Ah yes Sabrina (wed 16th Oct )-the PTSD claim 68% of women in prostitution meet the criteria for Post Traumatic Stress Disorder in the same range as torture victims and combat veterans undergoing treatment Is frequently repeated on prohibitionist websites-I was wondering when that would surface.
The claim was put forward by Melisa Farley and her co-workers from her paper (Farley M, Barkan H. Prostitution, violence, and post traumatic stress disorder Women Health 1998; 27:37–49.) here
First we should know a little about Melisa Farley-she is founder and director of Prostitution Research and Education, an organization with the avowed aim of abolishing prostitution-so she is not neutral. Farley is a campaigner and often wheeled out by those opposed to prostitution –and such was the case in Bedford v Canada a case in the Ontario superior court where three sex workers were attempting to get some of the prostitution laws overturned as they claimed (successfully as it turned out) that those laws breached their legal rights to operate as prostitutes. In her summing up Justice Susan Himel had this to say in her judgement about Farley’s evidence. see paras 353-356
[353] I found the evidence of Dr. Melissa Farley to be problematic. Although Dr. Farley has conducted a great deal of research on prostitution, her advocacy appears to have permeated her opinions. For example, Dr. Farley’s unqualified assertion in her affidavit that prostitution is inherently violent appears to contradict her own findings that prostitutes who work from indoor locations generally experience less violence. Furthermore, in her affidavit, she failed to qualify her opinion regarding the causal relationship between post-traumatic stress disorder and prostitution, namely that it could be caused by events unrelated to prostitution.
[354] Dr. Farley’s choice of language is at times inflammatory and detracts from her conclusions. For example, comments such as, “prostitution is to the community what incest is to the family,” and “just as pedophiles justify sexual assault of children....men who use prostitutes develop elaborate cognitive schemes to justify purchase and use of women” make her opinions less persuasive.
[355] Dr. Farley stated during cross-examination Farley cross examination that some of her opinions on prostitution were formed prior to her research, including, “that prostitution is a terrible harm to women, that prostitution is abusive in its very nature, and that prostitution amounts to men paying a woman for the right to rape her.”
[356] Accordingly, for these reasons, I assign less weight to Dr. Farley’s evidence
Now rather than like you lot who will entirely dismiss research if you think you can establish that there might be a hint of “conflict of interest” (which can be as little as the cover picture on a report! ()) I prefer to look at the actual research itself-but I am far from the first person to do this (see comments of Justice Himel above).
Farley’s claim on PTSD arises from a study conducted in several countries where she interviewed mainly prostitutes working on the streets or in the more desperate circumstances . She then generalizes her results to apply to all prostitutes-she also (as Justice Himel points out) attributes the PTSD uniquely to prostitution rather than other features in the background of the sexworkers. It is extremely important if you are doing research of this nature to include a control group of those with a similar demography and experience who do not prostitute to be able to make such a claim-this was not done in this case.
Leaving aside whether one could determine PTSD solely with the aid of a questionnaire let’s look at other research in this area-most of which is behind publishers subscription barriers so I reference the abstracts but really you need to read the entire paper.
In 2001 a study (Romans SE et al) 'The mental and physical health of female sex workers: a comparative study', Australian and New Zealand Journal of Psychiatry, 35:1, 75 —DOI: 10.1046/j.1440-1614.2001.00857.x here concluded ^No evidence was found that sex work and increased adult psychiatric morbidity are inevitably associated, although there may be subgroups of workers with particular
problems. The illegal and stigmatized nature of sex work are likely to make usual public health strategies more difficult to apply, considerations which should give concern from a
preventive health standpoint^
In 2002 Chadakov et al 2002 Motivation and mental health of sex workers Journal of Sex & Marital Therapy, 28:305-315, 2 Doi: 10.1080/00926230290001439 here used basically the same questionnaire as Farley to interview 55 brothel workers from the former Soviet Union working as indoor prostitutes in Israel, 17% of the women showed signs of PTSD, which meet Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) criteria compared to 11.8% in a U.S. primary care study. So while there was evidence of PTSD it was not as high as in the Farley study-but there was no really suitable control group.
In 2004 Venwesenbeeck Burnout Among female indoor sex workers Archives of Sexual Behavior, Vol. 34, No. 6, December 2005, pp. 627–639 ( C _ 2005) DOI: 10.1007/s10508-005-7912-y is a study of Dutch prostitutes here looking at “Burnout” and concluded “ burnout is not as much associated with sex work per se, but with sex work under certain conditions, among which stigma (notably negative social reactions) and stigma related experiences (such as role conflict, experiences with violence, and lack of a worker-supportive organizational context) are important”.(see also Vanwesenbeeck I. Another decade of social scientific work on sex work: a review of research 1990-2000 Annu Rev Sex Res. 2001;12:242-89.[[http://www.ncbi.nlm.nih.gov/pubmed/12666742 see here]]
In 2006 a study of street prostitutes (Roxburgh A et al 2006 Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia strategy\Pros lit from UL\Australia\NSW\BMC Psychiatry Full text Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia.mht here concluded that there were high levels of PTSD amongst street prostitutes some stemming from childhood trauma before entering prostitution. The results were not controlled for drug use or events preceding entry into prostitution.
In 2008 a study of Korean ex-prostitutes (Jung et al Symptoms of Posttraumatic Stress Disorder and Mental Health in Women Who Escaped Prostitution and Helping Activists in Shelters Yonsei Med J. 2008 June 30; 49(3): 372–382 doi: 10.3349/ymj.2008.49.3.372 strategy\Pros lit from UL\ptsd\Symptoms of Posttraumatic Stress Disorder and Mental Health in Women Who Escaped Prostitution and Helping Activists in Shelters.mht here concluded Female ex-prostitutes had significantly higher stress response, somatization, depression, fatigue, frustration, sleep, smoking and alcohol problems, and more frequent and serious PTSD symptoms than the other 2 groups. however one of the control groups were the activists in the shelters, so not necessarily appropriate.
In another study published in 2008 (Seib C et al 2008 The health of female sex workers from three industry sectors in Queensland, Australia Social Science & Medicine 68 (2009) 473–478 [[http://www.ncbi.nlm.nih.gov/pubmed/?term=The+health+of+female+sex+workers+from+three+industry+sectors+in+Queensland%2C here]] concludes Much of the increased levels of poor mental health among illegal sex workers were associated with more negative experiences before, and subsequent to entering the sex industry. These patterns were not seen among women from the legal industry sectors. This research suggests that illegal, street-based sex workers, from whom many previous results have been derived, may show patterns of disadvantage, and health outcomes not seen in sex workers from other industry sectors.
In 2010 RosslerW et al The mental health of female sex workers
Acta Psychiatr Scand 2010: 122: 143–152 here In a study of 193 sex workers in Zurich showed that PTSD very variable from nothing for those working privately and who are of European origin to a lot-those indoors who are non-European
A study in 2011 (Cregan et al 2013 The Effects of Age and Drug Dependency on the Emotional Exhaustion and Job Satisfaction of Adult Street workers in Australia Arch Sex Behav (2013) 42:851–861 DOI 10.1007/s10508-012-0049-x here points to drug addiction rather than prostitution itself as the major influence on psychiatric morbidity
A number of conclusions can be drawn. Firstly that the incidence of PTSD amongst sex workers reported by Farley is far higher than those reported by other researchers. A clue as to why this might be so is that Farley’s studies were based on the most disadvantaged sex workers frequently those in street work What a fuller analysis of the literature shows that levels of PTSD are more related to experience before entering sex work or drug addiction during sex work especially for those working on the street. Much of the research concludes that those prostituting indoors have levels of mental health which is similar to demographically matched control samples .
So the conclusion Farley want to take away-that prostitution iteelf is a major source of PTSD is simply not supported by the evidence