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Online Extra: "Consider a Mental-Health Checkup"

The company he had built from the ground up was the largest in its field and still growing rapidly by the time the entrepreneur reached his mid-30s. Admiring associates described him as "a tiger"--until he suddenly began to imagine cages around him everywhere. The first attack of severe claustrophobia hit while he sat on an airplane. Waves of panic swept over him. Before long he couldn't tolerate even an elevator ride. His fears overwhelmed him. His drive and leadership powers diminished. His business suffered. Finally, he sought help.

Therapy unlocked memories of early childhood psychological abuse, repressed as part of a posttraumatic-stress response. Dr. David Morrison, an occupational psychiatrist who consulted on the case, says that with treatment the entrepreneur returned to a successful career--and a far more balanced lifestyle. Ironically, while these memories had turned into demons, at an earlier stage the repression had a different effect: It fueled the entrepreneur's drive to build a business.

Are entrepreneurial "tigers" typically impelled to success by mental health problems? Of course not, say those who counsel and treat entrepreneurs. Most business owners draw their ambition from positive wells of strength and self-confidence.

Still, it's no secret that entrepreneurs can be harrowingly intense. Indeed, a certain form of madness may be a prerequisite for starting a company, with all the risks and burdens that it entails. So, alongside the laserlike focus entrepreneurs bring to their work there often lies a dark side of the entrepreneurial mind--psychological problems that range from "sudden wealth syndrome" to depression over business failures to troubled relationships with loved ones. And, of course, there's stress, which to one degree or another afflicts most business owners.

Increasingly, it seems, entrepreneurs are recognizing their problems. Witness the growing ranks of "personal coaches," psychiatrists, and therapists who specialize in counseling entrepreneurs and business leaders. Or check out the rising membership in support networks and forums offered by groups such as the Young Entrepreneurs Organization and the Young Presidents' Organization.

Interest in entrepreneurial angst is growing among outsiders, too: Scholars, academics, and foundations that have focused on the business end of entrepreneurship now are beginning to consider the personal toll of running a company. "We have to recognize the real drawbacks," says Michael Camp, director of research at the Kauffman Center for Entrepreneurial Leadership in Kansas City. "We have to be responsible and tell the whole story."

Statistically speaking, it's a tough story to tell. Mental health professionals who work with entrepreneurs believe their emotional problems are widespread. Still, there's not much hard data on the subject, which is why the Kauffman Center has undertaken a long-term study of several thousand entrepreneurs--an exploration that focuses largely on stress.

Scott Corlett, founder of Internet retailer NexGift, could serve as Exhibit A for the research. Corlett was 22 years old when he launched the first of his three startups. In spite of his youth, the stress of running a new business with 50 employees and a stop-and-go cash flow got to him. Twice, the San Diego gift manufacturer landed in the hospital with severe chest pains. They turned out to be anxiety attacks caused by the triple whammy of long hours, little sleep, and the unrelenting pressures of running the company. Corlett says he can't put his finger on any specific trigger. The pressure just built up. In his first four years in business he had six of these episodes, one so severe that paramedics had to cart him out of his office on a stretcher. Each time, the diagnosis was the same: stress. "I love the startup period when you are running a company and doing the undoable, but my body couldn't handle the stress back then," he recalls. "I'm now 36 with three children, so I've settled down. I'm still an entrepreneur, and I still drive myself and my company hard. Now, though, I have people that I communicate with to relieve a lot of that stress."

That's just what a lot of gung-ho entrepreneurs lack. They often have overdeveloped work habits and underdeveloped emotional support systems--which means stress, and particularly the stress of failure, can send them reeling. "They are like bodybuilders who build up their upper bodies but have little skinny chicken legs that, after a while, can't support their weight," says Morrison, a suburban Chicago psychiatrist who specializes in work-related mental health issues.

DIGGING DEEPER. As destructive as stress can be, it's the common cold of entrepreneurial mental problems. Dr. Philip Liu has spent 17 years studying and treating more serious conditions at their current Ground Zero--Silicon Valley. His specialty: the subgroup whose drive to succeed is rooted in the really dark side of the entrepreneurial psyche. What's his analysis?

"They seem to be self-assured, charismatic people who intuitively know what others want. They are often leaders, but they really are pretty disturbed. They hide their feelings of inadequacy well, but they can fall apart easily under stress. In varying degrees, they can be vulnerable to depression, drug or alcohol abuse, and discord in their relationships," says Liu, a member of the Academy of Occupational and Organizational Psychiatry. They ignore their personal lives, believing that success in business will ultimately bring them the respect, appreciation, and love they desire, says Dr. Liu. "Many tend not to have outside interests," adds Dan Sullivan, whose Toronto-based company, The Strategic Coach, conducts workshops every year for more than 3,000 high-income entrepreneurs in 12 countries. "Having free time is a negative to them. They can feel lost or insecure without work to do because, to some extent, their work is an addiction."

It's a malaise Liu calls Sudden Wealth Syndrome. Their goals achieved, these entrepreneurs blame spouses and close associates for their depression and dissatisfaction. Their emotional logic holds that if they're successful materially but not happy, there must be something wrong with the people around them. "Often entrepreneurs set the bar very high, and when they get over it they don't know what to do with themselves," says Dr. Jeffrey P. Kahn, president of WorkPsych Associates, a corporate and executive mental health consulting firm in New York. "Sometimes they will set the bar higher still but eventually they may come to a point where they say, `I don't have to push myself anymore, why do I feel so bad?"'

One answer that Kahn hears frequently is that misery is part of the job description. But, he observes, "I've worked with many successful entrepreneurs. I can't think of one who has been less successful as a result of becoming happier."

MISERY NEEDS COMPANY. Even more normal type a personalities can find the top of a business a lonely, frightening place if they've neglected relationships along the way. Entrepreneurs do best when they have strong and supportive networks, says James M. Hunt, assistant professor of management at Babson College. A network, in fact, is what saved Carol Frank, the owner of Avian Adventures, from emotional and business collapse.

In 1999, a competitor stole her company's sole supplier of the ornate birdcages she sells. It was a devastating loss. She had no product and the rival put her out of business for months until she could find another one. Frank, 41, she says became so stressed that she sank into an isolated funk and didn't date for an entire year. "I just felt like I had nothing to give anybody," she recalls. Fortunately, she didn't shun her fellow members of Group One, a confidential forum within the Dallas chapter of the Young Entrepreneurs Organization. "When you run a business, you don't want to admit to your employees--or to anyone--that things aren't going well, so being able to bounce things off other entrepreneurs who have gone through the same things is invaluable," she says. "With the help of friends in YEO, I eventually found another manufacturer, too."

A CPA with an MBA, Frank had two other successful companies before becoming one of six founders of the YEO Dallas chapter that has grown to more than 100 members since it began in 1994. Members, whose companies must have at least $1 million in sales, say the forum groups are the best part of the organization. The groups, comprised of 8 to 12 members, meet each month for confidential discussions about business or personal concerns. "Those relationships allow you to get perspective and to find new approaches," says Hunt. People under stress tend to simply repeat behaviors they're accustomed to, even when those patterns are the source of the problem. "Having other people around you in stressful times is very helpful in moving forward," says Hunt.

Serial entrepreneur Jon Brandt of Fairfield, N.J., found that to be true, particularly after enduring his second business bankruptcy, second car repossession, and second bout with depression. Brandt says the trip wire was a failed attempt to sell his business to a major corporate buyer. He had exhausted his resources on the deal, when the buyer backed out, he says, leaving him unable to keep the business going. It felt like a death sentence. At his psychiatrist's urging, Brandt joined the Let's Talk Business Network, which was created in 1994 by former tennis pro Mitch Schlimer, who had experienced "entrepreneurial terror" in the creation of four businesses of his own. The 100 members of the LTBN New York City chapter--there are also branches in Philadelphia, Washington, Vancouver, and New Jersey--meet each month in small groups for Mastermind Forums in which they share experiences, commiserate over setbacks, and celebrate successes. This entrepreneur network also conducts leadership and motivational seminars and hosts regular "de-stressing" events such as softball games, bowling parties, and golf outings. Brandt now has a thriving business that offers training and certification courses for hospital technicians. With annual sales of about $3 million. And (note to repo man) his two Mercedes are paid for in full. The forums still serve as welcome therapy. "It's just very, very valuable to sit down with peers who have had the same headaches and to know that they've survived," he says. That might not be enough to free the tiger from his cage, but for most entrepreneurs, it's just the release they need. You know you're perfectly sane. But that doesn't mean you can't be pigeonholed by your attitudes, foibles, and neuroses. It's a pseudo-science known as psychographics, and people who study small biz say it brings a sense of order to a diverse group. One problem: Psychographic definitions can get pretty diverse, too, depending on the focus. Some samples:

Self Image (Warrillow & Co.)

Mountain Climbers (10% of entrepreneurs)

Insatiable appetite for achievement. Live for fast growth. Win awards and media coverage. Demand excellence.

Freedom Fighters (30%)

Value independence above all. Started own company to "call the shots." Want to build a successful business and still have a life.

Crafts-people (60%)

Don't think of themselves as small-biz owners. Defined by profession (jeweler, plumber, caterer) and value mastery of craft.

Work Habits (Pitney Bowes/Yankelovich)

Idealists (24%)

Passionate about an idea they want to bring to life, but dislike details of running a business and finance. Seek work-life balance.

Optimizers (21%)

Enjoy their work. Seek efficiency. Savvy on finance and tech. Focus on profits, not size. Confident, happy with work-life balance.

Hard Workers (20%)

Growth, growth, growth--whatever it takes. Want a bigger company with growth in revenue, staff. They sweat all the details.

Jugglers (20%)

Worriers and control freaks. Pressed for time. Proud of ability to juggle. Want to grow to "promised land" where worries are over.

Sustainers (15%)

Just trying to make a living. Wants comfort, stability and to keep things the way they are. Good work-home balance. Not into technology.

By Objective (Wunderman/Cato/Johnson)

Success (20%)

Optimists who want to win. They value quick growth, money and material possessions. They want control and status.

Big Idea (16%)

Risk taking mavericks who seek social validation and creative fulfillment. Informal, intuitive, value self-satisfaction.

People (23%)

Want to create a good place to work and do business. Integrate work, home, community. Value emotional support, loyalty, respect.

Security (10%)

The Goal: Less stress, more leisure time. Value integrity. Cautious but optimistic.

Survival (31%)

Pessimists. Feel put upon, just want to stay in business. "Hard work and emotional distress are not the same," says New York psychiatrist Jeffrey P. Kahn, who designed this simple quiz to see if you've crossed the line.

Got Attitude?

1. Do people say you are pushing too hard?

2. Can you relax on holidays or vacations?

3. Does work feel like drudgery?

4. Is it hard to get excited about growing your business?

Can't Relate?

1. Do people say you seem confrontational or remote?

2. Have your feelings toward family or friends changed?

3. Do people seem increasingly incompetent?

4. Do relationships take more effort?

Moody Blues?

1. Do people say you seem sad or irritable?

2. Do you feel suddenly anxious or angry?

3. Has your appetite changed?

4. Do you have trouble sleeping?

5. Are you using more alcohol or drugs?


YES to one or two: Stress may be getting out of hand.

YES to four, or two in two categories: Talk to a friend or family member.

YES to more (or if symptoms persist): See a professional If you feel like you're losing it, don't try to go it alone. Here are a few places to look for help and support:

The Academy of Organizational and Occupational Psychiatry can steer you to mental-health professionals in your area who specialize in serving entrepreneurs.

The Young Entrepreneurs Organization has support groups for business owners under 40 with $1 million in sales. For the older set: The Young Presidents,

Let's Talk Business Network, open to all, aims to break the isolation of running a business. Groups of like-minded entrepreneurs meet solely for support, advice, and community. Do entrepreneurs suffer more than other people from mental disorders? So it seems. After all, it takes a little bit of madness to start a business, and, just as surely, a business can drive you a little bit mad.

New York psychiatrist Jeffrey P. Kahn, president of WorkPsych Associates, see a lot of troubled business owners in his practice. Many of them feel being miserable comes with the territory. But as Kahn points out, he has never seen an entrepreneur less successful for being happy. Kahn spoke with writer Wes Smith about what entrepreneurs can do to improve their mental health. Edited excerpts of their conversation follow:

Q: Is stress common in entrepreneurs?

A: Yes it is. I get the sense that it may be more common than among other folks for two reasons. First of all, entrepreneurs are in charge of their own success, but they have so many variables to track. And they don't always have a safety net. The other reason is that some people become entrepreneurs because they feel an itch to go out on their own, and that itch can sometimes come from an inner unhappiness about other aspects of their lives.

Q: Why is the unhappiness of entrepreneurship so little explored?

A: Well, even for those driven by inner unhappiness, entrepreneurship can be a pretty good coping mechanism, with the potential for rich rewards. When things are going well, the unhappiness isn't so obvious. And even when it increases, people have difficulty seeing that their distress is out of proportion to real problems, or that they just don't have to be so unhappy. People tend to see what they are trying to fix rather than their own distress about it.

When I got a new backup device for my computer, I spent many frustrating hours trying to get it to work right. Finally, someone said: "Do you think that maybe it's broken?" And actually, it was broken, but I'd been trying so hard to figure out what I was doing wrong that I didn't even think it could be a defective drive. Many people tend to think that emotional distress is just a byproduct of hard work. It's not, and distress can often even peak at moments of particular success or of reduced work pressure.

Q: What can people do to handle the pressures of owning a business?

A: I'd suggest starting with anything that takes your mind off work issues. Relaxation techniques can include meditation, prayer, music, travel, sporting activities of all kinds, and interacting with family members and even pets. Talk with people who are close to you about problems and solutions that might be hard to see.

If people have concerns about your happiness or coping, consider a mental-health checkup. Some companies now encourage senior managers to have annual mental-health checkups. It's just as important to get a sense of where you are mentally and psychologically as it is to have a regular physical exam. Your distress may have more causes than you can see. An occupational psychiatrist looks at the interplay of your work, workplace, and personal life, along with checking for commonplace anxiety and depressive disorders, and then talks about possible solutions.

Jeffrey P. Kahn, MD, is president of WorkPsych Associates in Manhattan. WorkPsych ( provides a range of executive assessment, development, and treatment services, as well as corporate benefits and management consultation. He is editor of Mental Health in the Workplace: A Practical Psychiatric Guide (John Wiley & Sons), past president of the Academy of Organizational & Occupational Psychiatry (, and active in the business relations efforts of the American Psychiatric Assn.

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