If you believe all the tabloids, fiction, Hollywood, and misogynist whorephobes out there, all of us hookers are crazier than cut snakes - after all, who would be stupid enough to let a bunch of strange men shag them for money? Oh, wait; women who like either sex or money, or both... I guess. The answer is not as clear cut as I'm sure many of you would assume. Yes, there is a disproportionately high number of sex workers with chronic illness and mental health issues, but it's not because we're all the "crazy bitches" your mates warn you about every time they have a Tinder date go bad because they suck as humans.
This industry is accessible for those with chronic illness, disability, addiction, and mental health issues.
Many people get into sex work because normal jobs are more difficult for them. If you have a severe autoimmune disease, like lupus, rheumatoid arthritis, or even Crohn's disease; your schedule for "days I can actually function as a human" is unpredictable. You don't know if you're going to be able to turn up to work on Monday, let alone every Monday to Friday for the next few years. Sure, regular people get sick and don't know if they'll be able to get to work, but they are only sick sometimes, and they get better. Someone with a chronic condition likely won't ever get better, and they don't know when their flare ups are going to occur -- they just know it's much more frequently and much worse than Joe from Accounting experiences his twice a year bout of man flu. All those conditions I used as examples cause horrendous pain when they flare up, and many workplaces would simply have to let you go, as they can't hire someone who cannot regularly be at work. Many of these conditions turn up after you have spent years training for one profession, so you suddenly need to find a new skillset that doesn't require keeping regular hours.
If you have a mental health issue, you often have similar problems with or without the physical pain -- psychosomatic pain feels excruciatingly real, it just isn't caused by physical damage. Holding down a regular job is extremely hard when you have depression so bad that getting out of bed is impossible, or crippling anxiety that all but paralyses you and prevents you from taking any meaningful action, or even the executive dysfunction that comes from ADHD. I won't even touch on disorders that affect your interpersonal professional relationships even more, like schizophrenia, BPD, PTSD, and bipolar disorder; even something as "mainstream" as ASD. You can still work with these conditions, it just takes some acting talent, personal management strategies, and a flexible work environment!
Sex work is, above all things, flexible. Brothel shifts can be irregular, agencies can have you available at different times, and if you're independent (including street based workers), you can set your own hours. If you have a flare up, or can't get out of bed, that's okay! You don't have to work or risk losing your only income stream*, or using up your very limited sick time - you can still make money tomorrow. The downside, of course, is that you don't get the stability a regular job affords you, and sick days are not paid; though often workers accommodate that into their rates so that there is some padding for breaks and slow periods, if they're lucky.
Full service sex work also has very low barriers to entry -- you don't even need functioning genitalia to do many aspects of it. For many people, their mental illness or disability has also prevented them from doing well at school, or attaining further qualifications (trade school, TAFE, or university). Sex work is an area that can, given some time, talent, hard work, and experience, earn you a solid amount of money - more than working other unskilled jobs. This makes it an attractive alternative for those with chronic or mental illness!
Sex work and health professionals have not always been the best of friends.
Sex workers are even less likely than the average person to seek professional help for their mental illnesses. An annoying, but necessary part of therapy is that you must be honest with your therapist so that they can help you. Unfortunately, many medical professionals either feel extremely negatively about sex work, or believe that it is the root cause of your problems, despite being told that the illness existed before the job. This prevents workers from getting the appropriate treatment, because the psychologist will say, "You need to find a different job". They seem to believe that some magic will cause all of the mental illness to vanish in a puff of smoke if you'd just stop shagging people in exchange for cash. Which doesn't really solve your problems at all, and gives you an extra problem labelled "financially struggling because I had to quit my job".
Many professionals also treat us like walking STIs or with visible disgust, and don't focus on the problems at hand, as they are apparently distracted by the revelation that you fuck for money. I know one worker who, every time she went in for much needed medication, was constantly asked about whether she'd had STI testing done, and was prodded into it even if she'd had it done at the free clinic (like basically every other sex worker, every other month). We understand that testing is something that we need to get done as workers, we do. But funnily enough, we not only know more about it than the general public, we're also less likely to even have STIs, so the conclusion drawn by the doctors (sex worker = STI prone) doesn't actually bear out. It's not their fault really, society has raised them and tutored them to believe that we're dirty, which is something we're working hard to change. Medical school didn't teach them about us.
We don't want to tell doctors about our jobs, lest they act repulsed, treat us poorly, or simply don't treat the issues we have at all -- so we just don't see doctors about our mental health issues, more often than not. Therapy is not as effective if you can't tell them about the primary, universal source of all stress for humans: work. (Also children I guess, but I have none of those.) Stigma is a very real problem, it's not just harmless jokes and the "dead hooker" TV trope; it has consequences.
Sex work can be a positive influence on existing mental illness.
Interestingly, I have heard many accounts of workers coming to love the industry because it has helped them heal from past sexual trauma by giving them more control over their bodies and who has access to them. Many experience more positive feelings about their bodies due to sex work -- I'm one of them; every day, I feel better about my flaws due to the pictures I look at and edit for posting, and the compliments from both other workers and from clients. Sex workers are some of the most wonderful people I know, with a genuine desire to lift others up. In a sex worker only space, the second you say, "I feel horrible about my body today," there are 50 comments immediately telling you that you aren't ugly, and that your flaws are not flaws at all; they make you interesting and unique. The industry itself is one giant demonstration of the fact that beauty is not one size fits all -- anyone can have a niche, anyone can be considered beautiful. Not to mention the help that is handed out without even thinking -- you're in hospital for something? Expect letters and visitors and your cats taken care of, no questions asked.
Clients get to feel that way when they spend time with us as well! I have mentioned before that I find something attractive about all of my clients, no matter if they fit into standard beauty ideals or not. It's a talent you develop as a sex worker, alongside a deeper empathy for everyday people and demographics you'd not usually come across; something that has had a positive effect on my life as a whole.
Empowerment is another positive aspect of sex work, especially for women and minorities - sex work helps them find their voice in a world that doesn't always accept them as equals. Learning how to set your boundaries with a particularly manipulative or pushy client can feel like a huge win, and often leads to learning strategies for setting boundaries in your personal life. Do you have a friend that says vaguely racist things which make you uncomfortable? Do you have an intrusive mother-in-law who uses manipulative tactics to get what she wants? Well now you know how to nip that in the bud and speak up for yourself, because clients weirdly use similar tactics - and I never thought I'd be comparing my mother-in-law to clients, but here we are.
We can also point out the less desirable aspects of sex work.
Of course, there are aspects of the industry, just like any other, that can impact mental health negatively. I'm not going to pretend this is somewhere full of rainbows and flowers -- let's not do anything to further that annoying "Happy Hooker" stereotype. We aren't perfect.
Body image can go in quite the opposite direction if you aren't careful, just like in any other image focused line of work. Seeing all the perfect, airbrushed, surgically enhanced images of your peers can be demoralizing even if you're constantly reminding yourself that they're all for marketing. Even though your pictures look the same in terms of editing, you see flaws in yourself more readily than others, because you know where to look. This can result in unhealthy obsessions with augmentation (though surgical modification is not, in itself, unhealthy -- most of us don't have that particular disorder, settle down), eating disorders, and self harm in other ways in order to become an ideal. Much like any other workplace, bullying and backstabbing can also have a negative effect on mental health; I'm sure you've all seen Twitter spats. Side note: don't go thinking it's just a hooker thing; I've worked in corporate and government settings, and they're all just as catty, even in all male work settings. Boy, the backhanded comments I heard when I worked in a male dominated workplace. People are nasty creatures sometimes.
We are at a disproportionately higher risk of sexual violence and institutional violence, and these can cause lasting trauma and mental health issues. Burnout is also a very real thing in this industry; becoming disenchanted at all the marketing of yourself, the acting with clients, holding clients' hands through a booking process they should be able to manage as functioning adults (but somehow they dick it up every time), the stress of not knowing if a new client is going to throw something awful your way, PTSD from any bad experiences, the stress of state laws (especially SA), the stress of keeping all of your identities separate... the list goes on, and it turns you into a frazzled, short-fused mess sometimes.
It's not daddy issues.
It's not that women are "inherently crazy". It's not that we're all insane nymphomaniacs. We're not more prone to mental illness or addiction. We are a rare profession, in that there are people from literally every single demographic - every religion, every race, every size and shape, every point on the gender and sexuality spectrum, every political affiliation (though, as a group, we do lean to the left; for obvious reasons), every level of economic and educational privilege, every nationality, every level of ability and disability. Mental health issues in sex work is not a simple issue, because we are not a simple group. There is much more that comes into play than what I have discussed here, and it varies so widely. It is banal and small minded to bring it down to "daddy issues" or "your work makes you mentally ill". We are complex, broaden your mind.
*Sometimes brothels and agencies aren't awfully accommodating, but that depends on the owners and managers. Occasionally, if you call in sick the day of your shift, they will refuse to assign you shifts; pretty much the same thing as firing you. Much like a lot of casual workplaces! Again, not exclusively a "see, this is why sex work is bad" thing.
Heading off any comments about my right to talk about mental health issues in the context of sex work: I have a mental illness, and a chronic health condition, but I don't feel as if the public sphere needs to be made aware of the details. I am speaking from a place of intimate knowledge on the subject, but that's all I'll say about me personally. If you book with me, I'll likely tell you if you ask, or if we happen to have that slice of crazy in common! Everyone has something!
Disclaimer that this blog is gendered to appeal to those who find it difficult to understand the gender diversity present in sex work.
On ASD (Autism Spectrum Disorder) and sex work, a piece by Angel Parker.
On working with clients with disabilities.
A review of sex work and mental health, by the University of Leicester.
On the stigma of sex work, a piece by Zahra Stardust.
This Psychology Today piece, by Dr. Zhana Vrangalova.
If you have a piece about mental health or disability and sex work, let me know, I'd love to link it for people to read!