The month of January has been designated Human Trafficking Awareness Month, culminating in National Freedom Day on February 1. Here, Danielle Castillejo, a second-year MA in Counseling Psychology student, writes about a recent shift working the “trash run” at a local shelter—and about the crisis of care that exists when complex trauma, mental illness, and sexual exploitation intersect. This post originally appeared on Red Tent Living.

My surprised skin bumped into the chills of the new fall morning air. Inhaling deeply from its fresh coolness, I steadied my beating heart’s morning aches that were left over from last night’s racing internal discussion about a life and a death. A young 19-year-old woman hung suspended before my mind, with her long, coarse, strawberry blond hair pulled tightly into a knot behind her head. She’s an average height, not skin and bones, but there’s not much extra. Her eyes don’t mask the dark terror of the voices. This body holds at least 16 years of consuming trauma. Trauma has mapped itself well, topographically: old scars and new ones mark her dips in and out of reality. She paces nightly, in pj shorts and tank top, racing through her own internal dialogue with accusing voices, imprisoning her body in my plain sight.

The darkness of winter seems to have arrived too early. I am unprepared for its tepid response to my request for a bit more light. Average gray clouds hold in sadness, lust, anger, desire, joy, and anguish, engulfing Seattle in the inevitability of pending violence. It’s the edge of a knife. The sharp edge presses my skin to see if I am real. Wincing, I look at the complications of loving, caring, justice, and reality. Her body remains unmoved from my mind.

With limited shelters and limited resources available to commercially sexually exploited persons, the short list of helpful and innovative options grows shorter when mental illness haunts bodies infected by complex traumas. This young woman will make frequent visits to the hospital in hope for relief and, yet, return to her life with little protection from the realities of her invasive trauma. Mental health hospitals diagnose these persons with schizophrenia, borderline personality disorder, dissociative identity disorder, major depressive disorder, suicidal ideation, and more. The self-harming behaviors of cutting and the dreams of suicide are identified and categorized, and the diagnosis procured.

“The short list of helpful and innovative options grows shorter when mental illness haunts bodies infected by complex traumas.”

Her shadow catches my eye. She walks down the street to wait for an Uber. The hospital door slams shut. She needs help and calls a friend.

The hospital releases her soul into a world of harsh expectations with little understanding of how in the hell she will come back from her severe mental illnesses.

I suppose, given the diagnosis, the hospital hopes that a plan of medication, therapy, and support will lead to healing. But without a buffer of time between the perpetual trauma and everyday life, hospitalizations, and a community that offers unconditional support, the commercially sexually exploited persons swim alone. They swim in dark, cold waters, gasping for air in systems unable to hold them compassionately.

Cutting edge therapeutic techniques are available to treat complex trauma; however, the skilled therapists are often financially bound to pay back student loans, bills, and to support a family. It’s difficult or nearly impossible to find social networks, churches, or systems that support the healing process of the lowest in society. And, most commercial sex workers are not white. They are Black, Asian, Pacific Islander, Latino/a, and bi-racial persons. When commercial sex workers walk into clinics, already stereotyped, reeking of addictions and death, only able to pay through state health insurance, there is not much hope to be held in those spaces.

These are the least of these. This is the trash run.

She sits, legs pulled to her chest, in the small shelter’s office, asking for grounding; she wants to get back to reality. Her phone buzzes just like mine, and her articulate analysis of her own internal reality questions my limited understanding. I mutter frustrations directed at a God who sees both of us. I resign to listen again to the accusing voices she narrates so clearly. We sit for less than 15 minutes because I am waiting on an Uber to take me home to a warm bed, husband, and four children. It is no consolation that I have spent precious hours away from my family to work here and get paid to chill with this woman and others. I don’t feel morally superior. I look at my watch one last time and excuse myself, telling her I am praying and hoping she stays safe. And with that, I remind myself that some would say I have completed my shift on “The Trash Run.”