“This is arguably the most famous book on trauma published in the last 50 years because it presents a cohesive connection of the mind and body following trauma. Not only that, Van Der Kolk points to potential opportunities for healing beyond traditional medication or talk therapy.”

The Body Keeps the Score fits into a conversation dating back to Freud on what happens to a person following a traumatic event. Instead of focusing primarily on the brain, Van Der Kolk expands the conversation to include the role of the entire nervous system, as well what we now know about human development and social context, to understand trauma’s impact on the whole person. He strikes a careful balance between anchoring his theory in fairly complex neuropsychological research without getting bogged down and losing the reader. He does this by including rich clinical examples from his career working with trauma survivors and even his own experience of trauma, being himself a victim of violence. The gist of his argument is captured in the title: the legacy of trauma is often borne in the bodies of survivors, often without their conscious awareness. In line with this argument, he proposes that in addition to psychotherapy, healing arts should incorporate other whole person interventions.

The Body Keeps Score should also be appreciated in its historical context. Published in 2014, it came out at a time when the Diagnostic Manual for Psychiatry was undergoing a major revision, and Van Der Kolk was leading a team of clinicians and researchers arguing for the introduction of a new diagnosis: Developmental Trauma Disorder. Although this diagnosis was not included in the DSM-V, their work on this diagnosis expanded the minds of a generation of clinicians to appreciate the lasting impacts of childhood trauma on adult psychological struggles. Through this book, Van Der Kolk presents an outline for how developmental processes get hijacked by trauma, creating early coping patterns that are difficult to outgrow even when they are no longer necessary.

The Body Keeps Score has been the target of much criticism, from being read as victim blaming at times and being over-inclusive in the definition of trauma to being pseudo-scientific in his methods or promoting treatments that are not proven to be effective and not highlighting those treatments that have a solid evidence base. On this last point, I agree - I wanted to see more inclusion for or defense of what has been effective in treatment. For example, Cognitive Processing Therapy and Prolonged Exposure have a strong body of evidence supporting their use in treating trauma, and I wanted to see such treatments incorporated into his review of the current treatment landscape. However, as a clinician, I found that his expansion of the concept of trauma creates a better context for why treatments like this can be effective. For example, I am better able to appreciate the history and background beliefs clients enter treatment with and am more attentive to the moment-to-moment physical state of my clients in our work.

This book should not be read as an authoritative guide to treating trauma, nor as a comprehensive explanation of the many sources of trauma that impact the individual. It also isn’t a definitive explanation for how the nervous system responds to trauma, though it offers very compelling theories on this front. What the book is, is a step towards a cohesive, integrated understanding of the human mind in relation to the body, how humans adapt in response to profound distress, how these adaptations can be costly in the long run, and ideas for better adaptations once the coast is clear.

Here’s an overview of the book’s five sections:

Part one - The rediscovery of trauma. A historical overview of how thinking of trauma has evolved.

Part two - This is your brain on trauma. The physiology of trauma as we now see it (circa 2014).

Part three - The minds of children: attachment and attunement, impact of abuse and neglect, role of love in healing and growth in children and the developing brain

Part four - The imprint of trauma

Part five - Paths to recovery: innovative treatments that engage the body in healing from trauma

Three quotes I found powerful:

“Trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present.”
- p. 21

“We now know that there is another possible response to threat, which our scans aren’t yet capable of measuring. Some people simply go into denial: Their bodies register the threat, but their conscious minds go on as if nothing has happened. However, even though the mind may learn to ignore the messages from the emotional brain, the alarm signals don’t stop. The emotional brain keeps working, and stress hormones keep sending signals to the muscles to tense for action or immobilize and collapse. The physical effects on the organs go on unabated until they demand notice when they are expressed as illness. Medications, drugs, and alcohol can also temporarily dull or obliterate unbearable sensations and feelings. But the body continues to keep the score.” - p. 46

“Trauma robs you of the feeling that you are in charge of yourself, of what I will call self-leadership in the chapters to come. The challenge of recovery is to reestablish ownership of your body and your mind - of your self. This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed. For most people this involves (1) finding a way to become calm and focused, (2) learning to maintain that calm in response to images, thoughts, and sounds, or physical sensations that remind you of the past, (3) finding a way to be fully alive in the present and engaged with the people around you, (4) not having to keep secrets from yourself, including secrets about the ways you have managed to survive.” - p. 206

Book - The Body Keeps the Score by Bessel van der Kolk

Book - I Don’t Want to Talk About It by Terrence Real