The Body Keeps the Score

The Body Keeps the Score argues that psychological trauma is not stored only as memory or narrative but registers in the body, the nervous system and the brain's threat-detection machinery. Bessel van der Kolk's central claim is that this is why traumatised people can understand their history intellectually and still experience the physiological states that go with it, and why treatment aimed only at talking through events often falls short.

The framework draws on imaging and physiological work suggesting that intense threat alters activity in regions involved in fear processing, self-awareness and the integration of speech with experience. From this he argues for approaches that engage the body and regulate arousal alongside cognitive work. The book surveys trauma-focused psychotherapy, EMDR, yoga, theatre and movement programmes, mindfulness, internal family systems, and neurofeedback, illustrated through patient histories and van der Kolk's own decades in the field.

It is a book about clinical conditions and their treatment, not a self-treatment manual. Post-traumatic stress disorder and complex trauma are diagnosed and treated by qualified clinicians, and readers who recognise themselves in these pages are best served by seeking that care rather than assembling a protocol alone.

On the evidence, the therapies it covers do not stand on equal footing. Trauma-focused cognitive behavioural therapy and EMDR have the strongest support and appear in major clinical guidelines. Yoga and mindfulness-based approaches have a smaller but reasonable literature as adjuncts. Neurofeedback, for which van der Kolk is an advocate, rests on a considerably thinner evidence base than the book's enthusiasm suggests. Some of the neurobiological explanation is also presented with more certainty than the imaging research supports. The book's lasting contribution is its insistence that trauma has physiological dimensions clinicians should take seriously.