For the most part, the healthcare establishment has no idea how to help survivors of human trafficking recover.
That’s the conclusion of a research letter and accompanying editorial appearing today in Annals of Internal Medicine.
Frustrated mental health therapists are presented with a multitude of behaviors from these victims of living hell: Acute anger; not just PTSD, but chronic PTSD (my diagnosis); flashbacks, night terrors, hostility, aggression, shame, guilt and fear.
Physically, the survivors have additional problems: Sexually transmitted diseases, up to and including HIV and/or Hepatitis C; skin problems, chronic pain syndromes, malnutrition, and, above all…
Substance abuse disorders.
“Substance use … is prevalent in trafficking and may persist afterward as a means of coping with physical and psychological symptoms,” the authors of the research letter explained. “Although substance use may predate trafficking as a factor making a person vulnerable to exploitation (me), the forced use of drugs and alcohol to foster dependence among victims is common.”
And that’s exactly the story of what happened to me after I moved back to the Quad-Cities from Los Angeles.
Sex you don’t want to have under the influence – to the point of being disabled – is abuse.
‘Come with me to Chicago…I’ll make it worth your while’
Shortly after my dad began to experience severe dementia, but had not ended up in a nursing home yet, I was told by someone he’d make it ‘worth my while’ if I went with him to Chicago. I said no.
I now have figured out what that was all about based on what I’m piecing together about the person I believe he took instead of me. It’s chilling.
I’ve seen human trafficking, and I’ve lived it. I have been “kept” to some degree or another in various ways throughout my life by an older man a time or two, particularly abusively in Los Angeles but also in the Quad-Cities.
But never have I allowed myself to become completely dependent on anyone other than my dad. We were codependent and, as it turns out, we both would have died prematurely had we not been.
Period. End of story. Because nobody else cared about either one of us, that has been proven a thousand times over since my dad’s death!
My abusive childhood may have saved me from being wholly trafficked out of the Quad-Cities – I trust no one. I also have a college education and skills to remain gainfully employed. It’s tough now, though, since powerful, dishonest politicians have blackballed me and cause me to obsess every living hour on whether I’m safe from their evil grasp. I have not worked gainfully in almost a year.
It’s only after blowing the whistle on human trafficking, drugs and political corruption that I find myself largely unemployed for almost a year now.
So, I think it’s safe to say I am a human trafficking victim, right here right now, as I sit here. At least to some degree.
Because that’s why I’m unemployed. Let’s face it.
I was the Rainbow Reporter live on the scene
During my tenure as chief bar stool warmer at the gay bar across the river from Rock Island, Ill. in Davenport, Iowa, I saw almost everything. Having been an executive news editor at the historic LGBT magazine The Advocate in Los Angeles, I am both book-smart and street-smart about human trafficking.
I saw young men, usually who wandered over to the bar from King’s Harvest Ministries, go from homeless to living high on the hog with older gay men. It would happen in a blink.
In the next blink, these young men were kicked to the curb and back on the street. Once, maybe twice, I knew of older men buying a homeless young adult an airplane or a bus ticket to go home. I observed this both in the Quad-Cities and Los Angeles. Those men likely thought they did the right thing.
But did they really go home? Who knows.
“Persons exiting trafficking often lack physical, psychological, and physiologic safety and stability,” according to the researchers, who hail from Massachusetts General Hospital. “Food, housing, clothing, financial support, safety and protection, transportation and acute substance withdrawal treatment are immediate needs that often are unmet.
“In one program for sex trafficked minors, creative and persistent efforts to meet these needs frequently take precedence over addressing the exploitation itself, because sex trafficking too often represents “the least-bad solution to meeting fundamental needs.”
In an accompanying editorial in Annals, authors from Boston University School of Public Health note that human trafficking survivors have been compared to war victims and torture survivors. Because their needs are so profound, “Little information exists on how to adapt (trauma-informed clinical PTSD interventions) to persons who have PTSD related to human trafficking.
“Are specific skills required to effectively care for this population?”
I say yes, and I suspect my therapist of more than two years (until I lost my private insurance) would agree with that conclusion.
The problem with chronic PTSD (my diagnosis)
There are two kinds of PTSD – chronic and not chronic.
With chronic PTSD, symptoms are most always present. It’s extremely difficult to treat people with chronic PTSD, like myself, because we no longer trust anybody. We’re always waiting to be shat on.
“Because CPTSD includes difficulty trusting others, fear of rejection, impaired affect regulation and impulse control, lower relationship satisfaction, and decreased self-protection from polyvictimization, it undermines the psychological capacity for interpersonal functioning,” the researchers explain in their report.
“These relational consequences strongly affect how survivors interact with health professionals. In addition, given the nature of human trafficking, any ongoing or perceived threats of violence after exiting may work synergistically with CPTSD relational impairments to undermine health care participation.”
Add being the victim of political corruption after blowing the whistle on human trafficking, and you almost would have to have a screw loose to seek treatment in the Quad-Cities on the Medicaid dime.
It’s why I canceled my appointment last week. I am just fine with work, an income, and a fair shot, just like most hardworking Americans.
But given the nature of the criminal case I have provided information about, I do not feel safe using my federal Medicaid insurance or going anywhere that accepts it.
And why should I? Look what happened to me last time.
Human trafficking victims often in legal trouble – for being victims
“Legal entanglement may also impede engagement in care,” the authors wrote. “As part of their exploitation, victims may be compelled or force to engage in illegal activities. Thus, in addition to victimization, some human trafficking survivors also may be adjudicated offenders, sometimes under the very antitrafficking laws designed to protect them.
“Such legal entanglements present obstacles to community reintegration, including registering as a sex offender or felon, diminished employment opportunities, and a reinforced sense of self as stigmatized. Court mandated mental health treatment is common but may be antithetical to basic tenets of trauma-informed care.
Where human trafficking survivor rehab is being done right
The Freedom Clinic at Massachusetts General Hospital is wholly dedicated to treating victims of human trafficking. The authors of the accompanying Annals editorial said we must learn as much as we can from The Freedom Clinic and then find ways to replicate what works.
Cost no doubt will be a problem for such intensive services, they warn.
“Understanding the barriers the authors have encountered and how they generate and allocate funding for the services the clinic provides is essential to those who wish to replicate their approach. Their conceptualization of a “continuum of wraparound services” that are iterative rather than linear and span different sectors (housing, legal and medical) through case management raises the tension between what is best for the patient and what can actually be carried out.
“Is this a model that can be adapted to other clinical settings, or is it best suited to a large, urban, teaching hospital?”
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