makes prostitution an identity, not an occupation. Once you have taken money for sex, you are a prostitute. Society does not allow an expiration date on that identity, nor a way to be publicly accepted as something else.

 

Society offers help to people in trouble largely based on the value set on that person. It is much easier to get help for a married, middle class, domestic violence victim, than for a refugee from the sex industry trying to escape from a pimp.

 

Many people prefer to view prostitution as a "lifestyle choice," or even an "addiction" to a lifestyle. They think most people in the sex industry are there to support their drug habits, when actually the drugs are used to cope with what is happening to their lives. Society assumes that nothing can be done to help them, so there is no need to try. The pimps count on it.

 

Being trapped, under the control of violent and merciless men, without hope of outside help, sets the stage for Stockholm Syndrome. When the victim cannot successfully fight or flee, she may try to form a protective relationship with her captor. She hopes that if she can prove her love and loyalty to the pimp, she can "love" him into being good. This can become such a desperate attachment that she actually believes she loves him, and passes up chances to escape. Stockholm Syndrome often is the real reason for what others see as the "choice" to stay in the sex industry.

 

Prostitution and the drug trade go hand in hand. Customers for sex often are buyers for drugs also. Many pimps are supporting their own habits, and dealing drugs as well.

 

The pimps consider drugs and alcohol a cost of doing business. Without the chemicals, their "livestock" may become psychotic or commit suicide. In addition to the brainwashing and violence, addiction provides a form of control. Drugs also produce isolation from people who otherwise might try to protect a victim or help her escape. The only creature less worthy of help than a prostitute, is an addicted prostitute.

 

The health effects of prostitution are devastating. Prostitution, especially in childhood, is at least as effective as war in producing post-traumatic stress disorder. Survivors usually have some combination of depression, anxiety, and dissociative disorders. Brain damage, psychosis, and suicide are common. Long term psychiatric disability, serious medical illness, and the effects of accumulating injuries shorten lives.

 

CONCLUSION

People who have had luckier lives, as well as those who profit from the sex industry in some way, frequently refer to prostitution and pornography as "victim-less crimes". They point to a tiny fraction of sex workers who actually might be involved by choice. They selectively read history to find some tiny minority, somewhere, at some time, who gained something in the sex business.

 

The very selectiveness of their attention indicates that, on some level, they know that for almost everyone, involvement in the sex industry is a terrible misfortune.

As many an old cop will say, "Anyone who thinks prostitution is a victimless crime, hasn't seen it up close."

 

BIBLIOGRAPHY

•  Herman, Judith Lewis. (1992). Trauma and Recovery. New York: Basic Books.
• Jarranson, James M. and Michael K. Popkin. (Eds). (1998). Caring for Victims of Torture. Washington, D.C.: American Psychiatric Press.