#2 - Entrepreneur Mental Health - Dr. Michael Freeman

Aug 2, 2019

Dr. Michael Freeman is a practicing psychiatrist and psychologist in San Francisco.  He has performed intensive research on the topic of entrepreneur mental health.  His work has been published in numerous journals, books and publications. 

Most notably, he co-authored a report called “Are Entrepreneurs Touched with Fire” in 2015 – which is a study that shows the link between entrepreneurs and mental illness.  This study has been cited numerous times and most recently in Forbes, as well as the July 2019 Wall Street Journal article, “Beyond the Confetti: The Dark Side of Startup Success.”

The best place to learn more about Dr. Freeman’s work, and to find the report on entrepreneur mental health, is on his website: michaelafreemanmd.com

Research Report Link: Are Entrepreneurs Touched with Fire?

Some of the key takeaways from my conversation with Dr. Freeman:

1. Entrepreneurs are more likely to have mental health issues than the broader population.  And these issues are rather easy to identify.  Dr. Freeman has embarked upon a research program for the last 8 years that has identified a specific mental health profile or footprint for entrepreneurs that shares many of the same characteristics we see when mental illness manifests itself (creativity, motivation, energy levels, extroversion, etc.).
   
   
2. We talked extensively about the relationship between bipolar disorder and entrepreneurship.  We talked about the spectrum of bipolar and how some characteristics of bipolar present themselves in people.  Some of the characteristics of bipolar like ambition, creativity and optimism, etc. can be very beneficial for a founder, but a full blow manic episode can ruin their life and their business.  Finding that middle ground, by treatment and asking for help is our goal.
   
   
3. Why is entrepreneur mental health a major issue?  Entrepreneurs create the vast majority of new jobs, pull economies out of recessions, introduce useful products and services, and create prosperity. Therefore, it behooves us to understand the cognitive, affective, and behavioral strengths and vulnerabilities of entrepreneurs and encourage them to get help and provide resources for help as well.

Jobs are under attack from many outside pressures such as automation.  People who have a job that can be automated, will lose those jobs due to automation, robotics, tele-migration and AI.  Entrepreneurs create jobs.  10% of jobs are held by entrepreneurs themselves, and when you add in their employees, 30% of all jobs are created by entrepreneurs. 

Right around the corner is this tsunami of unemployment and entrepreneurs will be the solution.

1. We talked about how those of us with mental illness can protect ourselves against the extremes.  Dr. Freeman encourages everyone to be evaluated.  You may or may not have a condition just because you demonstrate symptoms.  If you do have a condition, there’s a reasonable likelihood that you have more than one condition.  Start with an evaluation.  Find out how your mind is calibrated.  Then you will find many ways to “put up guard rails (managing lifestyle, medication, etc.)” so you don’t run yourself off the tracks.
   
   
   1. De-stigmatization – We need to normalize the mental health differences of entrepreneurs so that people are not afraid of it.  Start by de-stigmatizing yourself.  Ignore the negative messages you have been receiving. 
   2. Education – Society invents false explanations as to why someone is hyperactive or has another mental condition and we need to learn the real explanations. 
      
      
2. How do we address entrepreneur mental health?
3. Dr. Freeman discusses the concept of “Illness” versus “difference” when talking about mental illness.  He says that the concept of “illness” really benefits the “medical industrial complex” more than anyone else.  For example, if you are a doctor who wants to have a full waiting room, or a hospital focused on occupancy or a pharmaceutical company selling medication, then it’s great for there to be a lot of illness out there.  If we eliminate the language of “illness” and replace it with a vocabulary of relative differences, then we change the dynamic around the topic altogether.
   
   
4. Are we even close to a solution for mental health issues? We have a lot of hypotheses to test.  Some solutions are known.  That’s what Dr. Freeman is writing about these days.  We have a long way to go in communicating solutions.  Then we have a long way to go in changing social and public policy in ways that allow those solutions to be implemented.  For example, Dr. Freeman asked a woman to run a company he wanted to start, focused on mental health of entrepreneurs, but she won’t leave her current company because she can’t live without health insurance.  The limiting factor to getting this woman to take the leap to help mankind, is her health insurance.  We need social policies in place that unlock all the entrepreneurial potential energy in the country.
   
   
5. We talked about the concept of “innovation ecosystems” and how we need to help thought leaders recognize that jobs are created in ‘places’ and those places can usually be identified as innovation ecosystems where entrepreneurs feel welcome.  When you consider the “birthrate” of new companies per 100,000 employees in various geographies, the places with the highest birthrates are places with the most tolerant social policies.  We must get government policymakers involved in helping to shape the direction of such policies.  We can look at Austin, TX and the policies put in place by the mayors there over many years to encourage entrepreneurs to come there.

I hope that this episode is a resource for all entrepreneurs, regardless of if they are building in the mental health space, or any other industry. 

Lastly, and certainly not least important, we all need help.  We all need to check-in.  We all need to be evaluated.  Go talk to a mental health professional and ask for guidance on your path to mental wellness and mental performance. 

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2:55 – Why are entrepreneurs likely to have mental health issues?

5:35 – Why are people with a certain mental health profile better at being founders than others?

7:10 – The “approach network” in the brain is calibrated more highly among entrepreneurs

9:46 – What drives people with bipolar tendencies to become entrepreneurs?  Correlation, not causation.  These are ancient differences in the brain that we are talking about.  For most of human history, entrepreneurship didn’t exist but these traits did.  At this moment in time, these traits are particularly adaptable in dynamic economies.  This creates a great environment for people with these personality traits to become entrepreneurs.

11:30 – In the 60% of entrepreneurs who are not demonstrating mental illness, we find that half of those founders come from families with mental health conditions.  We believe the positive benefits can be transmitted without the negative components having to come along with them.

16:30 – Is there a way for entrepreneurs to harness the positive benefits of these mental conditions while mitigating the negative consequences?

18:14 – All of these mental health characteristics are good until they aren’t.  For example, optimism, you need it as a founder, but if you ignore negative feedback then you can’t pivot or change.

25:20 – If you have mental health symptoms that are making things works, then they can be managed.  You just have to ask for help.

26:10 – Should every entrepreneur reach out and get screened for mental health issues?

29:00 – Why should we address entrepreneur mental health issues?  Entrepreneurs are wonderful people, and they are largely misfits.  Entrepreneurs also create the jobs.  The economy is highly dependent upon this job creation.  As robotics and AI take more physical jobs away, entrepreneurs will keep creating jobs inside of new businesses.   

36:00 – How do we address entrepreneur mental health?  It starts with de-stigmatization and education.  We need to raise awareness.  We need to start by de-stigmatizing ourselves.  There is nothing wrong with you if you have some sort of anxiety, or mood swings or depression.  Society has invented explanations for why people are a certain way and that has stigmatized us.  These are false explanations.  People need to learn the real explanations then learn how to make it work for them not against them.

39:12 - Entrepreneurs are notably open-minded people.  They can’t afford to discriminate.  Entrepreneurs succeed by getting new information and building networks.  The more people you accept, the bigger your network and the more powerful you can be as an entrepreneur.

41:20 – Dr. Freeman would encourage us to stop using the language of “illness” and start using the language of “difference.  “Illness” the language of the medical industrial complex.

43:58 – How close are we to getting to solutions in the space?  Closer than you think, but we have a long way to go.  Some solutions are known.  Some solutions are sitting on lab desks inside of universities needing to be commercialized.