BENTON HARBOR, Mich. – Tasha Turner is in a position to know a lot about the pain of stress and trauma.

As a program director, Turner, a psychotherapist, directs trauma-informed initiatives for Lakeland Health, the health care system that serves Berrien County in southwest Michigan. In that role Turner is looking at the lives of many tens of thousands of people. It is a county polarized by race and economic disparities—and big gaps in health outcomes between blacks and whites. The view from Turner’s Lakeland perch is necessarily disturbing.

“We know that poverty and discrimination and racism are rampant in Berrien County. Can I get an ‘Amen!’?” she said to a receptive audience of doctors, nurses, social workers, others in the healing professions and lay people in April 2018.

Turner speculated that because of the systemic-traumas such as racism and the other expanded ACES, , Berrien County adults would probably rank higher than other Americans on traumatic childhood experiences.

Several times she returned to the theme that children have no control over the circumstances of their birth or early environment.

“As a community we have to think about: How do we help the most vulnerable?” she asked. “How do we help ourselves? How do we provide safe environments that don’t continue to re-traumatize? How do we think a little bit differently?”

She said a landmark 1998 study on adverse childhood experiences, or ACEs, found scientific proof that such experiences profoundly affected brain development and caused serious long-term health problems. The 10 adverse experiences included physical, emotional and sexual abuse, parents’ divorce or separation, and other factors. With each additional ACE, the risk increased for later problems.

But the ACEs study looked primarily at well-insured, affluent white males among more than 17,000 participants, Turner said, and did not include the effects on the emotions or body of experiencing chronic racism and discrimination, or of living in unsafe homes or neighborhoods, or other factors typical of racially segregated, impoverished communities.

Many people in Berrien County have suffered systemic racism in addition to ACES-type experiences, meaning that trauma is pervasive locally.

“This tells us that this is not just like a thing, a ‘them.’ This is us,” Turner said. “This is not just the people in this room, but all the organizations we represent, all the families that we represent. It touches everyone. This is a public health crisis. We’ve got to do something about this.”

Turner gave one of two presentations at the outset of a three-year speaker series, “Community Grand Rounds: Healing the Trauma of Racism” launched in April 2018.

She said systemic and organizational-level trauma is exacerbated when the perceptions of people suffering discrimination are discounted by others as not being real. They are told, “‘It’s not really a thing. You’re being too sensitive. These rules apply to everyone. It just so happens that 50 percent of the inmates in our county jails are black. It really has nothing to do with our sentencing structure. It really has nothing to do with our laws.’

“You internalize these negative experiences and feelings and have no way to get rid of them. You’re told, ‘Yeah, that’s not a real thing.’ “

Toxic stress happens when a person experiences prolonged activation of the stress or survival response without a buffer of support. This is an inborn, automatic response that is helpful in emergencies but destructive as a constant state of being. This prolonged activation leads to either hyper-arousal, a state of hypervigilance and hyperawareness typically known as the fight-or-flight syndrome, or to hypo-arousal, in which people seem shut down and frozen.

The “hyper” and the “hypo” states both happen because the stress exceeds a person’s ability to handle it.

Turner said trauma—from an event, series of event or set of circumstances—can have lasting adverse effects on daily functioning. Unresolved developmental trauma “impacts and follows us throughout the rest of our lives.” The problem is compounded because traumatic experiences are stored in a part of the brain inaccessible to the brain’s language center.

A traumatized person is “in a frantic fight for survival. The brain is frantically trying to figure out a way to regulate in looking for something, anything, that makes that pain, whatever it is, go away,” Turner said. The person turns to things like smoking, drinking, gambling or having sexual encounters, which are called “health-risk behaviors.” Turner dislikes the term. She said it implies a purposeful choice, as if people consciously choose to do risky things. She thinks these are more correctly seen simply as coping behaviors.