Talking about her mental health startup Wysa, Bengaluru-based founder Jo Aggarwal drops it casually: “When I was working on my first startup, I had founder depression.” We are about to move on to talking about her current company but the term stops me in my tracks. “Founder depression? Is that really a thing?” I ask, probably sounding sceptical. “Oh yes, of course,” says Aggarwal. “It’s very much a thing. Not studied much in India but in the US there has been proper research into it.”
Entrepreneurship research is a fledgling field in psychiatry even in the US but pioneering work by researchers like Michael A. Freeman, clinical professor of psychiatry, UC San Francisco School of Medicine, provides insight into the psychological dimensions of entrepreneurship and the mental health scenarios associated with it. A 2018 study led by Freeman found that entrepreneurs were more likely than comparison participants and the general population to experience depression (30% more likely than comparison participants or the control group), attention deficit hyperactivity disorder, or ADHD (29% more likely), substance abuse (12% more likely) and bipolarity (11% more likely than the control group).
This will probably not come as a surprise to anyone who has been an entrepreneur, worked with one or known one closely. Founders lead some of the most stressful lives. The highs are moderately high and the lows, extremely low. Unlike other small businesses that can grow at their own pace, startups have pressures to be unique, to “disrupt”, get funded and grow fast. Founders have to justify the funding they receive and do it within a limited period of time, all under media and peer scrutiny. So, though traditional small business owners have their own struggles, the pressures on startup founders are manifold.
For Aggarwal, the realisation that she was suffering from depression—she was subsequently also diagnosed with ADHD—came when she found herself struggling with her first startup, StayClose, an app for “real-time visibility of your family’s well-being”.
Launched in March 2015, it was the first app from her company, Touchkin, and was meant to help families living at a distance stay updated about one another’s well-being through a simple status update. It was a neat idea, and it got funded pretty quickly, but a few months down the line, the number of downloads stagnated. Aggarwal realised that the use-case she had developed it for—adult children staying updated on their elderly parents’ well-being—was not being met; instead, it was largely being used by parents to monitor their younger children.
“We were not getting a great product-market fit. We could have kept spending VC money on things like Facebook ads but I could see that money whittling away. That’s when I started spiralling a bit. I thought, ‘If I shut down this company, no one will give me money again.’ I started becoming afraid of failure. I constantly fought imposter syndrome. This was what finally triggered my depression,” says Aggarwal.
“I found I had a bad monster in my head, but once I had named it and started dealing with it, I stopped catastrophising and from this experience, I realised I wanted a solve for mental health.” She managed to pivot the company into her current startup, Wysa, which uses an Artificial Intelligence chatbot as a primary tool to help users cope with stress and other mental health issues using mindfulness and CBT (cognitive behavioural therapy) techniques.
“Founders face a very unique situation—if they express that they are depressed, it puts a lot of pressure on the company, on employees and co-founder… if you open up to them, they are going to freak out,” says Aggarwal. “Employees have joined you on the back of their faith in you. Fund-raising becomes an issue. VCs are investing in you, your grit and determination, and you feel like you have to keep telling everyone main hoon na. Ultimately, even if you are not the kind of person who stigmatises mental health, you feel like you have to ride it out.”
‘Everything is about validation’
In September, Ashok Varma, the 32-year-old founder of SaaS (software as a service) startups ReportGarden and SalesBenefits, died by suicide. In a moving Medium post, written as an obituary for Varma, his friend and fellow founder Rushabh Mehta (CEO of Frappé Technologies, an open source enterprise resource planning product) observes: “Ashok was a very sensitive and intense person, and he was under a lot of pressure. While he put on a brave face, he had also confessed to some of us that he was suffering from pain and depression. Entrepreneurship was a game which he was both winning and losing, and it had left him perplexed and anxious.”
Varma died when things seemed to be turning around for him; he had raised funds for his latest startup and moved to Singapore with big plans for his new company and life. However, the timing of his death isn’t surprising. Sometimes, the constant whirl of founder life, the 16-hour workdays, the inexorable knowledge that the buck stops with you, and the wildly yo-yoing emotions—giddy and hopeful one moment, consumed by intense anxiety the next—can create long-standing mental health issues that can manifest in various ways.
“Most founders go through it but don’t know what to call it,” says Vivek Khandelwal, founder of Delhi-based iZooto, a digital marketing platform that helps media publishers and retailers build and engage with their audience using web push notifications.
Talking over the phone, Khandelwal recreates a scenario that many founders go through daily. It sounds intensely personal: “Say you are the founder of a small, growing startup. People tell you, you should go to trade shows in the US to expand your reach and get new customers. You worry about the cost of travel and whether it will be worth it. Finally, you pack your bags and end up at the conference, where you have to immediately get to work. And it’s a complete white show. Everyone else is white and know other people already. How do I get people to talk to me? You start barging into conversations, they ignore you. With every interaction your self-confidence takes a bit of a beating. At the end of the day, you are miles away from home, from your family, your team...jet-lagged and snubbed over and over again.”
As a founder, you can’t even share the experience with your team, says Khandelwal. You bottle it up and share happy photographs on Instagram so that they feel motivated. “The whole thing leaves you scarred. And you do it again and again, month on month, till you reach the point where everything is about validation. Even something like an employee leaving to get another job feels like a personal failure. Every such experience keeps on piling up and the stress becomes unbearable at times,” Khandelwal says.
If you have a co-founder with whom you are in sync, you might be able to share the stress somewhat, but quite often, conflict with your co-founder can become a new source of stress and anxiety. “You feel like every action of yours is under scrutiny. You don’t feel validated,” says Khandelwal.
For most founders, work is all-consuming. “You are CEO and chief bathroom cleaner,” says Udhay Shankar N., a veteran of the startup scene and an independent consultant who advises early-stage entrepreneurs. “From fund-raising to hiring to building your product—you have to do it on your own, and often you have to do things that you are not trained for. Having a co-founder isn’t always a solution either—the No.1 reason early-stage startups fail is because of co-founder disagreement,” says Bengaluru-based Shankar.
It is well-known that seven out of 10 startups fail within the first 12-18 months. “And everyone wants to be among the three that make it, right? It’s a lonely journey, it can be extremely hard on mental health and in the past six-eight months, the trend has only accelerated because of covid-19,” says Shankar, who is also a former head of the startup accelerator programme at Axilor Ventures.
‘Like a physiotherapist’
Recognising that many of these experiences are common to founders, Prasanna Krishnamoorthy decided to do something about it. A partner at Upekkha, a Bengaluru-based startup accelerator for Indian SaaS startups, Krishnamoorthy has been an entrepreneur himself, and has worked with them throughout his career. He understands what founders go through only too well. “Founders blame themselves for failures even when they understand at an intellectual level that the failure was because of issues not within their control. It’s a lot of load for one person to bear,” says Krishnamoorthy.
It was during his stint with the Microsoft Accelerator in India, where he helped early-stage startups scale and become profitable, that Krishnamoorthy first came up with the idea of creating a no-judgement safe space for founders. “Soon after we started the sessions, founders started opening up about their problems. Some stepped up and said they were contemplating suicide. That’s when I knew this was serious and widespread,” says Krishnamoorthy.
He knew next to nothing about dealing with mental health—his own or others’—so he first went to work on himself, attending a vipassana course and starting therapy. He also attended American leadership coach Jerry Colonna’s Reboot workshop. Colonna, whom Wired magazine called “the man who makes founders cry”, is a former Silicon Valley executive and venture capitalist who co-founded Reboot.io, a leadership coaching company, in 2014 to help leaders confront their fears and own up to their mental health issues. Colonna talks openly about his own depression and suicidal thoughts, experiences that prompted him to start Reboot.
Krishnamoorthy wanted to create a support system similar to the one Colonna’s organisation was providing to founders in the US—but in a more affordable and accessible way for young Indian founders (with most sessions costing ₹1,000-2,000). Then he came across a new startup that was connecting users with therapists and counsellors using a digital platform, promising on-call help and anonymity—YourDOST, co-founded by Richa Singh and Puneet Manuja, one of the first online mental health platforms in India. Krishnamoorthy worked with YourDOST to create their Founders Program, a special therapy programme created with entrepreneurs and their specific mental health needs in mind. Over 50 founders at Upekkha have signed up. “What I tell them is, look at top athletes and sportspersons. They don’t go to a physiotherapist only when they are injured, they work with them and fitness coaches throughout. Running a startup is like running a marathon, so think of yourself as an athlete and your therapist as someone who helps you stay fit and agile, mentally,” says Krishnamoorthy.
Perhaps recognising this, the past couple of years have seen several startups focused on mental health being founded by people who themselves struggled with the challenges of entrepreneurship in their initial ventures. This includes Aggarwal of Wysa and Singh of YourDOST, as well as newer companies like True Therapy, started by former fintech founder Abhik Prasad, whose mission is to “make therapy accessible to everyone”. Along with trained psychologists and psychotherapists, Prasad says he has offered his own services as a “listener” specifically for founders to talk to about things that only a fellow founder would appreciate.
A number of more mature startups are also signing up for mental health programmes for employees. It is a positive sign that awareness about the need for mental health support is on the rise. Aneesh Reddy, co-founder and CEO of Bengaluru-based Capillary Technologies, founded in 2008, signed his employees up for the YourDOST programme, and says around 2-3% of their employees have availed of it. “Actually, that was a high enough number that it made us sit up. We actually started thinking, ‘What are we doing wrong?’ But then we realised it was a good thing,” says Reddy.
Two employee suicides pushed him to take mental health seriously: The first was when they were just starting off around 2008, and the other a few years later. Although the reasons were found to be unrelated to work, they left a deep impact on Reddy, who believes that even though founders are “inherently pretty good at dealing with ambiguity”, they do get affected by things like unhappy team members and employees. “Even employees leaving can be stressful. Startups are a lot about camaraderie and connections, and a co-founder or a long-standing employee leaving can be like a mini break-up,” says Reddy.
Founders see their organisations as an extension of who they are, and their companies become a part of their identity, says Puroitree Majumdar, a Bengaluru-based clinical psychologist who heads the founders’ programme at YourDOST and has worked with over 100 founders in the past one and a half years of the programme. Although Majumdar says that only a small percentage might be actually diagnosed with depression, many others go through it at sub-clinical levels—and that, again, might have something to do with the typical temperament of founders. “Most founders are high-functioning individuals and they operate at a different level of stress. They may not have observable symptoms but they might be simply ‘powering through’—their threshold for stress is just higher. But this can have long-term effects, including self-doubt, anxiety, depression and suicidal ideation.”
Why do we not hear of stress-induced depression and mental health issues among other cohorts of high-functioning professionals—say, doctors or pilots? I ask Majumdar. “They do, too, but a founder’s journey is slightly different. Pilots and doctors have teams and very specific, assigned roles. They perform jobs that they have been trained for, for many years. Founders have to constantly think on their feet and learn and do everything—you may be a software engineer but overnight you have to learn how to do social media for your company, whose entire existence may depend on that one activity,” she explains.
The culture conundrum
Startup culture is littered with terminology that references mortality: sudden death, near death moments, valley of death, startup hell, burn rate, kill switch. Even positive comments are often couched in machismo—“killer app”, “growth hack”, “hustle”. Though struggle is often glorified in the startup world, with a liberal sprinkling of quotes from Apple co-founder Steve Jobs, it is seen as a necessary step towards success—a cleansing “fire walk” that will lead you to greater glory someday. These popular narratives play a huge role in founders’ expectations from their own startups and their own selves. If you are not gaining something from your failure, what are you even doing here? The quieter, more realistic stories of startups that fizzle out, founders who give up, don’t get much airtime.
Success brings its own pressures—Majumdar says many of the founders who are struggling with mental health are not first-time entrepreneurs or heads of early-stage companies but those who have tasted some measure of success and are now weighed down by expectations and a “now I cannot fail” attitude.
The good thing is that high-profile founders are talking about mental health and the cultural issues around startups. In an August 2019 episode of the podcast GoFigure by Gojek, Nadiem Makarim, founder of Indonesian super-app Gojek, and Kunal Shah, founder of CRED and FreeCharge, share brutal truths about entrepreneurship and the emotional cost of becoming a startup founder.
“It’s harder to be more real,” says Shah. “It’s a constant challenge because people look up to founders as heroes and we are just normal people...constantly in this mode of insane optimism in front of people and insane paranoia inside and constantly switching those sides.”
It’s interesting, though, that even when founders talk about the “dark side” of entrepreneurship, they often talk in generalities and abstractions rather than about personal experiences. Very few, like Aggarwal, talk about their own specific struggles.
And one cannot blame them. The startup ecosystem can be a place of projection and swagger, of appearing more confident than you are, of “fake it till you make it”. So encoded are these expectations and behaviour patterns that most founders fall into them without much thought.
However, even the fledgling conversations are important, and the ecosystem needs more of those and fewer Steve Jobs and Elon Musk quotes.
Resources for founders: