#I can also talk a bit about the failures of the psychiatric industry but it's just going to be depressing for me

[giantkillerjack]

Let it be noted that chronic pain conditions like this can often take years to get diagnosed, ESPECIALLY when it comes to stuff that relates to gynecology.

I cannot stress enough how barely out of the Dark Ages we are with gynecology, and how many doctors will either shrug or give you a very confident wrong answer.

Like, by all means, please do seek out treatment if you can. If you have the resources to do so, be insistent, be self-informed, be extremely wary of any form of treatment that cannot be proven by rigorous scientific study. Be aware that a period that is so painful you wanna die IS indeed indicative of a real underlying issue.

I just wanted to emphasize that for so many people, not only is it not a simple or accessible thing to "go to a doctor," but also, the gynecological industry is similar to the psychiatric industry, in that we have not advanced that far past the dark ages, if we ever left at all. They are both so much less advanced (and in some cases, less humane) than you'd think they'd be by 2024.

Also, for both industries, I highly recommend avoiding doctors who are white cis male boomers. I've seen a lot of doctors, a lot of psychs, and a lot of gynecologists; and I've never had a white male boomer doctor who didn't do more harm than good.

Also also, be aware that sexism, ableism, fatphobia, and racism play a huge part in people with chronic illnesses struggling to get a proper diagnosis and help.

While there is nothing you can do to eliminate these risk factors, don't be afraid to ask a friend to come with you to an appointment if they can help you be heard. Don't be afraid to get it in writing from your doctor when they refuse to treat your issues.

And most importantly, please don't blame yourself if this incredibly inhumane medical system we have feels painful and impossibly difficult to navigate. It's not you. Truly, it's not.

It's a deeply broken massive system that gatekeeps our care through capitalism, and you DO deserve better, even if sometimes better is either impossible or must be pried out of the system's jaws like a bloody tooth.

So many people who get periods are like “Ugh it sucks that having a menstrual cycle makes you almost die every month” like no that’s not normal you need to go to the doctor

[back-and-totheleft]

“Make it for the soldiers”

The three-time Oscar winner is back with a new book—Chasing the Light: Writing, Directing, and Surviving Platoon, Midnight Express, Scarface, Salvador, and the Movie Game—and turning its pages is like entering a Stone movie. The one-time infantryman had a single condition in granting HUSTLER this Q&A: “Make it for the soldiers. You’ve got to make it interesting to them.” Movie stars are often household names, but Oliver Stone is one of the few screenwriters and directors to have a high public profile. Now he’s released a new book, and it’s a rip-roaring, rollicking read, full of tense drama and trauma. The 342-page memoir focuses on Stone’s life through the age of 40 and sheds light on what forged Hollywood’s movie maverick and makes him tick.

After the Allies liberated Paris, his father—Colonel Louis Stone, who served on General Eisenhower’s staff—met the Parisian Jacqueline Pauline Cezarine Goddet. In December 1945 they married, which Stone wryly writes was “possibly the greatest mistakes of their lives,” and sailed from France to live in New York, where Louis, a Yale graduate, resumed his Wall Street career as a stockbroker. Stone reveals how their divorce affected him and, for the first time ever, describes in detail his combat experiences in Vietnam, where he was awarded the Bronze Star and a Purple Heart. Coming under fire in Indochina’s jungles ignited an intense mistrust of government and hatred of war that actually compelled Stone to become a filmmaker. As the Chasing the Light subtitle indicates, the book zooms in on four movies and provides a behind-the-scenes peek at Stone’s maneuvering through Tinseltown’s machinations. Stone scored his first Hollywood triumphs as the screenwriter of 1978’s Midnight Express, winning an Oscar and a Golden Globe. Like his script for 1983’s Scarface, Midnight Express lampooned the so-called War on Drugs. This set the stage for Stone to tackle President Reagan’s secret war in Central America with 1986’s hard-hitting Salvador, followed later that same year by his grunt’s-eye view on the Vietnam War, the no-holds-barred Platoon. At the 1987 Academy Awards ceremony, Stone was in the rare enviable position of competing against himself in the Best Writing, Screenplay Written Directly for the Screen category for both Salvador and Platoon. Although he won neither, his boyhood idol Elizabeth Taylor did give Stone the Best Director Oscar for Platoon, which also won for Best Picture. The book’s curtain closes as Stone earns his sublime moment in the limelight, emerging as one of the movie industry’s most celebrated writer-directors of all time. His future body of work—1987’s Wall Street, 1991’s The Doors and JFK through 2016’s Snowden—are only mentioned in passing, if at all. An exception is 1989’s Best Picture-nominated Born on the Fourth of July, for which Stone was awarded his second Best Director Oscar, for helming this searing cinematic biopic about maimed Vietnam War vet Ron Kovic, whose relationship with Stone began during the period his memoir covers. HUSTLER interviewed Stone when he returned to Los Angeles in between trips to Europe to promote his book. In this candid conversation Stone opens up about the Vietnam War, drugs, censorship, Edward Snowden, Larry Flynt, Jackie Kennedy, his new Kennedy assassination film and so much more. HUSTLER: How did Chasing the Light come about? Did you write any of it while sheltering in place? OLIVER STONE: No. I was finishing up in that phase. I wrote it over two years. It was final draft, checking things, draft edits, around February, March… I was working on other things, documentaries and so forth. In your memoir you write about your time in Vietnam. Have you recounted those personal experiences extensively before? No. No, I haven’t. In interviews I’ve shared some of it. But no, this is all fresh material. The movies were dramatic presentations. I talk about Born on the Fourth of July and my relationship with Ron Kovic [the paralyzed Vietnam War vet portrayed by Tom Cruise in the 1989 feature]. And a lot about Platoon. Because both were written in 1976 [the year Kovic’s book was published], which falls in the period I’m covering in Chasing the Light, up to 1986. They play a significant role—the failures of those two films to get made haunted me. You were wounded twice in Vietnam—where you served with distinction as an infantryman, winning a Bronze Star and Purple Heart. So what do you think about President Trump allegedly calling dead soldiers “losers” and “suckers” and stating that military parades should exclude wounded vets? It’s a strange statement. I don’t know if he made it, but it sounds very bizarre. Obviously, I don’t agree with it. On the other hand, I don’t believe we should be over-glorifying our veterans either, because that leads to other sets of problems, which we’ve seen in the spate of recent wars. To prepare for this interview, I watched Scarface again. In your book you mention that you were probably conceived in Europe, your mom was an immigrant from France, and it struck me that Scarface is very much an immigrant’s saga. How do you view the Trump/Stephen Miller immigration and refugee policies? I abhor them. I do believe in immigration—it’s what the American way is about. This country has been built on immigration. Even in this lifetime of mine we’ve had such a new spate of immigration from different countries, Third World, Asia. It’s remarkable. In Scarface we talk about Latin Americans who are coming into Miami, some good, some bad. It’s a rich mix, and that’s what had given America its experimental nature. There’s no fixed America in my mind. It’s 250 years—it’s a constantly changing soup. Scarface, like Midnight Express, is drug-themed. Your memoir is quite candid about your own use of substances. What do you think of the War on Drugs? Who won? [Laughs.] It’s a ludicrous objective. It should not be called a “war.” Listen, I partook of drugs. I’ve been very honest about it. It started for me in Vietnam. I smoked it in the base camps, in the rear, when we came back. I smoked it to relax. I go into the reasons for it. It helped me get through that war as a human being. Very important to me. I respect it. I also talk about drug use later on in my life, like cocaine—which I don’t think worked for me at all, and I said why. So I’m on both sides of it. But I do think it’s an individual issue, of individual responsibility and education. The treatment for it is not punishment but hospitalization or medical help or psychiatric help. The War on Drugs is a waste of money, and again, it’s political. I saw that in Scarface, the birth of the Drug Enforcement [Administration]—very political, huge budgets; it’s growing every year. The Reagan war and all that—they call it a war. Everything in America is a war. But we don’t win any one of them. Have you encountered political censorship in Hollywood for your movies’ dissident politics over the years? You posit that Henry Kissinger and Alexander Haig being on MGM’s board may have affected an early effort to make Platoon. Yes. It’s been a long haul. And I emphasize the word may, because you never know when they turn it down. They never tell you, “It’s because of political reasons that we don’t want to make your film.” They never say that. They couch it in economic terms or, “This is too depressing.” “It’s blah-blah A, B or C.” You never know. In this case, it was a very easy deal for them to make. Dino De Laurentiis was behind it—as my producer he was financing the film. MGM had a distribution deal with Mr. De Laurentiis, and they didn’t live up to it. He was making very risky movies at that time, like Blue Velvet. MGM had to make a minimal investment in distribution costs, and they did not do it. Why? Well, I would assume that the president of MGM at the time, Frank Yablans, said that he had gone to the board and they had turned [Platoon] down, but I’m not sure he’s telling the truth. Because they sometimes don’t even bother to go to the board because they don’t want to take any heat. On the board, of course, were two very conservative men on Vietnam who I’d classify as war hawks. So, I mean, it became a political issue. I do believe that; I have no proof. Also, the Pentagon passed on the film, calling it completely unrealistic. This is an important issue because the movie is realistic. I was there, and I saw it on the ground. I was in four different platoons, in four different units, in three combat platoons. I served in the south and in the north and saw quite a bit of action. And I’m telling you, three things I wrote in the book, about the three lies in Vietnam, I believe apply even today to all fought wars. One is friendly fire. American soldiers get killed by their own side, by small arms fire, artillery and bombs. It’s not precision bombing. About 20 percent of the casualties, wounded and dead, comes from friendly fire. This is a very important point, because it is buried over and over again by the Pentagon in their after-action reports. Recently, the Arizona Cardinals’ Pat Tillman was killed in Afghanistan, and there was a whole mess in trying to get to the reasons for his death. Of course, that was a celebrity-type killing, but this goes on all the time in every war. In Vietnam, in the jungle, you can imagine the asymmetric aspect of it. When fire happens, you don’t even know where the fire is coming from. People are firing—you don’t know if it’s coming in or out. And various things like that are happening all the time. I believe my first wound came about through friendly fire. The second lie I talked about was killing civilians, trashing villages. Racism was really a huge factor in that. We treated the civilians mostly as enemies, as people who were supporting the enemy. [Secretary of Defense] Robert McNamara estimated three to four million Vietnamese killed. The third lie, the biggest one of all: “We’re winning the war.” We heard that lie again and again and again. It was fed to the American people. Even from the beginning, we never had a chance. In Neil Sheehan’s book A Bright Shining Lie, [Lieutenant Colonel] John Paul Vann made it really clear, in 1962 this was a hopeless situation, a hopeless war, because true patriotism was to fight for your country. This was a war, as he said, of independence that was fought against us as colonizers in the wake of the French. Inflating body counts, lying about enemy movements, CIA involvement in the war, no question about it. Misguiding the war. Often bad information, among other things, about the My Lai massacre in March 1968, when 500-plus villagers were killed in cold blood by [U.S.] units who were told that the enemy would be in the village. Not a single enemy bullet was fired in that whole day. And this was investigated by the Army itself, by an honest [lieutenant] general named [William Ray] Peers. He didn’t believe it at first. He thought it was bullshit, that the Seymour Hersh revelations were bullshit. He went in there and investigated thoroughly and came up with the conclusion. That’s what my movie I wanted to make on the My Lai massacre is about. He indicted 20-plus officers all the way up to the top of that division. He indicted the general of that division for his negligence. It’s a disgusting story. But it happens all the time in war and is covered up. Covered up for the dignity of the family, for the dignity of the death and so forth and so on. “How can you criticize the military?” You know, that horrible kind of righteousness, which prevents us from seeing what war is. Although you’re a decorated Vietnam veteran, the Pentagon denied you any support for Platoon—and, I assume, for your other Vietnam War-related movies. Yes, that’s correct. But other directors such as, say, Michael Bay, who never served in the military but who make pro-war, pro-military films, are given permission to shoot at U.S. bases, use of armed services personnel, access to high-tech equipment, etc. What do you make of this double standard? Does it violate the First Amendment? I don’t know about that, but it’s certainly a violation of morality. It’s much bigger than Michael Bay—there’s a book that came out in 2017, National Security Cinema: The Shocking New Evidence of Government Control in Hollywood by Matthew Alford and Tom Secker. James DiEugenio, who works with me, has covered this issue separately in another book, Reclaiming Parkland. These two books cover the involvement of the Pentagon in Hollywood. Alford and his coauthor talk about 800-plus films that were made with Pentagon cooperation. You’d be stunned at some of the films made. Among case studies are Pearl Harbor, Black Hawk Down—which is basically a whitewashing of the affair in Somalia—Charlie Wilson’s War, Hotel Rwanda, the Marvel Cinematic Universe, Rules of Engagement, The Terminator, 13 Days, United 93, Wag the Dog. Talks about people like Tom Clancy, of course a big military supporter, and the CIA too. TV series such as Alias, Homeland and 24—which had a tremendous effect on the American public in glorifying the CIA, making it seem like it was a backstop for our security, which is a lie too. It undermined our security. All this is much bigger than Michael Bay. In Chasing the Light you mention “surveillance” a number of times, and of course you made 2016’s Snowden. On September 2, the U.S. Court of Appeals for the Ninth Circuit ruled that the NSA’s warrantless mass surveillance—which Edward Snowden exposed—was illegal and possibly unconstitutional. What do you think of that, and what should happen to Snowden now? [Laughs.] It’s obviously correct. Snowden should be brought back to the country. I don’t know if he should be pardoned for his wrongs—because he never did anything wrong. He should be pardoned immediately, as should [WikiLeaks’] Julian Assange. The fact is, the NSA has been breaking the law for so many years. We owe it to George Bush and that administration. That was reported on as early as around 2004, but buried by The New York Times until after the election. The Pentagon Papers was released by The Times because they hated Nixon, but I guess with Bush, they gave him a pass. Terrible. It [NSA’s bulk surveillance] has resulted in this sense of unease—you’re always monitored, we have to check our behavior, we’re under control. This is a disaster for the world. Also, other countries have responded accordingly. The World Wide Web is very dangerous. It goes back to the worst days of J. Edgar Hoover. Free speech is a recurring theme in a number of your films. How were you involved in the making of 1996’s The People vs. Larry Flynt? I was a producer. It was written by Larry Karaszewski and Scott Alexander. It was their script. Milos Forman developed it with them. I did feel that Larry Flynt had a case—he won the case [against Reverend Jerry Falwell Sr.]. I’m glad. I’m proud of the movie. After Platoon was released, you quote Jacqueline Kennedy, who wrote you and said, “Your film has changed the direction of a country’s thinking.” Your movies presented a counter-narrative to the Reagan regime’s reactionary agenda. Modesty aside, do you think that Salvador, Platoon and Born on the Fourth of July may have helped stop Reagan and Bush from turning their Contra Wars in Central America into full-fledged Vietnam-like invasions? I don’t believe that they did. What happened was the fortuitous fuckup by the CIA when Eugene Hasenfus was captured after his plane was shot down. He was a contractor—he was in Nicaragua supplying [weapons to the U.S.-backed anti-Sandinista Contras]. It leads to the larger story of Oliver North, Reagan, George Herbert [Walker] Bush and the Iran-Contra affair. That’s what stalled them. Not that it was revealed in its entirety—that’s another story, of course, that’s been buried by The Washington Post’s Katharine Graham, who has been lionized in another kind of movie. But basically that scandal at least was enough to stop the momentum of an invasion, and Reagan did not have the power, the ability, the credibility anymore after October ’86. Which of course helped Platoon too, because it came out right in that juncture, and that revived Salvador, which was rereleased. Both films had an impact, but whether that would have changed the course of Reagan without the accident with the CIA—I don’t think so. Tell us about your new film, JFK: Destiny Betrayed. It’s a four-hour documentary, and it has the facts. More facts than ever. We deal with everything that happened after—in terms of documentation—since [JFK] came out in 1991. Very interesting. Because the assassination records review board, which was created from the JFK film with the JFK [Records] Act—although it was stymied by many restrictions, it did manage to release a fair amount of documents. Not all. And in those documents there’s quite a bit of information, including, of course, Operation Northwoods, that the Pentagon was operating to undercut Cuba. What are some of the highlights you learned since 1991 about the liquidation of President Kennedy? Well, I think you have to wait for the movie. [Laughs.] But certainly the ties of [Lee Harvey] Oswald to the CIA. That’s more explicit. Certainly, the evidence. We revisit the original evidence presented by Mark Lane but with new witnesses; new characters have come forward. Many people [didn’t] talk, but they start talking after the movie in the 1990s…People talk. All these informational signals come from all directions. You explain that your book title, Chasing the Light, refers to a moviemaking term. But does it also allude to your personal quest for enlightenment? And if so, have you attained it yet? Well, I’m much older [now] than when the book ends. But certainly that is an important moment, in 1986. After wanting to achieve a dream of writing and directing since I was 22 and being rejected and defeated many times, having some success along the way, and after having almost given up at 30—finally, at the age of 40, I really had a breakthrough of major proportions, with two solid movies back to back that really convinced the world, as well as myself, that I was a writer-director. It was a core victory for me and an important fact. That sets the tone for the foundation of my character. There’s going to be changes, more detours, pushes and turns in the story, but certainly, it’s established in 1986. So your memoir ends in 1987. That means a lot of your other classics are yet to come. So, in that grand Hollywood tradition, will there be a sequel to Chasing the Light? Well, I hope so. I do hope so. I hope the book does well enough to justify it. What’s next for you? I have two documentaries. One is the JFK documentary, four hours long, that won’t be out for a year. Another one is unedited, about the future, the need for clean energy, which includes nuclear energy. It’s based on a book I bought called A Bright Future: How Some Countries Have Solved Climate Change and the Rest Can Follow, by Joshua Goldstein and a Swedish scientist, Staffan A. Qvist. I understand you’re traveling these days. I’m about to promote the book in Paris. I just came back from Italy, France and Germany… It was big in Italy—they loved me. [Laughs.] Much better than in the United States.

-Ed Rampell, Hustler, Jan 16 2021

[phogenson]

A Hard Year: Doctors and Getting Help

The past weeks I've really looked at the conditions I was in dealing with anxiety. So I spent time in the hospital; time taking different medications; time writhing on the floor of my bedroom in panic; and time trying to just get through the day. Eventually I'd move on from those experiences, and I started that movement almost as soon as I got out of the emergency room although it was way too difficult to get to doctors who could help me.

This week I'm going to look at the process and difficulties I had setting up two different doctors appointments. For the record, I think that the medical bureaucracy in America is totally a shambles. The systems in place for getting care really does not serve people in my situation well, and I had a ton of advantages in navigating the system:

For one thing I was in Minnesota, which has one of the most all encompassing medical industries in the country. Like you can't throw a rock in Minneapolis without hitting a hospital, but doctors were hard to contact and offices were far flung enough to be problematic.

Additionally, I had insurance through a parent's work. It's not the greatest plan in the world, but I had it and I didn't have to pay for the insurance although I got the bills. The insurance company was helpful and for some reason insurance at all is a bit of a luxury in America so I was fortunate in that regard. Just for the record, I've been on Obamacare in the past and it's so important to have that.

And I had my family, many of whom work in health care in some way or another. And I was in touch with them throughout the process of finding care. That's a huge help. All these things also really inclined me to stay in Minneapolis at the time too. That didn't workout in the end, but I had support every step of the way through care. And I'm naturally pretty good at navigating systems like this so even with other difficulties, I could've been in my element but it still wasn't easy.

The point is there were places to go where I was, there was a company that was going to cover part of my care, and I could call my cousin when I was struggling with making very course grain decisions which were hard for me at the time. So this is one of those important features of dealing with mental health in America, it's unreasonably difficult especially for the person dealing with their mental health.

Initially I thought, since I hadn't been out of school for more than a year, I could at least start by going by student health services. After all, I'd gotten tested for mono there just a few months earlier after graduating. But it was 2016 and I guess that was when the University decided to kick me out of their health system--although I could still use their useless career services office and the library.

So February 19, 2016 was unseasonably warm. Upper 30s and drizzling in Minneapolis. I walked over to student health services early, before work, and just walked up to the desk. When they asked about who I was or whatever, they told me they couldn't help. That's real bummer when you basically see yourself as in a place where people are there to help you and you're asking for help. That dashed the notion that doing this very simple thing--seeing a doctor--would be as easy as walking into the building where the doctors are.

Needless to say, facing a setback in that state of affairs is devastating. I went to an auditorium on campus and thought about how the effort to end it all would be less than picking up the phone just to get buffeted around and told that there was no help available. Making that call took like an hour to just get around to. But eventually I started making calls and walking to work. I was very attached to my phone and my notebook that morning.

An hour or two after the failure at student health services I had the above notes together. But I was really just barely holding it together. I fielded a few more calls from clinics and offices which got stuck on the Post-It's.

On a personal note, I'd like to comment on the degree of organization and planning that was going on here. I'm frankly amazed looking at these notes that they are as organized as they are. So I'd like to clarify a few details about my experience dealing with anxiety:

First, specific to these days, getting through the calls and scribbling these notes down was basically all I was able to do. And it was hard to start. I wanted to just see a doctor, when that didn't work I felt pretty fatalistic about the whole day. I plugged away for a few hours doing research and writing notes. But before I did that I was thinking about bridges and jumping off of them.

Second, in general about my experience with anxiety, I was resistant to dealing with anxiety, or taking medication, or probably even acknowledging the problem. The reason I was resistant to change was because the fuel of anxiety is very compelling for putting notes like this together, agonizing over details and perfection. I definitely made notes and calendars and even some creative work with the force of anxiety behind me.

Now I can't speak for all neurosis or all people who struggle with mental health, but I'm confident in saying that frequently dealing with mental health is as difficult for people because it has some attractive qualities as much as it is difficult to deal with because it's harmful to the individual. I felt like anxiety was frequently what let me get better work done, and I still don't think I'm totally wrong about that.

Bipolars sometimes forego medication because manic episodes can be euphoric; alcoholics will relapse because drinking is part of how they get through the day and how they understand themselves and contextualize their relationships with others. Some of the activity of depressives, I hesitate to posit, is sometimes attractive to an interpretation of some alternative course of action to an individual dealing with depression. Certainly, because mental health permeates your experience of the world, it can be deeply tied to identity and I like some of my anxious energy and have some belief that there are good features of my life which seem only to be possible as a result of having that feature of my psychology.

Regardless of if having anxiety made it possible to effectively deal with my anxiety, by the end of February 19, 2016 I had two doctor's appointments set up. First was with a GP the following Monday, second was with a psychiatrist in March.

Meeting with the GP was pretty straightforward but it's not like a good time or anything. Doctor's offices kind of suck. The questions on paperwork about my own health history and my familial health history made me feel all kinds of ignorant and self conscious.

Basically, though, the GP felt confident in writing a new prescription for the lorazepam I was taking on an as needed basis. She also put me on sertraline, brandname Zoloft, a drug she said she'd "had success with for other patients with anxiety and depression." And that's really about it. Like any doctor I've talked with about Zoloft the GP talked about the caution and acclimation period to this drug. I started at half a tab every day for two weeks and then came up to a full tab after that. Zoloft takes about three to four weeks for the effects to be felt.

Zoloft gets prescribed left and right like it's the cure to the common neurosis. And it kinda is. It works for depression, it works for anxiety, generalized, social, panic disorder, it works for OCD. But the way it works is by setting a new baseline for serotonin re-uptake in the brain. People can feel "flatlined" on it, like there's no up or down. That's true, but for me that was a really positive feeling. By taking away my body's regulation of it's own serotonin the rollercoaster was gone.

So I was glad to have something working for me after meeting with GP. Only the lorazepam gave me any relief for a few weeks as I came up on Zoloft. It was suddenly obvious when this drug was working too, but it did take weeks and the increased dose. But when you realize that 41 million Americans take Zoloft and you sort of figure all these people are dazedly smoothing out the wrinkles in their emotions, I wonder what we really do with this blunt instrument of psychiatric stability.

I don't take Zoloft anymore.

Seeing the psychiatrist was not as straightforward. I had a very early morning meeting. I was going to have to go to a clinic that was miles away. I was resolved to bike to Edina, and it wouldn't have been that bad 13 miles 50 degree weather. But I got a little worried about biking in a light rain and not making it back to work on time. So I took an expensive Uber out there.

There was a lot of paperwork before the appointment. I brought it with me. There was more when I was there. And some of this stuff asks you to rate how you're doing on a scale and you can just tell that the higher the number the worse you are. Going about inpatient work like this almost makes you feel like you're in deep shit. It's like you got called down to some middle school principle's office for adults. I told myself it was better to just be honest.

They got some vital information like hight and weight for their records too. Then it's just a very impersonal interview. Talking to a psychiatrist just doesn't seem like the right way to go about dealing with mental health. Even talking to a really good doctor like I did, I wondered what could this person get from just asking a few pro forma questions that my therapist didn't already have a better grasp on. But moving forward through anxiety in this health system really requires a broad effort of people and approaches which is distressing in it's own right.

The truth is doctors are kind of like plumbers and psychiatrists are working on a very limited set of "if... then..." propositions that lead them to their eventual diagnosis and prescription. There's also something about talking so briefly with a person about substances that will change the way you feel that seems like talking to a two-bit dealer just with an office. I can never shake the Trainspotting feeling I'm in a psychiatrist's office--a feeling that the doctor is saying "this is some good shit, man, try it" because I was often left to just sign on with something like "oh yeah, Klonopin sounds good to me."

So March 15, 2015 I was taking Zoloft and Klonopin which is a pretty standard prescription for generalized anxiety. But it's hard to jump through all these hoops and I was a good jumper. It's weird that the medical industrial system is spread thin on patients. It's spread thin not just in the sense that getting to a doctor isn't easy even in terms of location--not everyone can Uber over the psychiatrist, that's a pain in itself--but who you see is just going to be less than the most helpful. In a sense the doctor is barely as helpful as a good friend, but they can write prescriptions which can help.

I don't want to catastrophize too much. It was paramount that I get help with my mental health. And I got it. Getting help was so much the right decision. Struggling is not right. I went through the next six months on the wave of medications and doctor visits that started on February 19, 2016 and occasionally still occur. But there's a framework for providing care and understanding the problems of people struggling with mental health that just isn't fleshed out enough for patients seeking help.

These are problems I could talk about at length another time.

[fmservers]

Investors and entrepreneurs need to address the mental health crisis in startups

Jake Chapman Contributor

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Jake Chapman is a managing partner at Alpha Bridge Partners.

More posts by this contributor

Driving the new American century

Specialization, Polymaths And The Pareto Principle In A Convergence Economy

Colin Kroll, was the co-founder of Vine and HQ Trivia, both consumer sensations that brought joy to millions; Anthony Bourdain, had been a chef, journalist and philosopher, who brought understanding and connectedness to millions of lives; while Robin Williams built a career as a brilliant comedian and actor.

What these three share in common is that they were all people at the pinnacle of their industry and they all died too soon. Their premature loss is a tragedy.

The most brilliant and creative amongst us are sometimes the most troubled and nowhere is that clearer than in the entrepreneurial ecosystem. With each passing unnecessary death the importance of mental health comes briefly into focus… but that focus lasts no longer than a news cycle and nothing changes. The time for lip service came and went long ago. We must take these issues seriously and we need to act.

The mental health epidemic is real. There are 18.5% Americans that will suffer from mental illness this year, 4% of them will suffer so acutely that it will substantially limit their ability to live their lives.

That means it is extremely likely you or someone you know is suffering right now and could use support. Moreover, unlike many of the challenges we face today, the most common expressions of mental health disorder (anxiety, depression, substance abuse and imposter syndrome) are largely addressable through individual action. Not only should we all take action, we all cantake action.

While national mental health statistics are troubling, they are downright terrifying for entrepreneurs. According to a study by Michael Freeman, entrepreneurs are 50% more likely to report having a mental health condition with some specific conditions being incredibly prevalent amongst founders.

Founders are:

2X more likely to suffer from depression

6X more likely to suffer from ADHD

3X more likely to suffer from substance abuse

10X more likely to suffer from bi-polar disorder

2X more likely to have psychiatric hospitalization;

 and 2X more likely to have suicidal thoughts

Photo courtesy of Flickr/Thomas Shahan

Addressing the ongoing mental health catastrophe in entrepreneurship is a moral imperative, and for wise investors, it should be a function of doing business.

Venture capitalists make their living off of the blood, sweat, and tears of founders. It is through their passion and efforts that we succeed or fail. We can either choose to see founders purely as a means to an end (generating returns) or we can see them as the whole people they are.

When I make an effort to get to know our founders beyond the most superficial level then I cannot help but be moved by their personal struggles. Seeing founders in our portfolio succeed on a personal level is just as rewarding for me as sharing in their professional success. Luckily, I believe the two are intrinsically linked, which means we don’t have to choose.

 As Michael Freeman writes:

“Mental health is as essential for knowledge work in the 21st century as physical health was for physical labor in the past. Creativity, ingenuity, insight, brilliance, planning, analysis, and other executive functions are often the cognitive cornerstones of breakthrough value creation by entrepreneurs.”

Depression, anxiety and mood disorders all actively work to undermine founder performance. They often contribute to burnout, co-founder conflict, toxic company culture, increased employee turnover, an inability to hire top talent, an inability to “show up” for important meetings and pitches and poor decision making in general. According to Noam Wasserman at HBS, 65% of failed startups fail for avoidable reasons like co-founder conflict. All of these experiences are exacerbated when founders are in a time of high mental and emotional strain.

Let’s assume that in a portfolio of 20 companies 15 of them fail or underperform and that Noam Wasserman’s 65% statistic holds true. That would mean that 10 of the 15 companies (65%) failed for avoidable “human centric” reasons. If a firm were able to help even half of those companies avoid failure caused by burnout and mental strain that would mean an additional five companies would be successful, doubling the number of successful outcomes in the portfolio.

Even if you’re a huge pessimist, to help change the trajectory for one out of ten companies, changes the portfolio from five winners to six. In other words, supporting founders before their “people problems” become business problems yields a 20% improvement in performance. Even if one were indifferent to the personal lives of the portfolio founders, they should care about founder health if they care about portfolio returns.

It’s great that investors profess to care about founders’ mental health, but words are not enough. We must act to reduce founders’ mental and emotional suffering. It’s the right thing to do and it’s good for business.

Photo courtesy of Flickr/Thomas Shahan

Why do entrepreneurs suffer so much more acutely? 

Mental health problems permeate every industry not just the tech industry, but the statistics above would seem to indicate that we have a particular problem. What causes entrepreneurs to suffer at substantially higher than average rates? It’s a hard question to answer, and soon research from progressive labs like that of the Founder Central Initiative will help us to identify these drivers. For now, based on our own observations of founders, we believe there are several explanations which may contribute.

Self-Selection: Most founders are smart, driven and skilled people whose resume could almost certainly land them a job with a higher lifetime expected value (the median salary at Facebook is now $240,000) but they still choose the grueling, uncertain and more creative founder journey. Founders are almost certainly pre-disposed towards certain conditions (like ADHD) for example, Garret Loporto, in his book, “The Davinci Method” cites Fortune Magazine as claiming that people with ADHD are 300% more likely to start their own company than others.

Poisonous industry tropes: The narratives our industry tells are less real than pictures that grace the front of fashion magazines and are just as destructive. Photoshopped pictures of “perfect people” create an unattainable standard of beauty, the constant stream of stories about “overnight success” and “crushing it” create an unattainable standard for founders.

Startups are hard: The magic of a great team is in building a group with complementary skills. When just starting out founders don’t have a complete team and are required to do things they are not well suited to do. Working on projects that do not fit within a leader’s innate skills tends to be emotionally draining. It’s not uncommon in an early startup for introverts in the company to have to pitch and make sales calls while extroverts are forced to sit at a desk and grind away in a CRM.

Startups are alienating: The all-encompassing nature of a startup often causes founders to spend less time with family, friends and significant others and many are required to re-locate away from these support networks for funding or strategic reasons. As stress at a company builds, founders are more inclined to double down at work (a natural response to an emergency).  This tendency only further burdens the founder by muting their supportive relationships and reduces their ability to cope with company pressures.

A founder must be a rock: There’s a lot of pressure put on founders to stay steady in times of company turmoil.  As a result, they are often alone when they need others the most.  Founders report that they feel that they cannot talk with their co-founders, especially when the problem is with the co-founder, they cannot pass the burden of their worry on to their employees, and feel that their friends and family do not understand or are tired of hearing about the company.

The “I am my company” syndrome: Founders blur the line between themselves and their companies in such a way that company failures often are felt as personal failures. Losing a customer contract or receiving a “no” from an investor can feel like a deeply personal rejection.

Founders eat last: I have yet to meet a founder who has a budgeted line item for self-care or who takes guilt free vacations. In almost every other skilled industry there is recognition that people have a right to take care of themselves and that a little bit of self-care actually leads to a more productive workforce. Investors, founders and poorly trained middle managers all perpetuate a myth in the startup ecosystem that the only way to be successful is to grind yourself inexorably to the bone.

Financial risk: In addition to opportunity cost, founders often go without a pay check and pour a significant portion of their personal capital into their businesses. This creates enormous financial stress and anxiety that sets up a scenario in which a business failure also creates personal financial ruin. A certain amount of “skin in the game” can be positive but founders are often already all-in emotionally with their businesses. A founder with too much skin in the game may live under a Sword of Damocles and be unable to focus on the key tasks, ironically bringing about their own worst fears.

Imposter Syndrome: Founders often suffer from the sense that they don’t belong where they are and that eventually they will be exposed as frauds. This leads founders to chalk success up to luck but to take all the blame for any failures. 58% of tech workers suffer from Imposter Syndromeand I suspect the number is substantially higher among founders.

Moving the goalposts: Founders find it difficult to celebrate the small wins, each victory brings on the next, greater challenge. The second most stressful time for founders is right before they are able to secure a major fundraise, the most stressful time is right afterwards.

Substance Abuse: Our industry is awash in alcohol and other substances that founders and tech workers are encouraged to consumer freely for bonding, as a social crutch, and for performance optimization. These substances are both a cause and a symptom of broader problems in the ecosystem.

I wager that simply reading the above list left you stressed out and self-identifying with a number of the factors that cause founders stress. Luckily there are some things we can all do to combat mental health strain.

Photo courtesy of Flickr/Thomas Shahan

What can investors and founders do about founder mental health?

Each of us who participates in the startup ecosystem contributes to the problem of poor founder health.  This puts each of us in a position to positively impact this experience by acting. Here are a few things we can do:

Destigmatize

o  Investors should make sure that the founders they work with know that they take mental health issues seriously. One way to do this is to take the Investors Pledge developed by Erin Frey and Ti Zhao at Kip. Just taking the pledge sends a powerful signal to founders that it’s OK for them to seek help. Better yet, investors, in their onboarding process with founders should explicitly touch on their support for the founders’ seeking mental health services when they feel compelled to do so.

o  Drop the act. Being an investor is different from being a founder but it isn’t easy and investors suffer in many of the same ways. If investors want to support their founders, they need to be authentic and vulnerable in front of them. Investors need to show founders its ok to open up and that it’s ok to have doubts or to struggle with mental health.

o  For founders, don’t spread or buy into the myths. When you’ve been grinding away on your business for years in anonymity and then have a major breakthrough, make sure your PR campaign accurately reflects the journey. You suffered to bring your company to the pinnacle of success and you had to invest heavily in yourself to survive the trip. Make sure when other founders read about your success they understand how you really got there.

Provide Resources

o  It’s easy for people to forget how financially constrained most founders are. Just because they’ve raised $5 million in a recent financing doesn’t mean they necessarily have the personal capital to seek help and support. A portion of financing rounds should be earmarked for the founders themselves and investors should hold founders accountable for investing in their wellbeing and development.

o  Founders need to include a line item in their P&L for wellness or self-care. Budgets are moral documents and they set the priorities of a company. If there is no line item for supporting the mental/physical/emotional well-being of the founders and employees, then the company will be devoid of the resources to offer this type of support. We, the participants in this ecosystem, need to put our money where our mouths are when we say that we are “founder friendly” and “invest in founders first”.

Don’t forget the mind body connection 

o  Mental, emotional and physical wellbeing are all deeply linked to one another. Just as mental health issues often lead to substance abuse, a lack of physical exercise or nutrition can also lead to depressive mood states and a lack of focus. The founder fifteen is as real as the freshman fifteen but it’s much more destructive.

Founders need to make sure to incorporate their physical activity of choice into their life, need to watch their nutritional intake and should consider activities such as yoga, meditation and intentional breathing that research shows help boost mood, sharpen focus and enhance emotional resilience. (Short plug, at Atlaswe work on addressing the whole person because we believe effective leaders are those who are both physically and emotionally fit.)

Connect, connect, connect 

o  Founders need to remain anchored in a support network. They should join a peer group, engage with old friends, go out on date nights with their significant other and make new friends. Not only is it a fun way to unload some of the pressure they’re under, but it’s a great reminder to founders that they have a separate existence from their company.

o  Founders should take an intentional vacation away from work, tech, and business. If, like me, a founder can’t voluntarily disconnect even while on vacation, they should consider joining a community like Soulscapeor traveling off the grid so that they are forced to disconnect and recharge. Burnout rarely appears as the primary track in startup postmortems, but a trained ear can usually find its influence.

o  Set a culture that is supportive of self-care. If everyone from the receptionist to the CEO is willing to seek help and take care of themselves, it creates a company-wide habit that enables everyone to thrive. A healthy culture will pay for itself a thousand times over in recruitment, lower turnover and happier, more productive people who are willing to sacrifice for the company when sacrifice is called for.

Set priorities not tasks

o  Founders and A-type personalities tend to live and die by their calendar and their task lists. Unfortunately, task lists are just reminders that there are countless things to be done. For most of us our task lists are quite literally infinite. This is a recipe for unbearable mental strain and unmanageable cognitive load. The definition of anxiety is when we perceive that our ability to achieve is overwhelmed by the tasks at hand, which is inevitable when our tasks are ill defined, too large or seemingly unending.  Instead of a task list, switch to a daily priorities list where only the urgent AND important items are listed. Completing these items may be more difficult but getting them off your plate is infinitely more satisfying.

 Be vigilant 

o  Learn the warning signs of depression and burnout. People who are drowning don’t wave their hands in the air and shout for help, they slip silently beneath the waves and only trained life guards tend to spot people in trouble. It’s the same way with depression. Depressed people don’t mope around and they aren’t necessarily sad so much as numb. Here are things to look out for:

Persistent feelings of pessimism

Sad, anxious or empty mood

Change in behavior and loss of interest in previously enjoyed activities

Change in diet or eating schedule

Change in sleep schedule

Irritability

Inability to make decisions or concentrate

You can also use this validated self-assessment for depression

Building companies is inherently hard mentally, physically and emotionally but our ecosystem is a toxic one with dozens of factors all contributing to make it even more so. We are quite literally killing ourselves and thereby sabotaging our long-term competitiveness. There are tangible actions each one of us can take to start fixing this toxicity but at the end of the day but I believe most of those actions boil down to treating each other and ourselves as human beings. If we recognize and embrace our weaknesses and support one another in our imperfections, we will start seeing a healthier more sustainable entrepreneurial ecosystem.

Resources:

National Suicide Prevention Hotline: 1-800-273-8255

Depression resources: https://www.everydayhealth.com/depression/guide/resources/

Free/Cheap Peer Groups: https://www.evryman.co; https://www.chairmanmom.com; Atlas Events and Peer Groups

(if anyone knows of similar free resources, please share them in the comments)

Via Jonathan Shieber https://techcrunch.com