The Body Keeps the Score

by Bessel van der Kolk

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The Body Keeps the Score Summary

The Body Keeps the Score is a 2014 nonfiction book about trauma by psychiatrist Bessel van der Kolk.

  • Using research and case studies from his own practice, van der Kolk argues that dissociation between body and mind is the defining feature of trauma.
  • The author describes the complicated nature of psychiatric diagnosis, the history of how trauma has been treated, and the limitations of traditional therapeutic methods.
  • Van der Kolk recommends therapies that incorporate physical movement, including yoga, EMDR, and theater, and stresses that trauma has become a serious public health issue in the United States.

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Last Updated November 3, 2023.

In The Body Keeps the Score, Bessel van der Kolk uses his own experience and research as a psychiatrist to describe and evaluate the effectiveness of some of the principal developments in the treatment of trauma patients over the course of his career. He begins by discussing such innovations as the widespread prescription of drugs to treat mental illness and the use of brain-imaging techniques by neuroscientists to understand the effects of trauma on the brain. Van der Kolk admits the importance of such innovations, which have assisted him in his work, but cautions against relying on them too heavily.

In chapter 4, van der Kolk begins to develop his central thesis that “dissociation is the essence of trauma,” particularly dissociation between the body and the brain. He uses case studies in each chapter to illustrate how trauma severs the usual connections between brain and body, which allow most people to retain a clear distinction between past and present.

He describes how trauma victims physically relive the past, as the emotional responses which would allow them to feel love and trust, or to be creative, shut down in repeated attempts to survive a threat that no longer exists in the present. This dissociation often begins in early childhood, when abused and neglected children are prevented from forming bonds with their primary caregivers. These early experiences of dissociation lay the foundations for dysfunctional relationships in the future, exacerbating the trauma and preventing victims from forming support networks.

In Chapter 9, the author stresses the complexity of psychiatric diagnosis and hence the vagueness with which patients are labeled. A diagnosis of depression will have important consequences for the patient but will never be as certain or meaningful as a diagnosis of pancreatic cancer, for instance. This complexity arises in part because everyone’s minds and formative experiences are different, but also because childhood trauma, in particular often has a myriad of causes, since dysfunctional families seldom suffer only from a single problem. The author describes child abuse and childhood trauma as a “hidden epidemic” in America. This hidden epidemic causes misery to the victims of trauma but also inflicts social and economic damage on the country as a whole, particularly in the size of the United States prison population.

Chapters 11 and 12 have a historical focus, with the former covering the development of psychology in the late nineteenth century and the introduction of the Freudian “talking cure,” which is still used today. Chapter 12 looks at the symptoms of trauma exhibited by soldiers returning from the First and Second World Wars and examines how they were treated.

Although war seems like an exceptional experience, far removed from the lives of non-combatants, the author shows that the symptoms of trauma in soldiers are similar to those experienced by civilians. He uses the words of a patient who was traumatized by remaining awake during an operation to illustrate this point while also showing the importance of learning directly from what patients say about their own experiences.

The final and longest section of the book, including chapters 13–20, addresses the ways in which patients can recover from trauma. The author points out that many psychiatrists are focused on the traditional talking cure, first developed by Freud in 1893, and on Cognitive Behavioral Therapy (CBT), which arose in the 1960s.

He does not dismiss either method but points out the limitations of both as “top-down” solutions, which rely too heavily on the therapist and deprive the patient of agency. He also notes that while it is vital for trauma victims to express what they have...

(This entire section contains 757 words.)

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suffered and put it into context, it is impossible for them to accomplish this using language alone. The author discusses physical therapies, including eye movement desensitization and reprogramming (EMDR) and yoga, as an alternative to more traditional methods.

Different therapies work for different patients, but more important than the technique is the patient’s ownership of and investment in it. Van der Kolk favors the use of theater in therapy, both as a means of allowing patients to rescript and direct their own lives and as a way of participating in a healthy group dynamic with a shared purpose and a positive role for patients, who claim a sense of agency and creativity as part of the process. The sign that any therapy works is an increase in the patient’s physical well-being, which it is impossible to simulate. The author ends with an epilogue in which he calls for more general recognition of and response to trauma as an urgent public health issue.


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