The Body Keeps the Score (2014) by Bessel van der Kolk is a landmark synthesis of neuroscience, clinical insight, and trauma theory. The book has become one of the cornerstone texts in contemporary trauma studies because it reframes trauma not just as a psychological event, but as a profoundly embodied phenomenon. It bridges neuroscience, psychophysiology, and clinical practice, influencing both academic research and therapeutic approaches. It reframes trauma not merely as a psychological wound but as a physiological imprint that reshapes the brain, body, and sense of self. The book is both a clinical synthesis and a cultural critique of how trauma reshapes the human mind, brain, and body — and how healing requires reconnecting them.
The book’s central thesis is that trauma is far more than a psychological wound; it imprints itself within the body’s physiology, altering brain function, stress responses, immunity and even posture. Trauma studies traditionally examined the psychological aftermath of overwhelming events. Van der Kolk emphasizes that trauma is also a physiological state that persists in the body long after the actual traumatic event or events. This aligns with the increasing research data supporting the idea that trauma becomes manifest in neural circuits, hormonal systems, and muscle memory, not just in conscious “narrative” recollection
From a physiological perspective trauma’s imprint disrupts the normative integration of sensory, emotional, and cognitive processing, in some respects disconnecting the “mind” from the body. While the brain may suppress or distort traumatic memories, the body retains the visceral imprint—manifesting in chronic stress, emotional dysregulation, and somatic symptoms. Primarily, trauma’s dysregulation occurs in the limbic system, alterations in the autonomic nervous system, and fragmenting sensory memory. With respect to symptoms, trauma results in bodily tension, hyperarousal, dissociation, intrusive sensory fragments and emotional numbing. Many traumatized individuals remain chronically “stuck” in survival mode with unresolved sensory and emotional imprints that keep reactivating stress responses despite the absence of current threat.
Key Takeaways from van der Kolk’s Work
1.Trauma is a mind-body disconnection — the thinking brain may suppress memories, but the body retains traumas sensory and emotional imprints. Trauma manifests in flashbacks, dissociation, emotional numbing, and somatic complaints. The body “remembers” trauma through muscle tension, gut distress, and chronic pain. Shame and isolation are common, reinforcing the trauma loop.
- Physiological changes — trauma recalibrates the brain’s alarm and threat system, heightens presence of stress hormones, and alters information processing.
- Memory Alteration— traumatic memories are often stored as fragments of sensation and emotion, not coherent narratives.
- Shame and isolation — trauma often breeds self-blame, secrecy, and withdrawal, which hinder healing.
- Healing is embodied — recovery requires re-establishing a sense of bodily safety, integrating fragmented memories, and restoring a sense of agency.
Why It Matters
Van der Kolk reframes trauma from being a purely psychological “narrative” to the neurological and physiological and immune/endocrine as well as cognitive states that can be transformed back to their more normal operations. His work bridges neuroscience, psychotherapy, and somatic practices, offering a roadmap for clinicians and survivors alike to move from reactivity to resilience. Effective treatment must address the whole person — mind, body, and relational contexts. Healing requires restoring agency, safety, and mind-body integration.
For van der Kolk, the symptoms of trauma are physiological residues; from an existential-analytic perspective, they are existential defenses. In my treatment of various forms of trauma, each type is seen as an existential rupture in one’s life, leading to destabilizing distortions that become manifest in anxiety, despair, loss of meaning, alienation, substance abuse and inauthenticity. The therapeutic goals in my existential-analytic treatment approach to trauma is to restore mind-body integration, reestablish a sense of safety, reclaim agency through embodied regulation and relational repair. These make possible authentic engagement with life’s possibilities, and expand the capacity for freedom of choice, responsibility, and the search meaning. These goals are achieved through open dialogue, meaning-centered exploration, adaptations to life’s existential givens, and values clarification. In this process the therapist role is that of an authentic partner in dialog and co-explorer of authentic meaning and freedom. In addition to my “top down” approach to treating trauma through existential analytic psychotherapy, as van der Kolk recommends, I also include “bottom-up” approaches that include breath work, exercise and mindfulness to address the more physiological aspects of trauma.
In a future post, I will present in more detail, the actual Neurological Systems (Limbic System, Prefrontal Cortex Brainstem & Midbrain) and Physiological Systems (Autonomic Nervous System, Hypothalamic–Pituitary–Adrenal (HPA) Axis, Vagal System, and Immune & Endocrine Systems) involved in the body’s response to trauma.