Yesterday, it was reported that August Ames, an award-winning porn star, had died of a suspected suicide. She was only 23 years old.

Immediately, speculation ran rampant as to what had prompted someone so young to take their own life. Because one of her last tweets (NSFW) about her refusing to work with a gay performer had garnered some backlash, some speculated that cyberbullying had prompted her to take her own life.

But of course, as mental health experts have previously pointed out, there is no one factor that is a greater contributor to suicide than mental illness, and on a podcast that she recorded months before her death, Ames spoke openly about her struggles with depression and bipolar disorder. In the interview with friend Holly Randall, she noted that she struggled to find a good therapist due to her role in the porn industry.

"I would get in contact with some people and then I would feel badly because they'd be like 'What's your profession?' and I'd be like 'Oh, I'm in the adult industry,'" she said. "Then I'd feel like they're like, 'Oh, that's the whole reason that you are the way you are' and then I'd get turned off.”

Unfortunately, that view is apparently widespread among mental health care professionals, according to many porn performers. Due to the stigma associated with the porn industry, as well as the frequent cultural misconceptions about the people who work in it (such as the false idea that they’re all addicted to drugs or riddled with STIs), it’s difficult for adult performers who struggle with depression to get the mental health care they need.

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“The problem is that most mental health and medical professionals have the same prejudices and misconceptions as everyone else,” says Conner Habib, an adult performer and writer. “It’s probably even worse in the mental health community because a lot of them follow false and damaging sex addiction models. They’ve absorbed all the stuff about porn being bad in our culture.”

It’s worth noting that there are financial reasons why adult performers might struggle to gain access to mental health care resources. “We are like most entertainers: we have independent insurance, and we are non-unionized, because of many things, one being the turnover rate (3 months for performers),” says Tasha Reign, the chairperson of the Adult Performers’ Advocacy Committee (APAC). The out-of-pocket health care expenses can also be prohibitive when you factor in the cost of testing: just to be able to book jobs, performers must pay nearly $400 twice a month to be cleared for STIs, a fee that they also must pay out-of-pocket.

In addition to the costs of mental health care, it’s also extremely difficult for adult performers to find the resources they need, due to the myths and misconceptions associated with the industry itself. Take, for instance, the widespread belief that porn performers must be struggling with drug abuse or childhood sexual trauma to be willing to do sex work: while Ames herself admitted to having survived child sexual abuse on Randall’s podcast, the idea that all performers are “damaged goods” is largely uncorroborated by the little research that has been done on the porn industry.

According to a study in the Journal of Sex Research, which surveyed 177 female performers, porn performers are not any more likely to have experienced childhood sexual abuse than members of the general population, though they were more likely to report having had sex for the first time at an early age and with more sexual partners.

Many adult performers also struggle to find therapists who do not subscribe to the view that being in the adult industry is not an aberrant mental health care condition in itself, which might discourage many performers from seeking treatment if they do struggle with depression. “Most mental health professionals don’t treat our job like a regular job. They treat it like it’s indicative of some deeper issue,” says porn performer Ela Darling. “Our jobs aren’t treated as jobs. They’re treated as symptoms.” (Men's Health reached out to the American Psychological Association (APA), and will update if we hear back.)

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Even less formal therapeutic resources, such as support groups, might fall short of providing resources. Such programs are “very gendered, very binary, very not open to alternative forms of varying ways that sexuality can be healthy, whether that’s part of your work or private life,” says Traci Mediros, a therapist who specializes in treating LGBTQ people and sex workers.

For this reason, the mental health treatment of sex workers is considered a specialized field in itself. The Sex Workers’ Outreach Project (SWOP) provides a network of service providers who are deemed sex worker-friendly, as does APAC, for those in the industry who are seeking mental health care. Yet if Ames’s podcast interview is any indication, the stigma might be far too overwhelming for some to overcome.

“While therapy is helpful and suicide is preventable... we have to normalize sexuality, sex workers, and porn in order to create an environment where we don’t feel ‘othered’ and alone,” says Reign. “It’s very difficult to tune out they negative attitudes. Even if we love what we do. I hope the world becomes more peaceful.”

If you or someone you know is having suicidal thoughts, please seek help immediately or call the National Suicide Prevention Hotline at 1-800-273-8255.

EJ Dickson Ej Dickson is a writer based in New York.

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