Imagine punching the clock every day and not knowing when you’ll be paid. On top of that, this pay is not only responsible for your livelihood but also for the livelihood of those whom you employ. What if you don’t get paid, or the checks come late, then what do you do? Even if you have a reserve, no pay and slow pay siphons those reserves over time.

And those endless decisions. Decision after decision. Make the wrong one and the domino effect gets real – fast. It’s not just about you. Your employees show up every day, expecting to leverage the opportunity you’ve provided to reach their goals. New cars, mortgages, babies – get it wrong and the greater good suffers. This is especially true for businesses with altruistic, rather than profit-center, missions.

For many entrepreneurs, this is the story of their lives. Fueled by both optimism and even pessimism at times, the world of an entrepreneur is nothing short of uncertain.

There are approximately 5.6 million entrepreneurs in the U.S., according to the Census Bureau. Entrepreneurship positively effects startup GDP per capita, exports per GDP, patents per population and job creation, according to World Bank. In the U.S. alone, startups create approximately 43 percent of new jobs annually according to Census Bureau’s Business Dynamic Statistics. The Small Business Administration calculated from 2000 to 2017, small businesses created 8.4 million net new jobs as opposed to 4.4 million jobs created by large corporations.

However, recent studies suggest that practically half of U.S. entrepreneurs suffer from poor mental health. One study, by University of San Francisco researcher Michael A. Freeman, focused on the ever-spiraling mental health crisis among entrepreneurs. It concluded that these men and women have at least one mental health condition like ADHD, bipolar disorder and a host of addictive disorders. According to Freeman’s research, entrepreneurs are:

  • 10 times more likely to suffer from bipolar disorder
  • Six times more likely to suffer from ADHD
  • Three times more likely to suffer from substance abuse
  • Twice as likely to suffer from depression, have a psychiatric hospitalization or have suicidal thoughts

Megan Bruneau M.A., RCC, an entrepreneur, whose bouts with mental illness led her to pursue a career in mental health, offers insight on the subject. Today, Bruneau is a therapist, speaker, podcast host among other titles. She writes: “A decade-plus-long battle with perfectionism-fueled eating disorders, depression and anxiety led me to pursue a master’s in psychology and a career as a therapist. I realized many of the characteristics that caused my suffering came from the same roots as the characteristics that caused my entrepreneurial strengths.”

Entrepreneurs have even more reason than other groups to hide their struggles: If people knew, it would be disastrous for business. Instead of seeking help, many self-medicate or simply suffer in silence as they deal with the following triggers:

Stress. Never-not-working is second nature for an entrepreneur. He or she could be (or seem to be) fully engaged in a conversation but secretly thinking about what was left off the task list, who needs a callback on Monday, or the follow-up needed to gauge the status of a new business lead. “We’re notoriously sleep-deprived, undernourished, over-caffeinated and financially constrained—with little to no emphasis on self-care and adaptive coping strategies (i.e., exercise and fun). Many of us live with a predisposition to addiction, vulnerable to developing unhealthy relationships to substances or other numbing tendencies,” Bruneau writes.

Uncertainty. Like everybody else, entrepreneurs want to see and touch whatever is coming down the pike, even as unrealistic as that is. Uncertainty is a natural byproduct of entrepreneurship. It’s that big fat question mark that courts and coddles anxiety.

Social isolation. This is a big one…Many people glamorize the notion of entrepreneurship. However, it can be very lonely. Entrepreneurs oftentimes work alone (even if they have employees). Isolation is a precursor for depression. “Additionally, even when not experiencing colleague-less aloneness, the interactions we do engage in are often networking or sales-focused, thwarting the vulnerability necessary for authentic connection,” Bruneau writes.

Optics. Making it look good at whatever the cost is draining. Yet, entrepreneurs often find themselves here because after all, protect that bottom line by any means necessary. There’s a fear that in order to be perceived as competent by stakeholders, weakness is not an option. Appear infallible, stable and have the right answers. This could lead to a new business referral if cards are played right. The truth is that insatiable need to demonstrate the right optics – all the time – promotes a level of disconnection that leads to depression, according to the experts, and leads to insecurity and identity confusion.

Barriers to care.
 Many business owners have either basic or no health insurance to help pay for the cost of mental health treatment. Paying out of pocket poses an even bigger barrier for many.

Predisposition to mental health challenges. According to mental health experts, entrepreneurs have a higher prevalence of mental health challenges than other populations. “The qualities that make me a great entrepreneur – creativity, empathy, adaptiveness, humor, independence, risk-taking, multi-tasking and crisis-management skills – come from the same roots of trauma as my experiences of shame, anxiety, perfectionism, ADHD and discomfort with stability,” Bruneau writes.

Identity and self-worth are fused with the company. It’s easy to lose yourself to your business. If there was no “X” company, then who would I be? Bruneau writes this leads to detachment and disconnectedness from friends, loved ones and sacrifices other sources of meaning such as relationships, parenting and even play. “The looming existential void (and self-worth tied to our company’s success) is a manifestation of perfectionism that causes both anxiety and an emotional roller coaster – dependent on our ever changing company forecast.”

The tide of entrepreneurial shame is changing. Many business owners have come out of the shadows to blog and podcast about their anxiety, depression and suicidal bents.

Freeman says this kind of openness about the positive and negative aspects of mental health issues is good for everybody. Awareness is growing that struggling with, while benefiting from, those mental health traits (i.e., creativity, risk-taking, humor, etc.) is [normal] for entrepreneurs, and that it’s okay to get help. “In my view, the next horizon we need to get to is how to help investors be okay about this,” Freeman says.

UC Berkeley’s Sheri Johnson said she’d like to see business 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 venture capitalists be a little more aware of it? Can we help corporate structures be a little bit more aware of it? Can we develop best-practice guidelines?”

The bottom line is simple. If half of U.S. entrepreneurs are battling mental illness and driving the world economy, mental health care should be an innate part of the business paradigm – from the classroom to the boardroom.

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