They say that prostitution is the oldest of professions. As early as 2400 BC, Sumerian records indicate that in a listing of professions, the word karkid appears. The male version of the same profession – kur-garru – also appears on this list, however, as an entertainer. Included in this same listing, among female occupations and professions, are found “lady doctor”, scribe, barber and cook. (1) Chinese history tells us that the very first commercial brothels appeared around 600 BC as a method to increase revenue for the government by the statesman, Kuang Chung. The ancient Greeks also established government sanctioned brothels and collected taxes on the prostitutes’ earnings. (2)
As soon as history starts tracking a more religion driven society, we see a lot of illegalization of prostitution, persecution of prostitutes and a variety of punishments meted out upon their clients. Around 1160 AD, Holy Roman Emperor Barbarossa targeted the prostitutes who travelled with the armies by ordering their noses to be cut off in an effort to make the prostitute less attractive. Soldiers found to be participating were known to lose an eye or a finger. Meanwhile, in England, Henry the Second championed rules and regulations for brothels that made it illegal to force the profession on any woman, required closure of the brothels on holidays, supervision by law enforcement and other requirements of the prostitutes themselves.
Heretofore, disease had been an issue, but not one of epic proportions, until the late 1400s, when the plague of the Great Pox, also known as syphilis, spread throughout the European continent for close to a hundred years. “The recognition of the venereal nature of infection, and the fear of disease, combined with the moral fervor of the various sixteenth-century Reformers, resulted in a reaction against prostitution”, states Vern and Bonnie Bullough in their 1978 book, Prostitution: An Illustrated Social History. (3) The end of the plague of Syphilis celebrated the advent of the courtly, genteel and aristocratic Italian courtesans. These women possessed not only beauty and youth, but education, wit and charm. (4) Strangely enough, during this same century, Henry VIII ended the regulation and tolerance of prostitution in England as did France in 1560.
Throughout history, prostitution has been accepted and demonized many times. In the United States, views regularly shift on a societal level and vary from state to state. In 1971, Nevada formally regulated prostitution, granting individual rural counties the ability to grant licensure to brothels as legitimate businesses. Internationally, there is much that is progressive with regard to the views on prostitution. Swedish law views the purchasers of prostitution as the real criminals, exacting violence of women and children by the very act. The Netherlands, on the other hand, has glorified, regulated, provided for medical care and established Amsterdam’s world-famous red-light district.
What is prostitution, really? Prostitution is the exchange of sexual acts for money, food, rent, drugs, and other material goods. Prostitution is a form of sexual exploitation. Sexual exploitation includes all of these facets: street prostitution, massage parlors or brothels, escort services, strip clubs, phone sex, pornography (print, film, and cyberspace) as well as domestic and international trafficking. Some interesting statistical evidence has been put forth in that women and underage girls engaged in prostitution have a forty times higher death rate than women and girls who are not sex workers. Further to this, nearly seventy percent of women and underage girls meet and exceed the standard for chronic PTSD at the same levels as veterans of combat. (5)
On an international level, human trafficking and prostitution is burgeoning. As recently as this year’s Super Bowl, human trafficking and the marketing of sex slaves was making headlines and being raised up in societal awareness. Trafficked girls have some specific and significant needs in order to escape this forced life. In fact, the need for safe and secure housing and overall support and advocacy are primary needs for virtually all victims of trafficking. These basic needs are usually accompanied by the immediate need for legal assistance with immigration issue, or to provide protection from the pimp or slavers. Beyond the immediate needs, the needs of these victims are as diverse as the countries from which they originate. In the situation of international victims, there is a great need for language interpretation.
As is seen in most victims where torture has been exacted, those who have been trafficked frequently experience PTSD, anxiety, depression, suicidal ideation and substance abuse issues.
In the matters of prostitution and human trafficking involving underage girls where no parents or primary caregivers can be located, medical, mental health, and social services are important for responding to the needs of these girls. Education and training foster care families about the dynamics of human trafficking, the needs of these victims, and the symptoms of trauma are also needed to ensure appropriate placement for children in need of homes. Given the complex needs of international victims of human trafficking, it is not surprising that providers report working with clients for more than a year and often for several years.
Overall, victims of human trafficking, whether international or domestic, have immediate needs for multiple and comprehensive services and treatment representing continuing care (emergency, short-term, and long-term assistance) that may be required for several years.
As we have seen in the treatment of prostitutes of both legal age of consent and underage girls in Sweden, in the US there is a trend for police and prosecutors to treat juveniles accused of prostitution as victims of crime and abuse and stop arresting these minors and putting them into the criminal justice system, according to a report released in 2013 by Institute of Medicine and the National Research Council. Law enforcement is growing increasingly more interested in learning more about legal responses to the trafficking of young girls for prostitution. They noted that girls involved in child pornography are not arrested, while girls who engage in prostitution are still arrested.
Psychologists and other researchers believe arrests may inflict more significant damage on girls engaged in prostitution who are already in an extremely fragile state. As of 2012, there were only nine states out of the fifty in the United States who have adopted what is known as “Safe Harbor” laws to treat underage children accused or engaged in prostitution as the victims that they are. There are many agencies across the country urging law enforcement and demanding a change to the laws where anyone under the age of 18 is arrested and should be, instead, steered toward systems, agencies and services that are equipped to meet their needs.
Children and adolescents who are arrested face commitment to institutions and incarceration, gaining permanent records as offenders.
Girls who enter prostitution, either by choice, force or trafficking, experience a gamut of emotional impacts. Research indicates that a very high percentage of underage girls engaged in prostitution of any form have also experienced sexual abuse of some form, either in the home, by someone known to her, or otherwise.
The two greatest emotional and mental health ramifications for girls engaged in prostitution at an early age, via many avenues, are the inability to identify, manage or produce appropriate emotional responses and significant and long-lasting disassociation.
The experience of any form of prostitution for a girl is classified as a complex trauma. Girls with these types of experiences frequently cannot express a feeling state, will completely internalize stress, and experience depression, anxiety and anger. Further to this, the emotional responses these girls are able to express are usually explosive, violent and unpredictable. .
Dissociation is the second most prevalent observed effect in girls involved in prostitution or trafficking. When girls encounter a terrifying experience, they mentally separate themselves from the experience. They may perceive themselves as separate from their bodies, or somewhere else in the room watching what is happening to their bodies. They may feel as if they are in an altered state that is not real. Or they may lose all memories or sense of what is happening to them, resulting in gaps in time or even gaps in their personal history. A girl could cut off or lose touch with various aspects of the self.
Once a girl has learned this mechanism, it may become an automatic defense used to deal with any stressful situation, reminder or trigger. It can rob a girl of her ability to be present in her own life or fracture her sense of time. Furthermore, it is difficult to discern when dissociation is occurring and therapy for a girl who has and does dissociate can be very challenging for the healing process.
Behavior, too, is affected in girls who have experienced prostitution in any form. They are easily triggered, with very intense reactions, struggle with self-calming, frequently lack impulse control or the ability to consider consequences. Girls who have experienced a complex trauma, such as sexual abuse or prostitution (although I personally believe prostitution to be a form of sexual abuse and make no differentiation between the two) are often viewed as unpredictable, defiant, and extreme. These girls, when in a safe place to recover, will often engage in other types of behavior, such as high-risk behaviors, including but not limited to self-harming, unsafe sexual behavior, risk-taking activities, assault, substance abuse, stealing, running away and more, making it much more likely that they will become part of the juvenile system.