struggling_CEOThe startup community has been jolted by a spate of suicides: Ilya Zhitomirskiy at the age of 22, wunderkind Aaron Swartz, and most recently eco-mom’s founder Jody Sherman. The startup community is grappling with challenging questions about the toll that entrepreneurship can have on founders.

Paul Graham was once asked if he chooses stable or crazy applicants for Y Combinator. His reply: “There’s some people who are crazy, who are basically manic depressives and somehow manage to keep the depressive part to a minimum. Those are good. But hearing voices kind of crazy? Not good.”

Graham isn’t talking about full-blown manic depression, which can include hallucinations and psychotic delusions. He is describing what UCSF’s Michael A. Freeman M.D., a psychiatrist and former VC startup executive, calls “soft bipolar.” Soft bipolar is a distant cousin to manic depression that often includes mild depressive dips and a light form of enthusiastic, energized, creative mania, called hypomania.

Dr. Freeman explains: “Hypomania can give entrepreneurs significant advantages. It includes elevated mood, expansive creativity, and an increased ability to tolerate risk. Soft bipolar entrepreneurs can be visionary, highly self confident, persuasive, energized, and boundlessly enthusiastic about the companies they are building.” Think of hypomania as a kind of “success gene.”

Hypomania can also be the “wiring” that helps make some entrepreneurs successful. In the book “The Hypomanic Edge: The Link Between (A Little) Craziness and (A Lot of) Success in America,” psychologist Dr. John Gartner lists well-known figures like Ted Turner, Andrew Carnegie, and Craig Venter, all of whom seem to display these traits.

I won’t speculate why the three beloved entrepreneurs I listed above died. In general, though, many believe that running startups can drive people to experience intense ups and downs. While this is true, it’s often the other way around: People in the bipolar spectrum are attracted to entrepreneurship. Building businesses can be a great way for hypomanic entrepreneurs to apply their energy and creativity.

Some people are more vulnerable to mood fluctuations and can also experience episodes of dark depression that may include feelings of hopelessness, irritability, fatigue, concentration problems, and feelings of worthlessness. People naturally don’t like diagnoses. Who likes being boxed in? While some of the soft bipolar traits can prime people for success, we need to acknowledge that the downsides confer significant risk, both to entrepreneurs and their companies.  If we as a community can overcome the stigma associated with mental health conditions enough to look at the suicides of our colleagues through this filter, perhaps we can begin to create awareness of, and access to possible cures.

It’s not just about preventing people from killing themselves. When people understand how they are wired, they can optimize their performance, increase the odds of building successful companies, and realize greater returns for the investors who help launch new ideas into the world.

As an executive coach and managing partner of a firm, I have clocked more than 5,000 hours with business leaders of many stripes. For most of our clients, we teach straightforward leadership skills and help them scale their companies. Over the years, however, I have helped many on the soft bipolar spectrum.

For those who are mostly hypomanic, they need support in checking the “irrational exuberance” that can put their companies at risk. They need to engage in calming activities like walking, meditating, and ensuring that they abate the insomnia that naturally comes with an active mind. They also need cofounders, employees, and advisors who are willing to challenge the feasibility of implementing some of their wild ideas. Those who experience mild depression must train themselves to follow exercise regimens, spend time with loved ones, and learn how to manage feelings of self doubt and negative thinking. And for those who suffer from bouts of chronic depression, the right medications and evidence-based therapies can be life changing.

That said, I believe the pharmaceutical industry pushes this country to be overmedicated. But I have seen great leaders, who are privately suffering, become depression-free when they get on the correct dose of the right medications, coupled with reframing negative thinking and making the right behavioral and life-style changes. I emphasize the right medications, because the wrong ones can be devastating.

There’s a lot to be done, though. Dr. Freeman cautions that many general physicians and psychiatrists don’t even know about soft bipolarity. If they prescribe traditional antidepressants, these medications can be like poison to people who are soft bipolar by making their mood swings worse.

As a community, we need to hold a nuanced view about the mind of the entrepreneur. Many are a breed unto themselves, born with a wiring that endows them with special abilities. With that sometimes come downsides.

As Steve Jobs once said, “Here’s to the crazy ones… because the ones who are crazy enough to think that they can change the world, are the ones who do.”

[Illustration by Hallie Bateman for Pandodaily]