The popular porn actress August Ames died by suicide a little over a year ago. She’d been a target of online attacks after suggesting that male performers who work in the gay industry are at an increased risk of getting HIV. Her death shocked the porn and larger sex work industry and sparked a conversation about mental health and cyberbullying.

Now Ames’s death is the subject of a podcast series released earlier this month by journalist Jon Ronson, who’d previously profiled the porn industry in his limited-series podcast The Butterfly Effect. This new series, The Last Day of August, unpacks Ames’s story, including the narrative that cyberbullying is what triggered her suicide. Instead, Ronson suggests, her story was far more complex, “something mysterious and unexpected and terrible.”

Ames was vocal about her battles with mental health and the stigma she faced trying to seek care as a sex worker. “I would get in contact with [therapists] 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,’ and 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,” she said in a podcast interview from 2017.

And she was not a unique outlier. Ames was one of five porn performers to die by suicide or drug overdose in just three months in the winter of 2017-’18. She has become the very public face of a crisis within the porn industry that’s often overlooked and rarely taken seriously. But the podcast, which spends six episodes exploring the specific details of Ames’s death, misses the opportunity to examine the larger story of suicide in the porn industry — and the steps the community is taking to ensure that porn performers and other sex workers are getting access to the mental health care they need.

Sex work and mental health can be thorny topics to navigate. Research has repeatedly shown a higher incidence of depression and other mental illness among sex workers when compared to other populations. A 2011 study that compared the mental health of female porn performers with that of other young women in California found that porn performers were significantly more likely to meet the criteria for depression than their peers who were not involved in sex work; a 2010 study of sex workers in Zurich found that “sex workers displayed high rates of mental disorders.”

To those outside the industry, these elevated rates of mental illness are presumed to signify an inherent problem with the sex industry. Porn performers and other sex workers come to the work with significant issues, the theory goes, because only “broken dolls” would even consider pursuing sex as a career. Furthermore, the industry itself is assumed to be so exploitative and abusive that anyone involved is just setting themselves up for trauma and PTSD. “Sex work is a major public health problem,” explains a study from Acta Psychiatrica Scandinavica, concluding that the “ill mental health of sex workers is primarily related to different forms of violence.”

Yet the sex workers I’ve spoken with challenge that read as overly simplistic. Yes, researchers may be finding elevated rates of mental illness within these industries, but part of that stems from the fact that the high pay and flexible hours of porn and sex work make these jobs appealing to people whose mental health issues make committing to a 9-to-5 office job difficult.

“I started out with doing online sex work as a camgirl in 2016,” says Jane, who requested to be identified by first name only and notes that between her depression and her schoolwork, she didn’t have the energy for most of the jobs that were available to her. “With sex work, I was able to spend my energy much more carefully,” setting a schedule that allowed to her to take time off on days when she felt overwhelmed, a luxury she wouldn’t have had in most jobs.

Another woman, who’s worked as a porn performer, stripper, and full-service sex worker in addition to more mainstream work in the health care industry, told me that “since returning solely to sex work, I am able to pay attention to what my body and my brain needs, in terms of sleep and kindness, and then give that to myself” — an essential tool for managing mental illness.

While working in the industry can exacerbate mental health issues, the many conversations I’ve had with sex workers suggest that it’s less because sex work itself is inherently traumatic, and more because the stigma of being a sex worker isolates people and prevents them from finding competent mental health care. “I’ve heard some horrendous stories about therapists refusing to treat sex workers,” says Leya Tanit, the founder of Pineapple Support, an organization that helps connect sex workers to mental health care services.

According to Tanit, many sex workers who seek out mental health care find that disclosing their line of work often provokes unwanted and unsolicited opinions — “[Your mental illness is] because you’re in the industry, you shouldn’t be doing this, it’s contributing to your illness,” Tanit sums up. Yet staying mum about work can compromise their care in other ways: If you can’t tell your therapist about the struggles you’re dealing with on the job, or how sex work stigma exacerbates your stress, your therapy might feel somewhat superficial.

Tanit hopes that Pineapple Support can help bridge the gap between sex workers and mental health care. The organization, which launched in April, offers porn performers access to a database of vetted, sex worker–friendly therapists; for those in immediate crisis, there’s a 24/7 online emotional support service staffed by volunteers who’ve been trained to address the needs of members in the porn industry. At this week’s Adult Entertainment Expo, Pineapple Support will run a booth staffed by therapists, offering trade show attendees the opportunity to engage in some drop-in therapy sessions.

The screening and training that Pineapple Support provides its clients is a much-needed resource, as the majority of therapists either aren’t aware of the particular issues faced by sex workers or come to these sessions with inaccurate, stereotypical ideas about sex workers. “Amidst a nationwide campaign about human trafficking, many therapists grow concerned that a patient involved in sex work has been subjected to human trafficking,” therapist Dr. David Ley writes in an essay on therapy and sex work, noting that this assumption can alienate sex-working clients and damage their relationship with their therapist. When reached for comment for this piece, a representative of the American Psychological Association noted that “we do not have any written guidance for treatment of sex workers or porn performers.”

Pineapple Support isn’t the only project hoping to help porn performers in crisis. This month, porn performer and producer Trenton Ducati will launch a collaboration with the Desert AIDS Project (DAP) — one he hopes will help connect performers to therapy, suicide prevention services, and substance abuse counseling, as well as HIV pre- and post-exposure prophylaxis (also known as PEP and PrEP).

Like Pineapple Support, Ducati’s program connects porn performers to sex worker–friendly mental health care services; the primary difference is that rather than waiting for performers to reach out for help, Ducati will encourage producers to broach the topic first with the help of a questionnaire designed by DAP. “The producer is a very important point of contact,” he tells me. “We can really check in with the models” — and, if they need help, connect them to resources that’ll keep them healthy.

Getting quality mental health care is never a simple endeavor, and dismantling the barriers to access faced by porn performers and other sex workers will be a long-term project. But if we want to build a world where sex workers are getting support when they need it the most, we have to spend more time dismantling the stigmas associated with mental illness and sex work — and less time analyzing the grisly details of individual sex workers’ deaths.

Lux Alptraum is a writer whose work has been featured in the New York Times, Men’s Health, Cosmopolitan, Hustler, and more. Her first book, Faking It: The Lies Women Tell About Sex — And the Truths They Reveal, is out.

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