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.

1

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 andvulnerabilities, hoping that application of this knowledge will empower future
entrepreneurs to prevail.

Acknowledgements
We gratefully acknowledge the support of the entrepreneurs and comparison participants who made thisstudy possible, and of our colleagues who recruited entrepreneurs to participate in this research bycommunicating to incubators, accelerators, entrepreneur networks and meet-up groups, email and online newsletters, and public entrepreneurship events.
Karen Aidem  James Colgan  Kyra Davis  Gloria Duffy  Emily Francher  Victoria Howell  Katy Fike  Saar Gur  Lisa
Gurwitch  Paula Hawthorn  Björn Herrmann  Steve Hoffman  Stephen Johnston  Shahab Kaviani  Matt Kursh  Jonathan
Malkin  Stephanie Marrus  Peter Mellen  Anamaria Nino-Murcia  Bryan Neuberg  Cassandra Phillipps  Cesar Plata 
Tom Ruginis  Dick Sander  Cynthia Scott  Ikhlaq Sidhu  Shervin Talieh  Rebecca Turner  Tom Wootton 

We thank the University of California Berkeley, the University of California San Francisco, and The
Entrepreneurship Center at UCSF for direct and indirect support of this project, and Rebecca Freeman for
her assistance with data visualization.

2

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.
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 macroeconomic3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.
Manuscript overview: This report begins by describing the role of neurobehavioral propensities
and traits in the evolutionary and macroeconomic context of entrepreneurship. Subsequently
we discuss prior research related to the relationship between entrepreneurship and mental
health differences, followed by describing the methods and findings of the current study. The
paper concludes with a review of limitations of the data, and a discussion of their implications.

Evolutionary and Macroeconomic Context
Why entrepreneurship matters
Entrepreneurship matters more than ever in today’s interdependent, competitive, volatile
global economy. Creative and innovative entrepreneurs drive regional and national social andeconomic growth, create the vast majority of new jobs, and stand as the critical last firewall
against recessions and catastrophic events produced by national and global economic volatility[2-4]. From 1980 through 2005 almost all American net job creation occurred in firms less than
five years old. During the depths of this American recession, entrepreneurs and their young
companies produced nearly 8 million of the 12 million jobs created in 2007 [5]. Contemporary
economies cannot function without entrepreneurs.
The mindset and mental health of the entrepreneurs we depend upon are thus an importantsocial and economic resource. What gives entrepreneurs this special power? Neurodiversity andneuroplasticity produced by eons of evolution has delivered a class of founders, co-founders,and self-employed individuals who have the cognitive, emotional, and behavioral propensities,
traits, strengths, and vulnerabilities required to think different and act different in ways thatmatter for our economy. It behooves us to understand these differences.
Entrepreneurship and its legacy in the human saga
Venturing and innovation have accelerated the separation of humanity from every other animal
species. Hominins, the family of primates that includes humans, improved upon primitivetechnologies used for hunting, fishing, cooking, clothing, and shelter between one million and
500,000 years ago. These technologies, and their corresponding material culture, allowed ourancestors to obtain, store, prepare, and consume more protein and omega-3 fatty acids derived
from fish and animals, which in turn fueled a rapid expansion in brain size [6, 7]and functioning.
As food technology innovations allowed our brains to quadruple in size, our journey departed
from that of our primate cousins.
Within the last 100,000 years our human ancestors, challenged by jungles, deserts, floods, andice ages, developed the capacity for social cognition, emotion-infused symbolic thinking,symbolic communication, and cultural transmission through language and the arts [7-10] . The
most highly evolved human abilities are supported by brain functions that underpin cognition,
perception, emotion, thought, and creativity [11].

4We also developed the capacity for cultural learning, instructed learning, collaborative learning[9], organized cooperation between groups [12], understanding the intentions of others [9, 13],pair bonding and partnership [14, 15], and forming expansive goal-focused networked social
systems requiring structure and leadership [16].
With our enlarged and evolved human brains, our enriched human culture, our capacity forcreativity, learning, partnership and teamwork, and the need to adapt to constantly changing
environmental conditions, necessity became the mother of invention. Innovation, thedeployment of invention, created a logarithmic cascade of accomplishment.
Maintaining the status quo (job holding) and disrupting the status quo (venturing) emerged ascomplimentary strategies to assure survival and reproductive success [17]. Entrepreneurshipwas born, allowing our species to deploy our capacity for invention and innovation in order tocope, adapt, and thrive in virtually any situation and to endure millennial environmental
changes. We were all shareholders in the human endeavor at that time and, from the beginning,
innovation and entrepreneurship enhanced shareholder value.
The wealth of notions and the rise of the creative class
Successive waves of innovation enabled the creation, growth, and transformation of civilization
by breakthrough inventions and understandings associated with agriculture, commerce,industrialization, and information technologies. While each breakthrough created value forinvestors, producers, and consumers, the rate of product commodifcation and value erosion has
accelerated in conjunction with shortening product life cycles and more rapid productintroductions [18]. Ever more rapid innovation-driven value creation [19, 20] has hastened thedisruption and “creative destruction” of entire economic sectors [21].
By the end of the twentieth century creativity became the driving force behind America’s
explosive economic growth [22]. The creativity that drives economic growth is also a common
feature of people with bipolar spectrum conditions, depression, substance use conditions, andADHD [23-29].
Creativity and its application through venture capital, research and development,
entrepreneurship, and intrapreneurship has become critical for value creation and economic
expansion [22, 30] because the most successful firms disproportionately come from the earliest
entrants into any new market [18]. The economic importance of creative capital now exceedsthat of human capital and obsolescing material assets[31] . As the wealth of nations has cometo depend upon their citizens with a wealth of notions, an elite “creative class” has emerged.
Creative entrepreneurial individuals increasingly participate in the value they create for businessowners [31] and become investors themselves, thus perpetuating and accelerating the cycle ofentrepreneurship.

5

Theory Development and Literature Review
Is there a link between the entrepreneurial mindset and mental health?
Who in their right mind would choose to be an entrepreneur? The barriers to success are
virtually unlimited and most startups fail as a result. Entrepreneurs have lower initial earnings,
lower earnings growth, lower long-term earnings [32], greater work stress, and more
psychosomatic health problems than employees [33]. Why would anyone voluntarily accept thelonger work hours, fewer weekends and holidays, more responsibility, chronic uncertainty,
greater personal risk and struggle, and greater investment of emotional and physical resources
required to be an entrepreneur instead of the security and long-term rewards of having a career[34]? By conventional standards choosing to be an entrepreneur is an exercise in bad judgment.
However entrepreneurs are not dissuaded by knowing that many are called but few are chosen.
Optimistic and confident by nature, entrepreneurs who close their firms, whether by choice or
due to business failure, repeatedly create new ones – often at the same time that they areabandoning their last business [35, 36]. Entrepreneurs clearly have different decision-making
priorities than their employed peers.
While much is known about the personality traits of successful entrepreneurs [37-40], little is
known about the mental health characteristics that may be associated with entrepreneurial
success and failure. Reports about entrepreneurs who commit suicide (see Suicide references)inspired the authors to wonder if entrepreneurial capacities, strengths, and vulnerabilities might
be associated with mental health conditions. The overlapping signature features of both
entrepreneurship and mental health conditions provide an important research focus.
Mental health among entrepreneurs
Mental health is as essential for knowledge work in the 21st century as physical health was forphysical labor in the past. Creativity, ingenuity, insight, brilliance, planning, analysis, and otherexecutive functions are often the cognitive cornerstones of breakthrough value creation byentrepreneurs. Yet despite the importance of cognition, affect, and behavior in
entrepreneurship, there is very little research about the relationship between entrepreneurshipand mental health issues.
Several popular books and case studies have suggested the importance of pursuing research on
entrepreneurship and mental health. For example, several authors have described theprevalence of bipolar spectrum conditions [41, 42], obsessive-compulsive disorders, and othermore severe conditions [27, 43] among business tycoons. A related literature on mental healthdifferences in leadership has discussed the occurrence of bipolarity, depression, sociopathy, andpsychosis among political and military leaders [42, 44-46].
Empirical research
The limited research that does exist suggests that broad-ranging mental health issues do not
influence overall measures of well-being among entrepreneurs. In contrast, elevations ofspecific syndromes among entrepreneurs have been noted.
As an example of a relatively broad-band approach, in one nationally representative study ofGerman individuals, 149 entrepreneurs (defined as self-employed individuals with or without
employees) did not differ from age- and gender-matched employed comparison participants in6

prevalence rates of affective disorders, anxiety disorders, or alcohol abuse. The entrepreneurs
showed a lower incidence of lifetime mental health diagnoses and higher life satisfaction thanthe employed participants [34].
Parallel findings were obtained in a study of self-reported anxiety, self-esteem, hostility,
sociability, life satisfaction, and morale among 235 entrepreneurs (self-employed participants
with or without employees) and a matched group of employed Canadians living in metropolitan
regions. The study found no significant mental health or job satisfaction differences between
employed and self-employed groups [33, 47].
Entrepreneurs and salaried employees in the UK were also found not to differ on the Goldberg
Health Questionnaire measures of psychological well-being [48]. Similarly, a study of 238
entrepreneurs and 288 managers in the United States showed no differences on measures ofdepression, anxiety, and anger [49].
Taken together, the null findings of these empirical studies suggest the need to reconsider
models. Here, we consider two more specific models. First, it has been argued that
entrepreneurs may derive a mental health protective benefit from the buffering role of social
support and a high level of control over their work – a high-demand, high-control work
environment [33, 47], and indeed, a positive correlation has been observed between social
support and mental health among entrepreneurs [33, 47]. Self-employed survey participants
devoted more time engaged in voluntary social and professional organizations [34]. The
buffering role of social support received by entrepreneurs was also validated by a British studyof entrepreneurs compared with employees [48].
A related set of studies suggests that there may be a greater occurrence of a few key mental
health conditions among entrepreneurs. We cover these next.
ADHD: Several authors have cited a relationship between entrepreneurship and Attention
Deficit Hyperactivity Disorder (ADHD). In a 16-year prospective study of 91 children with ADHD
and 95 comparison participants, Mannuzza and colleagues determined that 19% of probands(participants with ADHD), versus 5% of controls, owned and operated their own business asadults [50]. Verheul and colleagues studied 10,000 students and found that those with ADHDlike behavior had higher entrepreneurial career intentions compared to the others [51]. Dimic
and Orlov found significantly higher values in entrepreneurial tendency measures, and asignificantly higher marginal probability of being entrepreneurs among 103 ADHD participants ina survey that included 167 comparison participants [52]. Nicolaou and colleagues note that
dopamine receptor genes have been associated with sensation seeking, novelty seeking,entrepreneurship, and ADHD [53].
Bipolar spectrum traits and conditions: Akiskal et al. studied 263 professionals affiliated with an
outpatient psychiatric practice. They found that of the seven job classifications studied(physicians, lawyers, managers, industrialists, architects, journalists, and artists), self-madeindustrialists (entrepreneurs) had the highest rates of hyperthymic traits of all the groups
studied, which was three times the rate found in the comparison group [54]. Hyperthymic traits
include the tendency to experience positive moods and emotions, and dispositional positive
affects, which have been linked to a variety of both positive and negative outcomes among
entrepreneurs [55]. One of the current authors recognized the concordance between
7personality traits associated with successful entrepreneurs, and those associated with bipolarity[56]. However investigation of this relationship failed to demonstrate a main effect, indicatingthat such a relationship, if any, is more nuanced, moderated, and indirect [57].
Addiction: The addictive behavior patterns of serial entrepreneurs have come to the attentionof researchers. “Entrepreneurship addiction,” the compulsion to create and grow new ventures,has been compared to other behavioral addictions such as workaholism and Internet misuse.
Psychological, emotional, cognitive and physiological aspects of entrepreneurship may activate
neural reward circuits, disinhibit and reinforce the compulsive and addictive behavior of
entrepreneurs who may be predisposed and vulnerable to addiction [58, 59].
Mental health conditions associated with propensities required for entrepreneurship
Several mission-critical entrepreneurial propensities and traits are also clinical features ofbipolarity, depression, ADHD, and substance use conditions, suggesting the possibility that these
conditions may be more prevalent among entrepreneurs.


Creativity and innovativeness: Creativity is the foundational cornerstone of business
innovation [60]because entrepreneurs must generate novel ideas for innovative new
businesses [61]. The proclivity to innovate is a main driver of the intention to become anentrepreneur [62]. Additionally, there is a significant relationship between innovativenessand the intention to become an entrepreneur, business creation, and business success [39,62]. In today’s knowledge economy, the ability to innovate dictates the wealth generation
capacity of a resource, a business, and an economy. Innovation makes companies more
adaptive to change and enhances business performance [63, 64]. This is why “innovate ordie” has become the mantra of the business establishment [65].
Researchers have identified a relationship between creativity and mental health conditions
including psychosis [27, 66, 67], bipolarity [24, 46, 67-70], depression [24, 27], ADHD
[25]and substance abuse [27-29, 66].



Goal attainment and achievement motivation: Goal attainment has a direct effect on
venture growth [37]. Achievement motivation is significantly correlated with the choice tobecome an entrepreneur, with business creation, and business success [38, 39, 71].
Several studies have indicated a correlation between bipolarity and high achievement [7274]. Bipolarity has been linked to having ambitious goals, expecting to succeed, goal
engagement and zealous pursuit, striving, and goal attainment [75-77].

Risk Propensity: Risk propensity is correlated with business foundation [71]. A meta-analysis
of personality differences between entrepreneurs and managers reported in 12 large
studies found that the risk propensity of entrepreneurs is greater than that of managers,
and that the largest differences are found among the entrepreneurs whose primary goal isbusiness growth, rather than family income [78]. Similarly, a personality study of 500 toplevel executives found that the most successful executives were the biggest risk takers [79].
Risk propensity and risk taking are features of bipolarity, substance use conditions, andADHD [80-87].
8

The authors considered it reasonable to wonder if the endowments and vulnerabilities
associated with entrepreneurship may also be associated with the mental health conditions
identified in the research cited above.
Hypothesis 1: The prevalence of ADHD, bipolarity, depression and substance use
conditions among entrepreneurs is likely to be significantly greater than among anormal comparison sample.
Co-occurring mental health conditions among entrepreneurs
The authors could not identify prior research addressing the co-occurrence of mental healthconditions among entrepreneurs. The co-occurrence of mental health conditions is common andhas been studied in several large samples. The National Comorbidity Survey Replicationinterviewed a representative sample of 9,282 English-speaking American adults to determine
the lifetime and 12-month prevalence of mental health conditions. This study found a 46%
lifetime occurrence of any mental health condition, an 18.3% lifetime occurrence of one mental
health condition, a 27.7% lifetime occurrence of two or more conditions, and a 17.3% lifetime
occurrence of three or more conditions[88] .
This same study found a 26.2% 12-month occurrence of any mental health condition, a 14.4%
12-month occurrence of one mental health condition, a 5.8% 12-month occurrence of two
mental health conditions, and a 6% 12-month occurrence of three or more mental healthconditions [88].
Since we postulate that the prevalence of mental health conditions may be higher among
entrepreneurs, and since co-occurrence is contingent upon occurrence, we would expect ahigher rate of co-occurring conditions among entrepreneurs as well.
Hypothesis 2: Entrepreneurs will report a greater number of mental health conditions
than will participants in a comparison sample.
Do asymptomatic entrepreneurs come from asymptomatic families?
Many entrepreneurs may have no mental health conditions. Could these asymptomatic
entrepreneurs be the high-functioning, well-adjusted, and resilient ambassadors of families witha higher-than-expected prevalence of mental health conditions? If this is the case, the familiesof asymptomatic entrepreneurs may be burdened by excessive mental health challenges while
the asymptomatic entrepreneurs may be blessed with just enough of the creativity, energy,
optimism, and other advantageous mental health qualities that empower them to succeed,
without being burdened by more extreme mental health symptoms that result in disability.
Little is known about mental health conditions among the families of entrepreneurs. Of somerelevance, though, is the fact that previous research has shown that first and second-degree
family members of bipolar probands are high achievers across several domains that areimportant for entrepreneurship. Higier and her colleagues found that when compared to bipolar
probands and normal controls, the unaffected identical twins of people with bipolar disorderdemonstrate superior cognitive and interpersonal traits that would seem highly important forentrepreneurship, including enhanced social ease, confidence, assertiveness, intelligence, verbal
learning, verbal fluency, extraversion, sociability, optimism, and resilience [89].

9Coryell et al. found that the first-degree relatives of bipolar probands, including relatives withbipolar spectrum conditions, had significantly higher educational and occupational achievement
than the close family members of people with other mental health conditions [72]. Other
studies conducted over the last 100 years have reached similar conclusions [73, 74, 76, 90-92].
Creativity and innovativeness are foundational aptitudes of entrepreneurs. The close family
members of bipolar probands have been shown to have high levels of creativity [23, 68]. Firstdegree relatives of people with bipolar disorder, schizophrenia, anorexia nervosa, and autism
have been shown to be overrepresented in the scientific and artistic occupations [66]. Male
relatives of people with schizophrenia were shown to be overrepresented in a listing ofprominent people [93].
Drawing on the findings of heightened accomplishment and creativity in families of those withmental health conditions, we assessed the possibility that unaffected entrepreneurs may comefrom families with a significant prevalence of mental health conditions.
Hypothesis 3: The first-degree relatives of asymptomatic entrepreneurs are likely tohave significantly more mental health conditions than the first-degree relatives ofasymptomatic comparison participants.

10

Methods
Research procedures were approved by the UC Berkeley institutional review board.
Participants
All participants completed online informed consent and verified that they were at least 18 yearsof age. 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 werecompleted online. Participants completed multiple measures, including items not describedhere.
The first recruitment group, undergraduate psychology students and MBA graduate
students/faculty, signed up through university websites listing multiple studies. This study wascharacterized as an online survey of entrepreneurship and personality. Undergraduate
psychology students received course credit for participation. Students were offered alternative
assignments if desired. MBA graduate students and faculty members were paid $15 for study
participation. Total survey duration for this group was one hour. Additional measures notdescribed here were also included. After excluding 8 psychology and 6 MBA participants for
failing catch items (e.g. “please select two as your answer”), 76 MBA student and faculty pool
participants, and 149 psychology students participated.
The second recruitment group consisted of entrepreneurs who were recruited through study
advertisement and outreach marketing. The total duration of the measure taken by
entrepreneurs was 10-15 minutes. Twelve participants were excluded for failing catch items.
The combined sample was predominantly male (70.5%). Average age was distributed: 22.7%
between the ages of 18-30 years old, 25% between the ages of 31-39 years old, and 24.5%
between the ages of 41-49 years old. Regarding ethnicity, participants identified as 72.9%
Caucasian, 12.8% Other, 10% Asian, 3.8% Middle Eastern, and 0.5% African American.
Participants from either recruitment group who endorsed, “Have you ever been self-employed,a business founder, or a business co-founder (including non-profit businesses)?” werecategorized as entrepreneurs (n = 242). Participants who did not endorse this question served
as the comparison participants in the comparison (“control”) category (n = 93).
Measures
The Family Index of Risk for Mania (FIRM) [94] is a self-report measure of psychiatric history for
self and 1st (parents, siblings, or children) and 2nd (aunts, uncles, grandparents) degree family
members. Higher scores on the FIRM denote the presence of higher levels of familial
psychopathology. The measure was originally validated in a study of pediatric bipolar disorder,
11

showing a significant relationship between pediatric bipolar and family diagnoses. Cronbach’s
alpha, due to the questionnaire design, is not a useful measure [94].
For this study, participants also indicated whether they had experienced these conditions.
Participants were asked about personal or family diagnoses of ADHD, substance use conditions,bipolar disorder, depression, or anxiety. In addition, the FIRM assessed for a history of suicide
attempt/completion and psychiatric hospitalization among the participants and their family
members. The ADHD and anxiety items were added to the original FIRM items for this study.
The FIRM further separated the entrepreneurial and comparison participants: entrepreneurs
who reported having a mental health diagnosis (n = 119), entrepreneurs who did not reporthaving a mental health diagnosis (n = 116), non-entrepreneurs who reported having a mental
health diagnosis (n = 30), and non-entrepreneurs who did not report having a mental healthdiagnosis (n = 63). The entrepreneurs and non-entrepreneurs without a mental health diagnosis
were further separated by the presence of a 1st degree family history of mental health diagnoses
as reported by participants.
Analysis Plan
To determine whether entrepreneurs and the non-entrepreneurial comparison group differed ineither their personal psychiatric or family psychiatric histories, we conducted a series of chisquare tests and t-tests. Where p values are less than .05, these tests suggest that differences
between entrepreneurs and the comparison sample are larger than what we might expect fromchance variation alone, and so are labeled as statistically significant. When p values are greaterthan or equal to .05, these tests suggest that group differences might simply reflect chance.

Results
Figures in this report
Are Entrepreneurs Touched with Fire?
1. Respondents that report having any lifetime mental health condition
2. Lifetime prevalence of mental health conditions among entrepreneurs
3. Lifetime prevalence of co-occurring mental health conditions among entrepreneurs
4. Incidence of psychiatric hospitalization and suicidality among entrepreneurs

Do Asymptomatic Entrepreneurs come from Asymptomatic Families?
5. Prevalence of any mental health condition among first-degree relatives of asymptomatic entrepreneurs
6. Prevalence of mental health conditions among entrepreneurs and their first-degree relatives
7. Prevalence of specific mental health conditions among first-degree relatives of asymptomatic entrepreneurs
8. Number of co-occurring mental health conditions among first-degree relatives of asymptomatic entrepreneurs
9. Incidence of hospitalization or suicide among first-degree relatives of asymptomatic entrepreneurs

12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

One or more mental health conditions

Comparison

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.

13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).

14

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.

15

1%How many entrepreneurs report a history of psychiatric hospitalization and/or suicidality?

Figure 4
Incidence of psychiatric hospitalization and suicidality among entrepreneurs
percent of total respondents
100

80

60

82%

40

97%

90%

54%
20

0

5%
Entrepreneurs

2%
Comparison

2%
Entrepreneurs

SuicideHistory

1%Comparison

Hospitalization
No history

Unknown

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

Very few entrepreneurs or comparison participants reported either suicide attempts or
psychiatric hospitalization, and – perhaps as a result of the low base rates – groups did not differ
significantly on either outcome. Entrepreneurs (n=13) and comparison participants (n=2) who
reported suicidality did not differ in their endorsement of co-occurring mental health conditions(p=0.13).This question awaits further study.

16

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).
17

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%).

18

Which mental health conditions do asymptomatic entrepreneurs report among their firstdegree relatives?

Figure 7
Prevalence of specific mental health conditions among first-degree relatives ofasymptomatic entrepreneurs
percent of asymptomatic respondents
100

80

76%

60
49%
40
30%
26%
22%

19%

20
8%

12%

10%

6%

6%

10%

0
No conditions

Depression

Substance

Anxiety

Entrepreneurs

ADHD

BipolarComparison

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 7 illustrates the significantly greater reported prevalence of family mental healthconditions overall (Χ2 =9.31, n=175, p<0.01), family depression history (Χ2 =13.91, n=166,
p<0.01), family history of ADHD (Χ2 =7.28, n=159, p<0.01), substance use conditions (Χ2 =12.16,
n=165, p<0.01), and anxiety (2 =5.53, n=164, p=0.02) among the first-degree relatives ofasymptomatic entrepreneurs compared to the relatives of asymptomatic comparison
participants.
However, among those who were asymptomatic, entrepreneurs and comparison participants
did not report significant differences in the rates of familial bipolarity (Χ2 =0.59, n=164, p=0.44).

19

How many mental health conditions do asymptomatic entrepreneurs report among their firstdegree relatives?
To further characterize diversity of mental health conditions among the families ofasymptomatic entrepreneurs and comparison participants, the authors assessed the number offamily mental health conditions among the first-degree relatives of the non-affected
entrepreneurs.

Figure 8
Number of co-occurring mental health conditions among first-degree relatives ofasymptomatic entrepreneurs
percent of asymptomatic respondents
100

2%

4%
5%

11%

7%

48% ofentrepreneurs'familymemebers areaffected by one
to five mental
healthconditions

80
14%

60

18%

11%

40

24% ofcontrols'
familymemebers
areaffected by
one to four
mentalhealthconditions

76%
49%

20

0
Entrepreneurs
No conditions

One

Comparison
Two

Three

Four

Five

Unknown

Families ofFamilies of
Asymptomatic
Asymptomatic
Entrepreneurs*
Comparison**As reported by study participants.
Notes: Asymptomatic entrepreneur sample size: 116; asymptomatic comparison sample size: 62.
Figure 8 illustrates that asymptomatic entrepreneurs reported a significantly greater number ofmental health conditions within their families on average than did the asymptomaticcomparison participants (t(175)=4.11, p<.01).

20

As shown above, asymptomatic entrepreneurs reported a higher percentage of family memberswith the following compared to the asymptomatic comparison participants:● One or more mental health conditions (48% of asymptomatic entrepreneur families vs.
24% of asymptomatic comparison participant families),● Two or more mental health conditions (30% of asymptomatic entrepreneur families vs.
13% of asymptomatic non-entrepreneur families),● Three or more mental health conditions (16% of asymptomatic entrepreneur families
vs. 2% of asymptomatic non-entrepreneur families), and● Four or more mental health conditions (9% of asymptomatic entrepreneur families vs.
2% of the asymptomatic non-entrepreneur families).

21

How many asymptomatic entrepreneurs report psychiatric hospitalization or suicidality
among their first-degree relatives?
The authors sought to determine if the relatives of asymptomatic entrepreneurs were more
likely to have been hospitalized or suicidal than were the relatives of asymptomatic control
participants.

Figure 9
Incidence of suicide and hospitalization among first-degree relatives ofasymptomatic entrepreneurs
percent of asymptomatic respondents
100

80

60

40

57%

62%

47%

55%
20

0

8%

3%

Entrepreneurs

Comparison
SuicideHistory

12%

10%

Entrepreneurs

Comparison

Hospitalization
No history

Unknown

Families of Asymptomatic Entrepreneurs – Families of Asymptomatic Comparison**Incidence as reported by study participants.
Notes: Asymptomatic entrepreneur sample size: 116; asymptomatic comparison sample size: 62.
Groups did not differ in the family rates of hospitalization or suicidality, perhaps due to the lowbase rates of these concerns.

22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.
Reliance on self-report measures: Perhaps the most important limitation of this study is thereliance on self-report measures of personal and family mental health history, which may besubjective, and will be limited by awareness of family concerns, understanding of psychiatricterms, as well as willingness to describe potentially stigmatizing information [95, 96].
Accordingly, it will be critical for future research on this subject to include interview-based
diagnostic assessments.
Several studies indicate that self-report mental health surveys underestimate the lifetime
prevalence of mental health conditions [97], including the rates of ADHD [98], bipolar spectrum
conditions [99], depression [100], and alcoholism [101]. A related concern is that most of theitems used to assess mental health in this study have not been validated.
Shared method variance: The reliance on self-report for both psychopathology andentrepreneurship dimensions increases vulnerability to inaccuracies caused by shared method
variance, which may have amplified the reported correlations. That is, people who tend toanswer yes to most questions would perhaps skew findings to suggest a larger correlation
between entrepreneurship and mental health concerns[102].
Selection bias: A third shortcoming of this study is that the entrepreneur participants may havebeen attracted by, or interested in the mental health issues being examined. The survey was
distributed by mental health professionals affiliated with academic departments of psychiatry
and psychology, and recruitment included community outreach through clients and talks. One
author is recognized for his interest in mental health dimensions of entrepreneurship; another isrecognized for her interest in bipolar disorder. This may have produced a higher response ratefrom entrepreneurs with an interest in, or history of mental health issues. Future research could
control for this by assessing the differences between responders and non-responders, or byusing a registry-based approach to data collection in which priming, recruitment channels, andnon-response are not methodological issues.
Validity of the comparison group: This study relied upon a convenience comparison sample. On
average, comparison participants may have been younger than the entrepreneurs. Since more
entrepreneurs may have reached or passed the median age of onset for substance use
conditions (age 19-23 years) and mood conditions (age 25-32 years), lifetime mental healthconditions among the comparison sample may be underreported [88]. In addition to age, thecomparison participants were drawn from a prestigious school, and so may also have had fewer
mental health issues by virtue of this signal of academic success. In two ways, then, thecomparison sample may have underestimated rates of mental health conditions, and so inflatedgroup differences in mental health. Future research would do well to include a demographicallymatched comparison group of employees from the same economic sectors as the23entrepreneurs, which may yield more accurate results.
Study design limitations: Our cross-sectional design precludes accurate consideration ofwhether mental health conditions precede or follow entry into entrepreneurship. This prevents
understanding the direction of any effects pertaining to the relationship between
entrepreneurship and mental health differences.
The limited scope of this study also precludes understanding specific strengths andvulnerabilities of entrepreneurs with mental health propensities and conditions, as well as thestrengths and vulnerabilities of asymptomatic entrepreneurs with a positive family mental
health history. Furthermore, this study did not address the relationship between mental healthand entrepreneurial outcomes over time. Therefore there is a gap in our longitudinal
understanding of how mental health propensities, differences, and conditions may confer
strengths and advantages, as well as vulnerabilities and liabilities at different points of theentrepreneurial journey and the life cycle of a firm.
The data reported herein did not address the mental health-related adverse early life
experience of entrepreneurs, or the impact of growing up in a family with parents or siblings
who are challenged by a mental health problem. It remains possible that adversity in childhood
is a source of strength in adulthood. One researcher has indicated that adverse early life events
have a priming effect on resilient individuals who later become adult leaders and entrepreneurs[42]. Understanding such interactions is important yet beyond the scope of the research findingspresented here.
Each of these limitations suggests a need for replication and further study conducted with moresophisticated methodologies. This need is accentuated by the critical economic importance ofentrepreneurship

Interpretation
Despite the limitations cited above, the findings of this study are important because theysuggest an underlying relationship between entrepreneurship and self-reported personal andfamily mental health conditions. This is the first study to assess the prevalence and cooccurrence of mental health conditions among entrepreneurs and among the first-degree family
members of asymptomatic entrepreneurs. Understanding the influence of these conditions willcomplement the findings of an established literature about the personality characteristics of
successful entrepreneurs. Both mental health differences and personality traits appear
important for understanding entrepreneurial affect, cognition, behavior, and outcomes.
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. The findings presented above suggest that a broadand complex array of interacting cognitive, affective, and behavioral differences associated withindividual and co-occurring mental health conditions may also be associated with24

entrepreneurship. Some of the positive outcomes produced by symptomatic entrepreneurs inthis sample, and asymptomatic entrepreneurs from symptomatic families, include invention,
innovation, company formation, and job creation. Given that the vast majority of the jobcreating, value-creating entrepreneurs in this study sample are affected by individual and/or
family mental health issues, the strict focus on a disease model seems reductionistic andmisleading.
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.
Prevalence and co-occurrence of mental health conditions among entrepreneurs: This study
identified a significant prevalence and co-occurrence of a range of reported mental healthconditions among the study participants. Hypotheses 1 and 2 were confirmed by the findings inthis study:Hypothesis 1: The prevalence of ADHD, bipolarity, depression and substance use
conditions among entrepreneurs is likely to be significantly greater than among a
comparison population.

Entrepreneurs in the study reported experiencing a significantly greater prevalence and diversityof mental health differences than the comparison participants. They were significantly more
likely to report having a lifetime history of any mental health condition (49%), depression (30%),ADHD (29%), substance use conditions (12%), and bipolarity (11%) than were comparison
participants. Twenty seven percent of the entrepreneurs also reported a lifetime history ofanxiety, although this was not significantly different from the prevalence of anxiety among thecomparison group.
Hypothesis 2: Entrepreneurs reported significantly more mental health conditions on
average than did participants in the comparison sample.

Symptomatic entrepreneurs in this study also reported a significantly greater number anddiversity of co-occurring mental health conditions than were reported by symptomaticcomparison participants. While 49% of entrepreneurs in this sample report having any mental
health condition, 32% of the entrepreneurs report having two or more mental health conditions
and 18% report having three or more mental health conditions. The impact of these mental
health differences with entrepreneurial outcomes remains to be studied.
Family history of mental health conditions: This study also sought to determine the extent towhich asymptomatic entrepreneurs come from families with mental health issues. Hypothesis 3
was also confirmed by the findings of this study.
Hypothesis 3: The first-degree relatives of asymptomatic entrepreneurs are likely tohave significantly more mental health conditions than the first-degree relatives ofasymptomatic comparison participants.

25

The first-degree family members of asymptomatic entrepreneurs were reported to exhibit
significantly more mental health conditions than were the first-degree relatives ofasymptomatic comparison participants. Specifically, the first-degree family members ofasymptomatic entrepreneurs in this sample were significantly more likely to manifest one ormore mental health conditions, and to be affected by depression, ADHD, substance use
conditions, and anxiety than were the first-degree relatives of asymptomatic comparison
participants; 30% of non-affected entrepreneurs report two or more mental health conditions
among their first-degree relatives and 16% report three or more mental 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.)High rates of family mental health conditions have been previously reported in the context ofcreative and high-achieving relatives of bipolar probands. Mental health conditions that occur
among first-degree family members of asymptomatic entrepreneurs may be associated with (orconfer) propensities, characteristics, and subthreshold features that are adaptive andadvantageous to the asymptomatic entrepreneurs themselves without causing disabilities. This
would be parallel to the finding that symptomatic bipolar relatives of symptomatic bipolar
probands are also high-achievers [72].
Understanding these complex family history patterns is warranted. One possibility is that thecognitive, affective, and behavioral propensities associated with these conditions may foster the
pursuit of entrepreneurship under the right environmental circumstances. Further work isneeded to understand how these same qualities might provide benefits and challenges to both
symptomatic and asymptomatic entrepreneurs at different stages of the entrepreneurial
journey.
Suicidality risk: One objective of this study is to begin to understand factors that may be
associated with suicidality among entrepreneurs as a basis for developing protective
interventions and resources. There were only 13 suicidal entrepreneurs in this study, comprising
5.4% of the entrepreneur participants, so this remains a major goal of future research.
Mood spectrum conditions: Depression was the most frequently reported mental healthcondition among the entrepreneurs in this study; 30% reported a positive lifetime history ofdepression. Bipolarity, which includes both depressive and hypomanic or manic states, wasreported by an additional 11% of entrepreneurs. Family history of depression was also quite
common among the entrepreneurs. Our findings, then, dovetail with popular press articles
discussing the prevalence and impact of depression among entrepreneurs [for example, see106]. Since depression also commonly co-occurs with other conditions reported by theentrepreneurs including ADHD, mania, substance abuse, and anxiety, further study of moodspectrum conditions among entrepreneurs is warranted. Given the strong ties between a family
history of mania and accomplishment, mania will be a particularly important target for further
investigation.

26

How do mental health and personality characteristics affect entrepreneurial outcomes?
Additional related issues beyond the scope of this study are also relevant for future
investigation. Entrepreneurs, investors, and academicians alike have an interest in identifying
predictors of entrepreneurial success and failure. One issue that requires further examination is
the relationship between mental health conditions, personality features, and entrepreneurial
outcomes in the context of differing environmental circumstances. Due to sample size andresource limitations the authors were unable to address the relationship between personality
features that are known to be associated with entrepreneurial success and the mental healthconditions that may occur among entrepreneurs and their families in ways that enhance,interfere with, or otherwise modify entrepreneurial outcomes.
Given the critical importance of entrepreneurship to contemporary economies, the results ofthis study support a valid case for additional research to replicate and further address thequestions and issues that were raised in this report.

Policy Implications
The findings presented above suggest that some implications for entrepreneurs, businesseducation, executive coaching, corporate human resource management, macroeconomic policy,
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. Limitations of
the current study leave open many questions related to identifying modifiable risk factors
associated with psychiatric hospitalization, suicidality, and other preventable adverse life
outcomes among entrepreneurs. Conversely, questions remain to be addressed regarding how
entrepreneurs may build upon their unique strengths and advantages associated with theirpersonal and/or family mental health situations. Understanding these risk factors and advantage
factors may be particularly relevant for business school programs, incubators, and acceleratorsthat are tasked with the education and training of entrepreneurs at an early stage of theircareers. Business schools and incubators are uniquely positioned to offer self-awareness andvulnerability resistance resources to emerging entrepreneurs. Such resources could include
confidential screening for treatable mental health symptoms and conditions. Current curricula
devoted to human factors, organizational behavior and entrepreneurship may be augmented inways that help MBA students and nascent entrepreneurs understand and build upon theirpersonality and mental health propensities by developing risk management and strengthbuilding strategies. Executive coaching and self-management resources could also identify, andhelp 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 contribute27disproportionately 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. Governments may create social value by improving thecircumstances of the symptomatic families whose entrepreneurial kin create economic value as
they generate solutions, jobs, and prosperity. In order to produce social and economic gain,
policies and programs to properly insure and care for marginalized people with a wealth ofnotions (those with mental health conditions) may be synchronized with policies and programs
that empower their admirable relatives (the entrepreneurs) to create the wealth of nations.

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Suicide among entrepreneurs and venture capitalists: examples include:
http://betabeat.com/2011/11/u-cant-haz-sadz-the-hushed-dangers-of-startup-depression/
http://forthebrooksfamily.blogspot.com/
http://www.ibtimes.com/technology-focus-suicide-not-painless-212586

33http://toobbox.com/blog/suicide-in-silicon-valley/
http://www.businessinsider.com/jody-sherman-ecomom-2013-4?op=1
http://feld.com/archives/2014/10/founder-suicides.html
http://www.dailymail.co.uk/news/article-2781211/Mystery-three-suicides-tech-start-planning-bring-happiness-las-vegas.html
http://libn.com/2011/09/27/ex-falconstor-ceo-dies-in-apparent-suicide/
http://www.dailymail.co.uk/tvshowbiz/article-2030818/Russell-Armstrong-dead-Business-associate-Alan-Schram-commitssuicide.html
http://www.businesspundit.com/10-millionaire-businessmen-who-committed-suicide/
http://hollywoodlife.com/2014/03/19/lwren-scott-suicide-reason-business-closing-death-cathy-horan/
http://www.entrepreneur.com/article/231983
http://www.bizjournals.com/tampabay/news/2014/08/21/medical-examiner-steiner-s-death-was-suicide.html
http://bipolar.about.com/cs/celebs/a/heinzprechter.htm
http://www.rollingstone.com/culture/news/the-brilliant-life-and-tragic-death-of-aaron-swartz-20130215

34