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The Body Keeps the Score explores trauma and its role in society through the examination of van der Kolk’s personal research, patient accounts, and the work of researchers in the field. He invites the reader to consider the impact of trauma on their own life, as well as its greater impact on society as a whole, and how we as a collective may face, treat, and prevent trauma.

Part One: The Rediscovery of Trauma introduces the reader to the beginning of van der Kolk’s involvement in trauma research, and gives a brief history of neuroscience up until that point. In the Prologue, van der Kolk states that trauma of all kinds impacts the lives of everyone in society, both directly and indirectly. Trauma comes in many forms, child abuse, sexual assault, or combat experience. Van der Kolk encourages the reader to engage with trauma head-on, as acknowledging it is the first step to being able to both prevent and heal it. In Chapter 1, van der Kolk discusses his experience with treating veterans before PTSD was an official diagnosis, and the difficulties they faced without proper treatment or recognition of their symptoms, as many were misdiagnosed or ignored. Chapter 2 discusses the progression of mental health treatment from the 1960s onwards, when methods such as electroshock therapy were being replaced by medication, which quickly became the new “miracle” cure in the eyes of many psychiatrists, and grew to be heavily relied on. Chapter 3 moves on to technological advances in neuroscience, specifically the PET and fMRI, which are brain scans that now allowed researchers to see activity in the brain, and thus understand the physiological causes behind trauma.

Part 2: This is Your Brain on Trauma focuses on the physiological aspect of trauma, in both its causes and its symptoms. Chapter 4 details the anatomy of the brain, focusing especially on the rational brain, in charge of logic and reasoning, versus the emotional brain, in charge of emotion and instinct. Other important parts include the amygdala, which activates the body’s stress response when it perceives a threat, and the medial prefrontal cortex, which can abort the stress response if the threat is deemed to be a false alarm. The balance between these systems in the brain is vital for everyday functioning, but in traumatized individuals, the balance is often skewed. Chapter 5 describes the connection between the body and brain through the autonomic nervous system, which is responsible for both beginning and ending stress responses, through the sympathetic and parasympathetic nervous systems, respectively. Chapter 6 details the phenomenon of trauma survivors feeling disconnected from their bodies, as well as from their mental sense of self.

Part 3: The Minds of Children explores the particular vulnerabilities of children to trauma. Chapter 7 explains attachment theory, and how the relationship between a child and their caregiver(s) can dramatically impact their physical, mental, and emotional outcomes later in life. Chapter 8 explores these outcomes further, in the case of abusive or neglectful childhoods. Survivors of childhood abuse are at higher risk of autoimmune disease, as well as emotional and behavioral problems throughout both childhood and adulthood. Chapter 9 points out a gap in the current diagnostic system that does not serve traumatized children with a diagnosis of their own, instead labelling them with a host of comorbid conditions that do not capture the full story of their trauma, thus preventing these children from receiving the proper treatment. Chapter 10 details van der Kolk’s failed efforts to have Developmental Trauma Disorder, or DTD, be officially recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Part 4: The Imprint of Trauma explores memory issues pertaining to trauma. Chapter 11 discusses the history of traumatic memory research, and how symptoms such as dissociation, reenactment, and amnesia have been documented since the beginning of trauma research. Chapter 12 explains the difference between traumatic memory (disorganized, remembered over time) and normal memory (organized, remembered instantly), as well as addressing the controversy surrounding the idea of repressed memories and their relation to trauma.

Part 5: Paths to Recovery explores different options for patients recovering from trauma. In Chapter 13, van der Kolk emphasizes that there is no one-size-fits-all approach to healing trauma, and that treatments such as medication are inadequate in fully treating trauma. A balance must be restored within the self and the traumatic memories integrated fully into the past, not just desensitized to. Chapters 14-20 discuss the benefits of several different kinds of experimental therapy in treating trauma, including talk therapy, eye movement desensitization and reprocessing (EMDR), yoga, internal family systems (IFS) therapy, PBSP psychomotor therapy, neurofeedback, and theater and community involvement. In the Epilogue, van der Kolk once again emphasizes that trauma is a problem for all of society, not just those directly impacted, and states that social systems and attitudes must change in order for a safe space to be created to both heal and prevent trauma.

Previous section Part 5: Paths to Recovery (Chs 13-20) & Epilogue

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