Being a founder, not to mention a CEO, can be a very lonely place, carrying loads of stress and requiring to constantly be at peak performance. This often makes it hard to find a balance between one's professional and personal life. Maintaining strong relationships with the co-founders and investors is also not an easy task, where clarity and empathy are not always present. As one of my entrepreneurs says: “It’s not the technological challenge we deal with, it’s the mental one.”

“Throughout my +15 years as a professional, I've always been attracted to the intersection of business and psychology through entrepreneurship - What makes people tick? How do people think and act? And what motivates people in business? What drives me is being there for the amazing entrepreneurs, who are under constant pressure, so that they can make our world a better place. That’s what I’m here for, and this is my podcast – The Human Founder.”

With Yariv Ganor and Dr. Yaron Sela

Do entrepreneurs suffer from psychological disorders more than the general population?

I invited 2 friends of mine, who are clinical psychologists that research this question in depth, who also work with entrepreneurs to shed some light on the psychological aspects of being an entrepreneur.

Dr. Yaron Sela is an expert clinical psychologist and organizational consultant. He did his postdoctoral research fellowship on ‘the Psychology of the Internet’ at Reichman University and investigates the connection between psychology and technology in diagnostic and clinical aspects.

Yariv Ganor is an industrial and clinical psychologist specializing at Geha Hospital (one of Israel’s psychiatric hospitals), working with entrepreneurs and high-tech personnel. He made a "pivot" to the world of psychology after 15 years as a CMO in multiple technology companies.

When I was in the first year of my psychology degree, studying Hilgard's ‘Introduction to Psychology’, I remember that the lecturer gave the following disclaimer and I want to pass it on to you: When you read the content below, there is a high probability that you will identify with much of what you see. It’s natural and familiar to us since we are all dealing with something, at some time. But don’t rush into diagnosing yourself, rather try to understand what it is evoking in you. If you feel the need for emotional support, do not hesitate to seek the help of a suitable professional. It can save your life or those around you.

Personality structure

Let's start by looking at the aspect of personality - not everyone is suitable to be an entrepreneur. According to Steve Blank (author of ‘The Startup Owner’s Manual’), the right team is made up of a hacker, designer and hustler.

The hacker (the geek of the team) has a passion for technology, loves to build it; is a developer, an avid engineer, and creates algorithms and intellectual property. The hacker eats, sleeps and breathes code.

The designer (the hipster of the group) is an artist; he’s an architect and builds the brand. He makes sure that the user interface and experience are simple and likable. The designer eats, sleeps and breathes design.

The hustler (the visionary of the crew) has an extensive business orientation and knowledge. He is a good salesman, builds the team and culture, ignites the passion, passes the pitch to investors and makes tough decisions under the extreme uncertainty that startups work in. The hustler eats, sleeps and breathes the business model.

Usually, if a startup is founded by less than three people then one of the founders has to wear multiple hats to balance out the team.

In 2018, a study was published in the U.S. showing that almost 50% of entrepreneurs come from a home where at least one parent suffers from a psychological disorder – which can be a figure indicating genetic predisposition, or a factor that plays a significant role in the environment that the entrepreneurs grew up in.

The question of how a person deals with stressful situations always arises. There are entrepreneurs who have a higher ability to show resilience and those who are more vulnerable to it.

Entrepreneurs reside in the space that David Winnicott (English pediatrician and psychoanalyst) defines as the transitional space or the ‘potential space’ – the intermediate area of an experience that is nestled between fantasy and reality. It’s a mental space that sits between subjective ability and objective reality. This mental space is the basis for both creativity and the ability to expand the concrete daily experience. Entrepreneurs need to maintain the tension between these two aspects of vision and market it to the whole world.

Entrepreneurs are people who live at a high frequency for a long time. They have very high standards for themselves as well as for their environment. The uncertainty surrounding the world of entrepreneurship produces 2 poles - on the one hand, they are able to do exciting and influential things, but on the other hand, if they are not ‘on top of everything’ there is a lot at risk. Yes, with greater risk comes great reward, but the same holds true for failures- when you fail, you fall hard. Some people are aware of this risk, while others are not.

The same study published in 2018, indicated a high prevalence of the following psychological disorders among entrepreneurs. When compared to the general population entrepreneurs were 10 times more likely to suffer from bipolar disorder (manic depression), 6 times more likely to have ADHD, and 3 times more likely to suffer from addiction and depression.

How many people on your team were gifted as children?

Gifted children are children with special needs. Sometimes they have difficulty with social understanding and interactions. They are super intelligent, but sometimes there is a disconnect between their personal abilities and their emotions. When you’re a gifted child - people are always proud of you for your achievements and more often than not you get to join gifted programs that help you develop. But what happens when you are a gifted adult? How do you live with it in a "normal" environment? How do you manage the threshold of expectations? How do you always cope with dealing with the outside world, which can sometimes feel overwhelming for you? The mental and professional axis can develop greatly, but the emotional axis is not necessarily in harmony with them. And yes, in high-tech, there are a lot of gifted kids who have grown up and today have to deal with their 'giftedness' on their own.

Anxiety

Anxiety is a psychological and physiological condition in which a person feels fear alongside physical and mental restlessness, due to the thought that something bad is about to happen. Anxious thoughts can be thoughts of both real and imaginary threats and danger and may appear consciously as well as unconsciously.

You can suffer from anxiety no matter your self-worth; high self-esteem or low self-esteem, no one is immune. Your anxiety can stem from a past failure or fear of failure, but can also stem from a narcissistic nature of needing to prove yourself, which is an engine of growth. So in a way, that is the ‘catch’ of having anxiety - it has 2 sides and can be a double-edged sword.

Anxiety can have physiological effects like accelerating your heartbeat or causing excessive sweating. The sympathetic system in our body goes into action. "It's like a car in stormy weather - the alarm starts working but with no definitive cause."

Anxiety can have cognitive and behavioural effects as well, such as recurring thoughts, nervousness, and insomnia. It can also have emotional effects like worry, frustration, and even anger. Most people will experience anxiety one way or another. Entrepreneurs' main anxiety is the fear of not delivering - which can cause constant worry, insomnia, and cold sweat. A more general anxiety that they feel is what will happen if the startup fails.

OCD, obsessive-compulsive disorder, also sits on the anxiety spectrum; To neutralize our anxiety we produce repetitive rituals for ourselves. In anxiety, one feels that their bandwidth is reduced. When this occurs, entrepreneurs feel less sharp and focused. They feel something is wrong. Entrepreneurs have high-performance capabilities, so they can push these feelings aside but that often just delays the outbreak.

Yariv shares how at age 43 he went out for a run on a hot night, and when he was finished his heart rate wouldn't go down. It started at a solid 110 bpm. At the time, he was a CMO of a company before a big investment round which was a very tense time; living between the promises he held and what would actually be delivered. At 2 a.m. that night, he wasn't really well and was nervous he had had a heart attack, so he went to the hospital. No one called it a "panic attack" out loud. “No one talked to me about it. There was a very common stigma: not to mention it or talk about it; The fear of crashing in the peak moments. When a friend told me that "you probably had a panic attack" - it reassured me. I realized I was not alone. Since then, anxiety has become my friend, I realized it was a part of us.”

Another syndrome from the anxiety family is impostor syndrome– doubting our capabilities to a point that we fear someone will find out that we're “not supposed to be there”, and “that it’s all just mere luck or an accident” that we made it this far.

Naming your anxiety can be a very calming element. We define and limit the catastrophe.

It’s easy for the body to pay attention to anxiety when there are physiological signs - they need to be given space. But when it's just emotional – it's harder to notice. Studies show that soldiers during battle didn't even know they were injured because of the adrenaline. The sympathetic system operates in a fight mode and is therefore still high functioning - but over time this causes physiological damage. Many times, entrepreneurs operate in the same way– "in the trenches", all the time– but the underlying damage accumulates, in spite of their ability to continue to perform at high capacities.

So how do you deal with anxiety?

1. Give it a name–It’s not something to be ashamed of

2. Talk about it

3. Wrap ourselves in a supportive environment– Sharing with the people closest to us makes it very easy and helps us understand that we are not alone. A lot of times, when we are the ones experiencing a situation, our judgment is clouded. However, our peers' judgment is not. So if we speak out about a certain situation, they will be able to tell us that what we are going through is not okay. Sometimes they can put their finger on it better than we can, so sharing our anxieties or anxious situations is important. Sometimes we experience a split, where we have some people who we know we can talk about it with, and others who we know we can't. Often, we are fearful to talk about it, so we keep it to ourselves, but that can create a great feeling of loneliness, so it is important to have an outlet.

4. Going to therapy– Entrepreneurs have high crisis management skills and maintain resilience - but still, when anxiety appears - it’s worthwhile to find out what is going on with us more in-depth because sometimes it is actually related to things/ affects things not related to entrepreneurship so it is important to pay attention to them.

5. The world of therapy – one of the most effective treatments for dealing with anxiety is CBT - Cognitive Behavioral Therapy. The essence of this treatment is understanding that the way we interpret reality affects our emotions. It’s a focused and short treatment (on average about 12 sessions) with evidence that it works and helps in dealing with anxiety, depression and OCD. What does it include?

• Finding out the focus of the difficulty and the triggers that lead to anxiety
• Working on interpretation - and working with non-adaptive cognitions
• Adopting additional interpretations in which there is greater psychological flexibility
• Focus on the present
• Give the patient the skill to offer further interpretations on his own. In the business world – it’s very much related to scenario planning while thinking about a business move and all the possibilities it can lead to.
• Introducing a calming element – the connection of mind and body is proven to help and can be done through different techniques: meditation, guided imagery, mindfulness, listening to the body, and body review. A patient can get homework, for example, practicing a few minutes of meditation before bed to calm the flow of thoughts.
  

Aside from CBT, another branch of psychology has emerged called ACT - Acceptance & Commitment Therapy. It talks about our acceptance of the situation. While CBT helps to change interpretation and thought patterns - ACT advocates accepting existing conditions and working with them. This is a slightly different discourse.

Today, in the U.S. and Europe, it’s starting to be more legitimate to talk about anxiety - especially in the context of the employment market. Not coming to work because I don’t feel well from an anxiety attack is a real, tangible and important thing. We must give place to this discourse. In Israel, where everyone is a (seemingly) strong military veteran - and certainly in the entrepreneurial ecosystem - there’s a lot of egos; a strong image to protect and a sense of shame if you speak about it. But that’s the thing - this image is fake, and there’s no reason to remain within that illusion; we as entrepreneurs who build companies need to start leading this change - not only to build companies that do good for the world or for our users/ investors, but also for our employees and for ourselves. Anxiety is a disease that is not seen, and so it should be talked about in order to give it the place it deserves.  

Addictions

Anxiety is the "threshold" in which we deal with emotional and mental difficulties and if there’s no change in the environment / don't learn effective ways to deal with it, it can get worse. Entrepreneurs (and people in general), can get into the habit of dealing with anxiety and other issues by changing our conscientiousness state with substance abuse (like drugs and alcohol). This can lead to addictions and even put us into psychotic states.

Many times, the source of our many psychological problems is the need for control. I feel that "I must have control, otherwise something bad will happen." Sometimes we glorify this thought and become a slave to this way of thinking. In CBT, for example, there’s the intention to shift from a state of total control to partial control - what I control and what I don’t control, and through the therapy, you learn to tolerate these uncertainties. It’s important to note that there are many cases where intensive use of addictive substances can worsen the mental state of the entrepreneur and even lead them to enter a psychosis episode in which significant intervention at the therapeutic level is necessary. It’s important to lay it here - drugs are not the solution, and they can be a slippery slope to much more complex situations.