Do entrepreneurs have Psychological Disorders more frequently than (strike among) the general population?

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I invited 2 friends of mine, who are clinical psychologists that research this field and also work with entrepreneurs to shed some more light on the psychological world of entrepreneurs.

Dr. Yaron Sela is an expert clinical psychologist and organizational consultant. He did his Postdoctoral 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 in Geha Hospital, working with entrepreneurs and high-tech people, who made a "pivot" to the world of psychology after 15 years as a CMO in technology companies.

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When I was in my first year of studying for my psychology degree studying Hilgard's ‘Introduction to Psychology’ course, I remember that the lecturer gave the following disclaimer and I pass it on, to you:

When you read all the content below - there is a high probability that you will identify with many of the things and think that you have everything. It’s natural and familiar and we are all dealing with something. But don’t rush to diagnose yourself with headlines - look at what it evokes in you. If you feel the need for emotional support or feel that your psychological operating system has come out of a calibration that feels normal to you - do not hesitate to raise your hand and seek the help of a suitable professional. It can save lives.

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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 operator / visionary (Hustler).

The hacker (geek) has a passion for technology, loves to build technology, he’s a developer, an avid engineer, creates an algorithm, creates intellectual property. The hacker eats, sleeps and breathes code.

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

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

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

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In 2018 a study was published in the US showing that almost 50% of entrepreneurs come from a home with a parent who’s dealing with a psychological disorder - which is a high figure indicating some genetic predisposition, or significant choice influenced by the environment into which they grew up.

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The question arises - how does a person deal with stressful situations? There are entrepreneurs who have a higher ability to show resilience and there are those for whom it will be an acute variable.

Entrepreneurs reside in the space that Winnicott defined as the transitional space or the ‘potential space’ - the intermediate area of ​​the experience, nestled between fantasy and reality. It’s a mental space that is in the intermediate realm between the experience of all the childish subjective ability and the 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 the aspects of vision and marketing to the whole world.

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Entrepreneurs are people who live at a high frequency for a long time and with a very high standard of expectations of themselves as well as from they’re environment. The uncertainty surrounding the world of entrepreneurship produces 2 poles - in one, I do exciting and influential things, and in the other - when for a moment I'm not ‘on top of everything’ - I can experience falls. Some people know where they’re entering and some are less aware of the prices.

The same study published in 2018, indicates a high prevalence of the following psychological disorders among entrepreneurs in relation to the general population:

Bipolar disorder (manic depression) - 10 times more

ADHD - 6 times more

Addiction - 3 times more

Depression - 3 times more

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How many around you or your team were gifted children in childhood?

Gifted children are children with special needs. Sometimes they have difficulty with social understanding and social interaction. They are super intelligent and smart, and sometimes there is a disconnect between their personal abilities and their emotions. When you’re a gifted child - it's great, people are proud of you and many times it also gets addressed in the form of special 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 like it’s not mediated enough? 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.

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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 may be thoughts of both real and imaginary threat and danger, and may appear consciously as well as unconsciously.

Anxiety can sit on a low or high self-worth combined with a sense of failure or fear of failure on the one hand, but can also stem from a narcissistic nature of “look at me,” which is an engine of growth. And this is the 'catch', the trap of anxiety - it has 2 sides.

Anxiety can have physiological effects of an accelerated heartbeat, excessive sweating. The sympathetic system in our body goes into action. "It's like a car in stormy weather - the alarm starts working but not always with a defined cause."

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Anxiety can have cognitive and behavioral effects - recurring thoughts, worry, insomnia.

Anxiety can have emotional effects as well - worry, frustration, and even anger.

It’s difficult not to be accompanied by a certain level of anxiety. Entrepreneurs' main anxiety is the complete fear of not delivering - which can cause constant worries, insomnia, days when I feel drenched in cold sweat. Above it, there is a general anxiety of what will happen if the startup fails.

OCD, an obsessive-compulsive disorder, also sits on the anxiety mechanism; To neutralize the anxiety we produce repetitive rituals for ourselves.

 In anxiety, one feels that they’re bandwidth is reduced. The entrepreneur is less sharp and focused. They feel something is wrong. Entrepreneurs have high performance capabilities, so they push it aside and it will often delay the outbreak.

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Yariv shares how at age 43 he went out for a run on a particularly hot night, and at the end of the run his heart rate remained at 110. He was then a CMO before a successful recruitment, and lived within the tension between the promises and the ability for actual execution.

At 2 a.m. he felt unwell, sure he had had a heart attack, and referred himself to the hospital. No one called it "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.”

The impostor syndrome is familiar to all of us - also from the ‘anxiety family’ - the fear that someone will find out that we're not supposed to be there, that it’s all just mere luck or an accident.

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Naming the Anxiety is a very calming element. We define and delimit the catastrophe.

It’s easy for the body to pay attention to anxiety, when there are physiological signs - they need to be given space. When it's just emotional - it's harder to notice. Studies show that soldiers during battle don’t even know they were injured - because of the adrenaline. The sympathetic system operates in a fight mode, still high functioning - but over time there is physiological damage. Entrepreneurs - Many times operate in the same way, "in the trenches", but the damage accumulates, in spite of the high physiological power to continue at high capacity.

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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. Many times when something squeaks - the immediate environment hints at it. Sometimes we experience a split - with whom it is right / possible to talk about it and with whom it’s not. It can also lead to very great loneliness - because of the fear of talking about it with people, and then we keep to ourselves.

4. Going to therapy. Entrepreneurs have high crisis management skills and maintain resilience - but still, when anxiety appears - it’s worthwhile to find out more in depth what is going on there, because sometimes it sits on other things that are not related to entrepreneurship at all and it is right 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 the understanding that the way we interpret reality affects our emotions. It’s a focused and short treatment (on average about 12 sessions) with research evidence that it works and helps in dealing with anxiety, depression and OCD. What does it include?

a. Finding out the focus of the difficulty and the triggers that lead to anxiety

b. Working on interpretation - and working with the non-adaptive cognitions

c. Adopt additional interpretations in which there is greater psychological flexibility

d. Focus on the present

e. 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.

f. Introducing a calming element - the connection of mind-body is strong and proven and can be done through different techniques: meditation, guided imagery, mindfulness, listening to the body, body review. A patient can get homework, for example, practicing a few minutes of meditation before bed to calm the flow of thoughts.

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

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

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Addictions

Addiction is actually the intensity of which we are exposed to a stimulus.

Anxiety is the "threshold of entry" into a world of emotional and mental difficulties and if there’s no change in the environment and / or benefit in the way I handle it - it can get worse. Entrepreneurs and people in general, can get into the use of consciousness-altering substances (drugs and alcohol) that can lead to addictions and even reach 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 must develop tolerance for this uncertainty. 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 psychotic states that require more significant intervention at the therapeutic level. It’s important to lay it here - drugs are not the solution, and they can be a slippery slope to much more complex situations.