“The focus is not on helping people”: what van der Kolk meant, and what we did about it
One of the biggest names in trauma psychiatry made a blunt claim about who mental health care is actually built to serve. It is worth taking seriously, and worth being careful with.
On The Diary of a CEO, Bessel van der Kolk, professor of psychiatry at Boston University and author of The Body Keeps the Score, said something that has been clipped and shared a great deal since:
"The focus is not on helping people. The focus is on running successful financial organizations."
It is worth reading that in full, because the second sentence is usually the one that gets cut. Trimmed to "the focus is not on helping people," it becomes a blanket verdict on psychiatry, and on the individual psychiatrists doing careful work inside it. What he actually said is narrower and harder to argue with: that the institutions delivering care are organised around financial survival, and that this shapes what care looks like.
Why the distinction matters
A fifteen-minute appointment is not evidence that your doctor does not care. It is evidence of how the appointment is funded.
Reimbursement structures reward diagnosis and prescription because those are billable, discrete and quick. They do not reward the slower work of sitting with someone long enough to find out what happened to them, or coordinating with the four other people involved in their care. That is not a conspiracy. It is what a system optimises for when it has to keep the lights on.
Van der Kolk’s complaint, across decades, has been that trauma got squeezed out by this. Not because clinicians stopped believing in it, but because "what happened to you" takes time that the structure does not pay for, while "which symptom, which drug" fits neatly into the slot.
Where we would push back on the clip
Two things get lost when this quote travels alone.
First, van der Kolk is influential and also contested. Parts of The Body Keeps the Score have been criticised for outrunning the evidence, particularly on neurofeedback and yoga as trauma treatments. Being right about incentives does not make someone right about everything.
Second, and more importantly: this quote is used, constantly, as a reason not to seek help. That is a use it does not support, and it does real damage. If you are unwell, the imperfect appointment is still overwhelmingly better than no appointment. A system with bad incentives still contains people who will help you, medication that works for many, and, in a crisis, the only thing that reliably keeps people alive.
We would rather lose the rhetorical punch than have someone read a critique of healthcare economics on our blog and decide against calling their GP.
What we actually did about it
We cannot fix reimbursement. What we could do is take the incentive out on our side.
Mura is free. Not free-tier-with-an-upgrade-prompt. There is no paid plan, no session cap that appears once you are invested, no premium tier holding the useful screens.
That is a structural choice, and it is worth being specific about what it changes:
• Nothing here is designed to produce a second appointment, because there is no appointment to bill.
• The screens tell you when a result is unremarkable. A tool paid per finding has a quiet reason to find things.
• When the honest answer is "this needs a blood test" or "this needs a doctor," we say that. We have removed recommendations that did not hold up, including tests being sold commercially for conditions we screen for.
What this does not make us
Free does not mean neutral, and it certainly does not mean better than a clinician.
We are a screening and education tool. We can notice patterns, point at what is worth investigating, and hand you something more organised than a symptom list to bring to an appointment. We cannot diagnose you, we cannot treat you, and we cannot sit with you the way a good therapist can.
The honest version of van der Kolk’s point is not "avoid the system." It is that the system has structural reasons to be quick where you need it to be slow. The right response to that is to arrive better prepared, not to stay away.
If you are struggling right now, please talk to a professional. If you are in crisis, contact emergency services or a crisis line. Mura is here for the part before and around that, not instead of it.
This article is for general information and is not a substitute for professional care. If you are in crisis or thinking about harming yourself, please contact your local emergency services or a crisis line. See crisis lines.