You don't expect to experience post-traumatic stress disorder if you don't really understand that you have suffered a trauma. When what you've experienced is normalised, the psychological after-effects may be attributed to something else, or ignored entirely. But trauma comes in many guises, and violence is not always obvious.
A poorly understood fact is that PTSD is more common in women than in men - and one of the most common causes of women's trauma is sexual violence. On the surface we accept that sexual coercion, for example, is negative, but we don't often discuss the severity of its effect on women.
I was in prostitution for 10 years - middle-class, indoor, 'acceptable' prostitution. I was never held at knife point, beaten or tied up; I never worked the streets. My life was regular hair appointments, expensive brandy in nice restaurants, and strip clubs for faux fun: the laissez-faire libertine.
Of course with many punters I had to hold my nose and hope they wouldn't take too long. These weren't just men I didn't find attractive, but men who actively repulsed me. But it was just the 'job'. When I entered prostitution, everyone just shrugged it off. You saw women resigned to what was happening to them, their lack of sexual agency - you spotted their tricks for shortening appointments, the little hits of booze or dope to get them through, and you learnt to do the same.
But then I just seemed to stop. When my 'clients' visited me I began to feel a hurl of nausea in my throat. I felt anxious everywhere I went - every week there was a new thing I could no longer do, a place I could no longer go, because of the panic it engendered. Meeting new people, public transport, shops, swimming, the cinema, everything became frightening. I was like a prey animal.
I was not intellectually opposed to prostitution; I was a modern, open-minded, liberal feminist. But, as I became more and more isolated and fragile I started to reach out to other women exited from the sex industry, reading their articles, talking with them on social media, and I found the same patterns, the same textures to their stories.
Like Sabrinna Valisce, "When the flashbacks happen I can be anywhere, around anyone. They're unpredictable and intrusive and leave me wanting to shower and sleep it away."
Or Diane Martin CBE, "A few months before and after I got out of prostitution, I started having what I now know are panic attacks and I lost the ability to speak. I just couldn't talk, no sound would come, I was shutting down."
PTSD is a risk in a number of professions, but these tend to be 'front-line' jobs: soldier, paramedic, firefighter. It's useful to have this point of reference when considering trauma as a result of prostitution. My 'benign' servicing of thousands of men's sexual wants has had repercussions that ordinarily befall those who have witnessed bodies burnt, bombed or disembowelled. There was no single scene of violence in my experience of prostitution though; the assault came from the layers of intrusion built up over time.
We don't understand the scope of trauma in women because sexual violence and coercion have historically been dismissed as just other, if controversial, forms of sexual possibility. If we are to better understand PTSD in women we need to start - seriously - rewriting this script.
It took me a long time to fully understand my symptoms; the irritability, the anger, the fear, the strange existential sense that life no longer had any purpose. It was difficult, because by making the connection between mental breakdown and prostitution, I had to face the fact that what I had been through had not been benign at all. Not all women in prostitution will suffer from PTSD, but many of us do; even in the most conservative findings, prostitutes are shown to be significantly more likely to suffer from PTSD than the general population. For us it is the site of our suffering and the cause of our enfeeblement. Only by confronting that, have I begun to heal.