This is the text of a speech that Anna Fisher gave to a Royal College of Psychiatry Women and Mental Health Special Interest Group Conference on 8 December 2023.

I am going to start with a couple of quotes.

First from Emily. As a young woman in her first year at university, Emily, through no fault of her own, didn’t have enough money to pay her rent. She found a job, but it paid only the minimum wage (and as an 18-year-old, it was the reduced youth rate) and it required missing lectures. Try as she might, she couldn’t find another job that paid more or had hours that better suited her university commitments.

All around her, young women were promoting “sex work” as a real job, as good money, as a no brainer even, for cash-strapped students like herself. So she gave up the job and started in prostitution. This is what she said:

“I was sold a complete lie. It’s not easy money. To the buyer, you are nothing more than an object for their consumption, not an actual human being with emotions. You’re expected to just put up with whatever they want to do and say to you. The exchange of money makes them feel entitled to treat you however they like, with no regard for your feelings or consent. […]

I went into prostitution because I thought it was a short-term route to an easier life. In reality, all it did was further destroy my self-worth. It didn’t pay off any of my debts. I just spiralled into a full-blown mental breakdown. I dropped out of university because I couldn’t cope with the pressure. Without a degree and with terrible self-esteem, I went from minimum wage job to minimum wage job – always falling back on prostitution to keep a roof over my head. I kept my friends and family at arms-length because I didn’t want them to find out what I was doing. I was mentally and physically unwell, financially unstable, isolated from my friends and still recovering from an abusive [childhood]. The buyers knew this, but they were still somehow happy to buy access to my body for the cheapest price they could get.”

Now another one. This one from Harriet. In her mid-twenties, Harriet, again through no fault of her own, suffered a series of catastrophes that left her traumatised and deeply in debt. She, also, turned to prostitution in an attempt to pay off the debts and keep a roof over her head. This is what she said about it:

“People think prostitution is about having consensual sex for money. It’s not. Those men don’t want to pay for that. They paid me and then used me however they wanted. I was beaten with objects until I bled; spat at; anally raped; gang raped; passed around at sex parties like a toy, men slipping off their condoms; I was shouted at, threatened, choked, told to look like I enjoyed it or he’d take the money back. I was scared every single second. But the only thing that scared me more was being street homeless, so I saw no choice other than to put up with it until I could clear my rent arrears.”

Now, Mila. Mila started ‘sugar dating’ after being introduced to it by a girl she sat next to in English when she was 16. She had also been sold the lie that “sex work” is empowering. She said:

“All this alleged empowerment evaporated into thin air as soon as I was behind a closed door with a man or a couple. Ultimately, I had no say in what would be done to me. A price had been arranged, and I owed them a service. I allowed things to be said and done to me that had never been agreed. I was pressured into receiving acts that hurt, and performing acts that made my skin crawl. I was plied with drugs and alcohol, and sometimes berated if I was reluctant to take whatever drug the client was taking, even when I told them I had school the following day. My pay was often docked for saying no.”

I could go on, and easily fill my whole time with similar testimony from young women who’ve been in touch with Nordic Model Now! and had their lives blighted by involvement in the sex industry. But hopefully, you get the point.

Sometimes students who are writing a dissertation on some aspect of the sex industry also get in touch with us. By way of example, a couple of years ago I had a conversation with a young woman, let’s call her Elise, who was doing a masters. Her dissertation was about new regulations that a Swiss canton was introducing in an attempt to make the women involved in their legalised prostitution system safer.

She sounded excited by this prospect and was surprised that I was sceptical that the new regulations would make much difference to the women’s safety. I then explained the feminist critique of prostitution – a critique that was first pioneered by the Victorian feminist campaigner, Josephine Butler, and that has been developed by many other brilliant and courageous women, including Andrea Dworkin and Catharine MacKinnon in the 1970s and 80s, and many others more recently.

That critique sees prostitution as the cornerstone of the system of male supremacy known as patriarchy. My favourite definition of patriarchy is Marilyn French’s, which goes like this:

“Patriarchy means institutionalized male dominance, guaranteed by a set of interlocking structures that perpetuate the power and authority of an elite class of men over other humans and grant all men power and authority over women of their class.”

It may not be immediately obvious to most of you in this room who I assume are probably well-paid professionals – even if your salary is lower than your male colleagues – that most working-class women with working class women’s jobs simply cannot survive on their own wages – particularly if they have children to support. While working class men’s wages have been under siege in recent decades, there are still far more working-class male jobs that are sufficient to support a family.

This pushes large numbers of women into financial dependence on men in one of two key ways.

Through marriage or similar, where the woman is dependent on a single man with the social structures and resulting power imbalance allowing him to treat her like a non-person without consequences – should he want to.

OR through prostitution and related practices, such as webcamming, lap dancing, surrogacy, etc. where women are dependent on being treated as a non-person by large numbers of men.

Like Emily and Harriet, many women enter prostitution as a short-term fix to a financial crisis but end up trapped there. Many others are coerced into it by “boyfriends” and others who want to freeload off their prostitution. But regardless how they get into it, the majority of women enter prostitution poor and usually end up even poorer and with a host of additional problems caused by the physical, emotional and psychic trauma.

Prostitution serves the ruling elite by keeping women trapped in dependence on men’s whims – with no holds barred. And prostitution buys off the non-elite men by allowing them sexual access to women who really have little or no choice in the matter. It is divide and rule on steroids.

At the same time, this system, by designating men as the ones whose needs are paramount, and women as the ones who must always serve men’s needs and who can be bought and sold like commodities, implicitly defines women as second class. This sets up an endless feedback loop in which women are valued less and so their work is paid less, which sustains the imbalance of power through which men have virtual impunity. All made more vicious and efficient through the latest technological developments.

The imbalance of power in prostitution is such that nothing can make it safe for the women and others who are bought within it.

Prostitution won’t end until women stand together en masse and kick up a tsunami-sized fuss and say NO MORE. And insist that prostitution is incompatible with women’s human rights to dignity, equality and freedom from torture, and it has no place in a modern democratic society.

I noticed that as I was saying something like this to Elise, her mouth dropped open. When I finished, she said that never in her entire life and 18 years of formal education had she encountered a serious critique of the sex industry. Not once. Not ever. She had no knowledge that such a critique even existed. She was absolutely gobsmacked. Obviously, I gave her some suggestions for further reading and she thanked me and attended some of our subsequent events.

But it left me deeply disturbed. How could this happen? How could all that feminist analysis and testimony and courage be eliminated so quickly from the academic canon as if it had never existed? Surely this is evidence that prostitution is imperative to the success of the patriarchal system – and the capitalist and neo-liberal capitalist systems that are built on top of patriarchy? But regardless, it shows the lengths that the powers that be will go to ensure that girls and young women are not exposed to the feminist critique of it.

In prostitution – and pornography its propaganda arm – women’s sexuality and sexed bodies – the very core of our personhood – are used to dominate, humiliate and dehumanise. And because porn in particular has infiltrated every corner of our culture, this visceral oppression affects us all.

So without a feminist critique, what are women left with?

So often, it’s shame, whether we’re consciously aware of this or not. So many women are ashamed of our bodies. Ashamed of our high voices. Ashamed of our subordinate position. Ashamed that we earn less money. Ashamed that we are inseparable from the body of despised females.

This is not some personal failure. This is an inevitable response to the current reality. And the more we are exposed to that as children, the deeper the wounds go. And now we have a massive global pornography industry that is indoctrinating our children into these brutal misogynistic mores more thoroughly and efficiently than ever before.

This makes it hard for women to fight back and to campaign for change. Because to speak of the reality of the prostitution system draws attention to everything we would rather pretend wasn’t true – particularly our second-class sub-human status.

Maybe that’s why so many comfortably off young women are so keen to pretend that prostitution is a normal job – perhaps the psychological factor driving their activism is a pathological refusal to see the truth of their own situation.

But is it a personal pathology or a cultural one?

We know from anecdotal evidence that many, and perhaps most, of the young women who are leading the campaign to redefine prostitution as a normal job and to introduce the decriminalisation of brothels and pimping and buying sex, have not themselves been in the position that Harriet and so many other marginalised young women find themselves in, where they really don’t have a choice but to endure being raped by multiple men a day in order to keep a roof over their heads.

So this is the topsy turvy world we are in. Where large numbers of young women, including medical students who can expect a financially privileged future, are vehemently campaigning for something that is anathema to their own status and wellbeing: The full decriminalisation of the sexploitation industry.

And no, I didn’t use the word “rape” lightly. Rape is unwanted sex that is forced on someone against their will.

This is almost universally considered – in theory at least – a serious crime. This is an intrinsic recognition that our sexual integrity is fundamental to our sense of self, and that any assault on it is uniquely damaging both to the individual and to society as a whole.

But in prostitution, a woman might be experiencing this 10 or more times a day. Day after day after day. Tell me, how could a woman survive that without massive dissociation? Without massive psychological damage?

Which brings us to the issue of consent. For consent to have any meaning, there must be freedom to say no without serious consequences. If the only choices are to agree or be beaten up or to suffer some other serious negative consequence, any notion of consent is meaningless.

And isn’t that the reality of prostitution? She agrees because she doesn’t want the man in question or her pimp to beat her up. Or she agrees because she’s desperate for money – to pay the brothel’s daily “house fee” so she can take home enough to pay the rent and feed her kids. Or she agrees because her psyche has been so warped by early childhood sexual abuse and grooming by individuals, pornography and the culture, that she can only see herself as a sexual servant to men.

I know many women who have survived prostitution and I’ve talked with many of them at some considerable length. Most of those who endured prostitution for any length of time say that when they were inside it, they defended it and it was only after they had escaped and reached a place of relative safety that they could admit to the reality that they dreaded every single prostitution encounter and that it did in fact feel like rape.

But to admit to that reality, we have to defy all that we have learnt about what it means to be a good girl, a good woman. Because it means we have to say NO to men. To say to men, you are NOT entitled to treat women like this. Not one single woman or girl. And we are going to hold you to account, come what may.

If we don’t do this, individually and collectively, what does the future hold for our grandchildren and their children and grandchildren? What will life be like for the little girls born in 50 years’ time, if we continue down this path, giving free rein to this industry that feeds off women and girls and turns boys and men into predators – given the technological developments that have made the expansion and operation of the industry easier than ever before? Given the saturation of the culture with brutal, violent, misogynistic porn?

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Before I finish, I want to talk a bit about the fall out of all this.

One of the things that we hear over and over and over from survivors of the sexploitation industry is what happens when they disclose current or past involvement in it to professionals like yourselves who are tasked with attending to people’s mental and physical health.

For example, this is what Sian said about it:

“I once mentioned my history of prostitution to a psychologist and she acted as if it were something I’d made up. She simply didn’t believe me, and it made me really angry. When I later accessed counselling, I asked their views on prostitution first, because if they’d been the ‘sex work is work’ types I wouldn’t have spoken to them. Blaming women for their abuse is incredibly cruel.”

I’ve lost count of the number of women I’ve heard talk of their frustrations with the response they’ve received from counsellors, therapists, psychiatrists, and other medical and caring professionals after disclosing current or past involvement in the sex industry. One of the most common complaints is the practitioner’s conviction that prostitution is a ‘lifestyle choice’ and that, apart from the odd, isolated incident, it’s not inherently traumatising.

This can manifest as questions, such as: Why did you let it happen? Why don’t you just leave? Why do you keep going back?

Women talk about feeling judged, invalidated, gaslit even, and as if they have no right to feel traumatised by their experiences in the sex industry. This echoes how victims of domestic violence were treated in the past – even the questions can be the same. It took decades of feminist activism to bring about change in the response to domestic violence, and there is still a way to go.

Far too often, medical and therapeutic professionals position women who disclose involvement in prostitution as in control and making a genuine choice. Too often such women are described as ‘too complex’, their lifestyles ‘too chaotic’, and the causation of their problems is located in something inherently wrong with them. They are likely to be given a diagnosis of Borderline or Emotionally Unstable Personality Disorder (BPD or EUPD), for which they are sometimes told there is no cure.

This not only belies the immense trauma they have experienced, but also obscures who was responsible for that trauma – the men who buy sexual access to women and girls and the people who facilitate and profit from that.

This is a particularly vicious form of victim blaming.

It is notable that the men who cause such trauma are typically not given a diagnosis of Narcissistic Personality Disorder or similar, which you would think their behaviour might justify, and which would suggest there is something wrong with them. Mostly they are let off the hook, with their abusive and destructive behaviour unrecognised and unacknowledged and therefore implicitly condoned.

So it would seem that by accepting the sex industry lobby’s propaganda that prostitution is a normal job, the medical and therapeutic professions are contributing to the perpetuation of an inhumane system that causes immense damage to both individuals and society more widely. But not only that, they are also contributing to the invisibilisation of that inhumane system and the blaming of its victims.

Judith Lewis Herman, the American psychiatrist who has spent her life specialising in the treatment of trauma wrote the following in a letter to the New York Times in May 2016:

“For many years, I was the training director in a treatment program for patients with psychological trauma. A considerable number of our patients reported histories of having been used in prostitution. These were among the most severely traumatized people we saw, and they suffered from extreme forms of PTSD. The stories they told were horrifying, even to our seasoned clinicians who had borne witness to many horrors.”

Multiple peer-reviewed studies have confirmed this and found a very high incidence of PTSD symptoms among women with lived experience of prostitution – ranging from 47-68%.[*] This is double the rate that you would expect to find in soldiers returning from active service in a war zone. In addition, the PTSD that these women suffer is typically more complex than that found in combat veterans.

Herman, and many others, have shown that women can recover from such trauma when given appropriate practical and psycho-social support. But without recognising and acknowledging the trauma that these women have lived, the prospects are much less positive.

There is also a need for an understanding of the harms that pornography use and prostitution buying cause.

It is now widely recognised that problematic porn consumption is widespread, especially among young men, and that it is detrimental to mental and physical health and is associated with sexual offending. Buying sex is similarly associated with a propensity for sexual offending.

Problematic porn consumption is recognised by the World Health Organisation as a compulsive sexual behaviour disorder and research has correlated it with addiction-related brain changes. Many people find that they cannot control their pornography use even when they’re aware that it is negatively affecting their relationships, work, and behaviour and is causing sexual problems. There are also concerns that the rise in suicides of young men that we are currently witnessing might be connected to problematic porn consumption.

Unfortunately, porn use is not widely understood by many professionals. For example, an article in The Guardian said that:

“James tried to get help at university, when using pornography to ease the pressure of deadlines only further stole his time, harming his studies. He found a relationship counsellor. ‘I was gearing up to talk about my porn addiction for the first time ever, and I was really nervous, and the woman was like: ‘Why don’t you just stop watching it?’ She was so dismissive.’”

Whether we like it or not, what we are witnessing in the modern sexploitation industry is a social and cultural change of seismic proportions that has almost unlimited potential to ruin all our lives. It requires a courageous and holistic response. That must start with an unflinching understanding of what the sexploitation industry is and how it impacts the different demographic groups – girls and young women, boys and young men, and parents and those who work with children and young people in particular.

The wishful thinking of the “sex work is real work” lobbyists is as much use in this new reality as a pair of rose-tinted spectacles. Don’t fall for it.

Before I go, I just want to tell you about a handbook that we created for universities. It’s packed with useful information, including a realistic understanding of the sex industry and detailed discussion of how best to support students who are involved in it. You can download an electronic version for free from our website or buy a copy in our website shop.

Although primarily directed at universities, we believe it is a helpful resource for anyone in the helping professions.

[*] For example:

• Cumulative Violence and PTSD Symptom Severity Among Urban Street-Based Female Sex Workers
• Violence and post traumatic stress disorder in a sample of inner city street prostitutes
• Prostitution and Trafficking in Nine Countries: An Update on Violence and Posttraumatic Stress Disorder
• Posttraumatic stress disorders in prostitutes: Results of a study in Hamburg in the context of an international project

Further reading

• Working with students involved in the sex industry
• Handbook for Universities