by Robert Evans
The Medicinal Sex-Work Industry
Our friend Durkheim, the sociologist who first elucidated the safety valve theory of deviance, actually posited a third societal function for illicit behavior: It helps instigate social change.
Where crime exists, collective sentiments are sufficiently flexible to take on a new form, and crime sometimes helps to determine the form they will take. How many times, indeed, it is only an anticipation of future morality—a step toward what will be.
This is most clearly demonstrated by marijuana’s recent history. For decades it was—and in many places remains—a thing that can send you to prison for years of your life. But people kept doing it, and once its use spread across a wide enough underground, the users started agitating to change the laws. Now state after state, and a few whole countries, have decriminalized or legalized pot’s sale and use. Medical marijuana is now one of the fastest-growing industries in the United States.
Oddly enough, prostitution may be on a similar path. In 1970, the famed sexologists William H. Masters and Virginia E. Johnson introduced the practice of sexual surrogacy in their depressingly named book Human Sexual Inadequacy. Sex surrogacy became the therapy method du jour among the hip and hurting throughout the seventies and eighties, but it died down significantly in the nineties.
It was legalized nationwide in 2003, and over the last decade and change, surrogacy has slowly grown in both professional and social acceptability. But while “medical marijuana” in many states is just a sly excuse for people to get a recreational high, medicinal sex work is a different legal matter altogether. Surrogates don’t work alone; they provide treatment in tandem with a licensed therapist. Sexual surrogates spend only, on average, 13 percent of their time having sex with a patient.
And therein lies the key-est of differences between sexual surrogacy and prostitution. Clients don’t always wind up having sex, but if that’s what they want to pay for, that’s what they get. With a surrogate, you’re paying for therapy that may—or may not—include sex and certainly won’t start with it. The sex itself is actually the “climax” of a long process of therapy. Shai Rotem, a male sexual surrogate, gave me a broad outline of the process:
Basically the heart of the work is the mini relationship that has been created between the surrogate partner and the client. Every client has different difficulties, and by creating a mini relationship with a surrogate partner we’re able to see where she’s struggling.
So basically, the patient-surrogate relationship mimics an actual romantic relationship, allowing the surrogate and therapist to pinpoint the patient’s problems and work on building solutions.
It’s about having an experience with a person [that the client] is comfortable and safe with, and by doing that, she has a model now in her mind and heart of how to create a relationship.
I also spoke with Shemena Johnson, a Los Angeles–based therapist who has worked with Shai Rotem for the last two years. Sometimes Shemena refers patients to Shai, but, more frequently, women reach out to him directly and he then refers them to Shemena. Both Shai and Shemena conduct sessions with their patients separately, and then confer together over their notes and plans for treatment. As Shemena says:
The client is fully aware of our engagement; we update each other on the progress; and there may be issues that come up with the surrogate-partner therapy process [such] that [Shai] may reach out to me and say, “We might need to work this through.”
The most common issue that crops up is that patients take their “mini relationship” a little too seriously and start developing feelings for Shai.
Usually it’s a fantasy. “I want a friend, I’m lonely, I wish I had someone in my life who was similar to Shai.”
In those cases, Shemena’s job is to help her patients “grieve for the loss of that relationship” while still moving forward in their search for a healthier romantic life. And for many clients, dealing with the issue of growing too close to their surrogate is actually a valuable part of the therapy. As Shai explained to me:
Most of the clients that I see were referred because of either late virginity or an inability to create relationships.
Many of the people who require sexual surrogate therapy have never really had a healthy sexual relationship in their life. Learning how to make a clean break with a “lover” without losing their self-worth or -confidence is a skill they desperately need to cultivate. Shai describes this breakup process, at its best, as a sort of graduation:
All relationships will end at some point. Either the other person will die, or there will be a breakup or divorce, and most relationships end with pain and anger, people fighting. In surrogate relationships we give our client the ability to end the relationship with a form of graduation. I like to think of my clients as little birds. . . . When they’re ready, I want to help them take off and fly on their own.
One issue that frequently leads clients to surrogates is vaginismus, an involuntary spasming of the vagina that can render any form of penetration—even just a finger—painful or impossible. The best scientific evidence for the efficacy of sexual surrogate therapy actually comes from a 2007 study on vaginismus treatment. In the article “Surrogate Versus Couple Therapy in Vaginismus,” the researchers Itzhak Ben-Zion, Shelly Rothschild, Bella Chudakov, and Ronit Aloni studied sixteen patients receiving therapy for their vaginismus with a trained surrogate, versus sixteen patients undergoing the same therapy with their actual romantic partner instead.
The results were quite conclusive: 100 percent of the women undergoing surrogate therapy successfully treated their vaginismus. Only 69 percent of the women who underwent couples therapy were “fully successful” in the same time frame.
Becoming a trained surrogate isn’t a quick and easy process. The International Professional Surrogates Association (IPSA) offers a “100-hour didactic and experiential course of study in human sexuality” as the first stage of training to become a certified professional surrogate. The second stage is a two-year internship, in which, according to Shai:
[Students] work with actual clients in a very close internship with their mentor. So let’s compare a working practicing surrogate to an intern: a practicing surrogate reports to the therapist after every session. When it comes to interns, they report to the therapist as well as reporting to their mentor and having a once-a-week meeting with their mentor or supervisor.
Of course, not all people who call themselves sexual surrogates become certified through the IPSA. While I was working on this book I also interviewed an anonymous woman in the Saint Louis area who has worked as a surrogate for the last five years without an IPSA certification. She’s open about her career, and doesn’t hide from the law, but “Sarah” acknowledges that the legality of what she does is something of a gray area. While the legitimacy of her practice is certainly questionable, Sarah’s work with disabled patients struck me as incredibly valid, and valuable.
She told me about one of her regular patients, a man with muscular dystrophy who was initially told he wouldn’t live past the age of twenty. At age twenty-one the doctors realized his case was less severe than they’d feared, and suddenly this young man realized he might have a chance to enjoy some of the experiences he’d assumed were closed to him forever. As Sarah told me:
So when he was twenty-five he decided he wanted to know what sex was like. His therapist connected us. I’ve been seeing him for months—I started by helping him explore how to finger me. He’s got limited mobility but we’ve had intercourse, and he’s able to ask me really intimate questions. We’ve experimented with different toys. He asks me questions about female ejaculation, etc.; every time we get together it’s a different topic. He’s not gone off and gotten married, but it’s expanded his horizons.
Sarah’s not the only sex worker in the world helping physically disabled people experience the wonders of intercourse. Over in Australia, where prostitution is decrim
inalized or outright legal in every state, a woman named Rachel Wotton has made a name for herself working with disabled clients. The 2011 documentary Scarlet Road tells her story.
Rachel doesn’t bill herself as a sexual surrogate, though. And while Shai was very adamant about stating that surrogates aren’t prostitutes, the line between those two jobs is not always so clear. While researching an article in 2015, I spoke with a young male prostitute in Australia. He reported having several clients with vaginismus sent to him by therapists who felt some “hands-in” experience would benefit their patients.
Sexual surrogates find themselves in much the same conundrum as the legitimate medical professionals studying and working with marijuana today. Their treatments have proven value, but the potential future legality of their recreational cousin risks delegitimizing the medical side of things. Sexual surrogacy is currently legal, but it’s still considered a rather fringe treatment. As Shemena told me:
Shai has been doing this for two decades—I consider him very legitimate, but he doesn’t have the paper behind it that I do.
It’s hard to say if a change in “paper” is really what’s needed here. Perhaps what we need is a change in attitude. Shai Rotem and his colleagues are certainly pushing the boundaries of what sex work can be. But you can make a strong argument that they’re simply pursuing in an organized, clinical fashion the kind of goals sex workers have been achieving (often by accident) for centuries.
On Good Friday 1962, twenty divinity students of Boston University gathered at Marsh Chapel to celebrate the resurrection of Jesus Christ . . . and also to trip their preordained balls off. Those young students were all subjects of one of the most infamous studies in the history of science. The experiment had been designed by a graduate student named Walter Pahnke, and was conducted with the help of the academic world’s leading acid guru, Timothy Leary.
The goal of the Good Friday experiment was to settle a debate that’s been going on between recreational drug users and mainstream religious figures since . . . well, the late fifties: Is a spiritual revelation received with the help of psychedelic drugs somehow less real than one brought about without the use of drugs?
I talked to one of the study’s participants, then divinity student, now Reverend Mike Young, about what he and the other participants were told before they started ’shrooming for science:
The way Richard Alpert [then a Harvard professor, now a pan-religious mystic named Ram Dass] and Tim Leary explained it to us was that your brain normally has a kind of “volume control”; basically, they thought the brain had evolutionary blinders built in, blotting out a lot of excess stimuli that isn’t directly useful to keeping us alive. They thought . . . that psilocybin was simply going to turn the volume up, and all of our experiences would come flowing in and the stuff most active in our lives at the time would be at the center of what went on.
Mike and his fellow test subjects were all confused young kids, full of self-doubt and questioning whether a career as a holy man was right for them. It was an ideal group of people on which to test the spiritual potency of psilocybin.
Pahnke split the twenty students in half: Ten of them would be given 30 milligram doses of psilocybin, and ten of them would be given large doses of niacin instead. None of them would know which group they were a part of until well after the drugs kicked in. The niacin was chosen because its short-term side effects include elevated body temperature, sweating, and a flushed, red face. Those are both somewhat common reactions in people coming up on mushrooms. Pahnke’s goal with this trickery was to
potentiate suggestion in the control subjects, all of whom knew that psilocybin produced various somatic effects, but none of whom had ever had psilocybin or any related substance before the experiment.
In other words, he wanted his subjects, both tripping and sober alike, not to know which of them had gotten genuine capital-D Drugs. Mike recalled:
I think what Pahnke was up to in giving us the slightly active placebo is that those who got the placebo would think they’d gotten the drug, and those of us who had gotten the drug would relax and gently slide into the experience, and that’s exactly what happened.
The experiment was a success, at least for the people on team “drugs can cause genuine religious epiphanies.” Nearly every student dosed with mushrooms that Friday marked the experience as one of if not the most intense religious experience of his life. Mike Young was profoundly affected. He entered the experiment unsure of his future and full of doubt:
I was in theological school without a denomination, recently married, and I didn’t know what I was going to do.
Mike recalls being presented with a vision of many colored bands, each representing one of the paths his life might take. He knew he had to choose one of those bands but, “I couldn’t. And that’s when I died.”
These sorts of death visions are an extremely common psychedelic experience. Mike told me, “It felt like somebody had taken a very large rake and raked my innards out.” And remember, Mike was having his first trip in a church full of his classmates, all having similarly gruesome experiences. “In most ways, mine was comparatively mild compared to some of the stuff those guys were going through.”
It sounds like Mike and his friends had the quintessential bad trip. But when they were polled immediately afterward, the vast majority of the experimental group considered their trip an extremely valuable experience. Pahnke questioned all the dosed students six months later and got the same responses: The intensity of that Good Friday trip hadn’t faded in the sober light of day. Further follow-ups were planned, but Pahnke died in a scuba-diving accident not long after the study and the bulk of his research was lost.
But twenty-five years after the original studies, a scientist named Rick Doblin succeeded in rounding up most of the original participants. He wanted to see if the power of that Good Friday trip still held up for them a quarter of a century later. The results of his follow-up study seem to vindicate the idea that drug-induced spiritual revelations are no less real than ones brought on by sober meditation and contemplation. Here’s how Dr. Doblin summed things up in his “Long-Term Follow-Up and Methodological Critique” to the Good Friday experiment:
The experimental subjects unanimously described their Good Friday psilocybin experience as having had elements of a genuinely mystical nature and characterized it as one of the highpoints of their spiritual life.
That’s even more incredible when you consider that five of the eight mushroom-dosed subjects he was able to track down (including Mike) were still working as ministers. After a lifetime of devotion to their faith, they still considered that drug-induced mystic experience to be one of the realest moments of their spiritual lives.
The evidence suggests that magic mushrooms, and perhaps other types of hallucinogens, can be powerful tools for religious worship. And all this leads to a much bigger question: Could mushroom use among our early ancestors have helped give birth to religion itself?
Monkeys, Mushrooms, and the Birth of God(s)
Mushrooms are one of the oldest drugs in human history. It’s impossible to say exactly when the first humans embarked on the first mushroom trip, but cave paintings from seven to nine thousand years ago depict what are believed to be psilocybin-packing mushrooms. Other cave paintings from Spain, from roughly six thousand years ago, seem to portray another species of hallucinogenic mushroom.
Now, nine thousand years ago, human beings had a lot less standing between them and wild animals. It’s easy to see why people up against wolf-fighting odds might have wanted a drink; alcohol numbs pain and increases belligerence. But a high enough dose of mushrooms makes standing up a dicey proposition, let alone fighting off deadly lions or horse-eating birds or whatever other nightmares stalked the land nine thousand years ago.
Prehistoric tripping was too much of a risk to do purely for recreation. The ancients used hallucinogens as a way
to commune with their gods, taking the visions they received at face(-melting) value. And if one theory is correct, people have been tripping on mushrooms before we were even technically people. The ethnomycologist (fungus historian) Gordon Wasson was the first academic to suggest that hallucinogenic mushrooms played a key role in the birth of human religion.
Wasson’s theory sounds like something a dreadlocked suburban kid nicknamed “Shaman” would insist on telling you before selling you a bag of ’shrooms. But Gordon Wasson wasn’t some long-haired patchouli-scented weirdo. He was a former vice president of J. P. Morgan bank, and nearly ninety by the time he wrote Persephone’s Quest: Entheogens and the Origins of Religion and gave magic mushrooms credit for the birth of human spirituality. In Wasson’s view, pre-but-close-to-human people would’ve taken their hallucinogenic visions as the word of the Divine:
At that point religion was born, religion pure and simple, free of Theology, free of Dogmatics, expressing itself in awe and reverence and in lowered voices, mostly at night, when people would gather to consume the Sacred Element.
Weird capitalization choices aside, it’s an interesting theory. But it’s not like there’s any hard science to back up the idea that mushrooms first inspired belief in the divine. Mushroom-filled cave paintings around the world support the fact that many ancient peoples valued ’shrooms highly. But there’s a long damn gap between that and proving our simian predecessors took to mushrooms like a basement full of divinity students.
However, there is some evidence behind Wasson’s wild-eyed theory. Sigmund Freud, originator of the idea that we’re all eager to have sex with our mothers, also came up with the more widely accepted idea that human thought can be divided between primary- and secondary-process thinking. Secondary-process thinking is what your brain is doing right now: analyzing words and concepts and comparing them with your practical understanding of the world.
