Are Entrepreneurs “Touched with Fire”? [1]Updated April 17, 2015  Pre-publication manuscript

Contents
Acknowledgement
Abstract
Evolutionary and macroeconomic context
Theory development and literature review
Methods
Results:
 Are entrepreneurs “touched with fire”?
 Do asymptomatic entrepreneurs comefrom asymptomatic families?
Discussion
 Limitations
 Interpretation
 Policy implications

Thomas Edison

References

Michael A. Freeman, M.D.
University of California San Francisco
Sheri L. Johnson, Ph.D.
University of California Berkeley
Paige J. Staudenmaier
Stanford University
Mackenzie R. Zisser
University of California Berkeley
For review and discussion only
Correspondence about this manuscript can be sent toMichael Freeman at Michael.Freeman@marincounty.net
Copyright: © 2015 Freeman et al. This is an open-access article distributed under the terms of theCreative Commons Attribution Noncommercial License – developed by Aaron Swartz and his colleagues –which permits unrestricted noncommercial use, distribution, and reproduction in any medium,provided the original authors and sources are credited.

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I have a lot of illnesses. I don't talk about it much,for a variety of reasons. I feel ashamed to have an
illness. (It sounds absurd, but there still is anenormous stigma around being sick.) I don't want
to use being ill as an excuse. (Although I
sometimes wonder how much more productive I'd
be if I wasn't so sick.) And, to a large extent, I just
don't find it an interesting subject. (My friends areamazed by this; why is such a curious person souncurious about the things so directly affecting
his life?)
http://nymag.com/daily/intelligencer/2013/01/aaro
n-swartz-reader-in-his-own-words.html

………Ovik Banerjee  Paul Castle  Matt Berman  Steven Good  Steve Jobs  Glen Mueller  Kari Kairamo  Heinz

Prechter  Autumn Radtke  Eric Salvatierra  Alan Schram  Carsten Schloter  L’Wren Scott  Jody Sherman  Aaron
Swartz  Qinggen Wang  Susie Steiner  Ilya Zhitomirskiy………  “A diagnosis is not a disease.” – Thomas Szasz, M.D.

We honor the memories of our brilliant, brave and beloved entrepreneurs whose missions will
never be accomplished. We seek to understand the causes of their strengths and vulnerabilities,
hoping that application of this knowledge will empower future entrepreneurs to prevail.

Abstract
Importance: Entrepreneurs create the vast majority of new jobs, pull economies out ofrecessions, introduce useful products and services, and create prosperity. Therefore it
behooves us to understand the cognitive, affective, and behavioral strengths and vulnerabilities
of entrepreneurs. Prior research has identified the personality traits of successful
entrepreneurs, but little is known about the nature of their mental health characteristics or
those of their families.
Objective: To investigate the prevalence and characteristics of mental health conditions among
entrepreneurs and their first-degree family members.
Method: Research procedures were approved by the UC Berkeley institutional review board.
In this study, 242 entrepreneurs and 93 demographically matched comparison participants took
an anonymous on-line self-report survey to assess their engagement in entrepreneurship, andtheir individual and family mental health history. Differences between the two groups, and thefirst-degree relatives of asymptomatic members of both groups, were assessed for statisticalsignificance using chi-square tests and t-tests.
Results: Self-reported mental health concerns were present across 72% of the entrepreneurs inthis sample, a proportion that was significantly higher than that of the comparison group.
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Entrepreneurs reported significantly more symptoms than the comparison participants, as 49%
reported having one or more lifetime mental health conditions, 32% reported having two or
more lifetime mental health conditions, 18% reported having three or more lifetime mental
health conditions, and 23% reported being asymptomatic members of highly symptomaticfamilies. The entrepreneurs were significantly more likely to report a lifetime history ofdepression (30%), ADHD (29%), substance use conditions (12%) and bipolar diagnosis (11%) thanwere comparison participants. Groups did not differ in rates of anxiety, with 27% ofentrepreneurs and 26% of non-entrepreneurs reporting anxiety concerns. Asymptomatic
entrepreneurs described their first-degree relatives as experiencing significantly more mental
health conditions than did the asymptomatic comparison participants, including depression,
ADHD, substance use conditions, and anxiety.
Limitations: Limitations of the data include reliance on self-report measures, possible selection
bias, vulnerability to shared method variance and comparison group differences, and thereliance on a cross-sectional design.
Conclusions and relevance: The findings of this study are important because they suggest anunderlying relationship between entrepreneurship and many of the affective, cognitive, andbehavioral differences associated with mental health conditions. Current findings add to a
growing body of work suggesting that mental health symptoms, in individuals and their family
members, may co-occur with highly advantageous and adaptive outcomes that benefit both theindividual and society. Understanding the strengths and vulnerabilities associated with personaland familial mental health histories may contribute to improved entrepreneurial outcomes, andto the development of protective resources for entrepreneurs. These findings haveprogrammatic and policy implications for business education, executive coaching, large
employers and human resource managers, health policy, social policy, and macroeconomic
policy practitioners, and for mental health advocates. Policies and programs to properly insure
and care for people with a wealth of notions (those with mental health conditions) may be
synchronized with policies and programs that empower their admirable relatives (theentrepreneurs) to create the wealth of nations.

Methods
Research procedures were approved by the UC Berkeley institutional review board. All
participants completed online informed consent and verified that they were at least 18 years ofage. Participants were from two primary recruitment groups: 1) a mixture of undergraduate
psychology students and MBA graduate students plus business school faculty members
recruited through the research participation pools of a large public university, and 2)
entrepreneurs recruited through study advertisements posted on entrepreneurship websites,
newsletters, at entrepreneurship conferences, meet-up groups and organizations, and viraloutreach marketing. Entrepreneurs were defined as business founders or co-founders, with orwithout employees, including founders and co-founders of not-for-profit organizations (social
entrepreneurs). The study was advertised as a study of entrepreneurship and personality. All
measures were completed online.

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Results
Are Entrepreneurs Touched with Fire?
How many entrepreneurs report having mental health conditions (ADHD, Alcohol/Drugs,
Bipolar, Depression, Anxiety)?
Among the entrepreneurs in this study, 119 reported having a mental health condition whereas
116 did not. Among the non-entrepreneurs, 30 reported having a mental health condition
whereas 63 did not.

Figure 1
Respondents that report having any lifetime mental health condition
percent of total respondents
100

80
48%
67%
60

40

49%
20

32%

0

Entrepreneurs

Comparison

One or more mental health conditions

No mental health conditions

Unknown

Notes: Entrepreneur sample size: 242; comparison sample size: 93.

Entrepreneurs in the study were significantly more likely to report having a lifetime history of
any mental health condition than participants in the comparison group (Χ2=8.67, n=327, p<0.01).
As Figure 1 illustrates, almost half of the entrepreneurs reported having a lifetime mental healthcondition, as compared with 32% of the non-entrepreneurs.

4Which mental health conditions do entrepreneurs report having?
Figure 2 displays the prevalence of five common mental health conditions among theentrepreneurs and comparison group participants in this sample.

Figure 2
Lifetime prevalence of mental health conditions among entrepreneurs
percent of total respondents
100

80

60

62%

64%

63%

80%

71%
83%

90%

94%

81%
92%

40

20
30%

29%

27%

26%

15%

12%

5%

0
E

C
Depression

E

C

E

ADHD

Mental health condition

C

E

Anxiety
No mental health condition

4%

C
Substance

11%
1%

E

C

BipolarUnknown

E = Entrepreneurs C = Comparison Participants
Notes: Entrepreneur sample size: 242; comparison sample size: 93.
Entrepreneurs in the study reported significantly higher rates of ADHD (Χ2=21.71, n=310,
p=<0.01), substance abuse (Χ2=4.48, n=319, p=0.03), depression (Χ2=8.46, n=311, p<0.01), andbipolar disorder (Χ2=9.09, N=311, p<0.01) than comparison participates. As illustrated in
Figure2, entrepreneurs did not report significantly higher rates of anxiety than did participantsin the comparison sample (Χ2=0.62, n=305, p=0.43).

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How many co-occurring mental health conditions do entrepreneurs report having?
In light of the greater prevalence and diversity of mental health conditions experienced by theentrepreneurs in this sample, the authors sought to determine the extent to which
entrepreneurs were likely to have several mental health differences.

Figure 3
Lifetime prevalence of co-occurring mental health conditions among entrepreneurs
percent of total respondents
80
67%

60
48%

40

20

17% 16%

14%

13%

11%
3%

0
No
conditions

One

Two

Three

Entrepreneur

6%

0%

1% 0%

Four

Five

3%

Unknown

Comparison

Notes: Entrepreneur sample size: 242; comparison sample size: 93.

Figure 3 illustrates that the entrepreneurs in this sample reported significantly more cooccurring mental health conditions than were the comparison participants. (t(175)=4.01,
N=328, p<0.01). In this sample 32% of entrepreneurs reported two or more co-occurring mental
health conditions, and 18% reported three or more co-occurring conditions.

61%

Do Asymptomatic Entrepreneurs come from Asymptomatic Families?
The authors sought to determine the presence of mental health conditions among the firstdegree relatives of the asymptomatic entrepreneurs in this study.

How many asymptomatic entrepreneurs report mental health conditions among their firstdegree relatives?

Figure 5
Prevalence of mental health conditions among first-degree relatives ofasymptomatic entrepreneurs
percent of asymptomatic respondents
100

80
49%
76%

60

40

20

48%
24%

0
Entrepreneurs

Comparison

One or more conditions

No conditions

Unknown

Families ofFamilies of
Asymptomatic
Asymptomatic
Entrepreneurs*
Comparison**Prevalence as reported by study participants.
Notes: Asymptomatic entrepreneur sample size: 116; asymptomatic comparison sample size: 62.
Figure 5 illustrates that the asymptomatic entrepreneurs in this sample were twice as likely toreport one or more mental health conditions among their first-degree relatives than were theasymptomatic comparison participants, a difference that was statistically significant (Χ2=10.68,
n=175, p<0.01).
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Figure 6
Figure 6 illustrates the prevalence of mental health conditions among entrepreneurs and their
immediate families.

Figure 6
Prevalence of mental health conditions among entrepreneurs and their first-degree
relatives
percent of total respondents
100

asymptomaticfamilies
80

No
mentalhealthconditions

60

47%

No
mentalhealthconditions

24%

symptomaticfamilies

asymptomaticfamilies
51%

67%

23%
40

49%
20

72% ofentrepreneurs
are directly or
indirectly
affected bymental healthconditions

symptomaticfamilies
16%

32%

48% ofcontrols
aredirectly or
indirectly
affectedby mental
healthconditions

0
Entrepreneurs
One or more conditions

Comparison

Symptomatic family members

Asymptomatic family members

Unknown

Notes: Entrepreneur sample size: 242; comparison sample size: 93.
Asymptomatic entrepreneurs with symptomatic families constitute 23% of the entire sample of
242 entrepreneurs. Asymptomatic entrepreneurs with asymptomatic families constitute only
24% of the entire study sample of 242 entrepreneurs.
Reviewed in conjunction with the results displayed Figure 1, 72% of the entrepreneurs in thissample either reported a personal mental health history (49%) or were asymptomatic yetreported a family mental health history (23%). By contrast, 48% of the comparison participantsin this sample reported a personal mental health history (32%) or were asymptomatic yetreported a family mental health history (16%).

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Discussion
Limitations of the Data
The results reported herein are limited by reliance on self-report measures, vulnerability toshared method variance, possible selection bias, comparison group characteristics, and study
design considerations. In light of these limitations, the current findings must be consideredhighly preliminary.

Interpretation
Reconceptualizing mental health differences: A surprising 72% of the entrepreneurs in thissample reported a personal (49%) or family (23%) mental health history. This suggests anopportunity to reconceptualize mental health differences in a way that is not confined by thelimits of a disease model. Mental health conditions are referred to as “disorders” and cooccurrence is referred to as “comorbidity” in the illness-oriented psychiatric literature. However
the focus on a disease model does not address the adaptive benefits and positive outcomes that
may be related to mental health conditions. A broad and complex array of interacting cognitive,
affective, and behavioral differences associated with individual and co-occurring mental healthconditions may also be associated with entrepreneurship. Some of the positive outcomesproduced by symptomatic entrepreneurs in this sample, and asymptomatic entrepreneurs fromsymptomatic families, include invention, innovation, company formation, and job creation.
Given that the vast majority of the job-creating, value-creating entrepreneurs in this study
sample are affected by individual and/or family mental health issues, the strict focus on adisease model seems reductionistic and misleading.
Instead of viewing a diagnosis as a disease [103-105] it can be viewed as a description of a set of
empowering traits and personal endowments that are coupled with vulnerabilities and risk
factors. If properly managed, these endowments can result in significant social and personal
benefits. If the vulnerabilities prevail, adverse individual and social consequences may ensue.
The first-degree family members of asymptomatic entrepreneurs were reported to besignificantly more likely to manifest one or more mental health conditions, and to be affected bydepression, ADHD, substance use conditions, and anxiety than were the first-degree relatives ofasymptomatic comparison participants; 30% of non-affected entrepreneurs report two or moremental health conditions among their first-degree relatives and 16% report three or moremental health conditions among their first-degree relatives.
Mental health differences directly or indirectly affect 72% of the entrepreneurs in this sample,
including those with a personal mental health history (49%) and family mental health history
among the asymptomatic entrepreneurs (23%). Asymptomatic entrepreneurs withasymptomatic families constituted only 24% of the entrepreneur participants. (Data on thisissue was missing for 4% of the entrepreneurs surveyed.)

Policy Implications
The findings presented above suggest that some implications for entrepreneurs, businesseducation, executive coaching, corporate human resource management, macroeconomic policy,
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health policy, and mental health advocacy deserve consideration.
Business education and executive coaching: This study suggests the possibility of developing
more effective business education and executive coaching programs and resources forentrepreneurs by taking mental health risk and success factors into consideration.
Understanding mental health risk factors and advantage factors may be particularly relevant forbusiness school programs, incubators, and accelerators that are tasked with the education andtraining of entrepreneurs at an early stage of their careers. Business schools and incubators are
uniquely positioned to offer self-awareness and vulnerability resistance resources to emerging
entrepreneurs. Such resources could include confidential screening for treatable mental healthsymptoms and conditions. Current curricula devoted to human factors, organizational behavior
and entrepreneurship may be augmented in ways that help MBA students and nascententrepreneurs understand and build upon their personality and mental health propensities bydeveloping risk management and strength building strategies. Executive coaching and selfmanagement resources could also identify, and help to strengthen, mental health-related
entrepreneurial success factors.
Large employers and human resource managers: Innovation and “intrapreneurship” areessential to sustained corporate success [30, 107-110], and innovative, entrepreneurial
employees with mental health differences may have a critical role in achieving these businessresults. However, large corporations have focused on the disability costs of employees withmental health differences with less regard for the benefits that may accrue when these
employees are retained and managed properly[41, 111-113]. Psychiatrically “disabled”
employees may be the very same and critically important people who contributedisproportionately to the paradigm-shifting innovation and breakthrough value creation that isnecessary for the sustained success of large enterprises [114-117]. Alternate human resource
strategies may empower creative, risk-tolerant, entrepreneurial employees with mental healthdifferences to add both incremental and game-changing value that offsets or overshadows costs
related to disability and management issues[116, 118-121].
Policy and advocacy: From the perspective of macroeconomic, social and health policy, thefindings in this study suggest that the people whom we admire and depend upon for creatingjobs and prosperity, and the people whom we marginalize for being different (mentally ill) may
spring from the same gene pool. Empowering some people with mental health issues, theentrepreneurs, while stigmatizing and marginalizing others, including their first-degree relatives,
may thus constrain our talent pool and have limited net social utility.
Destigmatizing people with mental health differences, and understanding the strengths andvulnerabilities associated with the mental health differences of entrepreneurs, may inform more
evolved healthcare, social, and macroeconomic policies that add value to the lives of the people
who add value to our lives. Policies and programs to properly insure and care for marginalized
people with a wealth of notions (those with mental health conditions) may be synchronized with
policies and programs that empower their admirable relatives (the entrepreneurs) to create thewealth of nations.

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