Few people want to acknowledge the mental health impacts of a career choice--especially entrepreneurship. As an attorney I often pay the role of advocate, researcher, negotiator and adviser when problems arise. Sadly, that sometimes includes counseling a client through issues relating to substance abuse and mental health problems.

"No one said building a company is easy", but as Jessica Bruder wrote in Inc. magazine, The Psychological Price of Entrepreneurship, “it’s time to be honest about how brutal it really is”.  If you haven’t read Jessica’s article, I strongly encourage you to do so. Each semester I share it with my students at the UB law entrepreneurship clinic and share it on social media at least a couple of times per year.

Entrepreneurs (and frankly more of us than we'd like to admit) rely heavily on impression management—better known as “fake it 'till you make it”. On the outside we portray confidence and bold leadership, but privately we spend months, if not years, getting beat up, rejected, stressing out about fundraising, working every hour of the day (often underpaid if even paid at all), all while constantly having the fear that all this effort may lead to failure—that after putting everything on the line you won’t succeed. That we'll let down our team, our co-founders, our employees, our family, and perhaps worst of all, ourselves.

It becomes an emotional pressure cooker fueled by caffeine and fear. It's no wonder so many people end up quietly suffering and how we have created a system which isolates and exacerbates the problems. Depression, substance abuse, and mania, are all common traits among entrepreneurs (and lawyers for that matter).

To quote Bruder’s article:

Toby Thomas, CEO of EnSite Solutions (No. 188 on the Inc. 500), explains the phenomenon with his favorite analogy: a man riding a lion. “People look at him and think, This guy’s really got it together! He’s brave!” says Thomas. “And the man riding the lion is thinking, How the hell did I get on a lion, and how do I keep from getting eaten?”

And that’s exactly what happens. I’ve been unfortunate enough to experience firsthand just how painful this dynamic can be in the context of a startup. Ten years ago, it was myself while working through my own depression and anxiety. I've seen more people than I'd like to admit end up in substance abuse treatment for alcohol and drug abuse. Meanwhile others had to experience incredible pain and suffering before confronting their pain. More recently, a close friend tried to take his own life after feeling like a business he started failed. All of this is a painful reminder that despite appearing as though we have it all together, many of us are struggling. It may be your partner, your employee, your co-founder, your spouse, or your friend.

Admittedly, these conversations aren’t easy to have. It’s not easy for me to even write about. But pretending they don’t exist is ultimately an impediment to the long-term success and happiness of the people at the very foundation of the startup ecosystem. If we’re going to change this dynamic, we all must commit to acknowledging the psychological price that is paid and work towards ending the stigmatism that keeps people quietly suffering.