How Does Trauma Rewire the Nervous System? Why Being Unable to Move Makes an Event Traumatic, with Dr. Bessel van der Kolk
Updated: Oct 17
Trauma rewires the nervous system when the body faces a threat and cannot take action. Dr. Bessel van der Kolk, author of The Body Keeps the Score, explains that the blocked response gets routed toward helplessness, and the brain builds a lasting map of the world from what happened.
Many people know their trauma intellectually and still cannot feel safe. Their body reacts to a sound, a light through a window or a change in temperature, long after the danger has passed. In this conversation, Dr. van der Kolk describes trauma as something "unbelievable, unbearable, and overwhelming," and explains why the body keeps responding as if it is still happening.
Dr. Bessel van der Kolk is a Boston-based psychiatrist, researcher and educator, and the author of the #1 New York Times bestseller The Body Keeps the Score. He has spent his career studying how children and adults adapt to traumatic experiences. Your host is Dr. Aimie Apigian, a double board-certified physician in preventive medicine and addiction medicine and author of The Biology of Trauma.
TL;DR: When the body cannot act against a threat, something gets rewired toward helplessness. Childhood experience builds an inner map of the world that logic cannot talk anyone out of. Repair starts with agency, the body's basic housekeeping functions, pleasure and connection.
What does Bessel van der Kolk say about trauma and the body?
Dr. Bessel van der Kolk's central point is that trauma is held in the body, not only in memory. When a threat overwhelms a person and they cannot act, the body keeps responding as if the danger is still present, so talking about the event rarely resolves it on its own.
In this episode he connects that idea to four things: dissociation, the blocked response to threat, the inner map of the world that early experience builds, and the body's basic functions such as sleep and digestion. Each one is covered below.
What does "the body keeps the score" mean?
It means the body continues to respond to a past threat after the event is over. The nervous system holds the response and the map it built, even when the mind does not remember the details or has made sense of what happened.
Why can't people tell their trauma story?
Trauma overwhelms the capacity to put an experience into words. Dr. van der Kolk learned this working in emergency rooms, where people who had just lost family members or been shot were "deeply inarticulate." He says a person can tell a cover story of what happened, but words never tell the whole tale.
Dr. Aimie shares a patient from her surgical residency: a 22-year-old woman with a knife through her forearm who was completely calm and said she did not know what had happened. Dr. van der Kolk explains this as the capacity to dissociate, which people have shown throughout history.
Dissociation: a survival response in which awareness of part of an experience is cut off, so a person can know and not know, feel and not feel, at the same time.
Why does being unable to move make an event traumatic?
When the body cannot take action in response to a threat, the brain routes that blocked response toward helplessness. Dr. van der Kolk traces the observation from Darwin and Pavlov to the learned helplessness research in dogs, where animals that could not escape a shock stopped trying even once escape was possible.
He adds a caution: "we should not overestimate what we know" about the brain. What the research does show is that a sense of mastery in the face of threat is protective. He points to military basic training, where meeting a hard physical challenge and realizing "I can do this" builds resilience, and to programs that use theater, martial arts, tango and making music together.
Learned helplessness: a conditioned response in which an animal or person that could not escape a threat stops trying, even after escape becomes possible.
How does trauma create an inner map of the world?
Babies and young children build a map of the world inside the brain from their actual experiences, and that map makes the brain a predictive organ. A child who was abused or neglected grows up with a map that says people will hurt them.
That map is not a conscious belief. Dr. van der Kolk says you cannot talk people out of these core attitudes, which is why insight alone rarely changes them. The work is to create a new map of the world through new experiences.
How does trauma affect the body's health?
Living with this map takes a tremendous amount of energy, and triggers can be as subtle as the sound of an air conditioner. Asked about the rise in syndromes tied to a dysregulated nervous system, Dr. van der Kolk says the body's mechanisms underneath trauma are still "very much overlooked," and that we do not yet know much about how those biological systems may feed into conditions such as autoimmune disease. He cautions against being simplistic about it.
He shares his own story: born in 1943 during the famine in Nazi-occupied Netherlands, he was a sickly child for his first eight years. Of everything he tried, Rolfing, a deep bodywork method, helped him most to live in a body that felt more open.
Why does trauma treatment need to address sleep, appetite and digestion?
Many psychological problems show up as difficulty with sleep, appetite, digestion, touch and arousal, so effective treatment has to address these basic housekeeping functions of the body. Dr. Aimie describes how reading this in his book gave her permission, as a surgery resident, to treat her own sleep as seriously as her therapy sessions.
Dr. van der Kolk adds that agency should be part of every treatment program: cleaning your room, cooking, doing your laundry, taking care of "this creature we are."
What does a life worth living look like after trauma?
Healing means feeling fully alive in the present. Dr. van der Kolk explains that the terrible thing is over and you survived it, but your brain does not know it. So he steers people toward sensory awareness, such as raindrops on the leaves or the feel of the mud on a walk with the dog, and toward what brings pleasure, which trauma takes away.
Many survivors of abuse and neglect carry the feeling of being damaged goods. Cultivating the capacity to feel pleasure usually involves movement and interaction with people.
Why can't you be curious when you are traumatized?
Curiosity requires feeling secure enough to not know. Dr. van der Kolk names collaboration and curiosity as the core life skills, and explains that for a traumatized person, not knowing feels dangerous. Getting to know yourself matters, and it cannot be done alone.
How do you find the right trauma therapist?
Notice what it feels like to be with the person, and ask whether they have had the treatment they offer and whether it helped them. Dr. van der Kolk says the hardest part of trauma care today is finding the right people, and that when a treatment does not help, a traumatized person often concludes something is wrong with them. A better conclusion is that this treatment was not the right fit.
Key Takeaways
Trauma overwhelms the capacity to put an experience into words.
Dissociation lets a person know and not know, feel and not feel, at once.
Being unable to act against a threat rewires the response toward helplessness.
Learned helplessness can become a conditioned response that persists after escape is possible.
A sense of mastery in the face of threat is protective.
Early experience builds an inner map of the world that makes the brain predictive.
That map is not a conscious belief, so it cannot be argued away.
Effective treatment includes sleep, appetite, digestion, touch and arousal.
Pleasure, sensory awareness and movement are part of healing.
Curiosity and collaboration depend on feeling secure.
Notable Quotes
"You cannot tell your trauma story because it is overwhelming." - Dr. Bessel van der Kolk
"If you deal with trauma you deal with dissociation and people knowing and not knowing and feeling and not feeling." - Dr. Bessel van der Kolk
"If you cannot take an action in response to a threat then something gets rewired inside your brain." - Dr. Bessel van der Kolk
"We can push people, we can encourage people, we can love people, but they have to do it." - Dr. Bessel van der Kolk
"You cannot talk people out of these core attitudes." - Dr. Bessel van der Kolk
"I can't just go to therapy and expect, you know, my issues to be dealt with. I've actually got to learn to live with and work with and be in connection with my body and its functions." - Dr. Aimie Apigian
"Basically all good things in life come out of collaborations." - Dr. Bessel van der Kolk
"When you're traumatized, you can't be curious because it's dangerous to not know." - Dr. Bessel van der Kolk
"At the core there's only one person who can take care of you and that's you." - Dr. Bessel van der Kolk
Episode Takeaway
What Dr. van der Kolk describes is what I see in the body every day. Trauma is the gap between what happened and what the body could do about it. When the body could not move, could not protect, could not get away, that blocked response stayed inside and became the map it now uses to read every room.
That is why therapy alone can't resolve it. Understanding happens in the thinking brain, and the immobilization is held deeper, in the nervous system. The body needs the movement it could not make at the time, the kind of movement that would discharge the energy that gets stored when a survival response is blocked. The map updates through experience: new experiences of safety, support and agency, in that order.
I also want to come back to the housekeeping functions he names. Sleep, digestion, appetite and touch are not side issues to deal with after the "real" work. They are the biology the trauma response runs on. When I started treating my own sleep as seriously as my therapy, things began to shift for me.
This is the heart of the Biology of Trauma®: the mind, the body and the biology all hold what happened, and repair needs all three. If you are wondering whether your body is still holding something, start with the 2-Minute Assessment for Stored Trauma. It names the pattern your body is running, so you know where to begin.
FAQ
Who is Bessel van der Kolk?
Dr. Bessel van der Kolk is a Boston-based psychiatrist and trauma researcher and the author of The Body Keeps the Score. His work explains how trauma affects the brain and body and why treatment needs to include the body.
Can trauma be stored in the body without a memory of it?
Yes. Dissociation can cut off awareness of part of an experience, while the body still reacts to reminders such as a sound, a light or a temperature.
Why do I still feel unsafe when I know I am safe now?
The inner map of the world is not a conscious belief. It was built from experience, so it changes through new experiences of safety rather than through reasoning.
What is learned helplessness?
It is a conditioned response in which an animal or person that could not escape a threat stops trying, even after escape becomes possible.
Does talk therapy work for trauma?
Dr. van der Kolk explains that words never tell the whole story of trauma, so treatment also needs movement, the body's basic functions, pleasure and connection.
How do I know if a trauma treatment is right for me?
Notice how it feels to be with the practitioner, and ask whether they have had the treatment themselves and whether it helped. If it does not help you, that points to the fit, not to something wrong with you.
In This Episode
0:58 What makes trauma unbelievable, unbearable and overwhelming?
1:44 Why can't people tell their trauma story?
2:20 Why was a patient calm with a knife through her arm?
6:10 Why does being unable to move make an event traumatic?
10:10 How does learned helplessness take hold?
12:30 How does trauma create an inner map of the world?
16:30 How does a dysregulated nervous system affect health?
19:30 Why does treatment need to address sleep, appetite and digestion?
21:00 What does a life worth living look like after trauma?
24:30 Why can't you be curious when you are traumatized?
30:40 How do you find the right trauma therapist?
Resources and Guides
Steps to Identify and Heal Trauma: A Roadmap for Healing (free guide mentioned in this episode): what trauma is, how to identify it, and the steps to heal.
2-Minute Assessment for Stored Trauma (free): find out which pattern of stored trauma your body is running and where to begin.
The Foundational Journey: a 5-week guided journey through the essential sequence, with the somatic and parts practices that lay the foundation for deeper trauma work.
The Biology of Trauma by Dr. Aimie Apigian, with a foreword by Dr. Gabor Maté.
Related Podcast Episodes
The biochemistry underneath how we respond.
How early chaos shapes the adult nervous system.
For when you know the danger is over and your body has not caught up.
How the inner map forms in the earliest years.
What decides the timeline once you start.
About the Guest
Dr. Bessel van der Kolk is a Boston-based psychiatrist, author, researcher and educator. He has spent his career studying how children and adults adapt to traumatic experiences, and has translated findings from neuroscience and attachment research into a range of treatments for traumatic stress. He is the author of The Body Keeps the Score.
Your host: Dr. Aimie Apigian is a double board-certified physician in preventive medicine and addiction medicine, author of The Biology of Trauma (foreword by Dr. Gabor Maté) and the founder of the Biology of Trauma® framework.
Research
Seligman MEP, Maier SF. Failure to escape traumatic shock. Journal of Experimental Psychology. 1967;74(1):1-9.
Maier SF, Seligman MEP. Learned helplessness at fifty: Insights from neuroscience. Psychological Review. 2016;123(4):349-367.
van der Kolk B. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking; 2014.
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