At least according to Dr. Uri Nitzan of Tel Aviv University, who just published a report on psychotic symptoms he’s found in a number of Facebook users.

Some of his patients experienced delusions about people they were connected with on Facebook, including one who experienced tactile hallucinations, “believing that the person beyond the screen was physically touching her.”

So does using Facebook drive you crazy? Well, at least not crazy about the fact that you’re crazy. But in some circumstances, Nitzan highlights, vulnerable people who have recently lost love ones and have limited experience with technology look for connection online and go a little too deep, causing real psychotic symptoms.

As they developed extremely intense online relationships, sharing too much private information led to feelings of hurt and betrayal. And more:

In each case, a connection was found between the gradual development and exacerbation of psychotic symptoms, including delusions, anxiety, confusion, and intensified use of computer communications.

A caveat: Nitzan’s report is based on three case studies, not a full in-depth scientific study. So it’s impossible to draw strong conclusions about the effects of Facebook on people in vulnerable situations. But none of his patients had a history of mental illness.

Perhaps the most important point of the paper? Mental health professionals can’t ignore Facebook when they’re treating individuals.

“When you ask somebody about their social life, it’s very sensible to ask about Facebook and social networking habits as well as Internet use,” Nitzan said in a statement. “How people conduct themselves on the Internet is quite important to psychiatrists, who shouldn’t ignore this dimension of their patients’ behavior patterns.”

The good news? All of the patients had a full recovery.

photo credit: macwagen via photopin cc

This is a guest post by mental health entrepreneur, Sarah Seegal 

While most of her friends were deliberating about their college major, Jessica Mah was leading a company, managing finances, and laying off staff to keep her startup afloat.

By the time she was 21, the trilingual Y-Combinator alumna had already graduated from college and raised $1.1 million from angel investors like Steve Blank and Jawed Karim. Her company, InDinero, had been profiled by the Wall Street Journal and VentureBeat.

But InDinero, a website for small businesses to manage their finances, which Jess had founded with Andy Su in their UC Berkeley college dorm room, was in trouble.

“From around September to December of 2011, we went quiet and were really struggling,” said Mah. “We realized our users didn’t convert well into revenue.” Although the company tracked over $2 billion in customer transactions, according to Mah, they assumed that free users could be monetized at a later stage. When that assumption proved to be false, the entire business model collapsed, and the founders could no longer afford to maintain a full staff.

“I guess you just lose hope,” said Mah. But she found the strength to put the company back together. “At first, the goal was to survive. We wanted to return the money that had been invested in us and keep our reputations intact,” she added.

During this low point in her professional career, she needed to take a step back and keep things in perspective. “If we had had better emotional support, we could have fixed our problems faster. It was a lot,” she said. Mah has a firm head on their shoulders, but not all young entrepreneurs are equipped to make such tough decisions.

At 21 years old, would you have been able to fire half a dozen people, keep a company afloat, and investors at bay?

The tragic suicide of Ilya Zhitomirskiy, the 22-year old co founder of Diaspora, a non-profit, user-owned, distributed social network (it recently petered out), and Dan Haubert, the 25-year old YC Alum and co-founder of TicketStumbler, provide clear examples of the devastating pressure that young entrepreneurs face.

“Perspective is very important”, says Michael Groat, a practicing psychiatrist at Baylor College of Medicine, “particularly for young entrepreneurs.” Groat runs the only inpatient psychiatric treatment program for high-achieving professionals who are experiencing difficulty managing their careers and relationships because of a psychiatric disorder, addiction, demands or stress.

In many ways, Mah is a textbook example of failing well. Once it became clear that her company was struggling, she handled the immediate needs of the business, picked up new hobbies, and travelled to find perspective. The young prodigy who had started her first business at the age of 12, had to remember that there was more to her than the value of InDinero.

Dr. Groat told me that young entrepreneurs — highly achievement-oriented people — are often not so lucky. “They find themselves on a road where their life becomes very focused on one thing,” he said.

“When this thing collapses, people can be very vulnerable to collapsing along with it,” he said.

How can investors and incubators support young founders?

Some programs, such as the Thiel Fellowship, are leading the way in supporting young entrepreneurs.

Each year, the foundation awards $100,000 to about 20 fellows to drop out of college to start companies. All of these fellows are under-20, and many leave their friends and family to pursue entrepreneurship. Unlike traditional college students, the fellows often live alone and pursue their projects independently.

“Ilya’s (Zhitomirskiy) death was really scary for us,” say Danielle Strachman, Program Director of the Thiel Fellowship. “For anyone working on anything, entrepreneurship can be pretty lonely and we’ve developed a number of support structures for our fellows.”

While suicide may represent the extreme end of a continuum, the fundamental challenge of coping successfully with the ups and downs of bringing startups into the world, is significant. The Thiel fellowship uses its network of older fellows, advisors, mentors and staff to ensure the fellow stay grounded.

Don’t underestimate the value of a good mentor

When the news of Zhitomirskiy’s death hit the headlines, she reminded the Thiel Fellows about the importance of staying in constant contact with their mentor and the program’s staff. She resent all of the fellows the emergency contacts numbers. Strachman acknowledges that her fellows are on “a path to something big”, but they’re still young and run the risk of burning out.

According to Dr. Groat, mentors can play a powerful role. “Mentors can show us that it’s okay to be exhausted, take time out for vacation and be open about our struggles,” he said. In addition, young entrepreneurs often need help knowing their limits: how to scale back when they are exhausted, speaking up for themselves, and asking for advice when needed.

For the Thiel fellows, regular retreats, quarterly check-ins, tolerance for mistakes and an emphasis on the big picture, are an essential part of the experience. Strachman is very clear with the program’s participants that if they ever need anything from a ride out of a questionable neighborhood at 2 o’clock in the morning to a referral to a psychologist, the foundation is there for them.

Have options! There is more to life than your startup.

Investors, it’s not enough to just write a check to a young entrepreneur. Providing emotional support will make a positive impact on their achievements — both professional and personal. Don’t encourage talented young programmers and designers to have a singular focus. Aside from running their companies, the most grounded founders I interviewed had a project or interest that they’re equally passionate about.

This is essential for those that choose to forgo a college education. At the age of 18, Kristina Varshavskaya dropped out of high school to work at her sister’s company, Wanelo, a social store for international goods.

“I think that I put myself in a situation where if I fail, I fail harder because I don’t have the cushion of a high school degree,” she said.

Wanelo has grown quickly since she joined full time last fall. “Right now, we have a team of ten, [we] have raised $2 million, and have an office and a product that people actually use,” said Varshavskaya. “But I have total uncertainty in my life.”

Despite these early successes, there is a good chance that the company won’t succeed. “If Wanelo fails, I would be without a high school degree and a year behind if I wanted to go back [to college]” she said.

My advice to Varshavaskaya and others like her would be to have a backup plan. Most startups fail, so dropping out of high school or college is a huge risk. As the Huffington Post reported, only one of the five fellows from last year’s class is currently taking home an income.

If things don’t go as planned, I fear that young founders won’t be able to draw a distinction between personal failure and the failure of their company. To stay emotionally healthy, surround yourself with mentors, develop a keen hobby or interest, and think long and hard before dropping out of school. As these entrepreneurs are proving, you don’t have to choose one or the other.

If you or someone you know is feeling anxious or depressed, you can call the National Suicide Prevention Hotline 24 hours a day at 1-800-273-TALK (8255) or you can chat with a counselor online.

Sarah Seegal works at One Medical, a San Francisco-based primary care practice that is focused on the patient experience. One Medical has offices in San Francisco, Chicago, New York, Washington DC and Boston. Prior to this, she was one of the first non-technical hires at Breakthrough, a tele-pyschiatry startup in Silicon Valley. She has worked as a behavioral coach and counselor at Green Haven Correctional Facility and Harvard’s McLean Hospital. Seegal is the founder of The Listening Center, a peer counseling service at Vassar College. Follow her on Twitter at @sseegal

Top image via Shutterstock 

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In 2009, a startup known as Breakthrough announced it would make it cheap and easy for people to receive confidential counseling on the web. Three years later, with the upholding of healthcare reform, the startup has finally convinced angel investors to make a $900,000 bet that the shrink’s couch will go online.

With some still attaching a stigma to mental health and therapy, few entrepreneurs have attempted to explore how technology can help deliver care. An estimated 54 million Americans have a diagnosable mental health condition, according to Mental Health America.

And yet, the company’s founders said that more Americans will admit to having a rectal disease than a mental illness.

Breakthrough works by connecting users with counselors via basic keyword search. You select a practitioner based on factors like specialty or location and confidentially set up a video conference. Breakthrough patients with health insurance can chat with any in-network providers on the site for $25 or less. If you don’t have insurance, or you’re not covered by companies such as Blue Shield or Magellan, expect to pay about $100 for an out-of-network appointment. On average, patients book five appointments on the site.

Telepsychiatry, or “therapy 2.0,” has been slow to evolve, but the founders say that it is beginning to take off. They won’t disclose the total number of users for confidentiality reasons, but Mark Goldenson, the site’s CEO and founder, revealed that the site is tripling its user-base each month.

Magellan, California’s largest health insurer, recently agreed to extend its coverage to Breakthrough. This may be enough to tip the scales. Now, 33 million more people across the U.S. may use the service to receive affordable counseling on the HIPAA compliant video platform, meaning that it will protect sensitive patient data.

Prior to starting the company, Goldenson counseled teens on a crisis hotline and worked as a project manager for PayPal. This year, the company graduated from StartX, the Stanford University-affiliated startup accelerator. It counts a handful of licensed practitioners among its advisors, including Dr. Morgan Sammons, dean of psychology at Alliant International University.

Goldenson said that they will use the funding to hire more engineers and invest in marketing to reach thousands of new users.

But is the world ready for telepyschiatry?

Maybe. Goldenson cites research from the American Psychological Association that 10 percent of psychologists chatted with patients through live video in 2008. It’s probably closer to 15% now. In addition, the VA Greater Los Angeles Healthcare System has run 550,000 virtual mental health visits since May 2011. It’s proven particularly useful in connecting with rural patients, and those who are reticent to book an in-person visit.

Another good sign is that therapists are increasingly using video conferencing tools like Voyager Telepyschiatry, LLC and Secure Telehealth to virtually connect with patients who are out of town or otherwise unable to make a regular in-person visit. Insurance doesn’t usually cover video chats, so patients would have to be willing to pay for this service themselves.

On Breakthrough, you’ll find counselors via keyword search

But some doctors have expressed concern that telemedicine is perilous and will increase the rate of misdiagnosis. The most conservative among them fear that telemedics will fail to notice telltale symptoms. The majority of medical experts fall somewhere in the middle; they would argue that a quick consultation with patients online can be beneficial, but these must be coupled with regular in-person checkups.

“There’s a difference between advice and treatment,” Lyle Berkowitz, a medical director of information technology and innovation at Northwestern Memorial Hospital’s primary care group in Chicago, told the Wall Street Journal in a recent review of telemedicine sites.

In the case of telepsychiatry, it seems even more likely that a therapist might miss the subtle signs of depression. Goldenson said that they have yet to encounter any issues, but the company has liability insurance just in case. “We have taken a risk-averse approach,” he said. On its website, Breakthrough cites findings from Harvard University that connecting with a patient online is as effective as an in-person visit, perhaps more so in the context of mental health.

Goldenson told me that the startup has no direct competitors. I hear this often, but in this case, it might actually be true. There is a deluge of online therapy services, but for the vast majority, users will have to pay out of pocket as health insurers won’t foot the bill.

It’s been an uphill battle for entrepreneurs attempting to digitize mental health. Barriers to entry are high. In Breakthrough’s case, the first step is to convince insurers to include online counseling in their plans. Venture capital investment will be a challenge, as investors are typically reluctant to pour funding into niche areas of healthcare.

Angel investors include PayPal Director and former eHealth executive Avery Kadison, Ash Patel and Mike Marquez of Morado Ventures, Square COO Keith Rabois, Charles River Ventures, PracticeFusion cofounder Matthew Douglass, and Invite Media cofounders Nat Turner and Zach Weinberg.

Top Image via University of Alabama