The Body Keeps the Score by Bessel van der Kolk — review and summary

Bessel van der Kolk is a psychiatrist who has worked with trauma patients for over forty years, beginning with Vietnam veterans and extending to survivors of childhood abuse, domestic violence, and other forms of severe stress. The Body Keeps the Score is his synthesis of what decades of clinical experience and neuroscience research has taught him about what trauma is and how its effects can be addressed.

The book has become one of the most widely read accounts of trauma in the popular literature. This review covers the central arguments and what makes them significant, without attempting to provide clinical advice.

The central claim

Van der Kolk's most important argument is about where trauma lives. The conventional understanding of trauma, as he describes it, focuses on the narrative: the memories, the story of what happened, the meaning attached to the event.

His argument is that trauma is also — and perhaps primarily — stored in the body: in the patterns of physiological arousal, muscular tension, breathing, and autonomic nervous system activity that were established in response to overwhelming experience and have not been discharged. The body continues to respond as if the threat is present, long after the threat has passed.

This has significant implications for treatment. If trauma is primarily a narrative, the primary treatment tool is narrative: talking about it, processing it, making meaning of it. If trauma is stored in the body, treatment needs to address the body as well as the mind.

The neuroscience

The middle sections of the book cover the neuroscience of trauma in accessible terms: the role of the amygdala and the threat detection system, the way trauma disrupts the relationship between the thinking brain and the survival brain, the research on how the body's stress response is altered by severe or chronic stress.

Van der Kolk is good at making this material useful rather than merely interesting. The neurological account explains why certain talk-based treatments have limited effects for severe trauma, why certain physical and movement-based approaches can be effective when talking is not, and why trauma survivors often behave in ways that seem irrational from outside but make complete sense as adaptations to an ongoing threat state.

The treatment approaches

The later sections of the book cover a range of treatment approaches that van der Kolk has found useful in clinical practice: EMDR, yoga, theatre, neurofeedback, and others. These are presented as possibilities rather than prescriptions.

An important note

This book is not a self-treatment guide. It is an account of clinical research and practice. Readers who recognise their own experience in what van der Kolk describes are encouraged to seek qualified professional support rather than attempting to address severe trauma without it.

The anxiety mouse page provides a simpler framework for understanding the nervous system's threat response, which is a useful companion to the more clinical account here.

Practical reflection prompts:

• What does the distinction between trauma as a memory and trauma as a body state mean for how you understand your own reactions to certain situations?
• How does the recognition that some reactions are physiological adaptations, not character flaws, change how you relate to those reactions in yourself or others?

Bibliographic details

• Author: Bessel van der Kolk
• Published: 2014
• Publisher: Viking