The Mental Health Burden of Entrepreneurship

Paul O'Brien
5 min readDec 16, 2019

In 1985, management scholar Manfred Kets de Vries wrote in Harvard Business Review, “Entrepreneurs seem to be achievement oriented, like to take responsibility for decisions, and dislike repetitive, routine work. Creative entrepreneurs possess high levels of energy and great degrees of perseverance and imagination, which, combined with willingness to take moderate, calculated risks enable them to transform what often began as a very simple, ill-defined idea into something concrete. Entrepreneurs also can instill highly contagious enthusiasm in an organization. They convey a sense of purpose and, by doing so, convince others that they are where the action is.”

What an infectious and exciting observation. Almost 35 years later, our exuberance for entrepreneurship has reached pop culture status and thankfully, our attention has increasingly shifted from the important role entrepreneurs play in our economy, to the toll it takes on such people.

“Along with their mystique, however, entrepreneurs can have personality quirks that make them hard people to work with,” continued de Vries. “For example, their bias toward action, which makes them act rather thoughtlessly, sometimes can have dire consequences for the organization. Moreover, some entrepreneurs I have known have had great difficulty taking direction.”

de Vries asked, “Do entrepreneurs have more personal problems than other people?”

Since that time, published have been a few fantastic studies and articles that give us insight to the fact that we’re tackling the burdens of entrepreneurship.

The recurring theme? Mental Health.

How much do you earn as a entrepreneur?

Think about it a minute. The question comes up with surprising frequency; affirming that people are exploring being an entrepreneur, perhaps out of necessity as much as desire. But is the word “entrepreneur” a job title? How much do you earn as an entrepreneur?

Zip. Zilch. Nada.

Entrepreneurs don’t get paid.

Entrepreneur isn’t a job title. It’s not a job. It’s not a role.

Entrepreneur is more of a personality trait, distinguishing the type of person who is fixated on investing themselves to improve things.

Take, for example, Elon Musk and Mark Zuckerberg… how would you simply clarify how they operate differently? Zuckerberg, clearly a founder, business owner, and executive. Successful. Musk, the same for PayPal, and Tesla, and SpaceX, and…

Musk is more entrepreneurial.

Edison and Telsa would be another great example of the distinction. Tesla the incredible inventor while Edison was the entrepreneur.

And with that distinction aside, “entrepreneurs” get paid whatever their job pays them.

Why doesn’t everyone become an entrepreneur?

It seems an ideal under the circumstances doesn’t it? We all work for ourselves and in a job. Where then is our focus and priority? Is it even sustainable.

Frankly, encouraging it would be economically and societally devastating.

Only about 5% of the entire population could be sustained as entrepreneurs.

Investing their personal wealth and health in addressing major gaps and problems in the market, this subset of our economy is loses a lot of money.

The entrepreneur is the personality trait of some of those professionals, who can’t help but put it all on the line to disrupt or fix something otherwise considered too risky or impossible.

No one can take the risk of being an entrepreneur without companies, investors, and employees who help them. Most people need to be business owners, service providers, and employees; the work needs to be done. Thankfully, few risk everything to attempt to change something… if most did otherwise, our economies would collapse.

Still, so many are determined to try…

The Mental Health Burden of Entrepreneurship

Opposition, confusion, and doubt. Depression.

Entrepreneur defines the type of person who can’t help but address problems/gaps in work. In whatever context that means, that’s not necessarily a business owner or founder, it just refers to that personality that is fixated on fixing things.

i.e. Elon Musk would define Entrepreneur whereas a Zuckerberg, not so much. Hopefully that makes the distinction clear.

As such, two distinct ways to think about those challenges:

  1. Such people are working on things that are disruptive, unfamiliar, or seemingly impossible.
  2. Given that, they’ll fail, a lot, and people will question why they’re bothering.


  1. Opposition, confusion, and doubt
  2. And, mental health challenges such as depression

Yay! The Dark Side of Being an Entrepreneur

That means isolation, celebration of success in an aspect of the economy that fails (entirely) 90% of the time, and being opposed constantly.

That takes a toll that is only more recently being explored in depth. That takes a toll that is obfuscated by Media and culture/societal fixation with how “great it is to be an entrepreneur!”

Overwhelmingly, most entrepreneurial people struggle. They struggle financially, because they don’t fit well in conventional jobs. They struggle financially because they invest themselves and their time in endeavors likely to fail.

Even being capable of taking on that financial burden, constant failure and opposition takes a toll on everyone.

The bright side

There are brilliant efforts underway with a focus on this mental health crisis in work.

Efforts such as what Eddie González-Novoa,

, and we, in MediaTech Ventures, are doing throughout SXSW to explore health issues in entrepreneurship; what Bill Evans and team are doing in Rock Health; the soaring investment in mental healthcare, or what has put together to map out the Mental Health startup ecosystem. Heather Landi, senior Editor in Health IT, noted in August that mental health and wellness companies raised $321 million across 26 deals, in the second quarter of 2019, from top top investors Centene, Google Ventures, Oak HC/FT, Norwest Venture Partners, and Y Combinator are flocking towards mental and behavioral health.

Reach out and get involved here.

Make no mistake given the hype and exuberance for “entrepreneurship,” it is not the laughs and success that we see in magazines and on TV.

Media celebrates the success or briefly highlights the massive fallouts. As a result, it LOOKS rosy, the reality is never really understood by anyone except those actually living it. And that reality is painful even under the best of circumstances.

de Vries noted it long ago, “Whatever executives or venture capitalists finally decide to do, they should keep in mind that entrepreneurs’ personality quirks may have been responsible for their drive and energy and are important factors in making them so successful. Thus instead of fighting these idiosyncracies, managers should regard developing them as a challenge,” and on the job, in work, that’s as important as ever. Today, look to what we can do to keep such people healthy while they undertake the pain of serving us all.

Originally published at on December 16, 2019.



Paul O'Brien

CEO of MediaTech Ventures, CMO to #VC, #Startup Advisor. I get you funded. Father, marketer, author, #Austin. @seobrien & @AccelerateTexas.