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Isolated woman sitting on stairs staring at ocean, seeming depressed

Entrepreneurs, Stress & Depression

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Most entrepreneurs follow a “never-not-working” mindset and willingly sacrifice time, relationships, and financial security to build their businesses. Studies show that entrepreneurs suffer from mental health problems significantly more than the general population. While most entrepreneurs experience chronic stress, many develop depression. How can you tell if the stress you’re experiencing is normal or if you need to seek help?  Two entrepreneurs share their experiences with mental health issues as twenty-somethings at early-stage startups. For Hind Hobeika, Founder and CEO of Instabeat, prolonged periods of isolation and intense pressure during manufacturing setbacks manifested in chronic stress. For Andrew Dubowec, entrepreneur, investor, and VP of League, Inc., “normal” stressors compiled over time to trigger a significant mental health crisis. He shares how to recognize warning signs of clinical depression.

Entrepreneurs, Stress &  Depression

Is entrepreneurship bad for mental health, as Forbes stated in 2019? Or are entrepreneurs’ brains wired differently, potentially predisposing them to experience mental health challenges? High-achievers, both Hobeika and Dubowec resonate Type-A vibes. Each distinguished themselves as superstars in their academic pursuits. Hobeika had the idea for Instabeat, a revolutionary tracking device that allows swimmers to monitor their workouts in realtime, while she was completing her undergraduate degree in engineering in Beirut. She won third place in the multi-stage competition, “Stars of Science”—a pan-Arab reality show featuring young, predominantly male, students racing to turn ideas into marketable products. MIT Technology Review named Hobeika one of the “Top 5 Pan Arab innovators under 35” and Forbes featured her as one of 7 “Hottest Global startups” in 2013.

Dubowec also accrued impressive recognition. After completing a Bachelor of Commerce at Queen’s University, he worked for Wildfire, a division of Google. Subsequently, he earned an MBA from Harvard Business School where he distinguished himself as student-in-residence at the Harvard Innovation Lab. He was accepted into the competitive Rock Accelerator Program, for his startup idea, “openmind”—an online network that enables physicians, case managers, and counselors to coordinate patient care. His idea won an award and was described as one of the “most promising startup ideas from Harvard.” After graduation from HBS, he joined Thalmic Labs (now North), a pioneering wearable computing company that raised $120+ million was rapidly scaling. As VP, he shouldered significant financial responsibilities.

Pressure to Succeed

woman swimming underwater, alone, wearing goggles
Hind Hobeika swimming with Instabeat performance tracking device. Source: Instabeat.

By 2019, Instabeat became known as the “Google Glass and the Nike Fuelband for swimming.” But Hobeika labored for over six years to perfect the original prototype. Along the way, she reached dizzying pinnacles and abysmal lows. She endured cultural isolation, ran out of funding, struggled with problematic prototypes and unreliable manufacturers. In the midst of challenges, she moved to different continents three times. As a young woman founder in the Middle East and North Africa (MENA) the media lauded her as a role model, reporting frequently on her actions. The broad exposure added additional pressure to succeed.

When she ran out of funding the first time, Hobeika launched a successful crowdfunding campaign on Indiegogo. But even that success carried a self-imposed stress-provoking sense of obligation.

I need to ship to these people, I cannot fail.”

 

Losing Sleep  & Connections

During the first few years of running her business, Hobeika’s behavior changed. Hyper-focused on building a successful prototype, she became increasingly disconnected from friends. As the sole founder of a startup, she had little in common with peer-group in Lebanon and felt intense pressure to succeed. Working incessantly, she stopped actively playing sports and barely slept. She remembers, “I almost stopped swimming. Every time the prototype would not work, I would just avoid the pool. I gained a lot of weight. I was taking zero care of myself. 

One of the key stressors that make entrepreneurs especially vulnerable to serious mental health issues is social isolation. Hobeika combatted hers in part by moving to San Francisco and finding advisors. While establishing a team and network, she entered a promising deal with Flex, a prestigious global manufacturer who seemed to be a perfect fit. But Flex struggled to meet Instabeat’s complicated needs. The tiny product had to contain electronics and be waterproof, flexible, and in contact with skin. It also needed to fit—and remain attached to—any brand of swimmers’ goggles. One manufacturing failure followed another. Eventually, she and Flex parted ways. She interviewed hundreds of manufacturers to learn that no one in the U.S. had built a product with Instabeat’s requirements.

Prolonged Isolation & Hyper-Focus   on Your Product

Feeling enormous pressure to ship her product on time, she decided to gamble on a tiny manufacturing company in China. To that point, the company focused exclusively on producing vibrators. At first glance, it seemed an unlikely match. But their product requirements—to be waterproof and flexible, touch the skin, and house electronics—mirrored what Instabeat needed.

Initially, prototyping appeared to be going well. But the time difference disrupted her life, required her to “live at night mostly.” Increasingly sleep-deprived, Hobeika grew more withdrawn. Then, after visiting the factory in China to review the prototype in person, she discovered that things were not going well. She realized, “Oh my God, I’m going to have to stay.” For nine months, she lived in virtual isolation because of the language barrier.

“I was very alone the whole time. So I was trying to keep myself upbeat, especially when product iterations didn’t go well. And for the majority of my stay, product iterations didn’t go well. Because in manufacturing it’s one or zero. The product works and it’s shippable, or it’s not shippable. There’s no in between.

Over-Identifying Yourself with  Your Startup

During the darkest days of her six-year marathon to perfect the prototype, Hobeika—like most founders—went through an emotional rollercoaster intensified by sleep-deprivation and not eating well. At times, he struggled to separate her identity from the success of the business. She admits, “the first few years I was high on the work itself. That sustained me and gave me an excuse not to be healthy.”

Recognizing When Passion to Solve to Turns to Unhealthy Obsession

Many entrepreneurs and investors describe passion bordering on obsession to solve the problem as a desirable founder trait. Working closely with Hoebika in an advisory role, Alex Asseily praises her “unmatched passion for swimming and perseverance.” Hobeika acknowledges that her deep passion for swimming and desire to build a product that truly helped swimmers sustained her. But she reflects,

There’s a downside to being obsessive about an activity because it feeds the type A personality. . . . I had a lot of trouble actually removing myself from the final end goal. . . I wasn’t separating myself from the business because I didn’t know how to deal with myself.

Changing Habits

“It took a lot of mistakes to learn to keep myself healthy,” she admits. Running out of money, when she felt a deep sense of personal obligation to customers who pre-ordered Instabeat affected her profoundly. “That hit was more than a professional one,” making her question, “Who am I? How can I take care of myself?” while finding a way to keep Instabeat alive and deliver on her promise? Beginning therapy and coaching helped her disassociate herself from her business. She also created three priorities or “non-negotiables” on which she won’t compromise. She explained, “My first non-negotiable is sleep. I don’t put an alarm in the morning and my natural clock wakes up at 7:00.” Her second non-negotiable is eating healthy food, and her third pillar is working out. Strengthening her social circle and finding a romantic partner who understands and empathizes with the struggles of entrepreneurship also proved to be invaluable.

How Entrepreneurs Can Recognize the Signs of  Depression

Like Hobeika, Andrew Dubowec experienced social isolation. In his case, isolation combined with other circumstances to create a perfect storm for major clinical depression. Some things were great—he had recently gotten engaged, graduated from HBS, and accepted a job with North, a tech startup that builds cutting-edge sensor-based, hardware. At the same time, he felt awareness of student loan debt. Plus working remotely in a high-pressure sales role made him feel extremely isolated. As North scaled rapidly, Dubowec, previously an outgoing and confident leader, became riddled with self-doubt. It quickly grew into a serious depressive episode. Statistics show that Dubowec’s experience isn’t uncommon. In a pioneering study of entrepreneurs, 72% reported struggling with mental health problems, especially depression, ADHD, and substance abuse.

Self-Criticism

He recalls, “I was far too attached to my day job. I wanted to be attached to my day job because I wanted to work with passion.” But it became challenging to separate his self-identity from work. When he missed some sales targets, he began “confronting failure in a way that was very personal.” He conflated a failure at work with his identity and self-worth. In light of pervasive tropes, such as “being self-critical can make you a stronger founder,” he initially attributed his internal critique to working in a high-pressure, fast-paced startup. “In the earliest stages,” he shares, “it feels like stress.”

The really difficult part is knowing when you’ve crossed this proverbial line between what is stress, and what is a real clinical issue. It’s  really easy to sweep things under the rug and not recognize that there’s actually a deeper problem.

Physical Symptoms

Exhaustion, insomnia, lack of focus, or becoming less articulate, can be “stress responses—the mind sending you signals that you’re not operating in the right way.” He began to notice physical symptoms—like headaches or digestive issues—that many entrepreneurs stressing over a deal or under a tight deadline may experience. He shares, “You can feel tense. You can feel tightness in your chest. You might feel a little tingling in your hands. You might have a headache . . . signs that many people experience during points when you’re really pushing hard.”

“But there were elements that were  quite different for me  particularly around cognitions—beliefs, thoughts—that became chronically negative and quite disruptive.

While Dubowec had seen people experience depression before, he personally did not have a history of depression. Not knowing what depression felt like, “because there was no parameter,” he couldn’t recognize the seriousness of his own destructive thoughts.

Skewed Beliefs & Negative Self Image

One of the signals that Dubowec was experiencing more than typical anxiety was his changed perception of himself. The self-narrative that he constructed about his self worth and capabilities—who he was as a person—slowly shifted. Once energetic, smart, hard-working, fun to be around, and extroverted, he began to doubt his capabilities. He convinced himself that he was deeply introverted, didn’t have any friends, or any innovative, interesting thoughts. He confesses, “I started to use language like, “I’m not smart. I’m a loser. I’m a failure. I’m not capable.” A deteriorating self-image can be a warning sign of depression.

One of the hallmark signs of depression is that depression tells you lies, and those lies are really focused at you. Frankly, the worst things that were ever said to me through this entire experience, were entirely said about myself to myself.

Behavioral Changes

Another symptom of mental health conditions like depression, he learned, is that over time, his behavior began to reflect his cognitive beliefs. His internal dialogue became more scathing and his self-criticism mushroomed. What began as faulty self-perceptions started to manifest. Ghosh, who has studied how neurobiology affects entrepreneurs, explains, “you find the evidence that says that what you think is completely true. So the belief starts to change about who you are, what you’re capable of.” Dubowec became highly self-conscious, “I found it was harder to speak. It was very difficult to write an email. I could barely write a few sentences.” But, he remembers, he didn’t notice those things initially.

The degradation happens far more subtly until you hit an inflection point  and you proverbially fall off a cliff. Once you’ve fallen off the cliff, it’s much harder to do something.   If you had more awareness earlier, you could think about different interventions sooner that probably have a chance of being more efficacious in that moment.

One of the biggest behavioral changes Dubowec remembers is having paranoid reactions to situations. Not being cc’d on an email chain might provoke the reaction, “I’m going to get fired.” A less than scintillating conversation might lead him to conclude, “I’m a failure.” He explains, “You start to look for those reasons why your beliefs are true, and it becomes reinforcing.”

Declining Performance

As Dubowec’s inner critic grew harsher and his self-image eroded, his performance began to suffer. He found it nearly impossible to get out of bed. Colleagues started to notice that something was slightly off but no one at Thalmic suspected he was having a major depressive episode. He recalls a constant tension, “My body and my mind were telling me to slow down and shut down and rest” but he felt compelled “to keep going.”

Depression literally dragged me to the ground and trapped me in bed. My body needed sleep, my body needed rest. That’s why it was difficult to function cognitively. Rest was the antidote. It’s hard to accept that that’s what you actually need to do.

As Dubowec confronted his condition and embarked on recovery, he left Thalmic. Upon departing, he made the bold decision to share his mental health struggles with the entire company, despite the potential risk of damaging his career. Read How to Help Yourself or a Colleague Struggling with Mental Health to learn why he decided to share his experience with the startup community and how you can protect your mental health or help a co-worker.

Resources

National Suicide Prevention Lifeline: 1-800-273-8255. The lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.

Anxiety and Depression Association of America (ADAA) works to improve the quality of life of those affected by anxiety and depression-related disorders. The programs of the nonprofit provide education, resources, and support for people to find treatment.

The National Alliance on Mental Health, provides “advocacy, education, support, and public awareness so that all individuals and families affected by mental illness can build better lives.” One in five adults (47.6 million people) in the U.S. suffers from mental illness annually. NAMH measures how common mental illness is, to understand its physical, social and financial impact. They provide access to support, raise public awareness, de-stigmatize, and advocate for better mental health care.

“The Right Resources Can Help You Manage Depression” provides a Comprehensive List of Depression Resources.

Kip is a San Francisco-based startup launched by Erin Frey to improve the results seen in psychotherapy. It offers a hybrid of in-person therapy and software services to entrepreneurs and startup employees. The app, which is accessible 24/7, allows busy founders to be active collaborators in addressing mental health issues on their schedules. It also promises to be more effective than traditional therapy as it leverages user data to help therapists develop personalized treatment plans and lets users track their progress.

 

Explore More

In “Investors and entrepreneurs need to address the mental health crisis in startups,” Jake Chapman, a managing partner at Alpha Bridge Partners, cites studies documenting the link between the entrepreneurial mindset and personality and mental health issues. He makes an impassioned plea to investors: “Addressing the ongoing mental health catastrophe in entrepreneurship is a moral imperative, and for wise investors, it should be a function of doing business.” He stresses, “it is extremely likely you or someone you know is suffering right now and could use support” and their challenges are “largely addressable through individual action” such as de-stigmatizing the need for help.

In a recent study of entrepreneurs undertaken by Stanford and the UC system, researchers demonstrate an underlying relationship between entrepreneurship and neuropsychological and behavioral differences associated with certain mental health conditions. 72% of entrepreneurs reported mental health concerns at some point in their careers. 49%—reported having one or more lifelong mental health conditions, most commonly, depression (30%), ADHD (29%), substance use conditions (12%) and bipolar disorder (11%)—significantly higher than comparison participants. Their findings could impact business education, executive coaching, and human resource management as “understanding the strengths and vulnerabilities associated with personal and familial mental health histories may contribute to improved entrepreneurial outcomes, and to the development of protective resources for entrepreneurs.”

Why Is Entrepreneurship Bad For Our Mental Health?” offers a Q&A with entrepreneur, coach, consultant, and author, Louise Nicolson. Her latest book, The Entrepreneurial Myth, examines why entrepreneurs suffer from poor mental health more than the general population. She challenges business owners, educators, and policymakers to reconsider toxic  tropes about the “entrepreneurial mindset.”

In “7 Strategies Every Entrepreneur Should Employ To Optimize Their Mental Health,” therapist and executive coach, Megan Bruneau, provides tangible ways that entrepreneurs can safeguard their mental health, such as “notice where expectations are ruining your life,” connecting with others, and seeking help from a professional. In her podcast, The Failure Factor, she interviews entrepreneurs about how they coped with challenges and failures, and ultimately thrived.

Kip blog provides inspirational stories and mental health care tips. In 2017, Kip launched the Investor Pledge for Mental Health to raise awareness about how the pressure from investors contributes to mental health deterioration among founders and how they can effectively help founders build company cultures that promote mental health. By taking the pledge, investors weaken the stigma attached to mental health problems and signal that it’s acceptable for founders to seek help.

 

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