Being a founder, not to mention a CEO, can be a very lonely place, carrying loads of stress and required 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
Depression has been defined by Freud as a "state of unending mourning." We must process what we lost.
The difference between "mild" depression and prolonged chronic depression is in the level of impaired functioning. How much of it is about feeling stuck or sad versus how much of it is about losing motivation in the things to fulfill my life. Depression tends to spread.
We all experience hard times and manage to get back on our feet. When is it worrying and when should I seek guidance from a professional? When it's "stubborn."; a period of a week where the feeling doesn’t pass justifies the intervention of a professional.
Depression is a means of the body signaling to us that we need to slow our pace, slow down, or process something. Some of the depressive episodes will go away spontaneously and some will not. As mentioned in Part 1 of this series, CBT or medication are effective in dealing with depression. Depression can occur even after you experience great success in your company. For example, on the one hand, there’s a lot of money in the bank and you have been rewarded for all your hard work, but on the other hand, you may feel empty. Also, in case of a company being sold, there can be a sensation in which you feel your “baby was stolen" from you, which is accompanied by a feeling of worthlessness.
There is a blurring of boundaries between the startup and the founder - like a mother who needs to learn to let go and internalize separation from her children - because that is what will help the child grow. The sense of value and meaning are so closely linked in a startup, and sometimes the entrepreneur can’t see themselves without it.
With depression, people can’t always see a way out of it, which can lead to suicidal thoughts - thinking that it will be the only solution and way out to ensure no more suffer (which of course is not true).
And this is the time to mention - whenever such a frightening thought arises - it’s a warning light and a ringing bell that you must not ignore. If you have such thoughts, do not hesitate to get help, and consult with a therapist.
Suicide comes at high levels of depression - when we feel we can no longer cope with reality. Therefore, it’s important to create an organizational environment that sees adversity, depression, sadness, and loneliness, and spots the changes in behavior and the energy of the person. Studies show that when there’s a culture of listening in an organization, employees' ability to share failures increases, and this leads to several rising indicators, including job satisfaction and a sense of well-being.
When the depression is severe/stubborn, a psychiatrist can also be consulted, who often uses medication to help balance the neurotransmitters in the brain (for example, SSRI drugs that affect serotonin activity). The goal of such drug treatment is relatively short-term use. Depressive episodes are usually temporary (up to 6 months) but in some people the episode can be longer, therefore so is the treatment needed. Medication will usually be accompanied by therapy. And yes, there is a stigma against psychiatric meditation, and since people don’t want to be stigmatized, they avoid it. But remember, most people who need medication will receive gentler types to make the transition easier. Of course, situations of higher-dose pills, psychiatric intervention, and even hospitalization do exist but are not very common.
Yariv says that "We need to look at mental balance like diabetes - take a pill to take care of our health and live a balanced and efficient life– it’s nothing to be afraid of." Yaron adds that "It's like scaffolding that will help us continue to function. If we need it - then we need it. It obviously requires the involvement of a doctor and it’s an art form to find the right type of treatment. There’s also tolerance to medication which can lead to needing to change up a regiment from time to time."
Entrepreneurs also see the benefit of taking a pill - it saves time and works fast.
It’s important to remember that depression is that for some reason our environment has difficulty digesting which provokes antagonism. Dealing with this can be difficult and painful; sometimes you may feel as though there’s no air in the room; you may have a catastrophic vision of the future. These feelings are very powerful, so much so that they may cause a reluctance to see the future with clarity, if at all.
ADHD/ ADD - Attention Deficit Disorder
This disorder makes it difficult to regulate and control impulses, cognitive, and emotional attention. Entrepreneurs suffer from this 6 times more than the regular population!
Entrepreneurs, who "live on steroids", sometimes feel that ADHD is a part of what gives them their own fast pace and allows them to "break records". But on the other hand, it creates difficulty in controlling our impulses and regulating our behaviors. It can also lead to the phenomenon of addictions - which aim to produce a sort of “shielding from mental pain”, and so many people turn to "self-medicating" in the form of cannabis/drugs/psychoactive substances. There is a correlation between ADHD and substance abuse.
Because ADHD is chronic, it’s perceived as "less disruptive” to our functioning when compared to other mental struggles (mentioned above). There are also people who use central nervous system stimulant medication like Ritalin, to be more focused even though they don’t have any medical justification for its use. Of course, this is not recommended.
So, what does ADHD look like for entrepreneurs?
The quick mental ability, the rhythms, the entrepreneur's thought process, and the flow charts, the quantum leaps they can produce– all of these things go through their mind, in the same breath. Though among children today, ADHD it’s often diagnosed in educational settings, adults, who weren't diagnosed as kids often don't get diagnosed at all. This is a shame, because even an older person can benefit from the treatment if appropriate - both because the treatment is very focused, but also allows for the ability to enjoy the special energy that accompanies ADHD.
Bipolar Disorder is defined as an extreme change in moods between mania and depression– manic being characterized as having a lot of energy, not getting tired, and a feeling of greatness, while the state of being depressed is often accompanied by lying in bed, being and feeling disconnected, and not moving.
There are 3 types of bipolar disorder which are defined according to the intensity of the mania: Bipolar 1 - strong mania; Bipolar 2 - hypomania (mania in a less powerful form; the person can function, and it doesn’t seem abnormal); Cyclothymic disorder - a chronic mood disorder, characterized by fluctuations between depression and hypomania (which is less acute than in bipolar 1 and 2 disorders). Studies have found some causes of bipolar are due to changes in a person’s internal clock and the improper/incorrect use of chemicals or medications.
The purpose of drug treatment for bipolar disorder is to reduce the amplitudes (transition between states) and the magnitude (duration) of the outbreaks.
Conversational therapy for bipolar disorder helps to identify early triggers, pay attention to when and why the episode occurs, and how I can protect myself against it (and not, for example, go on an uncontrolled shopping spree or dangerous drive on the road).
When entrepreneurs deal with both ADHD and hypomania - they see it as more of an advantage than a disadvantage. They see themselves in having a crazy missile engine that they were was born with that allows them to reach peak results. The idea is to learn how to moderate it and make it serve us in a balanced way.
It’s important to pinpoint the difference between bipolar disorder diagnosed as a mental illness according to DSM 5 as described above, and a situational phenomenon we call mania-depression in everyday language, which describes the roller coaster that entrepreneurs experience every day at every stage in their entrepreneurial journey. Due to the pace of events and changes, this type of behaviour as a response to the ever-changing reality is very much in line with the complex reality in which entrepreneurs live.
What happens when the CEO suffers from depression or manic depression?
Entrepreneurs are part of several systems and life cycles (family, society, team). Sometimes identifying their problems comes from the help of their environment which is why having a supportive environment is a critical parameter for coping. Part of building entrepreneurial and organizational resilience is to build an environment that allows for "early detection" of mental crises and enforcing boundaries on how to cope with them– this can be achieved by genuinely listening to people.
When the CEO is dealing with depression or a manic-depressive episode - in the first stage, it’s important to diagnose how severe the crisis is, or perhaps it was present throughout life, and now slightly increased in this phase. The entrepreneur goes through the crisis, and then if everyone is in sync with his values for the company, they manage to overcome the crisis. It requires the joint efforts of the entrepreneurs, professionals, investors, and family; it requires a significant support system.
When the depression/anxiety attacks/depressive state of mania-depression don’t go away for an extended period, it may be best to intervene. If it leads to the dismissal or temporary leave of the entrepreneur, do it in the most humane way possible. Exchange of CEOs / entrepreneurs due to mental struggles, happens, like in the case of Uber and WeWork, as investors want to maintain the good of the company. There are also cases where the entrepreneur will "burn all the bridges” while leaving.
PTSD is a traumatic response to past events. The experience is that it’s not possible to completely return to the day-to -day life routine/ functionality because of fears, anxieties, thoughts, and memories that come back and arise from the difficult events in the past.
When the situation of leaving a startup (whether due to financial situation, layoffs or even an exit in which the entrepreneur leaves the company) is not done in a comprehensive and empathetic way - leaving can be a complex experience that burns into our skin as trauma and accompanies entrepreneurs later in their business and personal lives– so much so that they are being controlled and managed from this place. Trauma can also occur because of degrading or violent behaviour - even verbal - from a person that is perceived as threatening, such as from an investor or board member or direct boss. Of course, it can also arise because of a physical assault, or any event that is experienced as extremely threatening.
If the struggle of the entrepreneur is exposed and handled in therapy at an early stage - it is possible to help them cope and return to control. The danger in post-trauma is that it’s perceived as an experience of helplessness and may also worsen and develop into more complex symptoms and persistent anxieties.
In addition, especially in startups, one can talk about the organization/ company itself experiencing a trauma, which can affect efficiency, creativity, suspicion, and the freedom to take professional risks. This will often result directly from the entrepreneur's own personal feeling following an event that occurred - failed recruitment, criticism of the postponement of version release, massive layoffs, etc.
ASD - Autistic Spectrum Disorder
In the development and technological fields, there is a higher prevalence of entrepreneurs and workers who are on the Autism spectrum (dealing with Asperger's and/or autism).
They are less emotionally involved in things and managerial moves, and stronger in the technical and technological aspects. They don’t always understand humour/cynicism well and sometimes don’t know how to respond to promotions, or refrain from asking for or conceding to such. They are great workers but will sometimes be afraid of leadership and management roles.
In conclusion, we all deal with mental health, and I believe that it should be treated and strengthened even when "everything is fine".
Talk about it, be yourself, and be sensitive to those around you. Ask for a hand, reach out and turn for help if needed.