Psychiatrist, Entrepreneur and Researcher:

A Talk with Dr. Michael Freeman

One of his patients suffers from deep, dark depressions. He’s also a very successful serial entrepreneur on his fifth business. It took a while, but psychiatrist Dr. Michael Freeman figured out the guy has a family history of bi-polar disorder that probably affects him. “I was able to get him on the right medication,” Freeman explained during our phone conversation, “and he’s now gone like nine months with no depression, which for him is huge. As a result, he’s much more effective running his business.”

This patient is a case in point as to why Freeman unequivocally says, “What I would really recommend is that people who believe that they have depression, anxiety, mood swings like bipolar, substance use issues, that they should find a psychiatrist or a therapist and get an evaluation. Seek help because these conditions are very treatable.”

Yet, Freeman also said something kind of surprising. “There’s a stigma about mental health conditions that really should not be there because these people are starting companies, they are creating jobs, they are creating prosperity, they are coming up with new products, new services, things that make life better for everyone else.”

The Stigma Continues
Stigma? Still? In the enlightened 21st Century? It is somewhat surprising that there’s still a stigma considering all the talk of mental health issues related to entrepreneurs on the heels of the Vegas Suicides in 2013 and 2014 (connected to Tony Hsieh’s Downtown Project), and high profile suicides like Aaron Swartz and Austen Heinz, among a slew of others. Then again, most of the young entrepreneurs we’ve spoken with have also used that word: STIGMA.

Freeman sits in a position that gives him an incredible view of the entrepreneurial mental health landscape. Consider that he is not only a psychiatrist and psychologist, but a business founder himself; held C-level positions in venture capitalized startup firms; and has a coaching business focused on entrepreneurs and executives. A faculty member of the Department of Psychiatry at the University of California San Francisco School of Medicine, he was the lead author of the groundbreaking research paper Are Entrepreneurs “Touched with Fire”? (See our blog, “Let the Numbers Do the Talking”).

Freeman explained that he borrowed the title from Kay Jamison’s seminal book Touched with Fire: The Manic-Depressive Illness and the Artistic Temperament (title self-explanatory). When you mull over the prevalence of mental health issues among entrepreneurs, you can’t help but think of renowned half-mad poets, authors and artists (Sylvia Plath, Ernest Hemingway, Kurt Cobain, Vincent van Gogh, and on and on). We asked Freeman if there’s been any research comparing the artist to the entrepreneur and shared traits. While there wasn’t a formal study that came to mind, he noted, “The artistic temperament is associated with a very similar mental health profile as the entrepreneur temperament. And a lot of artists are entrepreneurs. There is definitely a blurry border as to where one starts and the other stops.”

Getting back to Freeman’s coaching work, that’s what prompted him to research mental health issues linked to entrepreneurs. “I recognized that among the CEOS that were founders of smaller growth companies a lot of them had diagnosable mental health conditions,” he explained. Of those with conditions, many were well aware of it but treated it in a self-deprecating way. “A lot of people knew. They would sort of laughingly refer to themselves as ADHD or manic or depressed. I would say the majority did not take it to the point of seeking treatment.” Freeman also believes that “a lot of the older serial entrepreneurs are aware of their mental health issues” and “the prevalence of mental health conditions” is about the same in older entrepreneurs as younger. However, Freeman did note that for entrepreneurs who take the plunge “at a later stage in life, yes, they are more likely to have self-awareness, life experience, networks of relationships, social capital, financial capital, all kinds of things that are going to help them be more successful.”

A Perfect Storm: Brain Development, Entrepreneurship, Mental Health Conditions
Self-awareness is certainly a factor in recognizing whether you have a mental health condition, and whether you should seek evaluation and treatment. It’s important to acknowledge that for the young entrepreneur whose brain is still maturing, the level of self-awareness might be lacking. This stage of life is when the perfect entrepreneurial storm can occur. “The age of onset of most psychiatric conditions is about 15 to 27,” Freeman said, “so virtually everyone who is going to have depression or have anxiety or have bi-polar disorder, it pops out at this window. So it turns out that the age of onset of mental health conditions and the age of onset of entrepreneurship are about the same.” Why then? Because the male brain doesn’t mature until the age of 26 or so, females a few years sooner. “That’s why the age of onset of mental health conditions and the age of onset of entrepreneurship are about the same,” Freeman explained, “because it has to do with changes that are going on in the human brain at that stage of life.”

Whether entrepreneurs are more or less likely to admit mental health issues and the need for treatment appears to be an area of debate – we’re definitely getting mixed messages depending on who we talk to. “I don’t think they’re anymore unlikely to acknowledge that than anybody else,” Freeman said of entrepreneurs. “I think that there’s a stigma about mental health that cuts across the whole culture. The optimistic part is that entrepreneurs are typically more open minded and they’re willing to try new things if it can help them get ahead, so they might be more open to considering this as one of many cards in their hand they can play to be more effective in what they do.”

Freeman added, “There is social pressure to convey success, and one of the things that happened in San Francisco is that has been counteracted by the acceptance of the idea that failing is part of succeeding so it’s ok to fail too. And to talk about that and learn from failure.” Regardless of how competitive the tech scene is out there, there is a lot of support for entrepreneurs, according to Freeman. There are founders groups, accelerators, incubators, business schools, alumni groups, etc. “It’s a very rich, highly interconnected network, which breeds more entrepreneurship,” he concluded.

We explained to Freeman that in the short time we’ve been running this blog, we’ve encountered some entrepreneurs who know they need to make changes in their life but for whatever reasons don’t take the steps to help themselves. Freeman suggested that for entrepreneurs who are aware that they have issues but won’t take steps, it becomes a questions of “how do you begin to engage as an outside resource. Typically I look for the change points.” What does the person talk about that could use some changing? “There could be coaching about business issues; there could be coaching about personal issues; there could be issues related to mental health. Where you start is where the person is willing to engage in some kind of constructive dialogue.” By way of example, we asked Freeman about the feeling of isolation some entrepreneurs have expressed. “Isolation is bad psychologically and also for business,” he answered. “On the business side, one of your main assets is social capital. Typically entrepreneurs are more connected and less isolated than other people.” So talking about the nature of the isolation is a place to start. Are there special circumstances that have lead to the feeling of isolation?

Beware of Simplification and Generalization
A key point Freeman emphasized is: “There isn’t a one size fits all answer” in addressing mental health issues. For example, when we asked him what advice he might give a college classroom of aspiring entrepreneurs in regards to mental health, he quickly responded that it’s not reasonable to stand in front of a classroom and provide advice on mental health issues and entrepreneurship. That’s too simplistic. You can’t generalize. Screening and evaluation is important “to give the right messages to the right people.”

“To the extent that you’re conveying information that’s actionable and that could have an effect on people’s lives,” Freeman added, “I think that with these young adults, there are such vulnerable moments, and they’re so early on in the adult development that if you can make a good choice in your 20s, it can lead to a lot of virtuous outcomes in your 30s and 40s and 50s; and if you make a bad choice in your 20s, the reverse can be true. So it’s really important to convey the right information.”

Freeman also cautioned about the over simplification you can encounter in the popular press: “The problem with the popular press is that it is anecdotal, and you get these small sample sizes. It’s very easy to draw inaccurate conclusions from small numbers. And people have a filter, they look for what they want to see and as a result they confirm their own biases.” In other words, you hear what you want to hear.

A Deep Dive into the Silver Lining
Freeman and his team are conducting further research that should shed more light on the entrepreneur personality, with results hopefully available in about six months. “We’re trying to figure out what is the relationship between mental health and personality, and entrepreneurial helpful,” Freeman said. “What’s the silver lining in the gray cloud? To what extent does having ADHD give you an advantage? Or does having a bipolar condition give you an advantage? There’s very little data. We’re doing a really deep dive on that one.” He noted that each condition has strengths and weaknesses. “Someone with anxiety might be more cautious and exercise better judgment. Someone with ADHD might be impulsive and be able to make decisions quickly. So it gets to be a little bit nuanced.”

If you take a look at Are Entrepreneurs ‘Touched with Fire’?, be sure to peruse the discussion section toward the end – that’s where he starts to get at some of this silver lining business. The following is an excerpt.

“Given that the vast majority of the job creating, value-creating entrepreneurs in this study sample are affected by individual and/or family mental health issues, the strict focus on a disease model seems reductionistic and misleading. Instead of viewing a diagnosis as a disease [103-105] it can be viewed as a description of a set of empowering traits and personal endowments that are coupled with vulnerabilities and risk factors. If properly managed, these endowments can result in significant social and personal benefits.”

So, rather than viewing mental issues as merely a disease, we need to also think of them as “empowering traits and personal endowments.” A few other Dr. Freeman takeaways to keep in mind:

• We can’t oversimplify or generalize this discussion;
• If you are symptomatic, get an evaluation;
• These conditions are treatable;
• Treatment can lead to being a much more effective entrepreneur.