The Body Keeps the Score

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma A Book Review by Bessel van der Kolk, M.D. Reading Time: 8 minutes

What if the anxiety you feel in your chest, the chronic pain in your back, or the rage that seems to come from nowhere aren't just random symptoms, but your body's way of speaking about experiences your mind has tried to forget? This is the revolutionary premise of "The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma" by psychiatrist Bessel van der Kolk. Based on over forty years of clinical work and research, this landmark book has fundamentally changed how we understand trauma and its treatment.

Understanding Trauma Beyond PTSD Van der Kolk begins by expanding our understanding of what trauma actually is. Most people think of trauma as something that happens to soldiers in war or victims of extreme violence. But the author argues that trauma is far more pervasive than we recognize. It includes childhood neglect, emotional abuse, car accidents, medical procedures, and countless other experiences where we felt overwhelmed, helpless, or under threat. The key insight is that trauma isn't really about the event itself, but about how our nervous system responds to it. When we experience something overwhelming, our brain's alarm system can get stuck in the "on" position. We become trapped in a state of perpetual threat, even when the danger has long passed. Our bodies continue to react as if the trauma is happening right now, in this moment. This explains why trauma survivors often struggle with symptoms that seem disconnected from rational thought. You can know intellectually that you're safe, but your body doesn't believe it. Your heart races, your muscles tense, you feel the urge to flee or fight, even in mundane situations. This isn't weakness or irrationality; it's your nervous system doing exactly what it was designed to do when faced with threat, except the threat is a memory, not a present reality.

The Science of Trauma One of the book's greatest strengths is how van der Kolk translates complex neuroscience into accessible language. He walks readers through what happens in the brain during trauma, using brain imaging studies to show how traumatic experiences literally reshape our neural architecture. The amygdala, our brain's smoke detector, becomes hyperactive in trauma survivors, constantly scanning for danger. Meanwhile, the prefrontal cortex, responsible for rational thought and emotional regulation, essentially goes offline. This is why people with trauma histories often struggle with feeling out of control of their emotions or unable to think clearly when triggered. Perhaps most fascinating is van der Kolk's discussion of how trauma affects our sense of time. The brain region that helps us understand that something happened in the past, called Broca's area, often shuts down during traumatic recall. This means that for trauma survivors, traumatic memories aren't experienced as memories at all. They're experienced as happening right now, with all the intensity of the original event. The author also explores how trauma affects our relationships and our sense of self. Children who experience trauma during critical developmental periods may never fully develop the capacity to regulate their emotions or form secure attachments. Their internal working model of the world becomes one where people can't be trusted, where danger lurks everywhere, and where they themselves are fundamentally flawed or unlovable. The Limitations of Traditional Treatment Van der Kolk doesn't shy away from criticizing the mental health establishment, including his own field of psychiatry. He argues that traditional talk therapy, while valuable, is often insufficient for treating trauma. You can't think your way out of trauma because trauma lives in parts of the brain that don't respond to language and logic. Similarly, he's critical of the over-reliance on psychiatric medications. While medications can be helpful for managing symptoms, they don't address the underlying dysregulation in the nervous system. A pill might dampen your anxiety, but it won't teach your body that it's safe or help you process the traumatic memories. The book describes van der Kolk's frustration with insurance companies and treatment protocols that limit therapy to a specific number of sessions or require certain approaches, regardless of whether they're effective for trauma. He shares stories of patients who were told they should be "over it" by now, or who were given medications that numbed them without healing them. Body-Based Approaches to Healing The heart of the book is van der Kolk's exploration of treatments that work directly with the body. If trauma is stored in the body, then healing must involve the body. He discusses a range of approaches that have shown promise: EMDR (Eye Movement Desensitization and Reprocessing) uses bilateral stimulation to help the brain reprocess traumatic memories. While it might sound strange, van der Kolk presents compelling research showing its effectiveness. Neurofeedback trains people to regulate their own brain waves, essentially teaching the brain to shift out of traumatic stress patterns. The author shares remarkable stories of patients whose lives were transformed by learning to modulate their brain activity. Yoga and mindful movement help trauma survivors reconnect with their bodies. Many people with trauma histories have learned to dissociate from their bodies as a survival mechanism. Gentle, mindful practices can help them inhabit their bodies again and develop a sense of safety in their physical experience. Theater and improvisation create opportunities for people to experiment with different ways of being in the world, to practice agency and spontaneity in a safe environment. What unites these approaches is that they all work to help the nervous system complete the incomplete survival responses from the traumatic event. They allow the body to finally discharge the energy that has been trapped since the trauma occurred. The Role of Relationships in Healing Van der Kolk emphasizes that healing from trauma is fundamentally a relational process. Trauma often happens in the context of relationships (abuse, neglect, betrayal), and healing must also happen in relationship. The therapeutic relationship itself becomes a laboratory where survivors can learn that connection can be safe, that their needs matter, and that they can trust another person. The book includes moving descriptions of group therapy, where trauma survivors find validation and connection with others who understand their experiences. There's something profoundly healing about realizing you're not alone, that your reactions make sense given what you've been through, and that others have found their way to recovery. He also discusses how community and social support are crucial for healing. Isolated trauma survivors rarely heal fully. We need connection, belonging, and the experience of being seen and valued by others. This has important implications for how we structure mental health treatment and social services. Childhood Trauma and Attachment Some of the book's most powerful sections deal with childhood trauma and attachment. Van der Kolk explains how early experiences with caregivers shape our entire nervous system and our capacity to regulate emotions, form relationships, and feel safe in the world. Children who grow up with inconsistent, frightening, or absent caregivers develop disorganized attachment. Their source of comfort is also their source of fear, creating an impossible bind. These children often grow into adults who struggle with intense relationships, self-destructive behaviors, and a fundamental sense that something is wrong with them. The author is compassionate in describing how caregivers themselves are often doing the best they can with their own unresolved trauma. Trauma tends to be intergenerational, passed down through parenting patterns and family dynamics. Understanding this can help break cycles of blame while still acknowledging the real harm that occurs. Practical Applications and Hope Throughout the book, van der Kolk weaves in case studies that bring his concepts to life. These are real people with real struggles, and we see their journeys toward healing. Not every story has a perfect ending, but most show meaningful progress and the possibility of reclaiming one's life from trauma. For readers who have experienced trauma, the book offers both validation and hope. Validation that their symptoms aren't character flaws but understandable responses to overwhelming experiences. Hope that healing is possible, even if it looks different from what they might have expected. For therapists and healthcare providers, the book is a call to expand our toolkit and to truly understand trauma from a neuroscience and somatic perspective. Van der Kolk challenges the field to move beyond outdated models and embrace approaches that address the whole person, not just their thoughts. Strengths of the Book "The Body Keeps the Score" succeeds on multiple levels. It's scientifically rigorous while remaining accessible to general readers. Van der Kolk's writing is clear and often moving, balancing research findings with human stories. The breadth of topics covered is impressive, from neuroscience to attachment theory to various treatment modalities. The book's greatest contribution may be legitimizing what trauma survivors have always known: that trauma lives in the body, that you can't just "get over it," and that healing requires more than talking about what happened. This validation alone has been transformative for countless readers. Potential Limitations At over 400 pages, the book is comprehensive but can feel dense at times. Some readers might find the neuroscience sections challenging, though van der Kolk does his best to make them accessible. The book covers so many different treatment approaches that readers might feel overwhelmed trying to figure out what's right for them. More guidance on how to choose among these options could be helpful. Additionally, while van der Kolk discusses the importance of relationships and social factors, some might argue the book could go further in addressing how societal trauma, systemic oppression, and social determinants of health impact individual healing. Who Should Read This Book This book is essential reading for mental health professionals, particularly those working with trauma survivors. It should be required reading in psychology, psychiatry, and social work programs. It's also invaluable for trauma survivors themselves, though it can be emotionally challenging. Reading about trauma while recovering from trauma requires care and self-compassion. Some readers might want to work through it with a therapist. Family members of trauma survivors will find the book helps them understand what their loved ones are experiencing and why healing isn't as simple as "letting go" or "moving on." Educators, medical professionals, and anyone working with vulnerable populations will gain important insights into how trauma manifests and what truly helps. Final Thoughts "The Body Keeps the Score" is more than a book about trauma; it's a manifesto for a more humane and effective approach to mental health. Van der Kolk's work has helped launch a revolution in how we understand and treat trauma, validating body-based approaches that were once considered fringe. The book's central message is one of hope: that no matter how deeply trauma has affected you, healing is possible. Our brains and nervous systems are more plastic than we once believed. With the right support and interventions, we can rewire the patterns that keep us stuck and reclaim our lives. This is challenging material, but it's presented with compassion and respect for the resilience of trauma survivors. Van der Kolk never suggests that healing is easy or quick, but he demonstrates convincingly that it's achievable. Rating: 5 out of 5 stars If you've ever wondered why traditional therapy didn't quite work for you, or why you can't seem to "get over" something that happened years ago, this book will provide answers. More importantly, it will provide a roadmap toward genuine healing. "The Body Keeps the Score" is a landmark work that deserves its place as one of the most important books on trauma ever written.