This is a particularly disturbing case study published by the AMA that goes to the heart of the problem with consent/trafficking:
Human Trafficking, Mental Illness, and Addiction: Avoiding Diagnostic Overshadowing.
Snippet:
Abstract
This article reviews an emergency department-based clinical vignette of a trafficked patient with co-occurring pregnancy-related, mental health, and substance use disorder issues. The authors, including a survivor of human trafficking, draw on their backgrounds in addiction care, human trafficking, emergency medicine, and psychiatry to review the literature on relevant general health and mental health consequences of trafficking and propose an approach to the clinical complexities this case presents. In their discussion, the authors explicate the deleterious role of implicit bias and diagnostic overshadowing in trafficked patients with co-occurring addiction and mental illness. Finally, the authors propose a trauma-informed, multidisciplinary response to potentially trafficked patients.
Case
Dr. Shah, an emergency department (ED) resident in New York City, entered the room of a young pregnant patient who was bleeding and visibly frightened. The patient, who only spoke Spanish, was accompanied by her brother, who translated. He explained that the patient suffered from schizophrenia and had been refusing her medications for the last couple of weeks. He added that she’d had a few episodes of aggressive behavior, directed at others and herself. While the patient’s brother was talking, Dr. Shah noticed a few bruises and puncture marks with associated ecchymosis (subcutaneous bleeding similar to a bruise) on the patient’s arm. The brother saw that Dr. Shah had noticed these marks and explained that the patient sells herself for drugs.
Dr. Shah began to suspect that the patient’s brother might not be trustworthy, so she requested a certified clinical interpreter. Through the interpreter, the patient conveyed that she was miscarrying and asserted that she does not have schizophrenia, although she admitted feeling depressed sometimes. The patient’s tone became increasingly desperate and she explained, through the interpreter, that the man claiming to be her brother was holding her captive. She stated she was brought to the US as his fiancée, and, upon arrival, he confiscated her passport, forced her to have sex with him, and introduced her to drugs.
At this point, the man explained that his sister had long had delusions of persecution. He also disclosed that she had required temporary restraints the day before after threatening family members while she was high. He suggested that perhaps this episode had fueled the current delusion.
Dr. Shah had recently read about a case in which a 14-year-old girl had been to the emergency department for treatment and had told the staff she was being sex trafficked. The man accompanying the girl had also claimed she had schizophrenia. The clinicians believed the man and discharged the girl to his care; he was later found to be trafficking girls into commercial sex. The girl was not rescued until police found her bound in a closet during a drug raid weeks later.
Dr. Shah wondered what to do.
Commentary
The clinical scenario described above might seem far-fetched or extreme. However, Dr. Shah’s dilemma mirrors many human trafficking clinical encounters in which patients present with medical, mental health, and substance use disorder needs. The health needs of this patient might very well suggest that she is being trafficked and should not be dismissed merely because the “brother” has identified the patient as having a mental illness or substance use disorder. This paper will discuss the implications of the patient’s presenting symptoms, the role of implicit bias and diagnostic overshadowing in trafficked patients with co-occurring addiction and mental illness, and the importance of providing trauma-informed care to patients who could be trafficking victims.
This goes directly to what I was talking about in regard to Zoidberg's anecdotes. How do we--the State, who is now effectively the pimp in a legalization scenario--ensure that any particular prostitute is like the ones Zoidberg hangs with, and/or are suffering from some form of coercion and how is that measured?
This is a question with or without the State taking over and could be applied to any industry, but then that's the point. We do have various screens (both physical and psychological) for various other commercial enterprises. Companies routinely give drug tests and have ethics clauses in their employment contracts and some have "background checks" and even straight up psychological evaluations before employment and periodically throughout as a condition of continued employment.
So, is that the solution? Case workers checking in and asking specially designed "are you under duress" questions? Weekly psych evaluations to see if they're still consenting
this week? And what would that yield, other than the inherently problematic baggage of self-diagnosis and unjustifiable defensive flare-ups like Zoid is currently working through?
Or do we just not give a shit and collectively compartmentalize, like we do with booze and guns?
Caveat Emptor (only in this case, it's
Sex Worker Beware).
ETA: And just to be clear to all involved, as I see it there are no actual sides here; there is a room with 100 people in it and a whole bunch of Venn diagrams. Or, rather, one big one. And in one circle, there's a percentage of the room who are firmly, 100%
I'm doing this totally without coercion and of my own free will and I've never done drugs or been abused and this has all been verified, I'm friends with Zoidberg and then there other percentages in that room that are in a whole host of different circles, with a whole host of different problems that aren't so simple or straightforward.
Just like life in general and for all time. So while 70 of the 100 may be over in Zoid's yurt, what about the 30 that aren't? Or ten? Or 5?
The question isn't necessarily about the 70, so bringing them up is a part of it, of course, but it's not the whole of it.
How do we--as their new pimps--sort any of this?
Do we sort any of this? What are the methods? Do they work? It's a dynamic, not a static, so is this just like any other potentially dangerous job? OSHA? Hard hats? On-call PTSD therapist?
Again, all considerations whether or not we legalize, but will legalization help to address them or make them exponentially worse?
It's endlessly ironic that the sex worker "side" has said for decades that their profession has been hypocritically shamed and shunted for centuries and pushed into the shadows and now when we want to push it into the light and seriously examine it, we're being shamed and shunted by its proponent, at least, for wanting to take a serious look.