The Reality of Mental Health and Startups

By Stefan Friend

It’s Mental Health Awareness Month.

It’s still not always cool to talk about mental health. Within the startup world, it’s still pretty heavily stigmatized. That doesn’t change the fact, though, that mental health is extremely important for all of us. We should consider it normal to talk about, seek help for, monitor, and improve as your physical health is. 

As we grow up, many of us find out that our families have a history of mental illness – myself included. I was aware of my family’s mental health challenges and it didn’t prevent me from having my own struggles with depression. It did, however, help me recognize that I had people that supported me and that I could rely on. But, mental health is complex and different for everyone, and even with no known family history, many people can develop anxiety, depression, PTSD, and others based on different factors in their lives. I also learned that there is an abundance of other resources that exist and support systems built to help people regardless of background.

I want to specifically focus on the unique mental health issues that founders, entrepreneurs, and startup employees go through, and rethink the stigmas associated with being in these realms. Entrepreneurs and their teams face unique challenges and work environment conditions that can produce a lot of uncertainty. With uncertainty comes mental health challenges that can quickly escalate.

The statistics around entrepreneurial mental health are startling. According to a study by Michael Freeman – a former entrepreneur and current psychiatrist who studies founders’ mental health – entrepreneurs are 50 percent more likely to report having a mental health condition. Here are some specific conditions being incredibly prevalent amongst founders:

• 2-times more likely to suffer from depression
• 6-times more likely to suffer from ADHD
• 3-times more likely to suffer from substance abuse
• 10-times more likely to suffer from bipolar disorder
• 2-times more likely to have psychiatric hospitalization
• 2-times more likely to have suicidal thoughts

While the mental health topic is variable, broad, and highly personal, there are some ways in which we can begin to tackle founder mental health and associated stigmas. *

*This post/list is composed of research and personal experience and is not written by a mental health professional. We, in no way, are suggesting that this should the place of seeking mental health help from a licensed professional. We always advocate that seeing one should be your first move. If you’re feeling suicidal, please call the National Suicide Prevention Hotline at 1-800-273-8255.

1. Kill the idea of “fake it till you make it.”

The toxicity of this mantra is brought to light by Jessica Bruder’s 2014 award-winning article from Inc.

“Rather than showing vulnerability, business leaders have practiced what social psychiatrists call ‘impression management’ – also known as ‘fake it till you make it,’” she says. The idea that we should pretend  “everything is perfect” can be a major player in negative effects on mental health as a whole – our own and those around us. 

 A study published in the Journal of Consumer Research found that people who tried to prove their worth to others were more likely to dwell on their own shortcomings. It’s the same rationale for why social media can make us feel bad about ourselves. It’s not an authentic look at each other’s lives because we’re curating what we’d like others to see. We tend to present the things that make us look successful and hide those which don’t. Transparency, though, is a hard concept to tackle – with ourselves and with the world. Admitting that we don’t have it all together is still a bit taboo, especially for entrepreneurs. It’s important to step back and recognize struggles as they come. This is part of what helps others, too, is taking away this stigma behind being transparent.

For my teams and I, the key difference is whether you’re focused on the appearance of having it all together – which ignores the challenges inherent to real growth and improvement – or you lean into the pursuit of perfection and recognize that it’s realistically unattainable. The value you get for yourself personally and professionally from being willing to fail fast and often, learn from trial and error, and learn vicariously from others, will ultimately accelerate a path to success much faster than “faking it till you make it.”

2. Build an identity outside of your work.

“Build a life centered on the belief that self-worth is not the same as net worth,” says Freeman in Bruder’s same Inc article. “Other dimensions of your life should be part of your identity.” Things like family, non-profit work, refurbishing furniture, dancing, bar trivia, etc. All these can make you feel fulfilled outside of your work. Making our work our life, as living in America has taught us to, diminishes our value beyond our work. As our labor becomes our identity, and as we become synonymous with our work, it makes it hard to find an identity beyond it. This is why it’s vital to do other things, if only for the fun of it.

One of the world’s leading thinkers on innovation, Clayton M. Christensen, wrote the book “How Will You Measure Your Life?” One of the key takeaways from it for me was the importance of relationships. It helped me build habits that allow me to slow down, stay present, and really give the most of myself to my relationships with others. The result is better connections, more meaningful experiences, and, in the case of work, more impactful results.

3. Ask for help.

Whether it’s from a fellow entrepreneur, another business owner, mentor, financial advisor, friend, investor, or most importantly, a therapist, it’s increasingly vital to recognize when we need help. No one gets anywhere on their own. Something I do to remind myself that I’m not (for lack of a better term) being needy, is I always reverse it. If someone came to me asking for my expertise on a business issue or conflict, would I be willing to answer their call and take a few minutes from my day to give advice? If the answer is yes, then don’t stress about asking the same from others. Chances are they’re more than willing. 

Beyond business help, therapy is always, always a good idea. The only person who can give anyone qualified mental health advice is a medical professional or registered therapist. You don’t even have to feel you’re struggling with your mental health – a therapist can help all of us sort out our thoughts and work on productivity. It’s always a good idea to seek professional help before anything else.

That all being said, I’m clearly not a therapist, but I am definitely willing to listen and help if I can for friends, family, employees or other founders. Don’t underestimate the importance of opening up to others. I’ve been fortunate enough to have great people around me, in and out of work, that I felt comfortable opening up to, being vulnerable with, and asking for help. I’ve found a lot of value in being vulnerable, and more often than not, the result of opening up first has been that it creates a culture where we all can be fully human. We ultimately move forward better together as a team and crush the goals we set for ourselves.

4. Don’t fall for hustle culture.

Brad Feld, a VC at Foundry Group, said in his column for Inc about his struggles with depression that “this is the very culture that turned the chestnut ‘pick yourself up by your bootstraps’ into a much-celebrated verb. Admitting you struggle with depression is like admitting you can’t reach your bootstraps. It’s assumed that successful people can just ‘shake it off.’ But that’s not how it works.”

And it’s definitely not. The idea – which has been cultivated and coined by much of startup culture – that we must grind 24/7 to achieve anything is detrimental to not only our mental health but also to our productivity as a whole. It leads to burnout. We need breaks, and we shouldn’t be ashamed of taking them.

Shame has been cultivated by American society as a mechanism for productivity, too, but its effects have been much more negative than positive. Shame is part of what stigmatizes. Mary C. Lamia says for Psychology Today, “When shame results in self-attack, it is overwhelming, and it can negatively color how you view yourself and how you assess the prospect of recovering your self-esteem.” Shame is part of what makes us feel guilty for having feelings. In turn, it has substantial effects on our mental health. In the world of entrepreneurship, when we don’t always feel productive, we feel ashamed of ourselves – like there’s something inherently wrong with us. Shame may be a motivator, but it’s one that often leads to anxiety, depression and confidence issues.

Over the past few years, and especially after a year of a global pandemic, we’ve found that all of these mental health challenges are more common than we ever realized. They have a deep impact on us and the world. Whatever challenges you might face, remind yourself that it’s more than okay to give yourself a break if you need it. I’ve been on both sides of this situation. I’ve pushed myself to the point of being sick – having a seizure in the office and being taken to the ER was the eye-opening experience that made me realize I needed a change. I’ve since been the biggest advocate for myself, my teams, and my clients that taking mental health days need to be a priority.

5. Use your resources.

This TechCrunch article articulates many of the struggles and mental health challenges of founders, as well as reasons why, with facts and research. It’s a great resource if you’d like validation or need much more context. 

National Suicide Prevention Hotline: 1-800-273-8255

Depression resources

Founder’s Therapy podcast (disclaimer: hosted by founders, not mental health professionals)

Psychology Today has a Find a Therapist tool.

It’s important to recognize when we might be getting into these negative cycles of working and come up with a plan to get out of them. This list is just a starting point, but ideally, as we start to disassociate negative stigmas from founder mental health, these ideas will become a part of normal life. Vulnerability is a muscle that can be practiced and built just like any other. The rewards from doing so are almost immeasurable.

If all of this still seems atypical, I get it. It’s only recently that I myself started to feel comfortable enough to share some of my own struggles with people outside of my close circle. Every time I’ve opened up, shared what challenges I was facing, how I was feeling, and the struggles internally that was creating, I’ve been blown away by the support and response, both inside and outside of the office.

Stefan is an investor and startup advisor helping entrepreneurs build scalable, innovative companies with the potential to positively impact lives. After a life-altering college rugby injury led to almost a decade of painkiller addiction, he’s since been sober for five years and enjoys helping others to find more clarity, build better habits, and create richly fulfilling lives.