The Founder’s Battle for Mental Health | Hacker News Reader

The Founder’s Battle for Mental Health

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> This battle is the worst, because you are fighting it with yourself — not with anyone else. It’s damn hard to win against someone who knows you inside out and knows your every weak spot (which are plenty).

This line of thinking is one of many general problems with the world. Many of us walk around fighting a battle in our head that does not exist. The last line stands out the most because it presumes there could be a winner. How can that be if you're the one who's making the rules?

It gets worse for founders because there's always something to be doing and always some problem going on. A couple of mental hops and they've now incorrectly associated their peace with the success of their business. This is bound to fail even if you do very well -- you'll always be fighting "problems".

Forgiveness goes a long way. Learning how to forgive others will teach you how to better forgive yourself and visa-versa. It's not noble to lash yourself on the back with a mental whip because you didn't live up to some superficial aim.

I don't care what happens to this stupid body of mine -- I'll die someday like the rest of you. This awareness shields me from damaging myself with superficial qualities that change with each passing whim.

Finally, I don't suggest pumping your body full of drugs to protect yourself from your thoughts. First, work with the thoughts and forgiveness then move onto drugs if they would help you better find the peace you need to forgive and let go.

> A couple of mental hops and they've now incorrectly associated their peace with the success of their business.

This.

Personally, I find physical activity the best way to combat this. Last year I biked 4,000 miles commuting and on long weekend rides, lost 30lbs and feel super healthy physically and mentally. Now I attack situations in my business and personal life like a big hill climb. I know I am going to get through the pain, I try to embrace the pain because I know if I don't give up I will be stronger because of it.

Lost 60lbs last year and got back to a semblance of decent shape (used to be a exercise nut) that had a big effect but not the largest effect.

That came from sorting out my sleep, I set an alarm for 8am and no matter how tired I was I got up at 8am, after 3-4 days I naturally fell into a proper sleep pattern (head down around midnight, asleep by half past).

I've struggled on and off with insomnia since I was a teenager and this "up at 8 every day" approach has worked really well so far, sucks getting up at 8am on a weekend when you have nothing to do but tight sleep pattern is worth more.

Valerian root and trazodone did wonders for my insomnia.

>The last line stands out the most because it presumes there could be a winner. How can that be if you're the one who's making the rules?

Reminds me of a quote from Stargate SG-1: "The only way to win is to deny the battle."

I prefer the more cynical version: "The only way to win is to cheat."

I think this is good but I would add diet and exercise. I'm sure many will disagree, but my experience has been that diet and exercise are even more effective than mental tricks.

  I'm afraid that some times
  you'll play lonely games too.
  Games you can't win
  'cause you'll play against you.

https://en.wikipedia.org/wiki/Oh,_the_Places_You%27ll_Go!

Startups can be super challenging for all of the reasons outlined in that article. We put together this guide to help explain some of the mechanics that make startups so stressful. It is primarily based on Jerry Colonna's work. He is a really good guy who has done some of the deepest thinking in this space. I highly recommend his work. You can find it here: https://www.reboot.io

The guide is here:

http://www.7cups.com/startup-support/

If you have thoughts/ideas on how we can make it better, then please let us know. Thanks!

I'm glad to see someone discuss their internal struggles so candidly. I also have a difficult time with maintaining internal peace, and your recommendations raise an interesting point.

Human connection keeps us sane, and it's so easy to use social networks in an attempt to remain connected. But in the process, the actual connection is missed, instead giving rise to feelings such as shame, anger, and fear. I believe in the case of mental health, social networking actually amplifies internal problems because of how one-dimensional the view of others is.

How many people do you know that would post when they are feeling depressed, or anxious about their life? Maybe if we saw a more holistic view of people on our networks, they wouldn't have such a detrimental impact on mental health.

Bipolar business owner here. Staying centered and level in the face of business ups and downs has been difficult. Very difficult at times. My reactions to stress and difficult situations, to successes too, are often imbalanced. Still I've remained successful. Here's how:

Talk therapy. I see a therapist weekly to keep the window's clean. To validate that what I believe isn't exaggerated by my varying states.

Medication. Very low does Lithium every night.

Sleep. I make sure I get it.

Exercise has been tough to execute on, but is proven - as much as meds - to help with bipolar and GAD.

Meditation I try to do once a week as part of yoga. I find it helps.

Family and friends who understand and can be supportive also are a huge help... but are often in the minority of people I know.

I don't really see what's unique about founders here. Don't these challenges and recommendations apply to pretty much anyone trying to live a life of purpose, no matter how large or small?

It's interesting that two of the six things that the author suggests negatively effect mental health are social media. I think that a better understanding of the impact of habits driven by social media will be a great step forward. Of course, they've hardly been such a pervasive force for very long, so the long-term effects could not be well understood at this point. I see this generally negative sentiment increasingly often, though, and I definitely think there's a lot of truth to it.

Social media when it is talking about your startup is particularly hard, trying to constantly manage the perceptions is a ... huge challenge (even if you don't have any internal challenges). Founding a startup is also a good way to work 9 years worth of time in 3 years (or whatever), I sort of view them like the life-extraction machine in the Princess Bride sometimes. You are constantly trying to balance all the forces, mini-max everything, wonder about what you are not doing, and it can always feel like the wheels are falling off the whole time.

I need to write a blog post on this myself very soon. Props on talking about it more, and the general theme of having more public conversations on the subject.

I find social media a generally negative experience, I have 23 friends on facebook (people I'm actually friends with), my twitter profile is private and I only follow people who have interesting positive things to say and company stuff (product releases and the like).

I've reduced reddit usage to once a day and certain sub-reddits.

Ironically the most negative community I still use a lot is HN.

I'm glad to see that more and more people are talking about this. People like Evgeny Tchebotarev, Rand Fishkin and Joel Gascoigne are pioneers for openly talking about depression, loneliness and stress. The dichotomy between what we really feel and what we need to show others can be really heavy and most of the times even friends and family are really open to understand what's going on.

One way to be able to discuss depression and stress is objectively like in this video animation of how selective serotonin reuptake inhibitors work.[1] Prozac, described in this video, is used to treat both panic attacks and depression. Constant stress from triggers like a boss who insistently attacks and berates or from endless hours working on a project can deplete available serotonin which the body produces at a certain rate. Stress untreated can also in people with genetic preposition trigger more severe diseases like bipolar borderline personality disorder and schizophrenia. There are other chemical systems at play such as dopamine and epinephrine[2]. Another way to deplete available stores of serotonin is using MDMA (ecstasy) which releases all the stored serotonin in the brain at once, however, that chemical requires about three days without stress triggers to rebuild during which time a user will likely experience panic attacks which users often counter with SSRI or THC.

We can mitigate these problems with drugs or by natural means such as learning how thought patterns effect chemical states of the mind, having a low stress job, work in a high stress job without giving a shit -- care without caring, eating healthy balanced foods, and most important daily exercise.

A founder needs to realize that stressors are important motivators for productivity but they effect chemical balances in the body which hasn't evolved much in the last 40,000 years. Different employees will have different coping mechanisms and different types of chemical balances. When the chemical balances start to become off kilter there are several signs verbal and physical such as irritability and heavy shallow breathing. It helps to have an intuitive sense of these and make sure an employee doesn't cross a threshold or in the case an employee does it is a worthwhile investment to help.

[1] https://www.youtube.com/watch?v=ElJaPZtSHoU

[2] https://www.youtube.com/watch?v=ejq99wLEMTw

Not to rain on your parade, but the mechanism of SSRI drugs in depression is unknown. They do affect serotonin and they appear to work (although how well they work is questionable), but it's far more likely to be something downstream that isn't necessarily related to the serotonin.

The stress, fear, euphoria, depression associated with starting a startup is not natural (or at least not normal) and I'm sure most founders experience emotions on a level that would qualify them as mentally ill at some point. I've just accepted that it comes with the territory.

Public Service Announcement.

If you are ill, go see a doctor. Skip the travel, spiritual enlightenment, and other ad-hoc treatment; cut to the chase - visit a psychiatrist. If you wouldn't treat your own diabetes, you shouldn't treat your own mental health.

Often times an afflicted person would not have the energy to make the visit, precisely due to the condition that needs treatment. If this happens to you, ask your friends for help.

It's perfectly normal for folks who are motivated, driven to succeed, and who work hard, to burden the stress and strains along the way. But there's wisdom in understanding one's own limits. It's a balancing act. A psychatrist and a blue pill aren't the fix here.

It is true that psychiatry has devolved (mostly) to writing a prescription, which is too bad. The idea of talking your problems through is more and more a thing of the past. And because of this, many people won't go to a psychiatrist, because they are opposed to the pharma approach.

If you're on psychiatric medications and you need a prescription refilled, you need a med check appointment with a psychiatrist. A psychiatrist is a medical doctor (MD) who specialized. If you're depressed or stressed and want to talk to someone, you need a therapy appointment with a psychologist, therapist or counselor. They're different professions, and they're not incentivized to talk you out of therapy (the thing they get paid for) in favor of medication (which they'll have to send you elsewhere for, because they can't prescribe it).

What is the basis for your blanket statements about psychiatry "mostly writing a prescription" and "talking ... the thing of the past"?

Au contraire.

It's perfectly normal for folks who are motivated and driven to succeed to be getting medicinal assistance with being the former. Bearing the stress and strains are often dealt with in a similar fashion.

The pill may not be the "fix" but it's a way to keep up for those who may fall behind and get ahead for those who are only par normally.

I'm not saying that this is the ideal situation, it's just what is.

Well said. Just to add, make a note of the things that OP said and keep up your effort by not relying totally 100% on medication, like you don't when diabetic and try a healthy meal along with the medication.

I agree in principle, but I feel that you have gone a step past the article. While the author did use the words "mental illness," I felt he was mostly talking about general mental well-being (i.e. how to avoid needing the doctor). To extend your analogy, you don't need to go to the doctor to eat well and exercise. You are correct, however, that a person should seek help if something does break. Further, for some people, it might be beneficial to seek assistance (such as therapy) before things break. To finish murdering the analogy, a nutritionist or personal trainer is probably not necessary to eat well or exercise, but they may be extremely valuable to some people.

> If you wouldn't treat your own diabetes, you shouldn't treat your own mental health.

I treat my physical health on my own all the time. I take DayQuil, I take time off, I lay on the couch and watch TV. Heck, I injured my arm 3 months ago (tendonitis), and after 2 months of self-treatment, I felt like I wasn't doing enough, so I went to the doctor and they told me I was doing everything I could and there was nothing more they could do for me.

I absolutely treat my mental health on my own, and I recommend everybody do it. It's not some bright line that you cross where you're all of a sudden "broken" and need a mechanic to fix it. It's the fuzzy art/science of medicine that absolutely requires patient cooperation and introspection to fix.

I don't want to come off too accusatory here but both your statement and the parents are damaging in my opinion. Depending on your issues you may be able to treat your own physical health and mental health but in both scenarios there may come a time when you require professional help. It may be different depending on where a person lives but for me there is no cost in visiting the doctor or getting mental health treatment. So in the example you gave of your arm it would make most sense to go to a doctor immediately rather than spend several months self treating when they may have a much more effective solution to the problem. Also, for mental health in the UK you general require a referral which can take several months so the longer you delay going to the doctor the longer you have to live with the issue. It doesn't apply in your case but it may in others. Not only may you get a solution immediately instead of spending months self-treating unsuccessfully but you may prevent the damage getting worse and in the case of mental health you can spiral downwards pretty quickly. I would say that if you recognise you have a mental health issue you should seek immediate professional help as if you let it get worse you can easily get to a point where you no longer have the right frame of mind to seek treatment even though it is even more necessary.

Right, totally understood. My point is that there are shades of grey.

- My arm. Did I mention this is the 3rd time I've hurt it this way? Since I'd seen this scenario before, I had heard professional opinion on how to treat it.+

- The cost. Time cost is real. In my case (and most founders), time is more valuable than money.

Should we encourage more people to talk to more professionals than do today? Sure, yes, I do think so. But we should also encourage people to self-educate and self-treat. Those aren't at odds with each other.

> Also, for mental health in the UK you general require a referral which can take several months so the longer you delay going to the doctor the longer you have to live with the issue.

In England it's a bit complicated.

IAPT (Improved Access to Psychological Therapy) should provide easy access to Cognitive Behaviour Therapy. People should be able to self-refer without using their GP. But it's different in different areas.

And while CBT is great for some people it doesn't work for everyone, and if you need a different therapy you're going to have to be referred. This will involve potentially very long waits - ideally at most 18 weeks from GP to start of treatment, but in practice people can wait for over a year.

Cold is different from diabetes. You can self-treat one, but not the other.

The problem is that the decision-making vessel is the thing experiencing the illness, so it's not always so simple as "Oh wow I'm ill, I should see a psych!" In addition, treatment for mental health is significantly less reliably effective than treatment for something like diabetes. If you find yourself questioning whether you should talk to someone, you absolutely should; my quarrel is with the way your statement seems to imply (to me) that diagnosis and treatment of mental illness is simple.

How do you square the circle of struggling startup founders having bare minimum health insurance and their stressors often being based in financial uncertainty, with the expense of mental health professionals?

Buy health insurance. When you're young, or even middle-aged like me, the cost is only a fraction of housing.

The problem here is that the very condition that needs treatment makes people seek excuses for not seeking help. This is why I advise leaning on friends - they won't look for excuses.

And by the way, the "open enrollment" period is open right now: https://www.google.com/search?q=health+care+plan+finder

In my experience, health insurance with affordable premiums has high enough deductibles that this sort of thing as the only ailment would be all out of pocket. I'm not saying your advice is wrong, just that for people struggling with financial stress, it is unfortunate that the advice is to spend a lot more money, whether it be in premiums or for services.

Easier said than done when personality and mental illness are so easily comparable.

The travel, etc was the catalyst that helped me clear my head to think about what was going on and finally ask my psychiatrist "What if I had X". I saw him maybe 10 times prior to that and the subject never even came up.

Shit's hard, yo.

That sucks, 10 times is far too long. If a doctor can't figure out what's up in that much time, then it's time to move on to another doctor. The hardest part is working up the energy to make a change.

It's not that simple, even for the doctor. I've had about five doctors tell me that I have ADHD which always led to amphetamine based prescriptions. That generally helped with the attention issues, which was my biggest concern.

The problem is that the mood issues were always just... "me". It just seemed like an aspect of mild depression that was always manageable. The daily internal dialogue would go: "My mood is absolutely awful right now. I have zero energy and feel depressed. But, this is just a fleeting feeling that should go away in an hour. I'll just deal with it. Coffee should help a bit for now, at least." In other words, I would swing between moods similar to bipolar II.

Turns out that's the wrong way to look at it. Some major life events caused me to re-evaluate many things, so I took a major vacation by myself without contact to the world to gain a lot more self insight. Eventually that led to me asking my psychiatrist about bipolar/schizophrenia as a possible cause of my problems. (Some article on hacker news on mental health actually led to bringing up the specific questions.)

When I brought it up, he even looked at me like I was trying to completely self-diagnose and initially shrugged it off. Technically, yes it's self-diagnosis, but it led to a more-correct diagnosis, but only after sending me to a research program that gave me a full psych evaluation. One of the doctors even mentioned multiple times "you're the perfect candidate for this study..." Go figure..

Mild aside - Similar doubt happens when I ask about lead poisoning as a possible attention/mood root. I used to shoot rifles competitively for years without taking care of washing my hands and such, so it's not a completely awful theory. Every doctor I brought it up to looked at me like an idiot and would just send me to get a blood test as if that's even a valid test. Still no answer there.

(edit - editing)

Oh dear oh dear oh dear, the medicine has let you down.

The second hardest thing, after getting yourself to the office, is conveying your problem in all its gruesomeness. I have a hunch they aren't allowed to lead you with questions, and if you think its "normal" you won't describe it in enough detail. It's too easy to start thinking that you are of bad character, or "it's just life". You aren't and it ain't - a healthy person, especially with a good skill set, can easily focus on his work, or put effort to find better work. Timid acceptance of suffering, absent an actual terminal disease, is the hallmark of a mood disorder.

The key trigger with doctors is to describe both how you feel and how that affects your life - e.g. you can't do your work in the afternoon, you can't sleep at night and feel tired during the day, your relationship unravels because you can't put any effort into it, the trash is piling over your house, the bills go unpaid more than they have to be, you get riled up about inconsequential things and can't calm down, that sort of thing.

I'm glad you found proper help. Tenacity pays.

Thanks for the kind words! Truly. I get the slight impression that you know me in-person, or at least someone very, very similar. Or you experience similar.

Things are definitely better these days. I'm currently in the process of switching careers (starting today, actually) to remove as many stress points as possible, which definitely has a major effect on my mental health. No more on-call ;)

Absolutely on the tenacity, btw.

> Skip the travel, spiritual enlightenment, and other ad-hoc treatment; cut to the chase - visit a psychiatrist.

A statement like this presumes all psychiatrists are equally good and roughly interchangeable. That hasn't been my experience at all. The variance is quite high and seems to be patient-dependent.

So better advice is, "visit a series of psychiatrists until you find one that works well for you".

Yeah, that works, although it might be quite tedious. There are several ways to speed up the convergence:

- Ask your friends for a referral. If you're ill, chances are that many of your friends are too - age, environment, and upbringing are contributing factors.

- Ask a doctor in an adjacent field whom you know is competent. Rinse, repeat. This is also know as 'optimistic routing'. Works wonders in any field of medicine, and likely beyond.

- Ask the local medical board. (Never tried it, but it should work).

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