Mental Health

Mental Illness May Plague Entrepreneurs More Than Other People. Here's Why (and How to Get Help).

One entrepreneur walks us through her struggle with the anxiety and depression that affects so many.
Mental Illness May Plague Entrepreneurs More Than Other People. Here's Why (and How to Get Help).
Image credit: Viktor Koen
Magazine Contributor
7 min read

This story appears in the July 2018 issue of Entrepreneur. Subscribe »

In seven years of running a startup, I experienced just about every emotion entrepreneurship has to offer: the adrenaline of launch; the calm energy of focused flow; the brittle, jittery high of riding a 2 a.m. work jag; the terror of feeling the mask slip, of telling an upbeat story to customers as panic churns in your guts; the grief of failure -- and the relief of failure, too; the ghostly lost-limb feeling that asks, Who am I if I’m not running this business?

Related: 4 Things My Battle With Depression Taught Me About Entrepreneurship

However, my mental health résumé is a lot longer than my entrepreneurial one. I’ve been dancing a medicated tango with depression and anxiety since childhood. I’ve racked up just enough time in the other wing of the hospital to be a bad life insurance prospect. I don’t have a formal ADHD diagnosis, but I suspect a clinical psychiatrist would take one look at my school records -- a tale of epic disorganization stuffed under a mattress of high achievement -- and call it like it is.

I often felt like my unruly brain made me an outlier in the startup world. But as it happens, faulty mental wiring like mine isn’t uncommon among entrepreneurs. A growing coterie of scientists -- psychologists, economists, management experts, business school professors -- are taking a long overdue look at the mental health of entrepreneurs. Their conclusion: Mental disorders are not only common but may actually fuel the entrepreneurial drive.

“These mental health conditions are accompanied by positive traits that enable entrepreneurs to excel,” says Michael Freeman, executive coach to entrepreneurs and clinical professor of psychiatry at the University of California-San Francisco School of Medicine. Take ADHD, a condition that research suggests is more prominent among entrepreneurial types. “If you have ADHD, two of the positive traits are a need for speed and an interest in exploration and recognizing opportunities,” he says. “[You have] an ability to act without getting stuck with analysis paralysis.” 

Related: 10 Ways to Turn Your Life Around for the Better

In a study published this year, Freeman’s research team found that entrepreneurs report elevated levels of ADHD, depression and substance use.  Another recent study discovered a link between entrepreneurial tendencies and traits associated with bipolar disorder. “One of the things we’ve found pretty consistently is that people with bipolar disorder tend to have very high levels of ambition and a willingness to persevere toward goals,” says a researcher on that study, Sheri Johnson, a psychology professor at the University of California-Berkeley and an expert on bipolar disorder.  

Symptoms and traits are not the same as a diagnosis, of course, and the effort to understand the relationship between diagnosed mental disorders and entrepreneurship is still in its infancy. But scientists are making gains. In one of the biggest studies on mental disorders thus far, the results of which were published last year in the IZA Institute of Labor Economics, researchers surveyed 9,800 college students in the Netherlands and found that students diagnosed with ADHD were almost twice as likely as other students to start a business.  (That’s not to say they’ll actually succeed -- which is a matter for further study.)

One of the biggest unanswered questions is just how prone entrepreneurs are to mental issues. There is plenty of anecdotal evidence that mental disorders are more common among entrepreneurs than in the population at large but little hard data currently available. 

To test that hunch, Freeman and several of his colleagues conducted a study, surveying 242 entrepreneurs and 93 control subjects. Nearly half of the entrepreneurs reported having at least one mental health condition, a rate significantly higher than in the control group. The entrepreneurs also reported having more mental illness in their immediate families than controls, suggesting that traits that drive entrepreneurship might be inherited, and linked to mental disorders. 

The results of that study weren’t officially published until this year, in Small Business Economics, but Freeman and his team released a draft in 2015 so their findings could be part of a broader conversation about entrepreneurship and mental health. “My main goal was to raise awareness of mental health among entrepreneurs, particularly those who might be suffering, so they can normalize the experience and then get help if they need it,” he says. It also goes without saying that some forms of mental illness can be catastrophic if left unchecked. A certain amount of gregarious optimism is helpful to an entrepreneur pitching VCs, but at higher levels, it can edge into destructive mania. And some bipolar entrepreneurs can fall into full-blown depression -- which is debilitating to a leader.

Related: Only 11 Percent of Employees Are Encouraged to Take Mental Health Days, and That's Tragic.

“One day you notice that nothing makes you happy, you’ve lost your motivation, your energy is low,” says Freeman. “Accept that that means you’re depressed and you have to deal with it. That is the responsible thing to do, not only for yourself but for your investors, employees and family as well.”

As science paints a clearer picture of how mental health differences shape and drive entrepreneurs, the business world itself has begun to grapple more seriously with issues of mental health. In blog posts and articles, founders are “coming out” about their struggles with anxiety, depression and suicidal impulses. It’s a movement fueled partly by tragedy, following in the wake of several high-profile suicides in the tech startup world, but also infused with a spirit of optimism. 

That kind of openness about the positive and negative aspects of mental health issues is good for everybody, Freeman says. There’s a growing awareness that struggling with mental health -- and benefiting from those mental health traits -- is normal for entrepreneurs, and that it’s OK to get help. “In my view, the next horizon we need to get to is how to help investors be OK about this,” Freeman says.

UC Berkeley’s Sheri Johnson would like to see incubators and business schools place a greater emphasis on delivering effective mental health support for entrepreneurs. “Can we at least broaden exposure to this topic in business training?” she says. “Can we help VCs be a little bit more aware of it? Can we help corporate structures be a little bit more aware of it? Can we develop best-practice guidelines?”

Johan Wiklund, a professor of entrepreneurship at the Whitman School of Management at Syracuse University, who is studying entrepreneurship and ADHD, wants to go even further in embracing entrepreneurial neurodiversity. “I’m interested in starting an incubator for people who are, you know, different,” he says. “It seems to me all incubators look the same and cater to the same population.”

We still have a long way to go, both in research and in practice. But as an entrepreneur touched with fire myself, it’s reassuring to know that these conversations are happening, and that I’m not alone.

“Most people would not do what you did and start a new business,” Freeman tells me, adding: “Everybody knows you have to be a little crazy to be an entrepreneur.”

If you are thinking about suicide or self-harm, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text the Crisis Text Line, a free text message service available 24/7, at 741-741.

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