My Body Has Kept Score

My body has unfortunately tallied my score from physical and emotional trauma, beginning at an early age, and it appears I'm losing the game.

I recall the day one of my orthopedic surgeons reviewed my imaging and said something I'll never forget. “Your body looks like it’s been through a war." He wasn't wrong. Ten surgeries in eight years, at the time, tell only part of the story. What the medical charts don't show are the childhood beatings, the violence that planted seeds of destruction deep within my developing bones and tissues. As I prepare for my 11th surgery next week—my right knee replacement—I find myself reflecting on a book my therapist recommended, Dr. Bessel van der Kolk's profound work, "The Body Keeps the Score," and how uncannily accurate that title has proven in my own life.

My father's rage is now permanently documented in surgical reports and molybdenum/polymer implants. Four back surgeries to repair what was damaged at his hands. Two hip replacements. One knee has already been replaced, with another surgery scheduled just days away. A metal femur where bone once was—now crumbling like chalk in other places. My body, it seems, has been a meticulous accountant, recording every traumatic event in its tissues, finally presenting the bill when I reached middle age.

In "The Body Keeps the Score," van der Kolk writes that "trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body." This resonates with me both intellectually and viscerally. The science behind his work confirms what I've experienced: trauma isn't just psychological—it's intensely physical.

When a child experiences physical abuse, their body shifts into survival mode. The sympathetic nervous system floods the body with stress hormones—cortisol and adrenaline—preparing for fight or flight. For a child being beaten, neither option is available. We can't fight back effectively. We can't escape. So the body adapts in the only way it can: it endures.

But endurance comes at a price. Chronic elevation of stress hormones weakens bone density. Muscles remain constantly tense, altering posture and gait in ways that, over decades, cause joints to wear down prematurely. Even breathing patterns change, becoming shallow and rapid, which reduces oxygen intake throughout the body. The immune system becomes weakened, inflammation persists, and healing slows down.

My orthopedic problems aren't just bad luck. They are the physical result of what happened when my growing skeleton took impacts it was never built to handle. They are what occurs when a young body spends years in a constant state of hypervigilance and fear.

The timeline of my surgeries unfolds with a poetic flow, as if my body is systematically exposing trauma.

First came the back surgeries—four of them—focused on the most essential support structure, the one that bore the worst impacts from being thrown against walls and pushed into small boxes. The spinal fusions, laminectomies, and disc replacements were all efforts to stabilize what had been fundamentally destabilized decades earlier.

Then came the hips, both of which were replaced within two years of each other. The surgeons were puzzled by the level of deterioration in someone "too young for this kind of wear." But it wasn't wear; it was damage—the kind that results from tensing your entire lower body every time you hear footsteps approaching your bedroom door.

The knees came next—the left one had already been rebuilt with molybdenum and polymer, and the right was scheduled for the same treatment the following week. These joints, meant to handle everyday impacts, had endured much worse over the years.

And perhaps most telling, my right femur—the most prominent bone in the human body, built to endure enormous pressure—had degraded to the point of needing metal reinforcement. Other bones are "crumbling like chalk" in spots, showing signs of premature osteoporosis that no amount of calcium supplements can reverse.

Van der Kolk notes that "the body continues to defend against a threat that belongs to the past." My body still braces for impacts that stopped decades ago, tensing against blows that no longer happen. The chronic pain, the deterioration, the countless surgeries—they're all echoes of a war that officially ended when I left home at 16 but still plays out in my body.

The physical trauma is only part of the story. Van der Kolk's work highlights how trauma impacts not just the body but also the brain and nervous system, forming patterns that go beyond physical injury.

One of van der Kolk's key insights is that traumatized people get "stuck" in defensive states, with their autonomic nervous systems constantly prepared for danger. I see this in myself—the hypervigilance that helped me survive as a child became unhealthy as an adult. For years, I struggled with:

- An exaggerated startle response that makes even minor surprises feel threatening.

- Chronic insomnia because my body won't relax enough for deep sleep.

- A constant feeling that danger is near, even in safe settings.

- Struggle to stay connected to my body, often feeling detached or as if I'm "floating above" myself.

These symptoms are not separate from my physical ailments—they are part of the same trauma response continuum. The nervous system dysregulation that contributes to my musculoskeletal issues also fuels these psychological and emotional patterns.

Perhaps the most challenging aspect has been how trauma distorts one's relationship with pain itself. After years of having to suppress my pain response—knowing that showing pain would only fuel my father's rage—I developed a dangerous dissociation from my body's warning signals. I would push through severe pain that should have sent me to a doctor immediately. This delayed diagnosis of several conditions allowed damage to progress unchecked.

Another part of my journey that echoes van der Kolk's work is the experience of navigating the medical system as a trauma survivor. Too often, conventional medicine treats the body as a collection of isolated systems rather than a connected whole. This fragmented method can unintentionally reinforce the disconnection that trauma causes.

Over ten, next week, eleven surgeries, I've seen doctors who focused solely on the bone or joint in front of them, never asking what might have caused such systemic deterioration. Some dismissively blamed my extensive problems on "bad genetics" or "just bad luck"—explanations that dismissed the reality of my lived experience.

When I've tried to explain the connection to childhood trauma, the responses have ranged from uncomfortable silence to outright dismissal. One orthopedist told me, "That was a long time ago. It can't be affecting you now," a statement that contradicts everything we know about developmental trauma.

This medical gaslighting is a form of secondary trauma. Van der Kolk writes extensively about how being disbelieved or minimized can worsen the original trauma, adding new layers of distress. Each time a healthcare provider dismisses the connection between my past and present, it reinforces the childhood message that my experiences don't matter and that my truth is invalid.

There have been exceptions—a compassionate and experienced therapist who understood the link between my personal history and biological reality. The awareness my therapist provided has been essential to any healing I've experienced. My therapist echoed what my surgeon said, explaining that my body had indeed "been through a war." This gave me validation by someone in authority, someone who cared and acknowledged the violence etched in my body.

Van der Kolk emphasizes that trauma recovery requires more than just addressing symptoms; it involves integrating fragmented experiences into a coherent narrative. It also demands reconnecting with the body, rather than remaining dissociated from it.

For me, this transformation began with acknowledging the full truth. My body keeps score not because it betrays me, but because it protected me in the only way it knew. The damage I'm experiencing now is the result of survival mechanisms that once served a vital purpose.

As I prepare for next week's knee replacement, I approach it differently than I did my first surgery years ago. Back then, I saw my body as an enemy that had betrayed me. Now, informed by my therapist and works like van der Kolk's, along with years of my own integration efforts, I see it differently. This body, with all its metal and plastic parts and surgical scars, carried me through unimaginable circumstances. It absorbed what it could not avoid and is still working to protect me as best it can.

Recovery will not be linear. There will be setbacks. After this 11th surgery, more are likely as other weakened areas eventually give out. The scorekeeper hasn't put down the pencil.

But alongside medical interventions, I continue the deeper work of reconciliation with this body that has borne so much. I'm learning to listen to its signals rather than override them, to offer compassion instead of criticism when it struggles, and to honor rather than resent its limitations.

Van der Kolk writes that "being able to feel safe with other people is probably the single most important aspect of mental health." I would add that feeling safe in one's own body is just as vital, perhaps even more so for those of us whose earliest experiences of danger involved physical violence.

I may never have a body that functions without pain or limitation. The score that has been kept cannot be erased; the ledger cannot be wiped clean. The metal and plastic vertebrae, the artificial hips, the replaced knees, the metal femur—these are permanent reminders of what happened.

But van der Kolk also offers hope when he writes that "trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body." If trauma can imprint itself, maybe healing can too. Maybe new experiences of safety, connection, and compassion can start to create their own record alongside the older one.

As I face my 11th surgery next week, I carry this thought with me. The body keeps score, yes, but maybe it can also record resilience, adaptation, and even moments of peace. Perhaps alongside the ledger of pain, there can be a parallel account of survival and, eventually, thriving.

The metal and plastic in my back, hips, knee, and femur will stay. The scars will never fully fade. But they only tell part of the story. They speak of what was done to me, but not of what I've done since—not of how I've fought to reclaim this body, to make peace with it, to honor both its limits and its remarkable endurance.

In one week, I'll add another line to the score my body keeps. But I'm no longer just a passive recipient of this tally. I'm also the author of a new story—one that acknowledges the pain of the past while refusing to let it define all of my present or my future.

The body keeps the score, but it also witnesses healing. Both truths can exist together. Both should be honored. Within that honoring lies the potential for integration that both my therapist and van der Kolk see as the core of trauma recovery—not erasing the past, but incorporating it into a present that offers more than just pain, and a future that holds opportunities beyond simple survival.

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For anyone interested in Dr. van der Kolk’s book, I’ve included a brief summary and review.

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

A Review of Dr. Bessel van der Kolk's Groundbreaking Work

In his influential book "The Body Keeps the Score," psychiatrist Bessel van der Kolk introduces a groundbreaking framework for understanding trauma that goes beyond traditional psychological methods. Published in 2014 after decades of clinical practice and research, van der Kolk's work is a key text in trauma studies, significantly shifting how we view the connection between traumatic experiences and physical health. As someone who has experienced the complex relationship between childhood trauma and chronic health issues, I found this book to be both scientifically enlightening and deeply affirming of real-life experiences.

The Central Thesis: Trauma as a Bodily Experience

Van der Kolk's most significant contribution is his claim that trauma is not just psychological but also fundamentally physiological. "Trauma is not just an event that took place sometime in the past," he writes, "it is also the imprint left by that experience on mind, brain, and body." This view marks a major shift from purely cognitive or narrative-based ideas of trauma.

The book carefully explains how traumatic experiences—especially those in childhood—change multiple bodily systems. The autonomic nervous system becomes out of balance, brain structure is reshaped, and the body's stress response systems stay activated over time. These changes aren't just signs of psychological distress; they are physical signs of trauma itself.

The Science: Rigorous and Accessible

What sets van der Kolk's work apart from many other trauma-focused texts is his ability to translate complex neuroscience into accessible language without losing scientific rigor. The book combines findings from developmental neuroscience, attachment theory, and psychophysiology to provide a comprehensive understanding of the effects of trauma.

Van der Kolk explains how trauma influences brain development and function, particularly in areas such as the amygdala (which processes fear), the prefrontal cortex (which facilitates executive function), and the hippocampus (which is involved in memory formation). He describes how traumatic experiences are stored not as clear stories but as fragmented sensory impressions that resist fitting into autobiographical memory. This helps explain why trauma survivors often have flashbacks, intrusive body sensations, and emotional flooding rather than clear memories.

Dr. van der Kolk also offers compelling evidence of how trauma disrupts the nervous system's ability to self-regulate. Drawing on polyvagal theory developed by Stephen Porges, van der Kolk explains how trauma can trap individuals in states of either hyperarousal (fight-or-flight) or hypoarousal (freeze and dissociation), making it hard to stay within the "window of tolerance" where optimal functioning happens.

From Childhood to Adulthood: The ACE Study and Beyond

One of the book's most important sections explores the landmark Adverse Childhood Experiences (ACE) study, which revealed strong links between childhood trauma and adult health outcomes. Van der Kolk builds on this work by explaining the physiological processes behind these connections.

He explains how childhood trauma can cause chronic inflammation, hormonal imbalance, and immune system changes, leading to biological vulnerability to various physical illnesses later in life. This section provides important insights for anyone trying to understand conditions like autoimmune disorders, chronic pain issues, and even accelerated aging related to early life adversity.

Van der Kolk's explanation of how childhood trauma influences developmental paths is especially nuanced. He avoids making deterministic claims while acknowledging the significant impact of early experiences on both brain structure and bodily systems. This method affirms the experiences of trauma survivors without giving them bleak forecasts.

Beyond Diagnosis: Critiquing Psychiatric Reductionism

A notable aspect of "The Body Keeps the Score" is van der Kolk's willingness to criticize mainstream psychiatric methods. He convincingly argues that the diagnostic category of PTSD, which he helped establish, does not fully reflect the complex developmental effects of childhood trauma. He strongly advocates for Developmental Trauma Disorder as a more precise diagnostic framework for understanding the impacts of childhood maltreatment.

Van der Kolk's critique targets medication-focused treatment methods. While recognizing the importance of psychopharmacology, he contends that medications alone cannot fix the core dysregulations caused by trauma. "Drugs cannot 'cure' trauma; they can only dampen the expressions of a disturbed physiology," he writes. This view questions the reductionist approach in modern psychiatry while still valuing the use of appropriate medication.

Healing Pathways: A Comprehensive Approach

The second half of the book emphasizes therapeutic methods, providing a notably comprehensive yet insightful overview of trauma treatment options. Van der Kolk categorizes these methods into several groups.

1. Top-down methods that activate the rational mind through talk therapy and cognitive techniques.

2. Medication to manage symptoms and correct biological imbalances.

3. Bottom-up approaches that target the body's physiological states through bodywork, breathwork, and movement.

4. EMDR and other techniques that assist in processing traumatic memories.

5. Relational approaches that use human connection to rebuild safety and attachment.

What makes this section especially valuable is van der Kolk's dedication to evidence-based practice while remaining open to innovative approaches. He assesses treatments based on both clinical evidence and neurobiological plausibility, avoiding both rigid traditional methods and uncritical acceptance of alternative techniques.

Van der Kolk's discussion of somatic approaches is particularly compelling. He describes how yoga, tai chi, and other body-centered practices can help trauma survivors reconnect with their bodies, increase interoceptive awareness, and regain a sense of agency that trauma often takes away. This emphasis on embodiment marks a significant step forward in trauma treatment, going beyond solely verbal or cognitive methods.

The Power of Connection: Trauma and Relationships

A central theme throughout the book is the importance of human connection in both causing trauma and aiding recovery. Van der Kolk stresses that trauma often happens in relationships and damages a person's ability to form secure attachments. On the other hand, safe relationships create an environment that fosters healing.

“Being able to feel safe with others is probably the most important part of mental health,” he writes.

Critiques and Limitations

Despite its significant contributions, "The Body Keeps the Score" has some limitations worth noting. The book sometimes presents case studies that seem almost too perfectly aligned with theoretical points, raising questions about selection bias. Additionally, while van der Kolk recognizes cultural factors in trauma, the book's outlook is mainly based on Western medical and psychological perspectives.

Some readers might also perceive van der Kolk's enthusiasm for certain treatment methods—especially EMDR and neurofeedback—as somewhat uncritical when compared to his more balanced view of traditional psychiatric treatments. While he provides evidence for these approaches, he sometimes seems more willing to accept preliminary results for innovative methods than for well-established ones.

Personal Impact and Broader Implications

For many readers who have experienced trauma, especially during childhood, "The Body Keeps the Score" provides a deep sense of validation. By connecting physical symptoms to traumatic histories, the book helps survivors see that their physical issues are not imaginary, exaggerated, or psychosomatic in a dismissive way. Instead, they demonstrate real changes in bodily systems caused by trauma.

Beyond individual healing, the book has important implications for public health, education, and social policy. Van der Kolk argues convincingly that addressing trauma involves more than clinical treatments; it also requires broader social changes that prevent traumatic experiences and foster resilience in children.

A Paradigm-Shifting Contribution

"The Body Keeps the Score" is one of the most significant books in modern trauma studies. By combining neuroscience, developmental psychology, and clinical practice, van der Kolk has developed a comprehensive framework for understanding how trauma impacts the brain, mind, and body.

Perhaps most importantly, the book offers hope without downplaying suffering. Van der Kolk recognizes the deep impact of trauma while also highlighting the brain's impressive ability for neuroplasticity and the body's potential to recalibrate. "We have learned that trauma is not just an event that took place sometime in the past," he writes, "it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present."

For anyone wanting to understand how childhood adversity connects to adult health issues—from chronic pain and autoimmune conditions to emotional regulation problems—this book offers crucial insights. It confirms that the body truly "keeps the score" of painful experiences, while also showing ways to heal that involve our entire humanity—body, brain, mind, and relationships.

As van der Kolk ultimately shows, trauma may leave a mark on the body, but with proper support and intervention, we can start to rewrite that somatic story and regain a sense of safety, agency, and connection in both the mind and body.

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