Startup Psychosis: Why Entrepreneurs Suffer from Extensive Mental Illness.

Gabe Zichermann
6 min readJan 29, 2020
Entrepreneurs Often Exhibit a Constellation of Psychological Disorders

I’ve coached and mentored hundreds of startups over the last 15 years and started a few of my own. One unavoidable truth is that every founder I’ve met — without exception — has a story of mental illness or other major psychological problem that has befallen them. I’ve started to refer to this constellation of issues as “Startup Psychosis.”

My story is the same. I’ve been so depressed I couldn’t get out of bed and considered suicide a few times. Cut to a couple of weeks later and I’m staying up for 30+ hours in a manic fugue, closing a round of funding or giving an (excellent, mind you) interview to Anderson Cooper. The extremes are mind-boggling.

Many entrepreneurs turn to drugs to manage their anxiety, and the scale of abuse in our industry is truly staggering. I’ve watched countless friends take Adderall and cocaine to stay up and be productive, while slamming down handfuls of sleeping pills and painkillers to take the edge off. Still others love to throw themselves into extreme diets (Soylent, anyone?), extreme exercise or extreme meditation (yes, this is a thing) to counter the voices that haunt them. And though drugs are not my thing, I’ve used sex and love to medicate my professional neuroses. Ultimately, they may not be that different.

This informs my belief that entrepreneurs have the highest rate of mental illness of any profession. Sure, lots of vocations are stressful and lead people to self-harm. But what sets entrepreneurs apart is the scale and consistency. Every single entrepreneur I know exhibits an “extreme” behavior (or 2, 3, 12).

So this raises the obvious questions of “why?” and “ what can be done?” Though I am a student of human behavior, I’m not a trained psychologist. So take what I write with the requisite sprinkle of kosher salt.


Perhaps it’s that entrepreneurs don’t develop negative behaviors and self-harm extremes because of their profession, but perhaps they choose their profession because of their tendency to do just that. Entrepreneurship is a field in which there are few people watching over your shoulder, managing your time, or telling you what to do. It’s pretty easy to develop bad…

Gabe Zichermann

Author and Public Speaker on Gamification, The 4th Industrial Revolution, the Future of Work and Failure. More about me: