For most of the three months she was in a coma, Sophie* was just another Jane Doe.
She kind of knew the man who dropped her off at the hospital, but not really. She hadn’t seen or spoken to her family in years. From 2003 to 2008, she’d lived on the street. She was alone.
The drugs and street hustle were catching up with her. A fever was burning. Her legs grew heavy and numb. “It was probably going on for weeks inside of me, but I just kept moving,” she recalls. Then things got worse: “I [couldn’t] lift my legs. I couldn’t walk. Something was really, really wrong—I didn’t know what it was.” Thoughts scattered like marbles; she couldn’t string them together to reach the obvious conclusion that she needed to see a doctor—and soon. “I was delirious,” she says, “but I just kept getting high.”
Endocarditis, a bacterial infection that can be fatal, was attacking the inner lining and valves of Sophie’s heart. It’s commonly contracted through dirty needles used to inject drugs. She blacked out. A client—that is, a man who’d paid her for sex—who was with her when she collapsed drove her to the hospital.
Sophie’s body lay stiff and motionless, but her mind kaleidoscoped through bright, vivid dream sequences that distorted and dissolved the divisions between her past, present and future. The scenes were cinematic and felt real. “I didn’t know that I had a feeding tube in me; I didn’t know I had a [tracheotomy tube] in me; I didn’t know I couldn’t walk. But in my dream, I was walking around trying to get high with a feeding tube in me, and I couldn’t walk, and nobody would help me,” she says. “It was just very—it was a very helpless feeling. I felt very, very helpless.”
Now it’s five years later. Sophie, 36, against the odds, is alive. In fact, she’s more than alive—she’s living. Sober for more than 19 months, she’s happy for the first time in memory. It’s a far cry from her previous state.
“[Being out on the streets] was very traumatic,” she says. In addition to the drugs, she’d been selling sex, hustling in what women like Sophie call, simply, “the life.”
“At certain points, I wanted to hurt the men,” she says. “I thought of seriously hurting them. I’d rob them. I had no respect for any of them. None of them.”
Not even the man who dropped her off at the hospital—who, for a long time, was the only person who visited her there.
“He was just a sugar daddy,” she says. “He had a lot of insecurities … He almost lived vicariously through me, ‘cause he was too scared to do anything. He liked watching me get high.” Ultimately, she says, she saw him much like the rest of the men she encountered on the streets: “Everybody uses everybody. I used them, they used me, and it was all because I was using [drugs]. It’s all a using thing … I don’t care how nice they were. Still, in my eyes, they weren’t, you know?”
Prostitution played a big role in Sophie’s life in the five years before she collapsed, as did drug addiction—which raises a curious point. While of course many sex workers are drug-free—and not all drug addicts sell sex—it’s common knowledge that, for a certain population of poor women like Sophie, addiction and street-level prostitution often go hand in hand. Yet we hardly know anything about the way those two things interact—or how that interaction affects recovery.
That’s mostly because, as a society, we’ve found it easier to ignore and even condone the routine violence that accompanies street prostitution, chalking it up as an occupational hazard.
The simplistic narrative we think we know is that a woman becomes addicted to drugs, then resorts to selling sex to pay for drugs. That the drug is the only addiction, and the prostitution is simply a byproduct of acquiring it. But talking with women who have lived “the life”—and with the experts who work with them—reveals that this unquestioned narrative is a fundamental misunderstanding of how addiction plays out in many women’s lives.
Because there’s one significant factor in this equation that’s often been overlooked: post-traumatic stress disorder.
PTSD is the phenomenon by which the brain and nervous system change in response to traumatic events such as violence, natural disaster or severe chronic stress from situations like poverty or physical abuse.
In May, health officials released early highlights of a forthcoming report studying adverse childhood experiences: the Philadelphia Urban ACE survey. Conducted by the Public Health Management Corporation, the study expanded on previous Centers for Disease Control research examining “a range of early childhood stressors and their relationship to clinical, public health and social problems” throughout a person’s life. The full results of the Philadelphia study, the first to focus on an urban population, will be released in the coming weeks—but we already know a few points.
The original CDC study reported that “abuse, neglect, witnessing domestic violence or growing up with alcohol/substance abuse, mental illness, parental discord or crime in the home can lead to social, emotional and cognitive impairments, increased risk of unhealthy behaviors, violence, victimization or revictimization, disease, disability and premature mortality.” And the highlights of the Philadelphia study reveal, essentially, a local crisis of childhood trauma: 35 percent of local adults interviewed were physically assaulted by a parent or caretaker as a child; 16.2 percent were sexually abused, and more than one in three grew up in a household with family members who abused drugs or alcohol. More than 40 percent saw or heard another person get beaten, stabbed or shot.
Counselors who work with poor, addicted female prostitutes say they’re often suffering PTSD from the stress of street violence—often compounded with an earlier childhood trauma that led them to the streets in the first place. It’s a vicious circle that thrives in part on the social stigma of sex work: Trauma leads to self-medicating with drugs and alcohol. Chasing drugs and getting high, in turn, can lead to further trauma by way of exposure to violence from men who know there’s little likelihood they’ll be arrested and prosecuted for their actions.
These women thus adapt to constant threat, becoming conditioned to danger, which morphs into another dimension of addiction. They don’t relapse and run back to the streets despite the threat of violence—but, rather, because of it. They’ve adapted to the threat of violence.