Human Trafficking

The International Labour Organization reported
that, in 2016, 24.9 million people were trafficked,
20.1 million as forced labor and 4.8 million for
commercial sex. These numbers are probably an
underestimate but they indicate that human trafficking is a huge problem that psychiatry has
neglected. The editors of Human Trafficking: A
Treatment Guide for Mental Health Professionals
have put together a very experienced group of
authors who provide a rich and comprehensive
review of this human tragedy. In their preface, the
editors state that their goal was to create "an
educational and clinical resource for mental health
practitioners as well as clinicians from any discipline who might encounter trafficked persons
(which is essentially all of us in the health care
field)." The 25 authors include international
experts in multiple disciplines, 14 of whom are
physicians. Each chapter is concisely written and
includes diagrams and charts as well as "Pearls
and Pointers" at the end to emphasize the main
points. As the editors' goal was to create a reference source, each chapter also includes an extensive bibliography.
For clinicians, I single out some particularly
helpful information. There is an excellent
description of signs and symptoms that may present in a trafficked person in the emergency
department. The discussion of comorbid medical
conditions covers sexually transmitted diseases
and the need to coordinate interventions for both
physical and mental health. Trafficked individuals
face many difficulties accessing medical care,
including especially being able to pay, language
barriers, safety concerns, and chronic illnesses
that require long-term care that is not usually
available to someone who is trafficked. Special
chapters deal with sexual abuse and child trafficking for labor and sex. Since many trafficked
persons in the United States come from foreign
countries, cultural issues and the need for culturally appropriate assessment is very important and
these topics are well covered.
When discussing management, all of the
authors emphasize the need for trauma-informed
care that is characterized by empathy, trustworthiness, and collaboration; however, this stress
on the need for "trauma-informed care" may seem
like an overused platitude. Although there are no
data or evidence to guide treatment, the use of
cognitive-behavioral or exposure therapies to treat
trafficked individuals does not seem to be a good
idea. These patients come from different cultures
and have massive traumas that greatly impair
their ability to process information. Providing
exposure therapy to people who suffer from frequent nightmares and startle reactions seems
almost harmful. For long-term treatment, gentle
consistency and judicious use of medicine in a
supportive relationship seems likely to be the
most helpful method for reducing suffering, even
though firm evidence is lacking.
The last chapter "Survivor Voices" presents
accounts by those who escaped and were able to
recover and write about their traumatic experiences. These are truly inspiring stories by remarkable people who have triumphed. However, I
wonder about the hundreds of others who were not
able to escape, who live out a life of humiliation,
fear, drug addiction, and struggles with depression
and suicidal thoughts.
In summary, this is an excellent book about a
neglected and underreported group. People who are
trafficked have multiple psychiatric and other health
disorders and clearly need medical approaches to
alleviate their suffering.

-- J. David Kinzie, MD * Journal of Psychiatric Practi