Book reviews, Trauma and PTSD

Book Review: The Body Keeps the Score

Book cover: The Body Keeps the Score by Bessel van der Kolk

The Body Keeps the Score by Bessel van der Kolk is perhaps one of the best-known books about trauma, and in particular early life trauma. It’s been on my to-be-read list for quite a while, and I’ve finally managed to get around to it.

This is a hefty book. The digital version that I was reading weighed in at 488 pages, including a lengthy reference section. It’s very in-depth, giving plenty of detail, but it’s not unnecessarily complicated. There’s some technical terminology used, particularly with respect to the functioning of the brain, but I thought this was explained well.

Van der Kolk is a psychiatrist who initially began working with trauma while treating war veterans. There was a lot that wasn’t known about trauma at that point, but he’s been an active researcher through his career, often at the forefront of new trauma-related knowledge.

In the book, he repeatedly stresses the importance of recognizing the changes that occur in the brains and nervous systems of people who’ve been through trauma, and targeting treatment accordingly to get back the functioning they lost. He writes:

Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.

He explains what imaging studies have uncovered about flashbacks. There’s activation of the right brain along with a drop in activity in the brain structure called the thalamus, which prevents the events from being remembered as a coherent narrative, as would be the case with other kinds of memories.

Brain scans have also showed impaired self-awareness, and van der Kolk explains that this is why it’s important to work on breathing, mindfulness, and recognizing the link between physical sensations and emotions. He writes:

The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.

The book pays a lot of attention to early life trauma, including issues like attachment and attunement. The author explains that trauma increases the need for attachment, even when the only attachment figure available to the child is the abuser.

Van der Kolk has long argued that complex PTSD should be a separate diagnosis from PTSD. He was part of the working group that proposed C-PTSD for inclusion in the DSM-IV, and the group that proposed developmental trauma disorder for inclusion in the DSM-5. Neither of those diagnoses were approved by the American Psychiatric Association.

There’s a section of the book devoted to several different therapeutic approaches that he’s seen patients have success with. While chapters in the earlier sections of the book tend to build on the information presented in earlier chapters, the chapters in this section are more stand-alone.

One chapter is focused on yoga, and how it can be helpful in settling down the hyperaroused nervous system and getting in touch with the body. There’s a chapter on internal family systems therapy, and the different internal parts and their roles. There are also chapters on psychomotor therapies, EMDR (eye movement desensitization and reprocessing), neurofeedback, and expressive arts, like theatre. The author expresses concerns that medications and cognitive behavioural therapy-based interventions aren’t actually as helpful as people tend to think they are.

As the book draws to an end, the author returns to the message in the title:

“The body keeps the score: If trauma is encoded in heartbreaking and gut-wrenching sensations, then our first priority is to help people move out of fight-or-flight states, reorganize their perception of danger, and manage relationships.”

He argues that the best way to help children who’ve been abused or neglected is to give them a good school environment that allows them to be seen, learn to self-regulate, and develop agency around their own lives.

This is a valuable read for anyone looking to more deeply understand trauma’s effects on mind and body. It’s by no means a quick and easy read, but it’s not unnecessarily wordy. It’s just jam-packed with information. While the subject matter isn’t exactly light, there’s a lot of hope for recovery and stories of tremendous healing.

The Body Keeps the Score is available on Amazon.

You can find my other book reviews here.

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44 thoughts on “Book Review: The Body Keeps the Score”

  1. Great review!! Would you say this book is more information-based, or does it have a lot of helpful info for treating trauma as well?

    Oh my gosh. In ninth grade, I went to Florida with my biology class, and my mom spent the week redecorating my attic bedroom. When I came home, that matisse artwork from this book’s cover was on my wall, and I was far too polite to tell my mom how much I hated it!! 😀 HA H AH AH HA

      1. HA HA H AH AH HA!! I don’t remember, but I think I kept it up for a long while!! Fortunately, the remodeling wasn’t all bad!! She got me two really nice bookshelves which are currently downstairs in my dad’s stamp room, and some nice globe bookends!! YAY!!

  2. Very interesting post. I suffered childhood trauma but have managed to live an ordinary life. The only thing is I never forget about it and often think of it. But I’m (almost) an old lady now and I figure I’ll continue to manage. I think it would be a terrific book for young and middle-aged adults to read.

  3. We read this book and found it indispensable. It frustrates us that disability insurers don’t use the brain imaging to prove that we are disabled from mental illness. Not doing the scans allowed them to end disability payments after 24 months because they don’t consider mental illness to be a permanently disabling condition apparently

  4. Finally a book I can read in my mother tongue 🙂 Sounds very interesting to me personally but the fact that it’s so lengthy scares me a bit.
    I’m making a list to order a bunch of books you recommended in one fell swoop, so thank you for you interesting reviews! Always handy to have a good reference.

      1. Oh no! For me it really makes a difference when I read in English, which takes more attention and energy and when I read in Dutch. I’ll see what is available at the bookshop.

  5. I’ve read this book. Very fascinating! As someone with complex trauma, it helped me understand how my brain works when it comes to trauma. Great review!

  6. I haven’t read the whole thing but know the bullet points. I’ve done enough work myself to understand that trauma is stored in the cells so your brain AND body have a memory of it that get triggered. I have felt the same about it’s heftyness lol….I’m easily distracted so audio books are better for me. Many years ago I could read bigger books but your comprehensive review has inspired me to dive head first into this book for the whole enchilada😊

    1. I liked that the chapters were fairly self-contained, so it’s easier to get through a chapter, put it down for a while, and then dive into the next one.

  7. Wow, super review Ashley, interesting and informative, and it’s made me want to read this book. Oops, I’ve just gone and bought it in Kindle books 🙂 Thanks for the heads up. C

  8. Fantastic review. This book was a gem to find.

    When you have lived through childhood traumas, the length of this book is welcomed. It speaks comfort through its understanding. I very thankful for his work and that he teaches those seeking to understand.

  9. The weight of this information is heavy yet it made absolute sense about many aspects of my personal experience, in turn making my load a little lighter. If that makes any sense. Dealing with PTSD is in and of itself, difficult to accept. Something I recognized awhile back is the resistance I have to believing myself a victim. This book not only helped to clarify why I “freeze” but it validated my inability to function as real. My diagnosis’ span the gamet, making me disbelieve any of us know what’s going on but when I read this book, I was able to discover what I feel is most true of my experience with mental illness, it’s symptoms, triggers, and overall state of mental stability.

  10. I had a traumatic birth, suffocated, proceeded into a near-death episode, returned to terrestrial world. Still here 76 years later.
    Did much healing in Dr. Janov’s Primal Therapy, starting in ’74.

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