The Body Keeps the Score

The Body Keeps the Score Plot Summary

Introduction

Sarah was only eight years old when she witnessed her father's murder. One evening, as she was preparing for bed, she heard shouting downstairs. Peering through the banister, she saw two men arguing with her father. Suddenly, one of them pulled out a gun and fired. Sarah froze, unable to scream or run. For years afterward, she suffered from nightmares, startled at the slightest noise, and struggled to concentrate in school. Even as an adult, certain triggers—like the sound of fireworks or angry male voices—would send her heart racing and mind reeling, as if she were reliving that terrible night all over again. This pattern is what trauma expert Dr. Bessel van der Kolk has observed throughout his decades of work with survivors. Trauma isn't just a terrible event that happened in the past—it lives on in the body, reshaping how we respond to the world around us. Through groundbreaking research and compassionate clinical work, we now understand that healing from trauma requires addressing not just the mind but the brain and body as well. This integrated approach offers hope to millions who have suffered adverse experiences, showing that with the right support, the human capacity for resilience can transform even the deepest wounds into pathways for growth and renewal.

Chapter 1: The Invisible Wound: How Trauma Reshapes the Brain

In the quiet of his office, Dr. Bessel van der Kolk sat across from Tom, a Vietnam veteran whose life had been frozen in time since 1969. Despite having graduated from law school and built a successful career, Tom felt dead inside. During their session, Tom revealed that he couldn't stop himself from taking the nightmares medication van der Kolk had prescribed. "I realized that if I take the pills and the nightmares go away," Tom explained, "I will have abandoned my friends, and their deaths will have been in vain. I need to be a living memorial to my friends who died in Vietnam." Working at the VA clinic, van der Kolk encountered many veterans who, like Tom, responded to minor frustrations with extreme rage. The clinic walls were pockmarked with the impacts of their fists, and security was constantly busy protecting staff from enraged veterans. These men couldn't control their emotions or impulses the way most adults can. Their trauma had transformed everything about them. The breakthrough in understanding came when van der Kolk discovered the work of Abram Kardiner, who had published "The Traumatic Neuroses of War" in 1941. Kardiner reported the same phenomena van der Kolk was seeing: after war, his patients were overtaken by a sense of futility; they became withdrawn and detached, even if they had functioned well before. Most importantly, Kardiner noted that "the nucleus of the neurosis is a physioneurosis." In other words, posttraumatic stress isn't "all in one's head" but has a physiological basis in the entire body's response to trauma. In 1994, Dr. van der Kolk and his colleague Scott Rauch conducted a groundbreaking study using brain imaging technology to understand what happens during flashbacks. When trauma survivors were triggered in the scanner, their brain scans revealed something remarkable: the speech center of the brain (Broca's area) shut down, while the right side of the brain—responsible for emotional and sensory experience—lit up intensely. The brain's timekeeper, which helps us recognize that events are in the past, also went offline. Another striking finding was that the thalamus, which acts like a "cook" blending sensory information into a coherent experience, showed decreased activity. This explained why traumatic memories are stored not as coherent narratives but as fragmented sensory impressions—images, sounds, and physical sensations. When trauma survivors are triggered, these fragments return as if the event is happening in the present. These discoveries revolutionized our understanding of trauma treatment. When people are triggered by traumatic memories, the rational part of their brain goes offline. They literally cannot put their experiences into words because the speech center isn't functioning properly. Their bodies react as if they're in danger right now, even though the event happened years ago. Healing requires not just talking about what happened, but helping people change the way their brains and bodies respond to reminders of the trauma.

Chapter 2: Frozen in Time: When the Past Won't Stay Past

Marilyn, a tall, athletic-looking operating room nurse in her mid-thirties, came to see Dr. van der Kolk after a disturbing incident with her boyfriend Michael. They had been playing tennis regularly, and after months of gradually becoming comfortable with him, she had invited him to stay over at her apartment. That night, when Michael turned over in his sleep and his body touched hers, Marilyn exploded—pounding him with her fists, scratching and biting, screaming, "You bastard, you bastard!" Terrified, Michael fled, and Marilyn was left sitting on her bed for hours, stunned by what had happened. During therapy, Marilyn initially said she "must have had" a happy childhood, but could remember very little before age twelve. When asked to draw a family portrait, her drawing revealed what her conscious mind could not: a wild, terrified child trapped in a cage, threatened by nightmarish figures and a huge erect penis protruding into her space. Yet she maintained no conscious memory of abuse. As therapy progressed, Marilyn began experiencing flashbacks and body sensations related to her trauma. She remembered her father raping her when she was eight years old. She recalled turning to her mother for protection, but when she ran to her and tried to hide by burying her face in her mother's skirt, she was met with only a limp embrace. Her mother sometimes remained silent; at other times she cried or angrily scolded Marilyn for "making Daddy so angry." Marilyn discovered that as an adult, she would "float up to the ceiling" during sexual encounters—a dissociative response she had developed as a child to escape unbearable experiences. Her body remembered what her mind had split off from awareness. This disconnection protected her from overwhelming emotions in the short term, but exacted a heavy toll on her identity, relationships, and capacity to engage fully with life. For many trauma survivors like Marilyn, time stops at the moment of trauma. The past continues to intrude into the present through flashbacks, nightmares, or inexplicable physical reactions. Rather than being integrated into a coherent narrative, traumatic experiences remain encoded as fragmented sensory impressions—images, physical sensations, and intense emotions without context. This fragmentation happens because extreme stress hormones impair the functioning of the hippocampus, which normally helps organize experiences into coherent memories. The burden of traumatic memory extends beyond the individual to affect relationships and even society. When memories are too painful to acknowledge, people develop complex psychological defenses to keep them at bay. Recovery begins when these fragmented experiences can be safely brought into awareness and integrated into one's life story, allowing the past to finally become past rather than an ever-present reality that continues to hijack mind and body.

Chapter 3: The Child's Burden: Early Trauma and Attachment

Seven-year-old Anthony was referred to the Trauma Center because his childcare center couldn't manage his constant biting, pushing, refusal to nap, and intractable crying and head banging. During the initial meeting, he anxiously clung to his mother, hiding his face, while she kept saying, "Don't be such a baby." When a door banged somewhere down the corridor, Anthony startled and burrowed deeper into his mom's lap. When she pushed him away, he sat in a corner and started to bang his head. "He just does that to bug me," his mother remarked. Anthony's mother revealed her own history of abandonment and abuse. She'd been raised by a series of relatives who hit her and sexually abused her starting at age thirteen. She became pregnant by a boyfriend who left when she told him about the pregnancy. Anthony was just like his father, she said—a good-for-nothing. While she admitted to having violent arguments with subsequent boyfriends, she was sure Anthony hadn't noticed because they happened late at night. The story of Anthony illustrates how trauma is transmitted across generations. His mother, unable to process her own traumatic past, couldn't provide the attunement and safety Anthony needed to develop healthy emotional regulation. Instead of comforting him when he was distressed, she rejected him, reinforcing his sense that the world was dangerous and that he was alone in facing that danger. Research by attachment specialists like John Bowlby and Mary Ainsworth has shown that secure attachment—the feeling of safety with caregivers—is the foundation for healthy development. When babies feel secure, they learn to regulate their emotions, explore their environment, and develop trust in others. But when caregivers are frightening or unavailable, children develop insecure attachment patterns that can last a lifetime. Mary Main's research identified a particularly troubling pattern called "disorganized attachment," which occurs when a child's caregiver is simultaneously a source of fear and the only person they can turn to for comfort. These children cannot develop a coherent strategy for getting their needs met. They may freeze, dissociate, or display contradictory behaviors like approaching and then suddenly avoiding their caregiver. This pattern is common in children who have been abused or whose parents have unresolved trauma of their own. The long-term impact of early attachment disruptions is profound. Children with disorganized attachment often grow up to have problems with emotional regulation, relationships, and even basic bodily functions like sleep and digestion. Their nervous systems remain on high alert, prepared for danger that could come at any moment. Without the foundation of feeling safe in relationship with others, they struggle to develop a coherent sense of self and to trust that the world can be a benevolent place. Breaking this cycle requires not just helping the child, but often supporting parents in healing their own wounds so they can provide the safety and attunement their children desperately need.

Chapter 4: Finding Safety: The First Step Toward Healing

Tom, a combat veteran who served three tours in Afghanistan, returned home physically intact but emotionally shattered. During his service, his unit was ambushed, and he witnessed the deaths of two close friends. Back home, he couldn't sleep without nightmares, jumped at the slightest noise, and felt constantly on edge. His marriage was falling apart because he couldn't tolerate physical closeness or crowded places. Even attending his son's baseball games became impossible due to the unpredictable noises and crowds. "I know I'm home," Tom explained during therapy, "but my body doesn't believe it's safe." Safety is the foundation of trauma recovery, yet it's precisely what trauma destroys. The essence of trauma is feeling utterly helpless in the face of overwhelming threat. This experience fundamentally alters how survivors perceive themselves and the world around them. Their bodies remain stuck in survival mode—fight, flight, or freeze—long after the danger has passed. For Tom, like many trauma survivors, the first challenge wasn't processing what happened in Afghanistan but establishing safety in the present moment. Recovery begins with understanding that trauma symptoms are normal responses to abnormal events. Tom's hypervigilance, emotional numbing, and avoidance weren't signs of weakness but adaptive survival mechanisms that had become maladaptive in civilian life. His brain and body were doing exactly what they were designed to do in the face of life-threatening danger: prioritize survival over all else. The problem wasn't the response itself but the fact that it continued when the threat was gone. Finding safety after trauma requires reconnecting with the body. Many survivors become disconnected from physical sensations because their bodies have become sources of pain, panic, and shame. Simple practices like focused breathing, progressive muscle relaxation, and mindful movement can help trauma survivors gradually reestablish a sense of control over their physiological responses. For Tom, learning to recognize and manage his body's alarm signals was a crucial first step toward recovery. Safety also has a relational dimension. Trauma, especially interpersonal trauma, damages the capacity for trust and connection. Survivors often oscillate between isolation and desperate attachment, finding it difficult to maintain healthy boundaries. Healing requires safe relationships—with therapists, support groups, or compassionate friends and family—where survivors can gradually relearn that not all relationships lead to harm. For Tom, a veterans' support group provided this crucial sense of being understood without judgment. The journey from trauma to safety isn't linear. Recovery involves gradually expanding one's "window of tolerance"—the zone where arousal is neither too high (hyperarousal) nor too low (hypoarousal). Within this window, survivors can engage with difficult emotions and memories without becoming overwhelmed or shut down. As this window expands, the world becomes less threatening and more manageable, creating the foundation upon which deeper healing can build.

Chapter 5: Beyond Words: Somatic Approaches to Trauma Recovery

David, a successful attorney, sought therapy for panic attacks that had begun after a minor car accident. Though physically uninjured, he found himself increasingly unable to drive or ride in cars. Traditional talk therapy helped him understand the connection to an earlier, more serious accident in his teens, but this intellectual insight didn't stop his body's reactions. During a panic attack, he described feeling disconnected from his body: "My heart races, I can't breathe, and I feel like I'm watching myself from outside." His breakthrough came when he began working with a trauma-informed yoga therapist who helped him track and respond to his body's sensations rather than fighting them. Trauma is not just stored in memories and thoughts but in the body itself. When faced with overwhelming threat, the body activates ancient survival mechanisms—preparing to fight, flee, or, when those aren't possible, freeze. In traumatic situations where effective action is impossible, these survival energies become trapped in the body. The muscles remain tensed, the breathing shallow, the heart rate elevated—a state of physiological emergency that persists long after the danger has passed. This physical dimension of trauma explains why purely cognitive approaches often fall short. Survivors may intellectually understand their trauma but still find their bodies hijacked by overwhelming sensations and impulses. As psychiatrist Bessel van der Kolk famously observed, "The body keeps the score." Traumatic memories are stored not as coherent narratives but as fragmented sensory impressions—images, sounds, smells, and physical sensations that feel as immediate and threatening as the original event. Somatic approaches to trauma recovery focus on restoring the body's natural capacity for self-regulation. Practices like yoga, tai chi, and sensorimotor psychotherapy help survivors safely reconnect with physical sensations, distinguishing between past threats and present safety. For David, learning to track subtle changes in his body—the first signs of tension in his shoulders, the slight quickening of his breath—gave him early warning signals that allowed him to intervene before panic escalated. Movement plays a crucial role in somatic healing. Trauma often involves physical immobilization—being unable to fight or flee—which leaves the body's defensive responses incomplete. Through mindful movement, survivors can complete these interrupted action patterns, releasing the energy that remained trapped at the moment of trauma. This physical completion often brings profound emotional release as well, as the body and mind integrate the experience. Perhaps most importantly, somatic approaches help trauma survivors reclaim their bodies as sources of pleasure and comfort rather than danger and shame. Many survivors describe feeling betrayed by their bodies or viewing them as enemies to be controlled or numbed. Through gentle, mindful reconnection with physical sensations, they gradually rediscover that the same body that holds their trauma also holds their capacity for joy, connection, and aliveness—the essential foundation for a life no longer defined by what happened to them but by what is now possible.

Chapter 6: Rewiring the Brain: Neuroscience-Based Healing Pathways

James had tried everything for his combat-related PTSD. Medication dulled his symptoms but left him feeling foggy and disconnected. Talk therapy helped him understand his triggers but didn't stop his nightmares or flashbacks. Then his therapist suggested neurofeedback. During sessions, sensors on his scalp measured his brain activity while he watched a simple video game that responded to his brain waves. When his brain produced more calm, focused patterns, the game rewarded him with progress. After twelve sessions, James noticed he could fall asleep without medication. After twenty sessions, he could talk about his deployment without being overwhelmed. "It's like my brain finally realized the war is over," he explained. The brain's remarkable capacity to change—its neuroplasticity—offers hope for trauma recovery. Traumatic experiences create neural pathways that prioritize threat detection over all else, keeping survivors trapped in states of hyperarousal or shutdown. But these same mechanisms that encoded trauma can be harnessed to create new, healthier patterns. Technologies like neurofeedback and Eye Movement Desensitization and Reprocessing (EMDR) directly target these neural networks, helping the brain rewire itself toward safety and regulation. Neurofeedback works by making unconscious brain activity visible and malleable. By showing people real-time feedback on their brain states, it allows them to influence patterns they normally couldn't access consciously. For trauma survivors, whose brains often show dysregulated activity in areas related to fear processing and emotional regulation, neurofeedback offers a way to directly address these imbalances. Research shows it can reduce hyperarousal, improve sleep, enhance focus, and decrease emotional reactivity—all without the side effects of medication. EMDR takes a different approach to neural rewiring. During EMDR sessions, clients recall traumatic memories while simultaneously engaging in bilateral stimulation—typically following the therapist's fingers moving back and forth across their visual field. This dual attention seems to mimic the brain's natural processing during REM sleep, allowing traumatic memories to be reprocessed from their fragmented, emotionally overwhelming state into integrated, coherent narratives. What was once experienced as an ever-present threat becomes recognized as something that happened in the past. Both approaches work by activating the brain's innate healing mechanisms. Under normal circumstances, the brain processes experiences by connecting them with existing memory networks, extracting meaning, and storing them as past events. Trauma disrupts this process, leaving memories stuck in an unprocessed state. Neurofeedback and EMDR help restart this natural processing, allowing the brain to complete what was interrupted by overwhelming stress. The success of these approaches highlights an important truth about trauma recovery: healing often requires bottom-up interventions that address the subcortical brain regions where trauma is encoded, rather than solely top-down cognitive approaches. By directly engaging the brain's plasticity, these methods help survivors not just understand their trauma intellectually but feel different on a visceral level, creating space for new experiences of safety, connection, and possibility.

Chapter 7: The Healing Power of Connection: Relationships as Medicine

Elena had survived years of domestic violence before escaping with her two children. Though physically safe in a new city, she remained emotionally isolated, struggling with depression and panic attacks. "I built walls to protect myself," she explained, "but now I'm trapped behind them." Her breakthrough came unexpectedly through a community choir she joined at her therapist's suggestion. Standing shoulder to shoulder with others, feeling the vibration of harmonized voices, something shifted. "For those moments, I wasn't alone with my pain. I was part of something larger." Over months, this weekly ritual of connection became a cornerstone of her healing. Humans are fundamentally social creatures, our nervous systems designed to resonate with those around us. This biological reality makes social connection not just a pleasant addition to trauma recovery but a neurological necessity. When trauma occurs, particularly at the hands of other people, it damages the neural networks that support social engagement. Survivors often describe feeling "dead inside" or "disconnected from humanity"—a profound alienation that compounds their suffering. Research confirms what Elena discovered through singing: social connection directly affects our physiology. Positive social interactions stimulate the release of oxytocin, often called the "bonding hormone," which counteracts the effects of stress hormones and activates the parasympathetic nervous system—our body's "rest and digest" mode. Studies show that trauma survivors with strong social support recover more quickly and completely than those who face their trauma alone. Connection heals through co-regulation, the process by which one person's regulated nervous system helps calm another's dysregulated one. This is most visible in the relationship between attentive parents and distressed infants, but it continues throughout life. Through facial expressions, voice tone, touch, and even breathing patterns, humans continuously regulate each other's emotional states. For trauma survivors whose internal regulation systems have been damaged, relationships provide external regulation until they can rebuild their own capacity. The healing power of connection extends beyond individual relationships to community belonging. Trauma isolates, but communities integrate. Cultural rituals, religious ceremonies, support groups, and community service all provide opportunities for survivors to reconnect with the larger human family. These collective experiences help counteract the shame and alienation that often accompany trauma, reminding survivors that their worth isn't defined by what happened to them. Yet connection requires vulnerability, precisely what trauma makes most frightening. The path to healing relationships often begins with small, manageable steps toward trust. For Elena, singing in a choir offered the perfect balance—the intimacy of shared experience without the pressure of one-on-one interaction. As survivors gradually rebuild their capacity for connection, they rediscover not just safety but joy, belonging, and meaning—the essential nutrients for a life that extends beyond mere survival to genuine thriving.

Summary

The journey through trauma and healing reveals a profound truth: our bodies literally keep the score of our life experiences, storing trauma not just in our memories but in our muscles, nerves, and even our genes. This biological reality explains why trauma's effects are so pervasive and why recovery must engage the whole person—mind, brain, and body. The science shows us that trauma fundamentally disrupts our most basic systems of self-regulation and connection, leaving survivors physiologically stuck in states of danger even when objectively safe. Yet this same science offers tremendous hope. The brain's neuroplasticity means that what trauma has rewired, healing can rewire again. Through approaches that address both the psychological and physiological dimensions of trauma—from EMDR and neurofeedback to yoga, creative expression, and compassionate human connection—survivors can reclaim their bodies and lives. The path forward isn't about erasing trauma's imprint but integrating it, transforming it from a source of ongoing suffering into a foundation for deeper wisdom and resilience. As countless survivors have demonstrated, it's possible not just to survive trauma but to thrive beyond it—to reconnect with one's body, rebuild trust in relationships, and rediscover joy, meaning, and purpose. The body keeps the score, but it also holds the key to our most profound healing.

About Author

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Bessel van der Kolk

​Bessel van der Kolk MD spends his career studying how children and adults adapt to traumatic experiences, and has translated emerging findings from neuroscience and attachment research to develop and study a range of treatments for traumatic stress in children and adults.In 1984, he set up one of the first clinical/research centers in the US dedicated to study and treatment of traumatic stress in civilian populations, which has trained numerous researchers and clinicians specializing in the study and treatment of traumatic stress, and which has been continually funded to research the impact of traumatic stress and effective treatment interventions. He did the first studies on the effects of SSRIs on PTSD; was a member of the first neuroimaging team to investigate how trauma changes brain processes, and did the first research linking BPD and deliberate self-injury to trauma and neglect in early childhood.

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