the body keeps score book review

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

Bessel van der kolk.

464 pages, Hardcover

First published June 12, 2014

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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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Self-Helped

How to Rewire Your Traumatized Brain

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By Concepción de León

• Oct. 18, 2018

I hear some people have trouble with therapy, that it can take years for them to open up to their doctors, let alone cry or break down. Not me. Day one, I told my therapist, Amy Bernstein, “I’ll just tell you everything , and we’ll go from there.”

I was assigned to her after revealing, during an initial interview to determine the appropriate therapist for my needs, that I’d been touched as a child. I hadn’t planned to bring it up at all, but I was asked directly, so I said, yes, you could say that. (At the time, I avoided the word “molested.”) And yes, it still crossed my mind.

To be honest, what happened had always felt like such a small thing. Many others have had it much worse; I counted myself lucky for only having been touched in subtle ways — a male relative digging his hands in my tiny skirt pockets to “feel around for change”; another bringing his hand to my crotch when he thought I was asleep. These were two of a handful of men who violated me.

Amy recommended books to help me understand what had happened, but I put them down after just a few pages, thinking, “This isn’t for me! My thing is too small.”

But then, as tends to be the case with therapy, things got harder before they got better. I returned to one of the books Amy had recommended, “The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma,” by Bessel van der Kolk, to try to understand my visceral response to remembering.

Dr. van der Kolk is a Boston-based psychiatrist who specializes in post-traumatic stress disorder and has worked with a broad range of clients, from veterans to sexual assault survivors. “The Body Keeps the Score” hinges on his idea that trauma is stored in the body and that, for therapy to be effective, it needs to take the physiological changes that occur into account.

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