Does the Body Really Keep the Score? Literally, No. Figuratively...also no.

"The Body Keeps the Score" by Dr. Bessel van der Kolk (2014) is a hugely popular and influential work in the field of trauma psychology. It explores the effects of trauma on the body and mind, proposing that trauma is not just a psychological issue but also a physical one, stored in the body's memory, often eluding our conscious awareness and affecting our overall health. This ‘stored trauma’ can dysregulate the brain's stress response system, leading to a range of physical and mental health issues, including fibromyalgia, chronic fatigue, headaches, irritable bowel and autoimmune diseases. He writes:

“The body keeps the score. If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.”

Subsequently, van der Kolk advances some physical remedies for trauma, such as yoga, massage, art therapy, theatre, psychedelics, karate, and dance.

Is It Correct?

Yes and no, but mostly no.

It’s certainty true that our bodies and brains are connected and influence each other. And it’s certainly the case that looking after the body through things like getting regular sleep, exercising, eating well etc. are huge factors in our mental wellbeing. It’s also true that psychological stress affects our bodies, like when we get stressed and our eyes start twitching or we get sick because we’re stressed and run down.

But none of this is the same as saying that trauma is stored in the body or that ‘the body keeps the score.’

In a 2023 Big Think video, Stanford Neuroscientist and world expert on emotions Lisa Feldman Barrett argued that everything, including trauma, is in our heads, and that “the brain keeps the score and the body is the scorecard…When you feel your heart beating, you are not feeling it in your chest, you are feeling it in your brain.”  “Your body is always sending sensory signals to the brain, of course, but emotions are made in the brain, not in the body. They are experienced in the brain, like everything else you experience, not in the body. If you experience a trauma, you experience it in your brain.”

Why It Matters

It matters because it’s having a similar effect as the now debunked Repressed Memories Myth from the 1990’s. The Repressed Memories Myth is one of many missteps in the history of psychology, this one largely contained to the USA, but damaging thousands of people. Coinciding with another misstep in psychology, the Satanic Ritual Abuse panic, therapists across the USA promoted a nationwide quest to root out evidence of children being sexually abused by hidden Satanic cults. The belief at the time was that traumatic memories were frequently suppressed by psychological mechanisms (this is an old idea, dating back to Freud), but could be ‘recovered’ through a blend of hypnosis and careful questioning. The 2008 book The Courage to Heal brought this narrative to the mainstream.

This (erroneous) belief led to hundreds of people in therapy suddenly ‘remembering’ incidents of childhood abuse, and dozens of people subsequently being convicted of crimes they never committed, some jailed for decades.  But groundbreaking research by Elizabeth Loftus demonstrated that the very techniques used by therapists to “recover” memories also worked extremely well to implant false memories and to create realistic, recalled experiences of things that never happened.

Moreover, The FBI investigated and found no evidence of any secret, organized cults of Satanic child abusers. Then research found that patients who underwent recovered memory therapy techniques actually experienced a decline in psychological health, functioning, and well-being.

Modern research now reveals that memory itself is far less reliable, and much more malleable, than ever commonly believed; no matter how strong and vivid memory may be, the human mind is desperately prone to fallibility and The Courage to Heal has been called "The bible of incompetent therapists”. Events of people’s past may sometimes come back to them in sudden recollection, but there’s no evidence that this happens with traumatic memories. Indeed, prospective research (following people after a traumatic event) finds that trauma victims often want to forget their experiences, but they cannot.

One would think, then, that mental health clinicians would treat these practices as anathema, and that new therapists would be carefully and explicitly trained to avoid these dangerous areas. But a new review, published by extraordinary and thoughtfully skeptical researchers, including the aforementioned Elizabeth Loftus, finds that widespread belief in repressed traumatic memories persists in the therapy industry. Between 60 and 89 percent of modern mental health clinicians believe that traumatic memories can be forgotten, repressed, or suppressed. A study of clinicians who utilize EMDR to treat trauma found that fully 93 percent of these clinicians believed that traumatic memories can be “blocked out.”

This idea of repressed memories is eerily similar to the idea of the body keeping the score. It’s essentially the same idea that traumatic memories can exist outside of conscious awareness: One version is repressed memories in the brain, the latest version is repressed memories in the body.  There is no evidence for either and there are harmful consequences for both.

I am not saying here that EMDR, or exercise, or dance, or any of the other somatic interventions recommended in the book are illegitimate. But I am saying the premise that BvdK is using for them is.

And this is important because while trauma and PTSD absolutely exist, trauma doesn’t take a toll on everything in your body and what you tell yourself abut trauma matters. Note carefully that two people can undergo the exact same experience and yet have vastly different responses.  Two people can undergo almost the exact same trauma (say sexual abuse or war), but one goes on to develop PTSD and the other doesn’t or one feels traumatised and the other doesn’t. How is this possible? If it was just the body, then all trauma survivors would be equally affected across the board. But they are not. Why? Partly it’s because of the story they tell themselves about their experience.

Emotions are the stories you tell yourself about these sensory experiences. This is not saying that trauma is ‘all in your head’ or anything like that (although it is all in your head, but everything is in your head so…) but it is giving you permission - especially if you are someone who has suffered something that might be considered traumatic, and you don’t feel particularly traumatized - to move on with your life. You don’t need to go around fishing for trauma in your body or somewhere else. You don’t have to feel traumatized just because something ‘traumatic’ happened to you or around you. It’s very possible you’re not traumatized. Humans are very resilient. We can endure horrendous things and come through alright. There’s even such a thing as ‘post-traumatic growth’.

The cynical part of me honestly thinks that BvdK and the like peddle these ideas because they are good for business. It’s great for business to have everyone out there believing they are traumatised even when they don’t feel like they are.  That way everyone needs therapy! I’m a big fan of therapy, but not everyone needs it. And for some people, its actually harmful to be in therapy, and that’s before we even talk about the large cost usually involved. 

What about Generational trauma?

A related popular idea is the idea of generational trauma. Headlines suggest that the epigenetic marks of trauma (epigenetics is the study of or the idea that certain genes can be turned ‘on’ or off’ by your environment or behaviour) can be passed from one generation to the next. But the evidence, at least in humans, is circumstantial at best.

The field of epigenetics gained momentum about a decade ago, when scientists reported that children who were exposed in the womb to the Dutch Hunger Winter, a period of famine toward the end of World War II, carried a particular chemical mark, or epigenetic signature, on one of their genes. The researchers later linked that finding to differences in the children’s health later in life, including higher-than-average body mass.

The debate centers on genetics and biology. Direct effects are one thing: when a pregnant woman drinks heavily, it can cause foetal alcohol syndrome. This happens because stress on a pregnant mother’s body is shared to some extent with the fetus, in this case interfering directly with the normal developmental program in utero.

But no one can explain exactly how, say, changes in brain cells caused by abuse could be communicated to fully formed sperm or egg cells before conception. And that’s just the first challenge. After conception, when sperm meets egg, a natural process of cleansing, or “rebooting,” occurs, stripping away most chemical marks on the genes. Finally, as the fertilized egg grows and develops, a symphony of genetic reshuffling occurs, as cells specialize into brain cells, skin cells, and the rest. How does a signature of trauma survive all of that?

Some promising work coming out of UMass and Oliver Rondo involving male mice and the epididymis, suggests maybe trauma marks could be attached to sperm cells, but this research is in its infancy and still quite speculative.

The idea that we carry some biological trace of our ancestors’ pain has a strong emotional appeal. It resonates with the feelings that arise when one views images of famine, war or slavery. And it seems to buttress psychodynamic narratives about trauma, and how its legacy can reverberate through families and down the ages. But for now, the research in epigenetics falls well short of demonstrating that past human cruelties affect our physiology today, in any predictable or consistent way.

NB. I stole the title of this blog from Abigail Shrier in her new book Bad Therapy.