Why Don’t More Founders Go to Therapy?
When the world treats you like a superhero, being vulnerable takes courage.
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Elizabeth Holmes goes by Liz now, but she still sounds like her old self.
As the Theranos founder prepared to go to jail for defrauding investors in her biotech startup, she confessed to the New York Times that “I still dream about being able to contribute in that space.” The author described Holmes as having “the idealistic delusion of a 19-year-old, never mind that she’s 39 with a fraud conviction.” Despite it all, she doesn’t seem to have overcome the megalomania that landed her in jail.
Holmes’ mental health isn’t just the subject of online gossip. It’s in her parole conditions, and was part of her defense. But while her shaky relationship to the truth may be extreme, her struggle is far from unique. Founders are dreamers, and mental health issues are an open secret in tech. And when those issues go untreated, the fallout impacts everyone, from shareholders to employees.
Founders’ mental health has been in the spotlight recently, and not just because May is Mental Health Awareness Month. After his crypto exchange, FTX, was exposed as a scam, Sam Bankman-Fried’s erratic media tour led some analysts to question his state of mind. And Elon Musk, who’s become fixated on the “woke mind virus,” is weighing in on mental illness and public health.
“Even if we’re doing all the right things, something can just come out of the blue and take the whole thing down.”
On top of these high-profile cases, founders are suffering from industry-wide whiplash. The abrupt shutdown of Silicon Valley Bank (SVB) sent many into shock as they learned just how precarious their operations had been. As one founder who narrowly escaped missing payroll told me, “Even if we’re doing all the right things, something can just come out of the blue and take the whole thing down.”
But to many investors, the roller-coaster is just the cost of innovation. As one of them told Insider, the unofficial policy on mental health is “don’t ask, don’t tell.”
The SVB crash led Naveed Lalani, Founder & CEO of Founder Copilot, to launch a Founder Mental Health pledge. With 445 signatures and endorsements that include Brex and Techstars, the pledge promises “a commitment to take an active role in encouraging mental healthcare for founders and the greater startup community” and “to encourage the founders we partner with to invest in their personal mental health and build a workplace culture that promotes mental health.”
Lalani’s mental health pledge mentions therapy, but stops short of endorsing it. Signers pledge “to be supportive of founders treating the direct cost of caring for their mental health as a legitimate, worthwhile, and encouraged business expense – including therapy, coaching, group support, and app-based solutions.”
In short: mental health is a valid write-off.
For founders, therapy is still the exception, not the rule
While higher than average, the number of entrepreneurs seeing a therapist is still quite low. Instead of talking to a professional, the majority seem to support their mental health by talking to and emulating other entrepreneurs.
According to a 2018 survey of 200 venture-backed CEOs and founders from Norwest Venture Partners, only 22 percent see a therapist, with 32 percent seeing an executive coach and an equal number seeing a wellness coach. Ninety-three percent socialize with other CEOs and founders at least a few times a month, with 27 percent doing so multiple times a week. Founders also lean on their partners, with 74 percent saying they enlist “family members” to help with the business a few times per month. And many in tech see self-directed therapies with drugs like ketamine and psylocibin as an effective (and conversation-free) replacement for talk therapy.
A founder’s mental health doesn’t just affect them; it affects their entire company. Unhealthy habits trickle down to managers and employees, while issues like anxiety and depression can lead to reactive decisions or lashing out. But even those who aren’t coping with acute mental health problems still cope with more common issues, like stress or imposter syndrome. In Norwest’s study, 90 percent of founders said fear of failure keeps them up at night more than anything else.
Which raises the question: why don’t more founders go to therapy?
Overcoming Silicon Valley’s culture of hero worship
It’s impossible to talk about founders without talking about demographics. Women make up less than 15 percent of founders, and part of why so few founders seek therapy may lie in the gap. A 2020 report from the Center for Disease Control found 12.1 percent of women go to therapy, versus 7.9 percent of men.
But gender aside, to be effective, therapy requires being open to reflection and self-awareness. That takes vulnerability, which makes most leaders uncomfortable. On TechCrunch’s Equity podcast, Lalani explained that as managers and employees open up about mental health, “it’s actually made executives more closed, because, you know, the perception of mental health is that might be a weakness.”
The stigma of weakness is no surprise. Tech loves comparing founders to superheroes, and many lean into the metaphor. Elon Musk embraced his image as a real life Ironman. The culture of self-optimization leads tech influencers to spend heavily on anti-aging treatments that promise superhuman longevity, nootropics that promise superhuman cognition, or stoic routines that promise superhuman willpower.
Early-stage investors are focused on the founder, not the business. But the spirit that drives a founder to win at all costs is the same one that prevents many from seeking therapy. When your identity is tied to self-optimization, asking for professional help takes humility and courage. And the natural insecurity of faking it till you make it, a standard practice in tech, can make self-inquiry feel especially daunting.
Tech’s superhero fixation isn’t limited to founders. The entire ecosystem embraces the fantasy of the Übermensch, often in ways that are surprisingly on the nose. Hiring teams ask candidates to describe their superpowers. Early-stage startups self-identify as small and mighty, a phrase that evokes a cartoon mouse in a cape. And for much of 2019, the buzziest app in Silicon Valley was an email app called Superhuman.
In this environment, it’s natural for founders to identify with masked vigilantes. They share so many narrative parallels. Misunderstood by society. Standing up to powerful enemies. Cool gadgets. And, of course, taking the law into their own hands.
This hero fantasy is deeply tied to the founding myths of Silicon Valley, which mirror those of the United States as a whole: think for yourself, take smart risks, push the hardest, and nothing is impossible. And it speaks directly to tech’s deep-seated belief that government can’t, or won’t, solve society’s problems in time.
Mental health is financial health
Going to therapy is good for business. For one, seeing a licensed therapist is the most reliable way to cope with the stress of running a company. Pedro Franceschi, the cofounder of Brex1, shared the benefits of therapy in a company-wide memo:
“It’s hard to overstate how much happier I became after starting to see a therapist regularly. After each conversation, I learned more about myself, and why I was feeling what I was feeling. In just a few weeks, I started to feel relieved. I understood what was happening to me, and felt in control again.”
But therapy doesn’t just feel good. It also helps founders make better decisions. A good therapist has a unique perspective on the unconscious forces that influence our choices. While some executive coaches are former psychoanalysts, it’s rare to find one who can discuss cash flow and attachment theory in the same breath. And for most founders, attachment is one of their biggest obstacles to success.
“Parental love brings forth the best and worst in human beings… Often, you are a little irrational about all you’re doing to grow your business.”
According to brain scans, founders love their companies the way parents love their children. That love is a killer motivator—just ask a solo parent. But it also makes it hard to take an objective view of their own culture. As Stripe’s guide to founder stress put it, “Parental love brings forth the best and worst in human beings… Often, you are a little irrational about all you’re doing to grow your business.”
Not every decision a founder makes is irrational. But as Nobel-winning economist Daniel Kahneman outlines in Thinking Fast, Thinking Slow, most decisions are unconscious. When a decision affects something a founder is personally invested in, like a key partnership or the company’s narrative, they’re more likely to go with their gut. And when the people below them are scared to speak truth to power, it’s easy to ignore or dismiss the facts that might change their mind.
Self-care starts at the top
Healthy leaders build healthy businesses. If companies are extensions of founders, perhaps seeing one’s own company clearly depends on seeing oneself clearly. Which is exactly what Freud managed to accomplish through a dialogue with his patients.
There’s a reason psychoanalysis’ most well-known patient called Freud’s method “the talking cure” and not “the thinking cure.” There’s something special about talking one-on-one. Meditation isn’t a substitute for therapy; neither is coaching, or self-medication, or reading essays by psychoanalysts like Adam Phillips. The only way to get the benefits of therapy is to sit down, open up, and talk to a therapist.
In the right hands, dialogue is a powerful tool. Rather than sharpening your memory, or allowing you to focus for 18-hour days, therapy gives you a different kind of superpower: the power to understand your own motivations.
All of us, no matter where we sit on the org chart, ought to treat therapy as essential. That means normalizing therapy with our peers or direct reports. It means shamelessly blocking off time for therapy without labeling it “Personal Appointment.” And it means encouraging each other to talk to a professional before a crisis.
Unlike superheroes, who only live in the realm of fantasy, founders have the ability to change the world we live in today. And instead of asking our leaders to carry the weight of the world, all of us should embrace the reality that they are human, just like us, with all of the limitations and frailties that category entails.
If that feels scary, therapy can help.
Disclosure: Pedro is an old friend and former employee of mine.