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Discussions of abuse, trauma, and mental illness follow.

I read an article about human trafficking in Texas a couple days back when a section on the mental health issues of trafficked sex workers caught my eye. The first condition mentioned was dissociative identity disorder (DID), which makes sense because prostitutes as a group suffer high rates of child sexual abuse and incest (85% and 70% respectively in the study cited). This kind of severe and repeated abuse in childhood is a leading cause of DID, so it makes sense that prostitutes would have high instances of DID. I'm not only talking about pre-prostitution trauma, either. As stated in the linked rapeis.org page the average age of entry into prostitution is 13, meaning many sex workers are still children.

It was particularly good to see the existence of DID discussed in this heavily traumatized group, because as recently as November 2014 I read an article attempting to discredit the whole idea of DID and repressed memories of abuse. And look, obviously some people are malicious or disturbed enough to make false accusations of abuse, and it's not out of the realm of possibility that unscrupulous and biased practitioners manipulated patients into false memories, though I'd like to see better documentation of this assertion. However, if your entire argument boils down to "it's impossible for traumatic memories to be suppressed so no such accusation can ever be true," despite numerous empirical and clinical records of this very thing happening--well, let's just say that's barely a step up from "bitches always lie about rape." Just add an adjective and it becomes "Forgetful bitches always lie about rape."

So, intrigued to find out more about DID in the context of childhood abuse and prostitution, I went searching and found these resources interesting.

Dissociation Among Women in Prostitution - This is a 2003 article summarizing four studies on dissociation done with current and former women sex workers in Canada, Turkey, and the U.S. The studies found higher Dissociative Experience Scale scores among these current and former sex workers than among the general population. And remember how multiple personality disorder is supposed to be a North American disease? Well it turns out the studied sex workers in Istanbul actually had higher rates of DID (18%) than the U.S. sample appeared to (16%).

The "clinical observations and theory" section of the paper had fascinating insights, too. It opens with a quote from W.E.B. DuBois who described the dissociative effect of slavery ("double-consciousness, this sense of always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity. One ever feels this twoness . . ."), which I think would be familiar not just to abuse victims but also to many women, who also maintain this bifurcated view of themselves as both the observer and the observed as a matter of social and even physical survival.

The paper also suggests that dissociation, particularly dissociated identity, is a forced adaptation for sex workers who must be whatever she is desired to be, ("You start changing yourself to fit a fantasy role of what they think a woman should be. In the real world, these women don’t exist. . . . They’re not really looking at you. You’re not you. You’re not even there.") Ultimately, the authors argue, healing won't take place until there is full integration and reckoning with reality. ("That was probably one of the hardest things to get over–re-attaching with feelings and re-attaching with myself and my physical body. . . . The goal . . .is to slowly take every shattered piece of your life and build you back up.")

I liked how the authors cautioned against therapists themselves having bad reactions to their clients' trauma and interfering with their healing. "A range of responses to extreme trauma are common in therapists working with survivors–from minimization, avoidance, denial and under-diagnosis to outrage, overreaction, and over-politicization of the treatment setting." This explains a lot of the therapist horror stories I've heard, come to think of it. Who knew, trained professionals are only human too and have their own defense mechanisms! It seems there needs to be greater recognition of therapists' own limitations and the way they might be retraumatizing their clients.

Overall this was a difficult read for obvious reasons. I had to take a break to compose myself when a survivor was quoted saying, "[A]ll I knew was how to be raped, and how to be attacked, and how to be beaten up, and that’s all I knew." Still, ultimately I found it helpful and hopeful, and there were some awesome parts like the one where it was proposed that the dissociated identities of women are "a small army fighting for the rights of women." It also helped me gain more perspective on DID and gave me a good talking point in case anyone started up with the "It's only been diagnosed in America so nyah" line in my hearing. If anyone needs the text, feel free to hit me up.

Diary of a Multiple Personality - This is a small blog with less than 20 entries and abandoned going on five years, but I still found the glimpses into this woman's life intriguing. Be warned, this blog discusses childhood sexual abuse beginning in infancy, and also the shenanigans of a therapist who appears to be an execrable human being in addition to a strong contender for Worst Therapist Ever outside of ones that committed outright crimes. The blogger as of last report doesn't seem to have worked out good communication between alters, since at least two of them not only engaged in embarrassing and disruptive behavior (sex in highly inappropriate settings) but also put the system in physical danger (unprotected sex with strangers, overdosing on medication). She also discussed painful front-switching and gaps in memory. I hope they've worked that out in the years since, especially seeing how they've left the Therapist From Hell.

The Sum of My Parts: A Survivor's Story of Dissociative Identity Disorder - This one is a memoir by fellow D.C. lawyer Olga Trujillo about her childhood abuse and healing. It seems to be really good, if the reviews are anything to go by. I'm pleased to report that there was not a single person on Goodreads popping out to yell "DID/repressed memory is a racket!" The author was even considerate enough to add a trigger warning for the first six chapters of the book, which everyone agrees are extremely disturbing though not graphic. I bought this one on Kobo and now just need to work up the courage to read it.
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L.J. Lee

August 2019

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