The Body Keeps the Score explores trauma’s physical and psychological scars. Bessel van der Kolk reveals how trauma rewires the brain and body, causing lasting distress. Healing requires therapies like EMDR, yoga, and neurofeedback to restore safety and control. A groundbreaking guide to reclaiming life after trauma.
1. Introduction to The Body Keeps the Score
“The Body Keeps the Score” by psychiatrist Bessel van der Kolk is a landmark exploration into the pervasive effects of trauma on the human body, mind, and society. Drawing on decades of clinical research, neuroscience, and patient stories, the book articulates both the wounds caused by trauma and the paths possible for healing. Trauma, van der Kolk argues, is not simply an event that happened in the past—it is the living legacy in the nervous system, psyche, relationships, and very physiology of individuals and communities who have experienced adversity, whether through violence, abuse, neglect, disaster, or war.
Through five major sections and a series of case studies, van der Kolk explores the history and rediscovery of trauma, its profound effects on body and brain, the especially vulnerable position of children, the imprint left by trauma, and the innovative, evidence-based treatments emerging for recovery. At once personal, scientific, and deeply humane, the book has become foundational for a new era of trauma-informed care, mental health practice, and social policy.
2. Author Biography and Perspective
Bessel van der Kolk is a Dutch-born psychiatrist and researcher, internationally recognized for his pioneering role in trauma studies. Educated at Harvard Medical School and professor at Boston University School of Medicine, van der Kolk’s clinical work began during the Vietnam War era with trauma-impacted veterans, leading to a career-long focus on trauma’s effects on mind, brain function, and body states. He is the founder of the Trauma Center in Brookline, Massachusetts and has served as president of the International Society for Traumatic Stress Studies.
Van der Kolk’s unique position, at the crossroads of clinical medicine, psychiatry, psychobiology, and community activism, informs his holistic view of trauma. He has been instrumental in the identification and naming of Post-Traumatic Stress Disorder (PTSD), led vital research into developmental and complex trauma, and has championed new treatments and policy reforms worldwide. His personal, empathic style—one that foregrounds patient voice and lived experience—shapes both the book’s tone and its practical orientation.
3. Book Structure and Organization
“The Body Keeps the Score” is comprised of five parts, with each exploring different dimensions of trauma:
1. The Rediscovery of Trauma
2. This Is Your Brain on Trauma
3. The Minds of Children
4. The Imprint of Trauma
5. Paths to Recovery
Each part draws on history, clinical case studies, and advances in neuroscience. The book also includes an introduction, prologue, and epilogue, together with resources for survivors and clinicians.
The narrative approach combines empirically grounded science, theory, storytelling, and intervention strategies, with a humanistic and at times urgent advocacy for better systems of care.
PART ONE: The Rediscovery of Trauma
Facing Trauma
Van der Kolk begins by establishing the ubiquity of trauma in contemporary life. Drawing on epidemiological data from the Centers for Disease Control and Prevention, he shows that traumatic exposure—ranging from sexual abuse, physical assault, witnessing violence, childhood neglect, to military combat—is not an exception but a common part of human experience. He laments the historical tendency to ignore, suppress, or downplay trauma, both in medicine and broader society.
He discusses the history of psychiatry’s uneasy relationship with traumatic stress—from the initial identification of “hysteria” and “shell shock” to the formalization of PTSD, in which van der Kolk himself played a role. The book notes that the wounds of trauma are often invisible, misdiagnosed, or obscured by shame and cultural silence.
Early Studies: Vietnam Veterans
Van der Kolk describes his formative clinical work in the 1970s with Vietnam War veterans, observing the intrusive memories, flashbacks, hypervigilance, numbness, and relationship struggles these men endured. He realized that the “return home” did not erase traumatic stress; instead, it fundamentally changed their brains, bodies, and lives.
The lack of effective treatment prompted an early turn to psychopharmacology (antidepressants, sedatives), which, van der Kolk notes, proved inadequate for most trauma survivors. He underlines the key insight: trauma is not just a psychological wound but a disruption of the body’s homeostasis, memory, and the core sense of self.
Scientific Revolution and Rediscovery
The book charts the revolution in brain science, developmental psychology, and attachment research that, by the 1990s, transformed the understanding of how trauma reshapes the brain, nervous system, and capacity for self-regulation. Drawing on the foundational studies of Pierre Janet, Sigmund Freud, and modern neuroscientists, van der Kolk weaves together a history of trauma studies, centering the stories of those who “kept the score” within their own bodies.
PART TWO: This is Your Brain on Trauma
Neurobiology of Trauma
Van der Kolk uses vivid clinical vignettes, brain imaging, and neuropsychological studies to illustrate how trauma alters fundamental brain structures: the amygdala (fear center), the hippocampus (memory processor), and the prefrontal cortex (rational regulator). Trauma can recalibrate the “alarm system,” increase stress hormone secretion, and even change the brain’s wiring, affecting how events are encoded, recalled, and responded to.
Key symptoms result: hyperarousal (anxiety, jumpiness), dissociation (feeling unreal, detached), and emotional dysregulation (swings from numbness to panic or rage). Traumatized individuals may respond to mild stressors with overwhelming panic or anger, or go “numb” to avoid the pain.
The Body’s Message
Van der Kolk goes beyond the brain to show how the entire body “remembers” trauma. Chronic muscle tension, somatic complaints, and immune system disruption are common. Many trauma survivors present to primary care with complaints ranging from headaches and stomach issues to autoimmune disorders, reflecting the body’s attempt to “keep the score.”
He writes that the split between medical medicine (focused on the body) and psychiatry (focused on the mind) undermines comprehensive care for trauma survivors, who typically experience their pain as both physical and psychological.
Memory, Dissociation, and Psychological Consequences
The book discusses the “problem of traumatic memory.” Such memories may be recalled as vivid, intrusive images or felt as nameless dread, without coherent narrative. This fragmentary encoding is due to trauma’s effect on the hippocampus—the mind’s filing system—and the brain’s inability to process simultaneously heightened arousal and contextual memory.
Survivors may dissociate, feeling as if the trauma is still happening or as if they are watching it from afar. This has survival value (temporary escape from pain), but if it persists, it can undermine the integration of self and reality, leading to complex dissociative disorders and chronic symptoms.
PART THREE: The Minds of Children
Developmental Trauma
Van der Kolk provides an extended discussion of “developmental trauma,” tracing how childhood neglect, abuse, household chaos, or lack of safe attachment relationships can irreparably shape the brain’s architecture and emotional regulation systems. While some children are exposed to shocking, acute violence (“big T” trauma), van der Kolk details how chronic, ongoing adversity (“small t” trauma) can be just as damaging, especially when adults or caregivers are the source of the danger.
Early attachment relationships are foundational for a child’s capacity to regulate emotions, trust, explore, and learn. Trauma disrupts these processes, leading to problems with emotional regulation, trust, impulse control, learning, and social connection. Van der Kolk argues for recognition of “Developmental Trauma Disorder” in diagnostic systems, to differentiate the long-term impacts of early adversity from adult-onset PTSD.
Case Studies: Attachment and Attunement
Vignettes of traumatized children—often in foster care or adopted from orphanages—demonstrate how early experiences of neglect or violence lead to disorganized attachment, emotional withdrawal, or extreme behaviors (aggression, self-injury). Van der Kolk explains how the child’s system adapts to survive in a world perceived as dangerous, with far-reaching implications for later mental health.
He draws on the research of John Bowlby and Mary Ainsworth, showing that secure attachment is a buffer against later trauma, while insecure or disorganized attachment increases risk for depression, anxiety, and even physical illness in adulthood.
The Hidden Epidemic
This section explores the prevalence of trauma in childhood; data shows one in five children experience sexual abuse, one in four is physically abused, and a significant number are exposed to household addiction, violence, or mental illness. Van der Kolk stresses that unaddressed, childhood adversity becomes a major risk factor for lifelong emotional, relational, and physical health problems.
PART FOUR: The Imprint of Trauma
Traumatic Memory
Van der Kolk carefully illuminates the particular nature of traumatic memory. Unlike ordinary memory, which is organized, contextual, and integrated into the life story, traumatic memory is often frozen in time and place, experienced as haunting feelings, somatic symptoms, flashbacks, or nightmares. Survivors may “relive” their terror emotionally and physiologically, even without conscious recall of the specific event.
He describes the work of neuroscientist Joseph LeDoux and imaging studies showing how the left prefrontal cortex (language, rationality) can be deactivated by trauma reminders, leaving the right brain (emotion, visual memory) in charge. This “speechless terror” explains why many survivors cannot easily “talk out” their symptoms and why cognitive or verbal therapies sometimes fall short.
The Unbearable Heaviness of Remembering
Survivors often go to great lengths to avoid reminders—leading to phobias, compulsions, addiction, or withdrawal. The price of avoidance is high, however, as emotional numbing, depression, and interpersonal disconnection become entrenched.
Van der Kolk discusses how traumatic stress “reprograms” the stress response system, altering patterns of sleep, appetite, cardiovascular and immune function. He describes the Adverse Childhood Experiences (ACE) Study, which links early trauma to high rates of chronic illness, mental health problems, and premature mortality.
PART FIVE: Paths to Recovery
Healing from Trauma: Therapy and Beyond
The final section is devoted to treatment—what van der Kolk calls “paths to recovery.” He argues that while medications can reduce some symptoms, the real work of healing requires helping survivors to feel safe in their bodies, reconnect with emotions, and reclaim agency and connection. Recovery is not re-experiencing trauma but restoring a sense of ownership over one’s mind, body, and life.
Key therapeutic principles include establishing bodily safety, building mindfulness of inner states, fostering supportive relationships, and helping survivors distinguish between past and present.
Talk Therapies
Traditional psychodynamic and cognitive therapies have a place, especially for developing insight, making meaning, and repairing relationships. However, van der Kolk insists that talking alone is seldom sufficient. Many survivors, particularly those with complex trauma, struggle to access or verbalize feelings, requiring additional forms of intervention.
EMDR (Eye Movement Desensitization and Reprocessing)
Van der Kolk details the origins and clinical application of EMDR—a now widely-accepted evidence-based therapy for PTSD involving guided lateral eye movements during the recall of traumatic images. EMDR appears to facilitate the integration and “metabolizing” of traumatic memories, reducing their emotional charge, and enabling more adaptive beliefs.
Body-Based Approaches
The core innovation of van der Kolk’s work is acknowledging the body as central in trauma healing. Methods such as yoga, somatic experiencing, and sensorimotor psychotherapy allow survivors to become aware of and safely inhabit their bodies. Practices focus on grounding, breath, movement, and mindful observation of internal sensations. These approaches reduce hyperarousal, restore bodily regulation, and enable emotional integration.
Neurofeedback and Brain-Based Approaches
Van der Kolk describes research into neurofeedback, in which individuals learn to change patterns of brain activity using real-time monitoring. Preliminary studies suggest neurofeedback can reduce symptoms of PTSD, anxiety, and hyperarousal and help recalibrate dysfunctional neural circuits shaped by trauma.
Creativity, Rhythm, and Community
Innovative therapies involving art, music, theater, dance, and rhythm (such as drumming) offer avenues for non-verbal expression and re-integration of body–mind. Group work and communal rituals help survivors reestablish trust, cooperation, and belonging. Van der Kolk highlights the power of theater (including Shakespearean performance) in helping survivors reconstruct narrative, connect with emotion, and practice new identities.
Self-Leadership and Empowerment
A recurring theme is empowerment—helping survivors move from helplessness or victimization to active self-leadership. This includes learning mindfulness, practicing self-compassion, setting boundaries, and choosing new ways of responding to old triggers. Healing is not just symptom reduction but reclaiming the capacity for pleasure, agency, and interpersonal connection.
Healing Systems and Society
Van der Kolk is sharply critical of systems—such as the US foster care, criminal justice, and medical systems—that often retraumatize individuals by prioritizing control, medication, or punishment over compassion and holistic care. He urges reforms in education, family policy, and mental health provision. Trauma, he argues, is a social as well as an individual concern, and “trauma-informed care” must be a societal priority.
Epilogue: Choices to be Made
The book ends with a call to action: van der Kolk insists that truly addressing trauma requires recognition, validation, and innovative action at every level—individual, family, clinical, and cultural. Healing from trauma is not quick or easy, but is fundamentally possible. Survivors can and do recover; entire communities can rebuild.
A trauma-informed society, van der Kolk notes, is one that reverses the historical patterns of denial, blame, and fragmentation, choosing instead connection, compassion, and science-based treatment.
4. Key Themes and Takeaways
Trauma is Universal
Trauma is not rare or confined to extremes; it is a part of the modern human experience, impacting millions across all lines of age, class, gender, and background.
The Mind-Body Connection
The brain, mind, and body are inseparable in the experience and aftermath of trauma. Healing must therefore address biological, emotional, and relational dimensions—not just cognitive symptoms.
The Limits of Medication and Talk Therapy
While psychiatric medications and traditional talk therapies may offer relief, they are seldom curative for trauma alone. Healing requires approaches that involve the body, foster self-regulation, and tackle the physiological legacy of trauma.
Neuroplasticity and Hope
The brain’s capacity to change—neuroplasticity—means that trauma need not be a life sentence. With appropriate support, survivors can rewire their responses and regain a sense of safety, agency, and belonging.
The Importance of Relationships
Safe, supportive relationships are at the core of recovery. Whether through therapy, family, or community, connection enables healing from the isolation and fragmentation that trauma breeds.
Trauma-Informed Systems
Societal responses to trauma must move from blame and punishment to care and empowerment. This requires broad policy shifts in education, justice, and health care systems. Prevention and early intervention, especially for children, are essential.
5. Reception and Impact
Since publication in 2014, “The Body Keeps the Score” has become a global bestseller, translated into dozens of languages and cited in fields as diverse as public health, education, law, social work, and neuroscience. Clinicians adopt its principles for trauma-informed therapy; educators use its insights to create calmer, safer classrooms; survivors cite the book as a turning point in understanding their experiences.
The book is regularly listed among the most influential texts on trauma psychology and therapy, and has revolutionized how professionals and the general public understand trauma.
6. Critiques and Controversies
Some critics have challenged van der Kolk’s emphasis on certain non-traditional treatments (such as EMDR or yoga) as lacking sufficient large-scale, randomized studies, though these methods now have growing evidentiary support. Others worry that the popularity of “trauma narratives” might lead to pathologizing normal responses to adversity. However, most responses celebrate the humanity, breadth, and transformative message of the work.
7. Conclusion
“The Body Keeps the Score” stands as the definitive modern account of trauma’s impact on brain, mind, and body. It is an essential guide for therapists, survivors, researchers, and anyone seeking to understand why the past remains so present in our lives, and how healing is possible. By integrating science, story, and practical innovation, Bessel van der Kolk offers not only an explanation of trauma, but, more crucially, a path toward hope.
