Depression has been defined by Freud as a "state of unending mourning." We have to process what we have lost.
The difference between "mild" depression and prolonged chronic depression - is in the level of impaired functioning. How much is “just” about feeling stuck or sadness versus how much is it about losing motivation in the things that have filled my life. Depression tends to spread.
We all experience hard times and manage to get back on our feet. When is it worrying and needing 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 to signal to us that we need to slow our pace, slow down, process something. Some of the depressive episodes will go away spontaneously and some will not. As mentioned, CBT or medication are effective in dealing with depression. Depression can occur even after great success or exit. On the one hand - there’s a lot of money in the bank and a reward for the hard work, and on the other hand - you feel empty. Also in the sale - there’s a feeling that the baby is "stolen" from me and then it’s accompanied by a feeling of worthlessness.
There is a blurring of boundaries between the startup and myself - like a mother related to a baby who needs to learn to let go and internalize the separation - because that is what will help the child grow. The sense of value and meaning are so closely linked in a startup, and the entrepreneur doesn’t see themself without them.
In depression, you can’t always see the way out of it, which can lead to suicidal thoughts - thinking that it will be the only solution and way out that no one will suffer from (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. Whenever there is any doubt, there’s no doubt, it’s time to consult with a therapist.
Suicide, comes at high levels of depression - when we feel we can no longer cope with reality, and therefore, it’s important to create an organizational climate that sees adversity, depression, sadness and loneliness - and spot 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 a number of rising indicators, including job satisfaction and a sense of well-being.
When the depression is severe / stubborn - a psychiatrist is also called in, who often uses medication to help balance the neurotransmitters in the brain (for example, SSRI drugs that affect serotonin activity and others). The goal of such drug treatment is relatively short-term use.
Depressive episodes are usually temporary - even up to 6 months. In some people the depression is long and then the treatment will also be longer. Medication will usually be accompanied by talk therapy.
And yes - there’s a stigma against psychiatric medical treatment, since people don’t want to be stigmatized. Most people who need medication - will receive gentler types.
Situations of higher-dose pills, psychiatric intervention and even hospitalization, 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 produce 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 artform to find the right type of treatment. There’s also tolerance to medication and needs to be replaced from time to time."
Entrepreneurs also see the benefit of taking a pill - it saves time and works fast.
It’s important to remember - depression is an experience that is very difficult for the environment to digest and provokes antagonism. Dealing with this is difficult and painful and sometimes you can feel as though there’s no air in the room and the catastrophic visions of the future are so powerful that there is a reluctance to see the future.
ADHD/ ADD - Attention Deficit Disorder
It’s a difficulty in regulating, controlling impulses, and cognitive and emotional attention disorders.
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 "breaking records".
On the other hand - this thing creates difficulty in controlling our impulses and regulating our behaviors. It can also lead to the phenomenon of addictions - which aim to produce a shielding of mental pain, which is why people turn to "self-healing" 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 functioning in relation to the other mental struggles we have mentioned.
There are also people who use Ritalin to be more focused - without any medical justification, and 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 that go through their mind in the same breath, the quantum leaps they can produce. While among children today - it’s often diagnosed in educational settings, as adults, we are not necessarily diagnosed as young children and suddenly we feel it more like you as entrepreneurs. An older person can benefit even more from the treatment - both because the treatment is very focused, and also the ability to enjoy the special energy that accompanies ADHD without sinking into anger.
Bipolar Disorder is defined as an extreme changes in moods between mania and depression. The person experiences a change between a manic mood characterized by a lot of energy and doing, a feeling of lack of fatigue, a feeling of greatness, and a state in which one is depressed - lying in bed, disconnected, not moving.
There are 3 types of Bipolar Disorder that are defined according to the intensity of the mania:
Bipolar 1 - strong mania;
Bipolar 2 - hypomania (mania in a less powerful form; the person is able to function and it doesn’t seem abnormal);
Cyclothymic disorder - a chronic mood disorder, characterized by fluctuations between depression and hypomania less acute than in bipolar 1 and 2 disorders. Studies have found that among the causes of the condition are also changes that occur in a person’s internal clock and the use of chemicals or medications taken incorrectly.
The purpose of drug treatment for Bipolar Disorder is to reduce the amplitudes (transition between states) and the magnitude (duration) of the outbreaks.
Talk therapy for Bipolar Disorder helps to identify early triggers, pay attention to when and why I get into it and how I can protect myself (and not for example get into an uncontrolled shopping spree or dangerous driving on the road).
When entrepreneurs deal with both ADHD and hypomania - they see it as more of an advantage than a disadvantage. "I have a crazy missile engine that I was born with and that allows me to reach peak results." And 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 and stage in their entrepreneurial journey. The pace of events and changes, their occurrences and their response to the ever-changing reality - and this is a response that 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 a number of systems and life cycles (family, society, team). Sometimes the identification comes precisely from the environment that is drawing attention to the existence of the problem. The 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 coping with them, and this happens 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 and erupting the crisis is, or perhaps it was present throughout life, and now slightly increased in dose. The entrepreneur goes through the crisis, and then if everyone is in sync with his value for the company, they manage to overcome the crisis. It requires the joint efforts of the entrepreneurs, professionals, investors, family - a significant support system.
When the depression / anxiety attacks / depressive state of mania-depression don’t go away for an extended period of time, the most humane thing is to help mediate this to the entrepreneur himself. Of course this will also include a process of mourning and loss on departure, and it’s important to do so in the most humane way possible. Exchange of CEOs / entrepreneurs leaving certainly stems from the background of mental struggles, as in the case of Uber and WeWork, in situations where investors will want to maintain the good of the company. There are also cases where the entrepreneur will "burn all the bridges” in case of leaving.
A traumatic response to past events. The experience is that it’s not possible to completely return to the day to day life routine because of worries, thoughts and memories that come back and arise from the difficult events in the past and often a difficulty in functioning normally on a daily basis.
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 that they are being controlled and managed from this place. Trauma can also occur as a result of degrading or violent behavior - even verbal - from a person perceived as threatening such as an investor or board member or direct boss. Of course it can also arise as a result of a physical assault, or any event that is personally 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 itself experiencing trauma as a whole, which will affect efficiency, creativity, suspicion and the freedom to take professional risks. This will often result directly from the entrepreneur's own personal feeling following the event that occurred - failed recruitment, criticism of the postponement of version release, massive layoffs, etc.
ASD - Autistic Spectrum Disorder
In the worlds of development and technological fields - there is a higher prevalence of entrepreneurs and workers who are on the spectrum - and 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 humor / cynicism well and sometimes don’t know how to respond well 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 have 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.