Home Health We’re Not Crazy For Doing This: Sex Workers With Mental Illness

We’re Not Crazy For Doing This: Sex Workers With Mental Illness

“Patients Waiting To See A Doctor, With Figures Representing Their Fears” by Rosemary Carson (via wikimedia)

Most people have some form of a lurid narrative about drugs, exploitation, childhood abuse, and mental illness come to mind when they imagine the life of a sex worker. However, sex workers’ relationships to their identity are far more complex and difficult to characterize than that trite narrative allows for. When it comes to sex workers who do live with the stereotypical trope of also having a mental illness, it becomes even more essential to uncover what these sex workers themselves have to say about their lived experiences of that mental illness and sex work.

People diagnosed with mental illness frequently have their decisions invalidated and undermined by the dominant culture. Many individuals who do not have much experience with mental illness will attribute any socially unacceptable behaviors to “mental illness.” In much the same way, people who have never been in the sex industry tend to sideline the decisions of sex workers by inferring that trauma or abuse must have predestined them to a life in the sex industry. When people who are neither mentally ill nor in the sex industry say these things, they are robbing us of our ability to exert agency.

Amber, a full-service worker from Washington DC, states, “I very strongly believe that the way that society treats sex workers, mentally ill people and other marginalized communities (that often intersect)…[is] based on kyriarchal/patriarchal, colonialist, and capitalist systems of control. In order to treat marginalized people better, I think we all have a lot of work to do regarding the unlearning of certain stigmas and stereotypes.”

The presence of stigma is one the key aspects of institutional violence keeping communities and individuals subjugated. It proliferates because it benefits those in power in this way. Stigma creates legal and moral justifications for the criminalization of sex work in America. It also creates an environment in which mentally ill people can be stripped of their rights through court-ordered institutionalization, coerced medication, and the assignation of relatives as proxies to control them legally and financially. The disqualification of the decision-making abilities of communities on the margins is a weapon of the oppressor.

Tara Johnson, a stripper from Portland, Oregon, elaborates on the ways in which decision making can be invalidated based on association with the sex industry, especially if one also has a diagnosis of mental illness: “Just because I’m (sometimes) crazy, doesn’t mean I’m wrong. My sex work was not me acting out, or indulging in yet another form of self-harm. It was nothing that entitles people to belittle my full humanity. It’s nothing that automatically means that mentally ill sex workers, especially ones who may have other issues too (drug use, etc.) should automatically be deprived of the rights that privileged, able-bodied civilians are entitled to.”

Sex work is not a dysfunctional behavior stemming from our disease. Rather, it is often the best choice we can make to adapt to our mental illness. In truth, many people with mental illness find sex work helpful in a variety of ways as an occupational choice. It gives us a less rigorous schedule which allows for more emotional instability. Sex work can also affirm us as something we can excel at when mental illness has hindered our success in more traditional pursuits.

Jane Way, an escort and porn performer, describes the ways in which sex work has helped them: “Sex work gave me the freedom to sustain myself, work through trauma, and build a sense of self. I don’t take shit from anyone; if you’re rude to me, you don’t get to see me. If you’re abusive, I get to leave. And I have handsome, amazing people giving me thousands of dollars a month to spend time with me and tell me I’m beautiful, smart, amazing, and so on. My confidence and self-esteem have never been better, and in turn, I’m able to cope with my mental illnesses in ways that are easier on my body, and healthier for me.”

Similarly, Johnson, also expands on some of the benefits that being a sex worker afforded her in dealing with her mental illness: “ [I]t set me free,” she explains. “It gave me role models who enabled me to put words to the abuse I’d grown up with. It gave me financial freedom to be who I needed to be, without being in a constant fight against financial benefactors who would pretend that because I was mentally ill, I was incapable of having a say in anything about my life. It gave me an easier, more flexible work schedule that left more room for days crying in the closet, or conked out in bed, unable to focus past the stabbing pain in my joints. It gave me the resourcefulness, and daringness to walk away from harmful situations.”

“It came with problems,” Johnson adds, “and in some ways it wasn’t the best for me in a perfect world, but it was still, by far, the best choice I could have made. Had I not made that choice, I would be a far worse person.”

Cheyenne Picardo, a NYC filmmaker and part-time pro-domme, describes how sex work provides a buffer for her mental illness. “Mental illness is the reason I have gone into the work I’ve gone into,” she says. “I am a freelance filmmaker, sometimes college professor, and after taking a long break, I recently started supplementing my income with sessioning. I have a pattern of extreme insomnia stemming from anxiety and depression. If I cannot reliably function at a nine-to-five because I cannot sleep enough be awake enough to do my job, multifaceted freelancing is my best option. I haven’t had a nine-to-five job since I was 22—I’m 37 now—and I would rather be medication-free than hurt myself to maintain a regular schedule.”

Mainstream culture presumes there is a standard or norm from which every human being is supposed to operate. If you have a mental illness, you yourself are a deviation from those standards. If you are a sex worker—especially a sex worker who has mental illness or trauma in their background—you are considered unable to make decisions from the same starting line of knowledge and competency as someone who does not hold these identities. Trauma, mental illness, and sex work are seen as detracting from a person’s potential to be a fully formed and informed individual. Looking at mental illness through this lens allow people with greater power and privilege a rationale for marginalizing sex workers with diagnoses.

As cited by the Washington Post, in his book Shamans Among Us, Canadian evolutionary psychologist Joseph Polimeni theorizes that schizophrenics are just modern-day equivalents of ancient shamanic healers, moving through multiple planes of existence at once. American industrial capitalism brands people living with mental illness as useless and maligns them into the margins. But it is important to remember that throughout various histories and traditions, this has not always been the way this issue is understood.

Portrait of a patient at the Surrey County Asylum, c. 1855 (via wikimedia)

If we were to widen our purview beyond the scope of capitalist values, we might consider that there is nothing inherently wrong with mental “illness.” It is only treated as a deviation by our society because of the stigma we attach to it, which serves as an excuse for the powerful to deny basic rights to this population. The way in which we deal with mental illness—prescribing medications, giving people diagnoses, and “treating” the “disease”—does not necessarily reflect a universal view on the topic. People with mental illness are told that getting back to the norm should be their goal. But why? This is an artificial, constructed value of modern capitalist American culture, not an end everyone should naturally aspire to.

But resisting these normative pressures takes its toll: “Not a day goes by in which I’m not constantly aware of the ways in which [my mental illness] makes me alien to 90% of the people around me,” says Johnson.

Many people assume that sex work and mental illness have an inverse relationship and that one naturally precipitates the other. This can cause not only direct oppression, but internalized oppression. Sex workers living with mental illness may begin to believe in the negative stereotypes associated with both of these identities and become self-hating and self-destructive. This is especially true when a sex worker with mental illness must endure added scrutiny because they choose to address their mental illness in a way deemed unacceptable by society, such as through holistic methods, or when they decide not to actively attempt to “treat” their condition at all.

Picardo elaborates on the complexities of her relationship with modern-day “treatment” for mental illness. “I don’t try to treat the illness anymore,” she says. “Every time I turn to meds I feel worse, and a few times I’ve been egregiously misdiagnosed. Now I just do what I can to cope with the lows when they hit and not to fight. Fighting has never worked for me.”

“I think that having anxiety and depression issues is integral to my creativity, and I think that a certain degree of openness and self-awareness makes me empathetic to others,” Picardo concludes.

“My mental illness makes me who I am; it’s a key part of my identity,” says Way. “I’m sick, and I’ll never get better, but that’s alright with me. It took me a long time to accept that, but I’m here, I’m fucked up, I’m crazy, and I’m complicated as hell, and that’s OK.”

“My mental illness shaped everything,” Johnson states. “It shaped and sometimes hindered my ability to cope with a physical disability. It worsened my resilience and ability to cope and heal after sexual violence and domestic abuse. That, in turn, has affected my anxiety in social situations, such as job interviews, customer-service-heavy professions, educational settings, etc. Every opportunity I’ve had has been touched by…[these] biases, restrictions, and incapabilities, forming the patches of an insanely uncomfortable heirloom quilt draped around my shoulders.”

Inequities and oppression are often part of why sex work can be such a valid option for many, especially marginalized people dealing with trauma and mental health issues. Yet this point is rarely discussed in larger cultural narratives that stigmatize sex workers. It is no coincidence that up to 40% of runaway youth in America identify as LGBTQ. Heteronormative white supremacist patriarchy narrows down economic options and access for many communities. Discrimination in the home, discrimination at schools, in workplaces, and by government institutions must be acknowledged so the decisions of sex workers can be acknowledged. Our choices are no less valid because they may be constrained by circumstance.

A sex worker who wishes to remain anonymous expands on this idea further: “They could acknowledge sex workers as humans who deserve security and respect. They could understand that MI and sex work often go hand in hand because sex work, disability, drug dealing, hustling, etc, are all part of an underground economy that benefits women of color, disabled people, survivors, queers, traumatized people, and gives us more autonomy; of course, addictions and other hard things associated with sex workers are real parts of coping with MI and should be destigmatized as in all areas of life…but there is a reason we (sex workers, psychiatric survivors, people with MI, people on federal disability, etc) flock together, and that is: the destigmatization that comes through validation and solidarity. Often, our lives depend on those connections.”

Mental illness can be extremely isolating. Sex work can create a community and a lifeline for us, recognizing and affirming us in ways we aren’t around “regular” people. In a world where all too often, mental illness is seen as an abnormality that must be corrected, the underground culture of sex work typically celebrates “weirdos” and “freaks” in ways that mainstream society does not. It can be a refuge for those individuals and communities who are told they do not belong, made to feel demonized by and alienated from the dominant culture. It is not necessarily every sex worker’s first choice for a career, but this does not entitle non-sex workers to judge the complex and multi-layered decisions that people with mental illness have to make while navigating the broader culture. Choices made because of oppression, marginalization, and alienation are not any less valid than choices which are not influenced by such factors. We all operate in different contexts of constraint, on multiple levels. The autonomy of sex workers and folks living with mental illness must be respected.

Laura LeMoon is a writer, sex worker and HIV researcher based in the Seattle area. She has worked with organizations such as St. James Infirmary, International Rescue Committee, and Durbar Mahila Samanwaya Committee (DMSC) in Kolkata, India on sex workers' rights issues, and she is one of the founders of Safe Night Access Project Seattle (SNAPS). She is never found without her beloved elderly rescue dog, Little Bear.


  1. “Heteronormative white supremacist patriarchy” An infallible bigotry marker, and a signal to stop wasting my time reading drivel.

  2. “Choices made because of oppression, marginalization, and alienation are not any less valid than choices which are not influenced by such factors.”


    Thank you for this; it was really empowering to read this. I have borderline tendencies, which I feel like have actually helped me perform sex work well! The extreme emotional oscillations help me to regulate proximity/distance to clients effectively. I tried to write a paper once for a uni course on affective labour, in which I proposed, based on my experience, that the borderline personality may actually be the “ideal” type for sex work:-) but my professor almost failed me for it, saying that my thesis was unethical…

  3. “In truth, many people with mental illness find sex work helpful in a variety of ways as an occupational choice. It gives us a less rigorous schedule which allows for more emotional instability. Sex work can also affirm us as something we can excel at when mental illness has hindered our success in more traditional pursuits.”

    Yes yes yes. It’s so difficult for people to understand that, though sex work isn’t all sunshine and rainbows (and really, what work is?), a “normal” job can cause far more problems for some people with MI than sex work does.

  4. As cited by the Washington Post, in his book Shamans Among Us, Canadian evolutionary psychologist Joseph Polimeni theorizes that schizophrenics are just modern-day equivalents of ancient shamanic healers, moving through multiple planes of existence at once.

    Uh.. I sometimes wonder about the sanity of psychologists, due to stuff like this. My aunt, by marriage to my uncle, who.. imho wasn’t always all there either, when she was “up” ran the ward at a psychiatric hospital. When she was having an episode she liked to lock her kids in a closet, or a cardboard box, and poke at them with the end of a vacuum cleaner. If that is what a “shaman” was in the old days people should have been running away from them, not venerating them. I also suspect that he has *never* actually talked to an actual modern shaman, from the cultures that still practice it, like, at all.

    Oh, you could probably argue, rightly, that she was an extreme case, but.. This sounds like something straight out of evo-psych, a branch of the two combined sciences that seems to be, always, and universally, about picking something you want to be true, or some bias society already has, then making up an explanation, out of the thin air, about how it must be how it got this way (both more sensible psychologists, and pretty much every single scientist I know about who deal with genetics, or anything else where actual research is needed to test ones ideas, think these people are a complete joke). There are two massive problems with this –

    1. The people doing it, despite their claim to be scientific about it, often do exactly what you rightly accuse the detractors of sex workers for doing – ignoring the evidence, or the people, who contradict their assumptions. In this case, modern, existing, people that practice some class of shamanism, in favor of making up some untestable idea that, “In some vague past, this was where it came from.”.

    2. Failing at the one single *key* factor than makes something science in the first place: You have to be able to test your hypothesis, and when you do, your goal is to hammer it to death, to see if it breaks, then, and only then, calling it theory, and presenting in as an answer, if it actually bloody works (How exactly does anything in evo-psych do this? You can’t even study modern people, in most cases, to test the idea, never mind go back in time to find out how and why some social view, or apparent idea came into use). I mean, sure you can say, “Modern people do X.”, and “if” you study history, archeology, and other sciences, you can sometimes show when something showed up, sort of, and how it progressed, some times, but.. not “why”, or always “how”. The answer, in most cases, with less biased minds, is almost always – humans can adapt to almost any stupid ideas, even bad ones. Which doesn’t, ever, explain why the ones that survived did, which ones are actually bad, or good, nor how they came to become dominate, just that they where not such horrible ideas they made us dead.

    3. When it becomes obvious that they pulled this out of their ass, its not defensible from evidence, and/or there is evidence they didn’t collect, or ignored, which contradict it, how exactly does the choice of using such scientifically unsound, but maybe comforting (hence the decision to fall for it), nonsense help defend against the accusation that everyone doing what you do is nuts, or damaged? After all, you picked a nuts idea to explain away why you have a diagnosed disorder. You see this sort of failure to find contrary evidence in everything from psychologists trying to explain why girls like pink (ignoring that its been less than 200 years since pink was too passionate for girls, and they should wear chaste blue), to why boys are aggressive (something shown, in many studies, to not be the case, until social cues “guide” the girls towards using other methods to act out, because its “not what little girls do!”), to.. every other social idea that someone feels the need to “explain” as an adaptation, which needs to be explained.

    So.. the idea that shamanism stems out of schizophrenia… Lets see evidence on this, not some book filled with evo-psych speculation and just so stories. And.. for the love of Zod.. don’t use this sort of stuff to try to promote the idea that the detractors of sex work, for example, or being “unfair” about how nuts the people doing it might be. It won’t help the cause. At best, it will just make people like me, whose only bias is, “Everyone, even me, believed stupid BS.”, shake their head and sigh at the silliness of even mentioning it.

  5. Thank you for this. Even though I am no longer active in transactional sex ( other than being a wife to my husband which has transactional elements but a lot less simple and a lot more drama-producing) – just did a very good job of illustrating several levels of this very complex situation. I wonder how many people who face mental illness issues would do this work if there were any other the filling and satisfying work available that provided a living wage. I guess I’ll never know because there aren’t any other jobs that do that. Transactional work turned out to not be sustainable for me for many reasons not having to do with the work itself. But I consider myself an advocate for decriminalization and hopefully one day some level of legalization in my state. I truly believe that is the best way to eliminate human trafficking in my area.


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