the body keeps the score book review

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Front Psychol

Book Review: The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Jacqueline mei chi ho.

1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China

Alex Siu Wing Chan

2 Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China

Ching Yu Luk

3 Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hospital Authority, Hong Kong, China

Patrick Ming Kuen Tang

4 State Key Laboratory of Translational Oncology, Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China

Bessel van der Kolk, editor. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. 2015. Penguin Books. 464 p. ISBN: 978-0143127741.

Posttraumatic stress disorder (PTSD) is defined as a psychiatric disorder in an individual who has experienced or witnessed a devastatingly traumatic event (Bufka et al., 2020 ). These patients persistently experience overwhelming stress responses beyond the traumatic period. Fear and stress are triggered predominantly in response to a dangerous event followed by a series of bodily changes, including increased blood pressure, heart rate, and breathing due to the release of adrenaline. This biochemical reaction is termed as the “fight-or-flight” mechanism, which temporarily protects people against danger (Kozlowska et al., 2015 ). It has been well-recognized that PTSD significantly impacts social functioning, physical well-being, and occupational ability (Watkins et al., 2018 ).

Bessel revisits his clinical experience and reconfirms the impact of PTSD on his patients. People with PTSD experience various symptoms, including personality changes, depression, social disconnection, poor sleep hygiene, flashbacks, and nightmares. Facing recurrent episodes of disturbing symptoms, PTSD patients are prone to develop risky behaviors, including alcoholism, substance abuse, or self-injury. PTSD has many negative impacts on patients' quality of life (QoL), and poses a potential health burden to society if no prompt assessment and support is guaranteed (Lewis et al., 2019 ).

In his work “The body keeps the score,” Bessel highlights that traumatic stress is at the root of neuroscience. Traumatic stress is associated with functional and chemical changes in the emotional part of the brain—the limbic area and brain stem. Knowing the functions of the amygdala, hippocampus, and prefrontal cortex, as the primary stress responders in the brain, can provide a new therapeutic direction for PTSD management. The hyperactive status of the amygdala triggers the release of stress hormones (Badura-Brack et al., 2018 ) and impairs the functioning of the hippocampus, causing traumatic memories to remain vivid. In addition, the deactivation of the prefrontal cortex function and the failure to maintain a balanced stress hormone system, causes panic, agitation, and hypervigilance responses in PTSD patients (Koenigs and Grafman, 2009 ). This hyperactive aroused emotional status can be evidenced by hyperactive brain waves over the fear center of the right temporal lobe of the brain, with suppression of electric activity over the frontal area.

Pharmacotherapy is the first-line of treatment for PTSD. Antipsychotics, anticonvulsants, and tranquilizers have been widely used to improve the QoL of PTSD patients over the past few decades. As some patients developed morbid obesity and diabetes from the medication as well as experienced drug overdoses, it alarmed the book author and pushed him to consider a much safer and natural approach to assist PTSD patients in dealing with their symptoms and responses using a self-regulation strategy. Bessel further suggests that medication cannot 'cure' trauma; it can only mediate the disruptive behavior of the sufferers.

This revolutionary treatment was enlightened by one of Bessel's patients, who could not get rid of his traumatic memory as a minister for many years after returning home from Vietnam. This memory was subconsciously imprinted in his life. Bessel continued working with this patient and explored that yoga can help him regain his sense of control and bodily pleasure. A subsequent experimental study showed that mindfulness yoga significantly reduced PTSD symptomatology and restore the homeostasis of the autonomic nervous system. With the aid of the mindfulness approach, we can raise awareness of bodily sensations, which can improve control over the flow of emotions by decreasing activity over the amygdala. Hence, individuals can have a reasonable degree of control over themselves, both physically and psychologically (Streeter et al., 2012 ).

To restore the emotional part of the brain and repair the limbic system, Bessel explains various psychotherapies related to the brain, mind, and body of PTSD patients. He emphasized on the human body as the means of communicating with oneself and others. Expressive therapies, through language, art, music, and dance, can motivate people orientate themselves and find their own identity and a meaningful purpose in life (Baker et al., 2018 ). Most importantly, the reconnection of attachment bonding with family and friends can help individuals feel secure in fighting against the threat (Chan et al., 2021a , b ).

“The body keeps the score” attempts to address how PTSD patients experience trauma over the years following a traumatic exposure. From the stories of different victims introduced by the author, Bessel used both scientific and philosophical approaches to explain the complex neurobiology and connection of the human brain-mind-body, and provided useful guides for specialists and the public. An abstract or summary of each chapter can aid readers in capturing the essence of the message. As various approaches that can help people with PTSD are suggested by the author, the book would be more comprehensive if further empirical findings are provided to demonstrate their effectiveness and how readers can integrate them into practice.

Author Contributions

JH is mainly writing this book review. CL, AC, and PT gave comment and suggestion in this manuscript. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Funding. The preparation of this manuscript was partially supported by funding's from School of Nursing and the Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong.

Badura-Brack A., McDermott T. J., Heinrichs-Graham E., Ryan T. J., Khanna M. M., Pine D. S., et al.. (2018). Veterans with PTSD demonstrate amygdala hyperactivity while viewing threatening faces: a MEG study . Biol. Psychol. 132 , 228–232. 10.1016/j.biopsycho.2018.01.005 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Baker F. A., Metcalf O., Varker T., O'Donnell M. (2018). A systematic review of the efficacy of creative arts therapies in the treatment of adults with PTSD . Psychol. Trauma Theory Res. Pract. Policy 10 , 643–651. 10.1037/tra0000353 [ PubMed ] [ CrossRef ] [ Google Scholar ]
Bufka L. F., Wright C. V., Halfond R. W. (Eds.). (2020). Casebook to the APA Clinical Practice Guideline for the Treatment of PTSD. Washington, DC: American Psychological Association. [ Google Scholar ]
Chan A. S. W, Ho J. M. C., Tam H. L., Tang P. M. K. (2021a) Book review: successful aging: a neuroscientist explores the power potential of our lives. Front. Psychol. 12 :705368. 10.3389/fpsyg.2021.705368 [ CrossRef ] [ Google Scholar ]
Chan A. S. W., Ho J. M. C., Li J. S. F., Tam H. L., Tang P. M. K. (2021b) Impacts of COVID-19 pandemic on psychological well-being of older chronic kidney disease patients. Front. Med. 8 :666973. 10.3389/fmed.2021.666973 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Koenigs M., Grafman J. (2009). Posttraumatic stress disorder: the role of medial prefrontal cortex and amygdala . Neuroscientist 15 , 540–548. 10.1177/1073858409333072 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Kozlowska K., Walker P.l., McLean L., Carrive P. (2015). Fear and defense cascade: clinical implications and management . Harv. Rev. Psychiatry 23 , 263–287. 10.1097/HRP.0000000000000065 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Lewis S. J., Arseneault L., Caspi A., Fisher H. L., Matthews T., Moffitt T. E., et al.. (2019). The epidemiology of trauma and posttraumatic stress disorder in a representative cohort of young people in England and Wales . Lancet Psychiatry 6 , 247–256. 10.1016/S2215-0366(19)30031-8 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
Streeter C. C., Gerbarg P. L., Saper R. B., Ciraulo D. A., Brown R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder . Med. Hypotheses 78 , 571–579. 10.1016/j.mehy.2012.01.021 [ PubMed ] [ CrossRef ] [ Google Scholar ]
Watkins L. E., Sprang K. R., Rothbaum B. O. (2018). Treating PTSD: a review of evidence-based psychotherapy interventions . Front. Behav. Neurosci. 12 :258. 10.3389/fnbeh.2018.00258 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

The Body Keeps the Score – Book Review 14 min read

May 3, 2024
Non-Fiction , Psychology , Self-Help

Trauma casts a long shadow. Its tentacles reach deep into the mind, body, and soul, altering neurobiology and physiology in insidious ways. For too long, the medical community misunderstood or overlooked trauma’s impacts. That changed with the pioneering work of Bessel van der Kolk .

Van der Kolk is a psychiatry professor and founder of the Trauma Center in Massachusetts . For over 30 years, he immersed himself in studying how trauma reshapes the brain and body. His book “The Body Keeps the Score” shares these insights through compelling patient stories and cutting-edge science.

As both a trauma survivor and someone fascinated by psychology, this book shook me to my core, I really learned a lot from The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma . Van der Kolk articulated experiences I’ve grappled with my entire life in a way that sparked profound revelations. His holistic, individualized approach to trauma recovery felt deeply validating.

This summary captures the book’s essential wisdom on the psychological and physiological effects of trauma, along with van der Kolk’s integrative mind-body framework for healing. I have also written 10 key takeaways if you want a quick run-through of the book. By the end, I am soooo sure that you’ll feel inspired to improve yourself.

Rediscovering the Body

The book starts by acknowledging a mind-body disconnect in modern society, including the mental health field. Van der Kolk highlights how trauma profoundly disrupts this connection, leading to experiences of dissociation, numbing, and feeling detached from one’s physical self.

He poignantly describes traumatized patients’ struggles to be “fully alive in the present.” Haunted by intrusive memories, thoughts, and emotional flashbacks, they find it nearly impossible to experience the here and now. Their physiological systems remain stuck in permanent states of fight, flight, or freeze.

The key thesis emerges: To heal trauma, practitioners must help patients revisit their traumatic experiences in a safe, contained way. This allows them to engage their bodies’ natural defensive responses, which get short-circuited during trauma. Only then can people “renegotiate” their relationship to the stored physiological imprints.

Van der Kolk argues Western societies overlook the wisdom of engaging the body. However, he learned from yoga teachers, martial artists, and trauma professionals worldwide that physical awareness and movement offer direct pathways toward resolving trauma. Of course, there must be many more sources where he could have learned these things. It’s more about where I or you are going to learn the things that will allow us to improve ourselves.

“Trauma affects the entire human organism – brain and mind, body and somatic experiences, attachment relationships, emotions and geometry of meaning. But as precise as this science has become, it can never completely explain the richness and immense complexity of human experience. Each person is an intricate mixture of genetic and constitutional factors, idiosyncratic developmental and temperamental dispositions, as well as unique personal, social, and cultural experiences.” Bessel van der Kolk

This Is the Memory House

Van der Kolk dives into how traumatic experiences get encoded at cellular and neural levels. Our two memory systems (rational/linguistic and emotional/imprinted) function independently, which explains why trauma memories feel so visceral and unspeakable. He describes patients vividly recounting traumatic events, feeling like their bodies were reliving them entirely despite being in a therapist’s office. These “body memories” hijack people into dissociative trances disconnected from reality. Meanwhile, their prefrontal cortexes (logic/analysis centers) go dark. The key is allowing somatically stored traumas to get expressed and renegotiated in the body. Standard talk therapy alone cannot accomplish this; the entire organism must process the experience.

Therapists provide safe, contained ways for patients to activate their defensive responses and release suppressed energies. Examples include:

Breath works to stimulate the fight-or-flight system
Letting the body shake or make sounds to discharge tension
Using eye movements to activate both brain hemispheres

“The imprint of the trauma seemed to be encoded in an abnormal way, becoming trapped in the body, and avoiding proper assimilation by the brain’s integrative mechanisms.” Bessel van der Kolk

Revolutions in Understanding Mind and Brain

The neurological basis of trauma gets examined, from brain imaging studies to breakthrough therapies like EMDR. Van der Kolk discusses how different regions get rewired by traumatic events, causing dysregulation between rational and emotional processing centers.

Key sections:

The amygdala : Trauma causes this “smoke detector” region to get permanently activated, locked in fight/flight/freeze mode scanning for potential threats.
Hippocampus : Chronic trauma reduces this region’s volume, impairing memory, and emotional regulation.
The body keeps the scorecard : Traumatic imprints live encoded in our cells, tissues, and physiological states. Only by accessing this “body brain” can we rewire trauma responses.
Top-down versus bottom-up therapies : Talk therapy like CBT takes a top-down rational approach that often fails with deep trauma. Body-focused modalities like EMDR target bottom-up sensorimotor processing for lasting change.

Barely Having Escaped Catastrophe

This chapter traces different coping styles and personality adaptations in response to trauma, especially during childhood. Patient stories illustrate self-destructive behaviors like addiction, eating disorders, self-harm, and rage outbursts as attempts to numb unbearable emotional pain.

Van der Kolk argues these seemingly dysfunctional behaviors have an innate logic: They represent courageous efforts to control and master intolerable physiological sensations. Unfortunately, this traps people in cycles of suffering and isolation.

The path forward: developing mindful self-awareness of one’s inner physiological landscape. Body-oriented therapies help people safely inhabit their embodied selves. From that grounded presence, they can start addressing core traumatic imprints.

Having been shattered by trauma, they had devoted their lives to making sure that would never happen again. Their valiant attempts to maintain control over their bodies had turned into rigidly destructive behavior. Bessel van der Kolk

Trapped in Relationships

People who’ve experienced trauma often develop coping mechanisms that become ingrained habits. These can show up in all kinds of relationships, from families to friendships, work to therapy. Think of it like a bad habit you learned as a kid.

Here’s the tricky part: trauma survivors might unconsciously recreate the very situations that hurt them in the first place. This happens because trauma can make it hard to have a strong sense of self. Without that foundation, it’s easy to fall into unhealthy roles and patterns in relationships. It’s a vicious cycle.

Breaking Free: Building Trust and Reconnecting with Yourself

The good news is there’s a way out. Healing starts with building trust in relationships. This means therapists, partners, or even friends need to be genuinely attuned to the other person and create a safe space. Imagine it like feeling comfortable enough to just be yourself, completely.

One powerful tool for healing is body-centered therapy. This helps people reconnect with their bodies and emotions, a skill called “interoception.” By learning to listen to their inner signals, people can start to rewrite those negative patterns that keep them stuck. It’s like learning a new language – the language of your own body – to help you build healthier relationships .

Flesh Unveiled

This section looks at the effects of trauma on one’s fundamental sense of self and spirituality. From survivors feeling like impostors in their own bodies, to questioning the meaning of existence, trauma upends all stability.

Yet within this existential reckoning lies an opportunity for profound alchemical transformation, according to van der Kolk. Discovering how to inhabit the present embodied experience – the gateway to true presence – liberates us from past constrictions.

He advocates using creative, exploratory modalities to support people facing such deep voids and abysses. These include yoga, drama therapy, and other consciousness-expanding practices that help people re-author their self-narratives.

Examples include one patient who started painting and poetry to process speechless inner realms. Another tapped into native Balinese spirituality, shifting from powerlessness and victimhood to reclaimed agency.

As they stopped being professional victims and started feeling powerful in their bodies, they stopped being so intimidated by danger. Bessel van der Kolk

The Path of the Therapist

In this section, van der Kolk provides guidance for therapists working with trauma. He stresses the importance of creating an environment of relational safety and trust. Without this foundation, no effective trauma work can occur.

Bessel van der Kolk shares his journey from starting as a traditional talk therapist to becoming a leading expert in trauma therapy. At first, he relied on standard talk therapy, but he quickly realized it wasn’t enough for people with trauma. This insight led him to a major change in how he helped his patients. Van der Kolk started incorporating therapies that involve the body, like theater, yoga, and EMDR, into his practice. This fresh approach was a big step towards treating trauma more effectively, opening up new and exciting ways for people to heal and recover.

He advocates for therapists to act as mindful guides, attuned to their clients’ subtle somatic cues and defensive responses. Moving at the right pace, introducing new practices gently, and meeting each person’s nervous system where it’s at – this is the path of the skilled trauma therapist according to van der Kolk.

One story illustrates a therapist successfully using trauma-sensitive yoga to help a client stuck in perpetual fight/flight mode. By tracking her bodily sensations on the mat, she could finally inhabit her window of tolerance and self-regulation.

Language Revisited

Imagine a storm raging inside you, a torrent of emotions and fragmented memories you can’t quite grasp. That’s the experience of trauma for many survivors, as Bessel van der Kolk explains. Trauma can steal your voice, leaving you speechless or reduced to primal cries when those buried experiences threaten to erupt.

But here’s the good news: finding your voice again is key to healing. By weaving words into a narrative, you transform the raw, confusing jumble of emotions into a story that makes sense. It’s like taking scattered puzzle pieces and forming a coherent picture.

Van der Kolk doesn’t just preach talking it out. He suggests innovative methods like movement therapy or cycling on stationary bikes to tap into those memories through your body first. Think of it as jumpstarting your vocabulary. By reconnecting with the physical sensations of the trauma, you begin to build the emotional vocabulary to express what happened.

The ultimate goal? To reclaim the power of language in all its richness. Van der Kolk envisions therapy fostering imagination, metaphor, and the freedom to express yourself authentically. He shares powerful examples: poems by survivors, and artworks that capture truths too painful for words. These creations become a bridge between the unspeakable and the world, a testament to the strength of humankind .

So, the next time you think about trauma, remember – it’s not just about what happened, it’s about finding your voice again and reclaiming the power to tell your story.

The Imprint of Trauma

The final chapters make out how trauma shapes not just the psychological realm, but leaves indelible imprints on the body and chronic health conditions. Van der Kolk examines links between trauma and autoimmune disorders, chronic pain, obesity, and other ailments.

He presents striking cases of trauma survivors healing entrenched physical illnesses through therapies like yoga, meditation, and sensorimotor psychotherapy. As they released stuck survival energies and completed defensive responses, their bodies’ self-healing capacities were restored.

At its core, this underscores van der Kolk’s central philosophy: trauma is a whole-body experience, and true healing requires a whole-body approach. His case examples show this holistic trauma lens facilitating profound mind-body transformations.

In conclusion, van der Kolk shares his humble wish: that society will integrate these insights so future generations can access trauma-sensitive education , healthcare, and restorative support systems. With this foundation of embodied awareness, violence, and trauma’s cyclical perpetuation can finally get disrupted.

He leaves readers with the empowering notion that no matter how deep one’s traumatic imprints, integrating top-down and bottom-up interventions offers pathways to reclaim one’s full humanity. The body may keep the score, but it also holds keys to our healing and freedom.

A Lifelong Journey Reading – My POV on The Body Keeps The Score

Reading “The Body Keeps the Score” made me understand the broad and profound effects of trauma and clearly showed me ways to heal, and it is so interesting. The book stresses the need to tackle trauma at several levels by integrating mind and body in the healing process. And I am sure, each person will perceive this in a different way, which tells a lot about this book.

I just couldn’t stop reading it! My psychologist suggested it to me. I finished the entire book in just a few days, and it was super duper constructive. I’ve recently returned to therapy, which has been quite anxiety-inducing because I’m taking it more seriously this time. I also switched therapists, so that’s that. On top of that, I started EMDR therapy, which was new to me. Reading about how the author helped his patients, and knowing there was someone out there who went through what I did and was significantly helped by him, made me feel less anxious about my own situation. I’m still a bit nervous, but I remain motivated to continue. My copy of the book is filled with underlined sections and notes because it really positively resonated with me.

Now I have a compassionate map for making sense of flashbacks, disassociation, self-destructive patterns, and feeling disconnected from my body. More importantly, I can embrace a safe, embodied path for tenderly renegotiating those traumatic imprints and restoring my psychophysical wholeness. But hey, it’s a long journey I am very sure there are so many things that I can learn more, and I will!

If this summary has caught your interest and you wish to learn more about psychological healing and trauma recovery, I encourage you to visit thebooklore.com . On this site, you can find more articles and resources that further these topics, aiding in both personal and professional growth in mental health.

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Inside the Best-Seller List

Does a Writer Ever Get Cozy on the Best-Seller List? Bessel van der Kolk Says No.

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By Elisabeth Egan

July 8, 2021

MEET A REGULAR If you spend enough time scrutinizing the best-seller list , you may notice that it has a lot in common with a party. There are guests who drop in, pop a bottle of champagne and exit promptly. Others arrive with a companion, or occasionally an entourage. (These authors have more than one book on the list at the same time: Madeline Miller, Leigh Bardugo, James Patterson, Jason Reynolds and Ibram X. Kendi, to name a few.) Finally, there are guests who amble in, make themselves comfortable and stay for weeks.

Bessel van der Kolk is of the fixture variety. His guide to healing trauma, “The Body Keeps Score,” has been on the paperback nonfiction list for 141 weeks — 27 of them in the No. 1 slot. The book has also appeared on the audio nonfiction list, the health and science monthly lists (now discontinued), and the combined print and e-book list, where it is currently No. 2. Not to belabor the soiree analogy, but this Boston-based psychiatrist and co-founder of the Trauma Research Foundation is a serious party animal.

Does van der Kolk keep track of where “The Body Keeps Score” falls on the list each week? “How could you not?” he asked in a phone interview. “I have friends who say, ‘Bessel, are you always checking your phone to see how your book is doing?’ I say, ‘Wouldn’t you?’”

You might wonder whether the pandemic has been partially responsible for readers’ interest in the ways the body metabolizes trauma. “I am not so sure about that,” van der Kolk said, admitting that he has been inundated with inquiries like this one. “My answer is, no, the pandemic is not a trauma. The pandemic is a challenging event which for some people might turn into a trauma. It has really shown the enormous issue of inequality and how different groups of the population were very differently affected.”

In addition to members of the media seeking his expertise, van der Kolk hears from readers who recognize their struggles in “The Body Keeps Score.” He recently learned that Oliver Sacks answered all his mail, which would be impossible for him to do: “My life would come to a complete end.” But van der Kolk keeps a close eye on his Amazon reviews, which number 32,046 at the time of this writing. (“HEAVY,” said a recent one. “Great read, but HEAVY.”) There are new reviews every day and, like the best reveler, this author pays attention to them all.

Elisabeth Egan is an editor at the Book Review and the author of “A Window Opens.”

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The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Paperback – September 8, 2015

Print length 464 pages
Language English
Publisher Penguin Books
Publication date September 8, 2015
Reading age 18 years and up
Dimensions 1.1 x 5.4 x 8.4 inches
ISBN-10 0143127748
ISBN-13 978-0143127741
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FACING TRAUMA

One does not have be a combat soldier, or visit a refugee camp in Syria or the Congo to encounter trauma. Trauma happens to us, our friends, our families, and our neighbors. Research by the Centers for Disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.1

As human beings we belong to an extremely resilient species. Since time immemorial we have rebounded from our relentless wars, countless disasters (both natural and man-made), and the violence and betrayal in our own lives. But traumatic experiences do leave traces, whether on a large scale (on our histories and cultures) or close to home, on our families, with dark secrets being imperceptibly passed down through generations. They also leave traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology and immune systems.

Trauma affects not only those who are directly exposed to it, but also those around them. Soldiers returning home from combat may frighten their families with their rages and emotional absence. The wives of men who suffer from PTSD tend to become depressed, and the children of depressed mothers are at risk of growing up insecure and anxious. Having been exposed to family violence as a child often makes it difficult to establish stable, trusting relationships as an adult.

Trauma, by definition, is unbearable and intolerable. Most rape victims, combat soldiers, and children who have been molested become so upset when they think about what they experienced that they try to push it out of their minds, trying to act as if nothing happened, and move on. It takes tremendous energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability.

While we all want to move beyond trauma, the part of our brain that is devoted to ensuring our survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. This precipitates unpleasant emotions intense physical sensations, and impulsive and aggressive actions. These posttraumatic reactions feel incomprehensible and overwhelming. Feeling out of control, survivors of trauma often begin to fear that they are damaged to the core and beyond redemption.

The first time I remember being drawn to study medicine was at a summer camp when I was about fourteen years old. My cousin Michael kept me up all night explaining the intricacies of how kidneys work, how they secrete the body’s waste materials and then reabsorb the chemicals that keep the system in balance. I was riveted by his account of the miraculous way the body functions. Later, during every stage of my medical training, whether I was studying surgery, cardiology, or pediatrics, it was obvious to me that the key to healing was understanding how the human organism works. When I began my psychiatry rotation, however, I was struck by the contrast between the incredible complexity of the mind and the ways that we human beings are connected and attached to one another, and how little psychiatrists knew about the origins of the problems they were treating. Would it be possible one day to know as much about brains, minds, and love as we do about the other systems that make up our organism?

We are obviously still years from attaining that sort of detailed understanding, but the birth of three new branches of science has led to an explosion of knowledge about the effects of psychological trauma, abuse, and neglect. Those new disciplines are neuroscience, the study of how the brain supports mental processes; developmental psychopathology, the study of the impact of adverse experiences on the development of mind and brain; and interpersonal neurobiology, the study of how our behavior influences the emotions, biology, and mind-sets of those around us.

Research from these new disciplines has revealed that trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant. We now know that trauma compromises the brain area that communicates the physical, embodied feeling of being alive. These changes explain why traumatized individuals become hypervigilant to threat at the expense of spontaneously engaging in their day-to-day lives. They also help us understand why traumatized people so often keep repeating the same problems and have such trouble learning from experience. We now know that their behaviors are not the result of moral failings or signs of lack of willpower or bad character—they are caused by actual changes in the brain.

This vast increase in our knowledge about the basic processes that underlie trauma has also opened up new possibilities to palliate or even reverse the damage. We can now develop methods and experiences that utilize the brain’s own natural neuroplasticity to help survivors feel fully alive in the present and move on with their lives. There are fundamentally three avenues: 1) top down, by talking, (re-) connecting with others, and allowing ourselves to know and understand what is going on with us, while processing the memories of the trauma; 2) by taking medicines that shut down inappropriate alarm reactions, or by utilizing other technologies that change the way the brain organizes information, and 3) bottom up: by allowing the body to have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that result from trauma. Which one of these is best for any particular survivor is an empirical question. Most people I have worked with require a combination.

This has been my life’s work. In this effort I have been supported by my colleagues and students at the Trauma Center, which I founded thirty years ago. Together we have treated thousands of traumatized children and adults: victims of child abuse, natural disasters, wars, accidents, and human trafficking; people who have suffered assaults by intimates and strangers. We have a long tradition of discussing all our patients in great depth at weekly treatment team meetings and carefully tracking how well different forms of treatment work for particular individuals.

Our principal mission has always been to take care of the children and adults who have come to us for treatment, but from the very beginning we also have dedicated ourselves to conducting research to explore the effects of traumatic stress on different populations and to determine what treatments work for whom. We have been supported by research grants from the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, the Centers for Disease Control, and a number of private foundations to study the efficacy of many different forms of treatment, from medications to talking, yoga, EMDR, theater, and neurofeedback.

The challenge is: How can people gain control over the residues of past trauma and return to being masters of their own ship? Talking, understanding, and human connections help, and drugs can dampen hyperactive alarm systems. But we will also see that the imprints from the past can be transformed by having physical experiences that directly contradict the helplessness, rage, and collapse that are part of trauma, and thereby regaining self-mastery. I have no preferred treatment modality, as no single approach fits everybody, but I practice all the forms of treatment that I discuss in this book. Each one of them can produce profound changes, depending on the nature of the particular problem and the makeup of the individual person.

I wrote this book to serve as both a guide and an invitation—an invitation to dedicate ourselves to facing the reality of trauma, to explore how best to treat it, and to commit ourselves, as a society, to using every means we have to prevent it.

THE REDISCOVERY OF TRAUMA

LESSONS FROM VIETNAM VETERANS

I became what I am today at the age of twelve, on a frigid overcast day in the winter of 1975. . . . That was a long time ago, but it’s wrong what they say about the past. . . . Looking back now, I realize I have been peeking into that deserted alley for the last twenty-six years.

—Khaled Hosseini, The Kite Runner

Some people’s lives seem to flow in a narrative; mine had many stops and starts. That’s what trauma does. It interrupts the plot. . . . It just happens, and then life goes on. No one prepares you for it.

—Jessica Stern, Denial: A Memoir of Terror

The Tuesday after the Fourth of July weekend, 1978, was my first day as a staff psychiatrist at the Boston Veterans Administration Clinic. As I was hanging a reproduction of my favorite Breughel painting, “The Blind Leading the Blind,” on the wall of my new office, I heard a commotion in the reception area down the hall. A moment later a large, disheveled man in a stained three-piece suit, carrying a copy of Soldier of Fortune magazine under his arm, burst through my door. He was so agitated and so clearly hungover that I wondered how I could possibly help this hulking man. I asked him to take a seat, and tell me what I could do for him.

His name was Tom. Ten years earlier he had been in the Marines, doing his service in Vietnam. He had spent the holiday weekend holed up in his downtown-Boston law office, drinking and looking at old photographs, rather than with his family. He knew from previous years’ experience that the noise, the fireworks, the heat, and the picnic in his sister’s backyard against the backdrop of dense early-summer foliage, all of which reminded him of Vietnam, would drive him crazy. When he got upset he was afraid to be around his family because he behaved like a monster with his wife and two young boys. The noise of his kids made him so agitated that he would storm out of the house to keep himself from hurting them. Only drinking himself into oblivion or riding his Harley-Davidson at dangerously high speeds helped him to calm down.

Nighttime offered no relief—his sleep was constantly interrupted by nightmares about an ambush in a rice paddy back in ’Nam, in which all the members of his platoon were killed or wounded. He also had terrifying flashbacks in which he saw dead Vietnamese children. The nightmares were so horrible that he dreaded falling asleep and he often stayed up for most of the night, drinking. In the morning his wife would find him passed out on the living room couch, and she and the boys had to tiptoe around him while she made them breakfast before taking them to school.

Filling me in on his background, Tom said that he had graduated from high school in 1965, the valedictorian of his class. In line with his family tradition of military service he enlisted in the Marine Corps immediately after graduation. His father had served in World War II in General Patton’s army, and Tom never questioned his father’s expectations. Athletic, intelligent, and an obvious leader, Tom felt powerful and effective after finishing basic training, a member of a team that was prepared for just about anything. In Vietnam he quickly became a platoon leader, in charge of eight other Marines. Surviving slogging through the mud while being strafed by machine-gun fire can leave people feeling pretty good about themselves—and their comrades.

At the end of his tour of duty Tom was honorably discharged, and all he wanted was to put Vietnam behind him. Outwardly that’s exactly what he did. He attended college on the GI Bill, graduated from law school, married his high school sweetheart, and had two sons. Tom was upset by how difficult it was to feel any real affection for his wife, even though her letters had kept him alive in the madness of the jungle. Tom went through the motions of living a normal life, hoping that by faking it he would learn to become his old self again. He now had a thriving law practice and a picture-perfect family, but he sensed he wasn’t normal; he felt dead inside.

Although Tom was the first veteran I had ever encountered on a professional basis, many aspects of his story were familiar to me. I grew up in postwar Holland, playing in bombed-out buildings, the son of a man who had been such an outspoken opponent of the Nazis that he had been sent to an internment camp. My father never talked about his war experiences, but he was given to outbursts of explosive rage that stunned me as a little boy. How could the man I heard quietly going down the stairs every morning to pray and read the Bible while the rest of the family slept have such a terrifying temper? How could someone whose life was devoted to the pursuit of social justice be so filled with anger? I witnessed the same puzzling behavior in my uncle, who had been captured by the Japanese in the Dutch East Indies (now Indonesia) and sent as a slave laborer to Burma, where he worked on the famous bridge over the river Kwai. He also rarely mentioned the war, and he, too, often erupted into uncontrollable rages.

As I listened to Tom, I wondered if my uncle and my father had had nightmares and flashbacks—if they, too, had felt disconnected from their loved ones and unable to find any real pleasure in their lives. Somewhere in the back of my mind there must also have been my memories of my frightened—and often frightening—mother, whose own childhood trauma was sometimes alluded to and, I now believe, was frequently reenacted. She had the unnerving habit of fainting when I asked her what her life was like as a little girl and then blaming me for making her so upset.

Reassured by my obvious interest, Tom settled down to tell me just how scared and confused he was. He was afraid that he was becoming just like his father, who was always angry and rarely talked with his children—except to compare them unfavorably with his comrades who had lost their lives around Christmas 1944, during the Battle of the Bulge.

As the session was drawing to a close, I did what doctors typically do: I focused on the one part of Tom’s story that I thought I understood—his nightmares. As a medical student I had worked in a sleep laboratory, observing people’s sleep/dream cycles, and had assisted in writing some articles about nightmares. I had also participated in some early research on the beneficial effects of the psychoactive drugs that were just coming into use in the 1970s. So, while I lacked a true grasp of the scope of Tom’s problems, the nightmares were something I could relate to, and as an enthusiastic believer in better living through chemistry, I prescribed a drug that we had found to be effective in reducing the incidence and severity of nightmares. I scheduled Tom for a follow-up visit two weeks later.

When he returned for his appointment, I eagerly asked Tom how the medicines had worked. He told me he hadn’t taken any of the pills. Trying to conceal my irritation, I asked him why. “I realized that if I take the pills and the nightmares go away,” he replied, “I will have abandoned my friends, and their deaths will have been in vain. I need to be a living memorial to my friends who died in Vietnam.”

I was stunned: Tom’s loyalty to the dead was keeping him from living his own life, just as his father’s devotion to his friends had kept him from living. Both father’s and son’s experiences on the battlefield had rendered the rest of their lives irrelevant. How had that happened, and what could we do about it? That morning I realized I would probably spend the rest of my professional life trying to unravel the mysteries of trauma. How do horrific experiences cause people to become hopelessly stuck in the past? What happens in people’s minds and brains that keeps them frozen, trapped in a place they desperately wish to escape? Why did this man’s war not come to an end in February 1969, when his parents embraced him at Boston’s Logan International Airport after his long flight back from Da Nang?

Tom’s need to live out his life as a memorial to his comrades taught me that he was suffering from a condition much more complex than simply having bad memories or damaged brain chemistry—or altered fear circuits in the brain. Before the ambush in the rice paddy, Tom had been a devoted and loyal friend, someone who enjoyed life, with many interests and pleasures. In one terrifying moment, trauma had transformed everything.

Product details

Publisher ‏ : ‎ Penguin Books; Reprint edition (September 8, 2015)
Language ‏ : ‎ English
Paperback ‏ : ‎ 464 pages
ISBN-10 ‏ : ‎ 0143127748
ISBN-13 ‏ : ‎ 978-0143127741
Reading age ‏ : ‎ 18 years and up
Item Weight ‏ : ‎ 14.4 ounces
Dimensions ‏ : ‎ 1.1 x 5.4 x 8.4 inches
#1 in Anxiety Disorders (Books)
#1 in Post-traumatic Stress Disorder
#1 in Popular Psychology Pathologies

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About the authors

Bessel van der kolk.

Bessel van der Kolk (born 1943) is a Boston based psychiatrist noted for his research in the area of post-traumatic stress since the 1970s. His work focuses on the interaction of attachment, neurobiology, and developmental aspects of trauma’s effects on people. His major publication, the New York Times bestseller, 'The Body keeps the Score', talks about how the role of trauma in psychiatric illness has changed over the past 20 years; what we have learned about the ways the brain is shaped by traumatic experiences; how traumatic stress is a response of the entire organism and how that knowledge needs be integrated into healing practices.

Bio from Wikipedia, the free encyclopedia.

Bessel van der Kolk M.D.

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The Body Keeps the Score: how a bestselling book helps us understand trauma – but inflates the definition of it

Professor of Psychology, The University of Melbourne

Disclosure statement

Nick Haslam receives funding from the Australian Research Council.

University of Melbourne provides funding as a founding partner of The Conversation AU.

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In a new series, we look at books that have become cultural touchstones.

If new books are lucky they enjoy a brief honeymoon of attention before ebbing away into oblivion. Not so The Body Keeps the Score , a publishing phenomenon that has kept selling long after it first hit the shelves in 2014. The book has spent more than 150 weeks on the New York Times best seller list for paperback nonfiction, including over half a year in the coveted #1 spot during 2021. It has reportedly sold almost 2 million copies.

Why a long, dense, and demanding book on the psychology and neurobiology of trauma should occupy so bright a spotlight for so long is not immediately obvious. Post-traumatic stress disorder is old news, a staple of psychological chatter for over four decades, and the book doesn’t offer any quick fix solutions for self-helpers.

Clues to what has driven The Body Keeps the Score’s success can be found in its sales trajectory. On bookriot.com , writer Gina Nicoll notes that sales began to liven up around 2018 and then grew in spurts, reaching a peak in 2021. The pandemic may have contributed to this surge by bringing collective trauma to our doorsteps, she speculates, but the pre-pandemic upswing suggests other factors are also at play.

Reckonings with sexual and racial trauma in the wake of #MeToo and Black Lives Matter have combined to raise the cultural profile of trauma, Nicoll suggests.

But alongside this increase in cultural attention, there has been a broadening of what we take trauma to be.

People are seeing trauma everywhere and re-conceptualising their own experiences of misery and misadventure in its terms. They are doing so, at least in part, because the concept’s meaning has been stretched. More on that later.

Read more: Six psychiatric concepts that have mutated: for better or worse

The book explained

So what is all the fuss about? Bessel van der Kolk , a Dutch-born psychiatrist who has been a successful researcher and clinician in the Boston area since the late 1970s, wrote The Body Keeps the Score as a guide to the understanding and treatment of trauma.

The book adopts several standard features of the popular psychology genre: case studies from the author’s clinical practice, autobiographical reflections, and sharp critiques of mainstream views to assure readers the author is not merely doing good but slaying dragons in the process.

However, its presentation of the science of trauma is unusually compelling, setting it above most works of popularisation. Van der Kolk has substantial legitimacy as a researcher, and his interleaving of the personal and the scientific makes for an engaging read.

Van der Kolk begins his blockbuster with a discussion of the neuroscience of trauma, complete with explorations of brain anatomy and function and how they underpin reactions to extreme threat.

He presents traumatic reactions not simply as disturbances of fear and anxiety – how the amygdala becomes an over-sensitive “smoke detector” that triggers traumatised people into fight or flight reactions – but also as disruptors of interpersonal relationships and a stable sense of self.

Trauma’s somatic signature extends beyond the brain. Van der Kolk explains at length how hormonal influences and the vagus nerve, which runs from brain to abdomen and regulates several internal organ functions, reverberate its effects throughout the body.

In trauma, he argues, people may lose a sense of body ownership to accompany their loss of self, felt connection to others, and even their sense of being fully alive. Recovering a sense of personal agency and of bodily ownership – what he refers to as befriending the body – is a key to recovery.

Childhood trauma

Trauma in childhood becomes the second major focus of the book. Whereas early investigations of post-traumatic reactions focused on adult combatants in war, van de Kolk directs much of his attention to impacts of trauma and hardship earlier in life. Once again, his focus is expansive, extending beyond traumatised individuals in isolation to the disruptions trauma creates in their intimate attachments.

Abusive family environments produce children who lack a secure sense of connection to others and suffer elevated risks of illness and re-traumatisation. They are more likely than their peers to experience and perpetrate violence as adults, to engage in self-damaging behaviour, and to experience cancer, heart disease, obesity and a range of psychiatric conditions.

Van der Kolk presents childhood trauma as a “hidden epidemic”, swept under the carpet by society at large and by psychiatry in particular. He advocates for policy responses that combat the economic and societal drivers of childhood adversity, and for better recognition by organised psychiatry of the mental health impacts of trauma.

In this second quest he has had limited success. His proposal of new diagnoses that recognise the outcomes of repeated childhood trauma – “complex PTSD” and “developmental trauma disorder” – were rebuffed by the developers of American psychiatry’s classification of mental disorders, the DSM.

The DSM’s third edition, published in 1980, recognised PTSD for the first time. But the fourth and fifth editions, DSM-IV (1994) and DSM-5 (2013), would have none of these new proposals.

Van der Kolk’s outrage at this rejection, and his jaundiced, if sometimes straw-mannish view of the psychiatry profession, seasons his book with anti-establishment saltiness. The alternative view – that the DSM’s guardians were wary of adding new disorders that overlapped substantially with existing conditions, privileging trauma as the single, dominant cause of a diffuse and multi-determined set of symptoms – does not get a hearing.

The Body Keeps the Score closes with an extended exploration of alternative forms of treatment. Despite his neuro-biological leanings, van der Kolk does not see medication as the best line of intervention. He contends that effective therapies must target meaning rather than chemistry and allow traumatic memories to be processed rather than blunted.

Among his diverse collection of preferred treatments are neurofeedback, in which people learn to alter brain waves via real-time encephalographic feedback, somatic psychotherapies, yoga, theatre, and eye movement desensitisation and reprocessing ( EMDR , in which people recall traumatic experiences while performing rhythmic, therapist-guided eye movements).

His enthusiasm for these interventions, some of which veer towards the fringe and the faddish, sometimes outstrips the evidence for their efficacy, but has contributed to their growing popularity.

Understanding the book’s appeal

The Body Keeps the Score has been remarkably popular for reasons beyond its alignment with our current cultural preoccupations. For one, it is a hopeful book. Although it underscores the sweeping extent of traumatic experiences and the severity and range of their impacts, it also argues that therapy works and post-traumatic distress need not be a life sentence.

The same optimism shines through in the book’s dialectical account of the history of the mental health disciplines. A period of “brain-less” psychoanalytic interest in the meaning of psychological distress – carried out with no eye for biological processes – gave way to an era of “mind-less” psychopharmacology. We have now arrived at a stage in which neurobiology and a deep appreciation of human psychology can go hand in hand.

The book also contributes to an ongoing de-masculinising of trauma studies. Psychiatric thinking about trauma was long dominated by investigations of combat reactions in soldiers, described variously as shell shock or battle fatigue. The flood of psychological casualties among Vietnam veterans spurred the official recognition of PTSD in 1980.

Van der Kolk pays much more attention to sexual abuse and violence as sources of trauma. These disproportionately affect women and girls and account at least partially for women’s higher rates of PTSD diagnoses.

Read more: What is complex PTSD and how does it relate to past abuse and trauma?

The same feminising of trauma can be seen more symbolically in van der Kolk’s emphasis on the bodily and relational dimensions of trauma. Historically, the gender binary has been overlaid on the mind/body distinction, and on the distinction between stereotypically masculine independence and stereotypically feminine relatedness.

By paying heed to somatic impacts and treatments of trauma, and the ways in which it disrupts attachments and relationships, van der Kolk is making the psychology of trauma more inclusive of the experiences of female trauma survivors.

Inflating trauma

The Body Keeps the Score offers a vision of trauma that is inclusive in some respects. But is it over-inclusive in others? Van der Kolk’s understanding of trauma is expansionary, offering a broad view of its impacts and implications.

He recognises a wide range of manifestations of trauma, promotes new trauma-related diagnoses, affirms a broad definition of what counts as a traumatic event, and recommends diverse modes of treatment.

For example, conventional descriptions of PTSD point to a restricted set of symptoms, such as flashbacks, nightmares, and hyper-vigilance. Van der Kolk connects trauma to a much wider web of phenomena. It is examined as a primary source of relationship problems, emotional disturbances, and forms of acting out such as rebellious, defiant, impulsive, and inattentive behaviour.

Most significantly of all, Van der Kolk sees trauma lurking beneath an array of somatic complaints. Trauma is embodied and manifested in such concerns as irritable bowel, auto-immune conditions, fibromyalgia, headaches, and a range of diffuse physical symptoms.

Similarly, Van der Kolk’s work expands the range of events that are considered traumas. When PTSD was first defined in DSM-III, the condition could only be diagnosed if the event that precipitated it was life-threatening and outside the range of normal human experience.

Later editions of the diagnostic manual loosened the definition to include unpleasant events witnessed indirectly, which are not physically endangering.

Van der Kolk uses the term “trauma” more freely still, often employing it to refer to almost any form of life adversity, including enduring circumstances rather than only discrete incidents. Trauma can easily be stretched to encompass minor illnesses, normal romantic breakups and disappointing exam results.

On this broadened definition, all but the most cosseted among us have been traumatised and can view our struggles and sufferings through the potentially magnifying lens of trauma.

This expansion of the meaning of trauma has taken place in parallel with a steep rise in the cultural prominence of the concept. Research shows that the word “trauma” appears in everyday discourse much more frequently now than it did even two decades ago.

That rise has been even more dizzying within the mental health professions, a recent study finding that “trauma” appeared at an almost 20 times higher rate in psychology journal articles in the 2010s as it did in the 1970s.

Read more: More than half of Australians will experience trauma, most before they turn 17. We need to talk about it

It should not be surprising to learn that this sharply spiking interest in trauma has generated some push-back. In 2021, Eleanor Cummins observed in The Atlantic that the concept of trauma has become “uselessly vague – a swirl of psychiatric diagnoses, folk wisdom, and popular misconceptions”. In the same year, writer Will Self criticised “how everything became trauma” and Parul Sehgal decried how trauma-driven plots flatten fictional narratives and hollow out characters in The New Yorker.

In 2022, in the New York Times, Jessica Bennett asked “if everything is trauma, is anything?” and denounced “post-traumatic hyperbole”. Lexi Pandell , writing for Vox, argued this “word of the decade” has become close to meaningless.

Like Bennett and Pandell, several writers have queried whether trauma is now being used too promiscuously. Some have distinguished big “T” trauma from less severe little “t” trauma to resist this concept creep .

Others worry that the growing popularity of trauma narratives represents an encroachment of medical language into the realm of ordinary adversity, reducing unjust social arrangements to individual pathologies, or promoting personal fragility. Still others have voiced concerns that the concept of trauma has become politicised .

The argument that broad concepts of trauma produce fragility rests on the belief that defining moderate life challenges as mind-shattering traumas might undermine our resilience.

Understanding an adversity as a trauma implies that it overwhelms our capacity to cope and is likely to have lasting effects. In the popular mind, trauma still carries a connotation of indelibility.

Of course, many adversities do take people beyond their breaking points and have enduring consequences. The question is whether perceiving less severe experiences as traumas makes them loom larger and longer than they need to. Emerging research evidence suggests that it might.

Van der Kolk can’t be held entirely responsible for the runaway success of his book or for the runaway semantic inflation and popularity of its central concept. The Body Keeps the Score has been successful because it resonates with its cultural moment, and it has helped to mould that moment for millions of readers.

The recent elevation of trauma attests to a time in which people are keenly attuned to their individual and collective suffering, increasingly attribute it to causes beyond their control, and look to a therapeutic mindset to resolve it. Van der Kolk’s book is a lucid guide to this new reality.