I received the below question from an anon at tumblr, and since I wrote a really long answer I thought people here may be interested in it too.
I answer below the cut to avoid any potential spoilers, but since I know a lot of people won’t click that I want to highlight something before I answer.
Please check out the below links—and research more—to find out more about human trafficking and sex trafficking that’s happening right now in the world. Some of these links lead to organizations you can support through donation or advocacy, and others tell you ways you can help fight the issue on your own.
- Polaris Project: fighting to end modern slavery. (Their founding story is good to read)
- Not For Sale campaign
- 20 Ways you can help fight human trafficking
- Human Trafficking: How You Can Help
- I also highly recommend you check your Slavery Footprint— one really cool thing about it is as the end it also lets you send notes to the big companies that affected your score. (My count was 45 😦 )
If we ever were to publish Fade, I would really like to be able to include some of these links in the book for people to get involved if they were affected by anything in the story itself.
Okay! Onto the answer. (and once again it’s super long, I’m sorry)
So, there actually isn’t a TON of research done on the ongoing psychological, physical, and other effects of human/sex trafficking on the victims— most of the places that talk about it say how more studies are needed. The studies that do exist tend to focus almost exclusively on women as the victims, and some of the studies are several years old. The general belief is that the effects seen in the women probably are going to be pretty similar in men but there haven’t been multiple studies done to prove or disprove this.
As a result, to be able to 100% answer your question I feel like I’d have to interview psychiatrists who deal specifically with victims of trafficking to get an idea of what official diagnoses would exist— because Shapiro was definitely a professional who would have given him a proper diagnosis.
What seems to be the case based on what I’ve seen is that there isn’t necessarily a specific diagnosis other than PTSD that many trafficking victims have— instead, there are a lot of lists of psychological effects and reactions.
I have included below my answer multiple sources to give you a better idea of what is often seen in trafficking victims — I excerpted parts that were particularly relevant to Boyd.
But what you’ll notice is a lot of his reactions that you see in the beginning of Fade (and that are referenced from when he first returned to the Agency during the months before Chapter 1) are what you see in the lists below. I think for sure he would have had PTSD or there’s also something called complex trauma which is not in the DSM so is not technically a diagnosis but I think fits best what he had/has.
Basically what it all comes down to is some overarching reactions you saw in the book:
- distrust of others and their motivations
- suicidal ideation
- nightmares and insomnia/difficulties sleeping
- disconnection from feelings/disassociation
- (and then physical effects like weight loss, and any substance abuse issues, etc)
There are also studies that talk about how long it takes for initial major reactions to fade, if at all—and a lot of it comes to 90 days for the percentages to drop significantly. As could be seen in Fade, that’s pretty much what happened with Boyd, too. He’d been in rehab for 2 months before the book started and then was given another couple of weeks off because he was still too unstable.
But even then, some things come back and others don’t. I’d say he did improve psychologically over time—he’s much better now than he was immediately following his return from the mission. However, he’s still not 100% “over” (for lack of a better word) what happened. Some things will probably always have the ability to trigger him.
That was something that came up repeatedly throughout the book, highlighting the way the major effects were relatively short-lived but still could resurface.
For example, he was kind of doing better (mostly through disassociation and extreme focus on his job coupled with the fatalism of believing he would just help others in his work until he died) until in chapter 9 there was the triggering event with Bex commenting on her replacing Hsin. That upset both Emilio and Boyd, which rekindled Boyd’s self-destructive tendencies he had been trying to deny. Namely, how in the later scene he wanted to use drugs despite having worked hard to try to get over his Slide addiction, and when denied that he grew angry and then hopeless and instead drank himself into a blackout— at which point what happened, happened. And after that it started the cycle over again of self-hatred, self-blame, and some disassociation of the event.
None of that ever would have happened before the Aleixo mission, because despite the trauma he’d been through in his life and the Agency prior to that point, he hadn’t previously been broken down so thoroughly that he abused substances. But after being forced into drug use on the mission, substance abuse became something that was an option to him when he was completely overwhelmed.
(When I say ‘broken down’ I don’t mean to imply that everyone who abuses substances was first broken before this occurred– because there’s a lot of biological/chemical reasons in the formation of the brain and many more factors that go into which people abuse substances, when, and why. But in Boyd’s case, usage of drugs and alcohol at all–let alone misuse–had never been his way of coping with trauma. He tended to disassociate himself, or become depressed, or shut down, etc, rather than drink. It’s after the Aleixo mission that drugs or alcohol became an option for him when dealing with trauma)
Another example is how he managed, again, to overcome most of his urges for drugs or alcohol, until he’s triggered later in Fade in that party and the same feelings from before resurface. He starts to cycle again but this time has something else to focus on to draw him out of it.
And another example is how he had a small panic/anxiety attack, reacting with anger, hostility and feelings of helplessness, hopelessness, fear and lack of control when Chance asked if he wanted to perform on screen, Boyd said no, and then Chance turned to Hsin and asked him if he’d perform with Boyd. The combination of performing for someone else’s benefit, performing on camera, and his personal choice in the matter being taken away right in front of him like he was an object with no control over his own life, started to bring him back to his time with Aleixo. Before Aleixo, he wouldn’t have cared about that interaction with Chance—he probably would have had Hsin’s response instead—but the complex trauma from the mission meant that simple conversation triggered something much stronger in Boyd.
As a last example, you can also see the ongoing effects by his reaction after Janus. There, he’s unstable again—this time with paranoia and distrust particularly high, especially distrusting others’ motives. He also develops an extreme aversion after that to anyone coming at him with drugs, particularly in a syringe, because he perceives it as a direct threat to his control over his own body and mind.
That aversion is something that still lasts to this day. It’s not as strong as it was immediately following both events but he still distrusts the motives of other people much more than he ever had before Aleixo, even taking into account his time at the Agency.
Sorry this is a long answer but the fluctuation of Boyd’s decisions, moods, and the way his trust, beliefs and hope changed was something that I did really specifically in writing his character arc, both over the entirety of the series but also especially in Fade. One ongoing theme in Boyd’s entire story/character arc is about consequences: the consequences of trauma on a regular human being, the consequences of choices, and the consequences of having or not having control.
I suppose that would be a whole thing on its own and I feel like this post is already long enough so I won’t go into it. But suffice it to say, while most of the major psychological effects of his time with Aleixo (and the Agency) have faded over time, there will probably always be times he reacts especially strongly to specific circumstances.
If you want to read excerpts from various sources on the topic of psychological effects on human trafficking victims, see below:
Beyond the physical effects for sex trafficking, many victims experience psychological effects as well. Here is a list of some of the various mental health effects that sex trafficking can have on its victims
**Post-Traumatic Stress Disorder (PTSD)
** Disconnection from feelings and flat affect
** Anxiety disorders
** Hopelessness, helplessness
** Nightmares – dreams of rapes, sexual assaults, physical abuse
** Anger and anger management issues
** Suicidal ideation and attempts
** Stockholm Syndrome
** Spiritual disruption
** Fatalism and rage
** Dual diagnosis
** Self-care issues
** Sleeping issues
** Disassociative disorders
Depression, anxiety and hostility are symptoms frequently detected among torture victims and victims of other traumatic events and were also identified as prominent psychological reactions in an earlier study on the health of trafficked women.
A victim’s expression of hostility may be surprising for some investigators, who are more likely to expect victims to appear broken, tearful and/or fearful. Yet, hostility is a well-documented response to trauma. It will not be uncommon for a victim to be “annoyed or easily irritated”, “easily upset” and “irritated by everything”, have “temper outbursts”.14 Again, while these feelings may subside, they are likely to ebb and re-emerge depending on the stresses the victim faces.
It is not uncommon for victims who have been aggressive to be regretful, baffled, and embarrassed by their own behaviour. Women in the study in Europe described their irritability and related acts of aggression, such as punching walls, throwing items and hitting others
Studies of trafficking victims (particularly for sexual exploitation) have found that victims display many PTSD symptoms. The pattern of a steady decline in symptoms was also found in the trafficking victims, although rates of decline varied between symptoms. Another common feature of PTSD reflected in studies on trafficking in persons was that some victims still have symptoms some time after the trafficking or removal from the site of exploitation. In the study conducted in Europe, a more significant reduction of symptoms occurred after the women were in post-trafficking care for approximately 90 days.
Complex trauma, defined as “a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts” (Courtois, 2008, p. 86) is receiving increasing attention in the mental health field. […] Complex trauma has been linked to trauma endured during periods of extended captivity and has been directly associated with human trafficking (Courtois, 2008). Victims suffering from complex trauma often experience depression, anxiety, self-hatred, dissociation, substance abuse, despair, and somatic ailments. Individuals exposed to this type of trauma are also at heightened risk for self-destructive and risk-taking behaviors as well as re-victimization, and tend to experience difficulty with interpersonal and intimate relationships (Courtois, 2008).
• Poor mental health is a dominant and persistent adverse health effect associated with human trafficking. Psychological consequences include depression; post-traumatic stress disorder and other anxiety disorders; thoughts of suicide; and somatic conditions including disabling physical pain or dysfunction (22).
• Forced or coerced use of drugs and alcohol is frequent in sex trafficking. Drugs and alcohol may be used as a means to control individuals and increase profits (19,23), or as a coping method or by the trafficked person as a coping method.
women in the sex industry sustain the same kinds of injuries as women who are battered, raped and sexually assaulted. The difference is that when women are subjected to these same injuries in the context of prostitution, the violence is ignored, or redefined as sex. “Rough sex,” sadism, and rape are often accepted as “job liabilities” or “occupational hazards.” When unwanted sexual behavior is perpetrated against non-prostituted women on the job, it is called sexual harassment. When men in a sex club or brothel pay for the same behavior, it is accepted as commercial “sex work.”
While in the industry and even after escaping, the victims face an array of psychological effects:
**Mind/body separation and disassociated ego states
** Self-hatred, suicide and suicidal thoughts
** At very high risk for Post-traumatic Stress Disorder (PTSD) which can include anxiety, depression, insomnia, physical hyper-alertness, and self-loathing
You can find a lot more sources below too if you want to do further reading. I haven’t had the chance to fully read all of these yet:
- Psychological stress and the human immune system
- Addressing the internal wounds
- Human trafficking: a review for mental health professionals