Ask HN: How do you cope with mental illness as a founder and/or employee?

> as my mental/emotional issues can, and perhaps will, make me a poor decision maker and even (irrationally) emotionally abusive at times.

This resonates with me, and it's taken a ton of work on my part. I have compassion and empathy, but real talk, it is of utmost importance that you get this very specific thing in check. As an employee, that's legitimate grounds for termination; as a new employer, it's a lawsuit that will end your business.

Learn your triggers, and learn your triggered behaviors. In my life... that happened over the course of 20 years of failed romantic rationships; seeing harmful behaviors in my partners and doing hard self-reflection to identify those behaviors in myself. Maybe you'll have better luck in counseling. Maybe not? Progress is hard; setbacks are easy.

Once you can recognize that you're about to do harm, you can pull yourself away. Take a mental health day. Work on something else. Avoid that co-worker, but be explicit about it: "hey, I can't do this right now, can we come back to it tomorrow?". Be vague but open about mental health issues -- saying the words "mental health" is great to establish why you're stepping back; going into detail about your challenge in the moment is never a good idea, in my experience.

I appreciate the candor and I definitely appreciate the empathy at the top. I have never once felt good about an outburst of intense sadness, crying and panic. The effect it has on those near me is devastating and something I try to minimize as much as possible. We've all had a talk of some form to just not engage with me and know that I'm not myself. This also limits my motivation to make new friends as I don't want that burden for anybody.

I suspect my vagueness isn't helping, but to be clear I have never had any sort of outburst incident in the actual workplace. I'm a _very_ non-violent person (never even been in a fight) and prefer logic to emotion when I'm not too overwhelmed. I've been "fired" (it was a contract to hire position so it's totally fair) once for issues related to depression.

As for the suggestions, I think before I was able to do that I would need to tell my employer in some way about my mental health issues and I have never once felt comfortable doing that. There have been times when I could have opened up but didn't, and that's something I can work on I think.

Do you really think that will go well? Just saying - "I'm so sorry but I'm dealing with some mental health issues and won't be able to attend today's meeting"? To be clear, this is something I've desperately wanted to be able to just have the _option_ to do because I very consistently get panic attacks during meetings. I'm quite good at hiding them but it's a deeply unpleasant experience. I've left to use the bathroom several times and people just wait for you to come back because they don't know you need to just not attend.

I suspect the answer is "it depends". I've had bosses who definitely would've reacted better to this than others. The search continues.

Thanks again.

I've worked with several startup founders and a few early engineers who told me they'd been clinically diagnosed with mental health problems.

Generally I've noticed that an unfunded, stressful startup environment magnifies their existing problems.

Some suggestions to avoid a breakdown:

- wait for the right time to begin your own startup (get funding based on a powerpoint first, start a popular blog or podcast to have PR traction before writing any software, get caught up at the dentist, buy a new car if needed, see if any medication is needed/works for you, etc.)

- or join an early but funded startup

- understand that startups are usually 7-10 year marathons before the final success or failure, so you need to be able to keep it together for several years. That includes maintaining the best physical and mental health you can so you can handle inevitable setbacks. Even if you're an introvert, that includes relationships.

Starting your own company to "escape" civilization usually doesn't make sense unless you can self-fund it for several years, or your existing contacts can quickly be paying clients.

What happens when you're not prepared is that paranoia will dominate your relationships, depression will deepen, etc. so your startup marathon doesn't have a chance of finishing.

Having said that, manic people can accomplish a lot during their manic phases, but to sustain that over several years means they need to follow the preparation above.

If you're a non-technical founder, understand that engineers are very expensive to make payroll (which adds to your stress), and have options (don't really need you or other mentally ill people in their life.) So ensure you have adequate runway, or structure your staff relationships, so that you don't stall your project.

Also, in the US, ensure you've considered health insurance expenses before doing the startup thing. Most small businesses struggle with that, and it gets worse every Jan. 1.

I havent been clinically diagnosed and as its manageable I doubt its anything serious, but occasionally I suffer from some "light" health issues around anxiety, anger, very visible changes in longer lasting temperament etc. Heavier mental health issues are above avg in my family.

I found that the initial setup and early stage of our startup was a rollercoaster but not really a trigger. I guess it was because I had already framed the failure in my head and even when the expense was way more than planned and Id lost the bulk of my savings I still had my initial, though wobbly, frame to fall back on (had a month or two in salary and could likely find a regular job, kids weren't gonna starve).

Ironically it was when we got larger, well funded and more secure that it become more difficult for me. As the larger you grow the more time you spend dealing with people-stuff. The solution seemed to match general founder-advice when scaling. Hire good people, build process, delegate etc.

A caveat though, ive always been the type of person to thrive in situations adverse to me, but not social situations. I would probably have a worse time in a large corporate if I was psychologically invested in its success.

I think its possible to start a consulting / services / freelance style business without cofounders and with mental health issues. Don't expect to start the next disruptive startup without putting in a lot of time to develop mental resilience and learn to collaborate better with other people. But if all you want is to be free and run your own business, then yeah, definitely possible.

Im pretty open with it. I am a conference speaker on behalf of OSMI[0] (Open Sourcing Mental Illness) and I've been incredibly open about my depression/anxiety and my time with a therapist.

It's not easy, but I feel that if at least one person is helped by me speaking up it's absolutely worth it.

0: https://osmihelp.org

This looks fantastic and is a great idea. Really hope this gets more traction. The mentally ill are truly undervoiced in society for so many reasons from lack of professional diagnosis to shame or even just being an emotional and awkward topic to bring up, particularly for those with social anxiety.

I need to dig more into the various books and policies when I have more time but do feel free to post a video of a conference you've done if you have a good one posted somewhere!

Im not sure if any videos of myself exist however here is the founder of OSMI, Ed Finkler, giving a talk at Google

https://www.youtube.com/watch?v=NHulgcO_16U

appreciate you doing that. vulnerability is seen as a weakness, but it should be seen as a strength and form of empathy. Are their other organizations/resources that you'd recommend that are in this space?

OSMI is probably one of the most well known in the developer/mental health space that is speaking out on this topic. I know there are some apps and start ups trying to do things but I dont keep close tabs on them.

Seeking professional help was the single most productive step towards dealing with my mental health issues. Fore that was talking to my family doctor and starting regular counseling. From there everything else got easier. Hang in there. Talk to someone, just get it started and good things will happen.

Absolutely. Great advice. Have been seeing both a therapist and psychiatrist for years.

I've got Pure O and Depression and all I can say is that with time it got easier to manage. I've lost 4 jobs owing directly to my mental illness, so I do not know if I'm there yet but having someone to talk to has helped.

My own has helped me empathize and help with employees issues. But that doesn’t help with ones own and it has been a struggle personally.

If you don't mention anywhere if you are getting treatment or not how do you expect people to help you with context?

I've been answering this question a lot so I'm just gonna copy paste another comment I wrote elsewhere -

>I am currently seeing a therapist and psychiatrist. I'm also not looking for general help or a diagnosis from anyone, which people tend to do inappropriately sometimes on the internet. That's why I've been somewhat vague. I'm just looking for other people's experiences specific to either starting a company or being a programmer. That's not something I can really get from my therapist.

Not sure, but can generally keep myself composed in public. I imagine it will catch up to me eventually

Mine catches up to me about once a year these days. Best of luck.

Drink too much.

Feel bad about it, repeat.

Try and be better about it tomorrow, repeat.

Where’s my drink?

You need to do what you can with what you've got. Get help but don't stop your life. Keep doing what gives you meaning.

This is a very delicate subject to expect people to open up about on a very public forum.

I agree and I implore people to keep things vague and post on throwaway accounts if they want to post.

Back in November 2013 I spontaneously developed what would become permanent depersonalization/derealization dissociative identity disorder. I have three weeks of missing time I can’t account for when it triggered; according to my family I was at home the whole time while it happened, as if I was sleep walking, but no one noticed.

When I came to, I found myself in a very literally dark, distored, and morbid hell-scape. I was very confused and although I still had memories of being “me” I no longer associated them with whom or what I was now and likewise for family and friends. I was a stranger to myself and everything and everyone I had ever known.

I went to see my primary and the nurse went to take my pulse and it was so high that she brought in the doctor to take it multiple times because they thought the machine was broken. I was recommended to a psychiatric clinic by my home and went there for about eight months before I switched to a private practice psychiatrist. This was because clinics are too afraid of being sued and thus their doctors rarely are willing to experiment or go off-label on their patients in order to cure them.

After almost 8 years of experimentation and trying pretty much every medication on the market and with the help of my doctor, I can say I have recovered to my satisfaction. My disorder is rare and thus isn’t well documented in the DSM and therefore is hard to treat and diagnose. I still, from time to time, have periods of “missing” weeks that I can’t account for but I’m still functional and appear normal during those periods.

I learned many lessons about the medical industry over the years, but the most important is: “Only experimentation cures patients”. You have literally 5 minutes per month with your psychiatrist because they “prescribe“ whereas psychologists “talk”. Buy the best healthcare you can afford and only go to pharmacies and doctors in very affluent neighborhoods. If a medication or class of medications, such as SSRIs, didn’t work the first time, they won’t work a second time. Be patient, because your doctor has other patients—this means you have to be responsible for doing your own homework about your disorder and what treatments might be effective for you. This also means you have to learn a considerable amount about neurochemistry and biology sadly and keep a journal of controlled experiments to determine what factors are significant or not. Don’t be afraid to fire your doctor if it’s obvious they don’t value your time, such as routinely being late for appointments, or ignore your every word and just follow a scripted dialogue with you. I wish I could tell the readers here all that I’ve learned, but for brevity’s sake I won’t here, but I can comment on any responses.

Lastly, my advice is do NOT tell your employers nor your coworkers about your condition. They won’t care nor understand what you’re going through and they will use it against you the first chance it becomes convenient for them. I’ve seen this happen time and time again with past employers; they love to say “Oh, he was crazy” as the reason they fired a developer who dared challenge their authority. This is the unfortunate stigma the mentally ill have to contend with on a daily basis and only makes things worse for those of us whom are struggling.

One final word: true mental illness is a life long struggle and what has kept me from giving up so far is remembering, “There’s always something better”. No matter what stage of recovery you’re at, you can always be a better you—never stop improving.

Thank you very much. It sounds like you've been through a lot of pain and I know what that feels like. It's comforting to hear the cold truth that "employers don't want to hear it", but it honestly conflicts with the more positive mindset mentioned in another comment. I think I could find an employer who really did understand. It would be an effort though for sure.

> If a medication or class of medications, such as SSRIs, didn’t work the first time, they won’t work a second time.

Source?

Is there some reason you can’t see a professional instead of asking on a Internet forum?

I am currently seeing a therapist and psychiatrist. I'm also not looking for general help or a diagnosis from anyone, which people tend to do inappropriately sometimes on the internet. That's why I've been somewhat vague. I'm just looking for other people's experiences specific to either starting a company or being a programmer. That's not something I can really get from my therapist.

If you have a history of abusive behavior do not start a business, seek professional help and professional/peer solutions.

Everyone "continues to deal with mental illness," getting professional help does not just resolve things. It takes a lot of work.

It seems to be difficult to advise you on this without knowing more about the specific nature of your mental illness — although it's entirely understandable that you're not too keen to share details.

But ultimately, everybody is dealing with some mental health issues (Sigmund Freud said something along the lines of perfect mental health being an unattainable goal for any civilized person), so being aware of your specific issues might put you ahead of the game, if you use this as motivation to monitor your symptoms and counteract your detrimental behaviors, instead of normalizing them.

If it helps I am seeing a psychiatrist and a therapist and know my own diagnosis. It has indeed put me ahead of where I would have been.

Sorry about the vagueness but I very much am looking for just anecdotes from other people. I don't need advice for my specific situation because I frankly don't think anyone should give or take psychiatric advice over the internet unless it's "please dial this hotline".