The work stopped being fun at some point, and most founders can’t say exactly when. You’re still showing up, still getting it done, still telling everyone you’re fine. Something has gone, and you haven’t stopped long enough to ask what it was or when it left.
Ross sits down with Dr Manuel (Manny) Astruc, a board-certified psychiatrist, EO member, and founder of Your Next Act, for a conversation about the version of burnout nobody is talking about: the one that accommodates itself, long before anything looks like a crash. They dig into the performance gap, the distance between where you are and where you’re capable of being, and what it actually takes to close it.
Key Takeaways
- Fun is the first thing burnout takes, and the last thing you notice is gone.
- The I’m fine entrepreneur is functioning, but they’re not thriving.
- Recovery is not passive. Scrolling is not recovery.
- Burnout narrows your view. Tunnel vision is one of the first symptoms.
- Three questions reveal where you are: energy, curiosity, patience.
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More About Manny Astruc
Dr Manuel Astruc is a board-certified general adult psychiatrist with over 50,000 hours of clinical experience. He is the founder of Your Next Act, a coaching practice for entrepreneurs navigating burnout. He is an EO Albany Capital Region member and Accelerator graduate, the author of Happiness Rules, and a provider of TMS therapy for treatment-resistant depression.
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Full Transcript
Ross Drakes: Hello and welcome to RadEO, a podcast by entrepreneurs for entrepreneurs. I’m your host, Ross Drakes. In this podcast, we share the stories of entrepreneurs, their personal paths, experiences, and stories of what they’ve learned building their businesses, and what drives them to keep going.
Today on the podcast, I’m talking to Manuel Astruc, who’s a psychiatrist. He’s an EO Albany Capital Region member, and he is an Accelerator graduate. Welcome to the podcast, Manuel.
Manuel Astruc, MD: It’s my pleasure to be here. Thank you so much for having me on.
Ross Drakes: So I ask everyone the same question as the kickoff. Can you give me your elevator pitch?
Manuel Astruc, MD: Yeah. So I’m a psychiatrist, I’m an entrepreneur, and I am someone who has suffered from and overcome burnout. Now I am helping entrepreneurs suffering from burnout recover so that they get back their energy and their focus, and can be successful in their business and personal life.
Ross Drakes: The cool thing to do. I mean, take me back to the beginning of your entrepreneurial journey. Was tiny-baby Manuel thinking, “You know what I want to do? I want to help people with burnout”? Was that your dream when you were starting out?
Manuel Astruc, MD: No. I was actually a rugged individualist. When I became a psychiatrist, I had worked in inpatient psychiatry, transitioned to an outpatient private practice 30 years ago, and never wanted to have employees because of the headaches involved.
In medical school, they don’t teach you anything about entrepreneurship or business, right? So the model that I had was that if I needed to make more money, I added more hours to my day.
Over time, I was working 12-hour days, seeing patients 12 hours Monday through Friday, six hours on Saturdays, and then two hours or more returning phone calls and sending in prescriptions.
And I knew that this was not sustainable. I hit a bottom in 2008. I had seen this coming for a long time, gradually getting more depleted, more emotionally tired, more physically tired, losing my edge, no longer feeling effective at work.
As the psychiatrist, I’m the person that everybody’s turning to for help, and I didn’t really have other people that I could talk to. So it was like a treadmill where every day I was just running, knowing that there was going to be a crash at some point.
I hit that crash in September of 2008. At that time, I was just absolutely miserable.
In spite of having a successful practice, everything looked good on the outside. On the inside, I was dying. And my twin sister, Magdalena, had died the month before.
Ross Drakes: Sorry.
Manuel Astruc, MD: She’d had a three-year fight with brain cancer. That evening in September, I was looking at a picture of her and, in the picture, she’s glowing, she’s smiling. You can’t tell, but she’s wearing a wig because she was going through chemotherapy.
It was just so striking to me that she’d lived her life with such a grim prognosis with a smile on her face and this incredible attitude of grace.
And I was healthy, successful and miserable.
That’s when I drew a line in the sand. It was really a moment of truth for me where I decided that I had to fight back from this depression. Over a year or so, I did that, wrote a book, and this led to becoming much more interested in entrepreneurship and business, and ultimately led to joining EO.
Ross Drakes: Wow. I mean, it must be… How do you find… You know, I’m interested. As you were talking, I remember a story. It was a couple of years back. I’ve been running my business now for 19 years, and I’ve had good times and I’ve had bad times.
Manuel Astruc, MD: Go get ’em.
Ross Drakes: I was in the process of buying out a business partner and we weren’t agreeing. There was a lot of fighting and trauma.
I remember I had friends coming over for dinner, and I love cooking for people. I had the food on the table. My friends were about to arrive. I was excited. Then I realised that I’d forgotten to buy cream to finish my meal.
And this tiny thing was just enough to send me over the edge. My entire back seized up. I had to go and lie on the floor, and I missed the entire dinner party because I’d been running myself so unbelievably empty that that tiny little thing was enough to tip me over.
Manuel Astruc, MD: I got lucky in some ways. First off, there was a commitment that, no matter what, I was going to get out of this. But I started to make some choices that fortunately worked out.
I’m supposed to have it all together. But what I knew was that something had to change.
So I looked at very low-hanging fruit for myself. One thing that I started doing was eating better. I had been eating terribly, just grabbing fast food here and there, wherever I could.
I started making a smoothie every day.
I knew that exercise was important, and I’d tried to exercise over the course of my life multiple times. I would exercise for a week and then it would fall off, and it wasn’t sustainable.
So I decided, “I’m going to exercise for three minutes a day.” I’m going to do a couple of jumping jacks, some push-ups, a couple of crunches. Three minutes a day. That’s all I’m going to ask of myself, but I want to stay consistent with that.
And that’s actually one of the best ways to build a habit. I found out about this afterwards, studying habit formation, but starting with very small steps to install the habit and then building from there.
So it was a series of these small steps.
I cleaned up negative energy from around me. One of the things I loved was listening to sports radio on the way into work, but sports radio had started to become something…
Manuel Astruc, MD: So, for me, that was an introduction to this world where I could just tune in to entrepreneurs and see the amazing things that they were building, what they were doing, their attitudes. There was so much to learn.
Ross Drakes: It’s interesting that small shifts can make a huge difference. How did those small shifts lead you into entrepreneurship? How did that lead you into thinking about your business and moving away from selling time?
Manuel Astruc, MD: Well, it took a while to move into entrepreneurship. My burnout got better.
One of the things that developed as a result of listening to entrepreneurs and podcasts was this concept that other people have called the “adjacent possible”.
An adjacent possible is if you imagine that you’re in a room with four doors. That’s your life. You can walk through one door without too much effort, resources or time, and explore a room that’s next to you.
I started to explore adjacent possibilities next to my psychiatry practice.
One thing that I did early on was start to look at information products. I wondered if I could make an information product about bipolar disorder or something similar.
I knew that I wanted to join EO. I’d seen it, and all of a sudden a message popped up on Facebook that there was an Accelerator programme going to be started in the Albany region.
I was primed to start. My mindset had changed from, “I don’t want any employees. I don’t want the hassle,” to, “I want to scale. I want to grow. I want to focus more on coaching and helping entrepreneurs. I want to be working on…”
Ross Drakes: Interesting. And you’re an interesting business. I think you’re the first psychiatrist that I’ve met in EO, the first person in this kind of industry. What’s it like coming from this world into entrepreneurship?
Ross Drakes: From the world that you’ve worked in for so long.
Manuel Astruc, MD: It’s been a pleasure. Being around entrepreneurs, that’s really who I consider my tribe, my people. I much prefer to spend time with entrepreneurs than with other psychiatrists or my medical colleagues.
I think that they tend to be much more positive in their outlook and focused on getting results and adding value to the world.
It’s one of the reasons that I love working with entrepreneurs. If I help an entrepreneur, it’s going to help them to help their family, their communities, their employees. The ripple effects of helping an entrepreneur are real.
My mission is to help change the world that way: help more people to help more people.
Ross Drakes: I like that. And there’s something you’ve just said now for the second time. You’re saying a positive thing. You tuned out sports radio because it wasn’t positive. Now you’re saying that you find that entrepreneurs are more…
Manuel Astruc, MD: Yeah. And what’s interesting is when you look at burnout, burnout occurs across a continuum.
I think sometimes positivity can get in the way of identifying the early stages of burnout. These are the entrepreneurs that I call the “I’m fine” entrepreneurs.
They’re more tired than they used to be. They’re less decisive than they used to be. They’re a step slower with their capacity and capabilities at work. They’re showing up at work as a version of themselves that’s not their ideal.
So this is a performance gap between where they are capable of functioning and where they’re actually functioning.
And they haven’t hit bottom. They haven’t gotten to the parts of burnout where you absolutely can’t go on anymore and you’ve got to make a change.
These individuals, because they’re positive and because they’re still functioning, are settling for this version of themselves.
When I talk to them, they do have symptoms. They have traits that are consistent with the performance gap between where you are, where you have been and where you could be.
They nod their heads, they stay positive, but it’s a challenge to get them to see that they can tune up the engine.
If it’s a high-performance car, there’s something that you can do to get that car’s performance back. That positivity sometimes says, “Yeah, I’m doing fine. I’m okay.”
Ross Drakes: I suffer from this. I suffer from eternal optimism. So when things aren’t going right, I’ll probably hold on a bit longer than I should because I believe that there’s a positive thing out there.
You talked about the signs of burnout and the continuum of it. What are those signs? What is that continuum like in terms of burnout?
Manuel Astruc, MD: Burnout was identified as an occupational syndrome resulting from poorly managed workplace stress by the World Health Organization. They give three core symptoms of burnout.
Number one is exhaustion: mental and physical exhaustion.
Number two is bitterness and cynicism. There’s an attitude change that happens. The reason you do what you do, for the people that you do it for, all of a sudden, instead of being grateful to do this, they become a thorn in your side.
And the last one is starting to lose professional efficacy.
With all of these symptoms, there are mild forms and then there are more severe forms. We talked about the “I’m fine” entrepreneur, who in early burnout can be experiencing some of the fatigue, attitude changes, getting a little more bitter, getting a little more cynical, losing some effectiveness, but they’re still functioning.
At the extreme, you hit bottom and you just can’t go on anymore.
Ross Drakes: And how did you, I mean, you said you diagnosed yourself. How did you diagnose yourself? How far down that path were you? And how can people start to see this in themselves?
Manuel Astruc, MD: I was at the end. Literally, I was at a point where I was going to have to make some radical changes or I was not going to be able to go on.
If burnout is left untreated, you’re going to get depression and more and more functional disabilities as a result of that.
I kind of knew what I was getting into and I’d seen it coming. So it was definitely a self-diagnosis, but it was no surprise to me that this was what I was dealing with.
In terms of recognition for entrepreneurs, trying to catch things at an early stage:
Are you getting tired more than you used to? Do you wake up and you’re not as refreshed as you used to be, mentally or physically?
Is your curiosity, your interest in doing things, changing? Are you having to work harder to do something that used to come pretty easily?
Are you finding that bitterness, that reactivity to demands and stresses, is increasing?
And are you noticing that slight slippage in effectiveness at work? Making decisions when they need to be made, emotional reactivity, losing options at work because you’re getting tunnel vision.
Those are early warning signs that burnout is moving along and that something should be done.
Ross Drakes: I need to tell the difference between burnout and being a parent of a young child, because those two things sound very similar.
Manuel Astruc, MD: No, you’re right. And with the continuum, it’s kind of like, how do you tell the difference between someone who’s kind of tall and really tall?
If they’re really tall, we can all agree. But on a continuum, where do you draw that line between, “This is moving beyond being a parent, being an entrepreneur, grinding, going hard”?
I think, first, is the awareness that there is this line where you can get into the red zone and it’s starting to detract from your performance.
Just staying open to not letting your performance and your relationships suffer as that line gets crossed.
The areas that I have people look at are their energy level when they first get up. Are you getting up and looking forward to your day, or are you starting to dread the day?
The level of curiosity that you normally have: how is that?
And your patience, your emotional reactivity: how’s that going?
If, over a period of a week, two weeks, three weeks, you’re taking a look at that in the same way that you look at your balance sheet or your bank statement, measuring where you are in this continuum, and the answer is that you’re depleted in these areas, it’s probably more than just parenting.
Ross Drakes: Mm-hmm.
Manuel Astruc, MD: With the entrepreneurs I work with, we have a mental fitness scorecard that we work on, measuring on a weekly basis where you are in terms of what we call mental fitness: strength, endurance, flexibility and recovery.
Ross Drakes: And for the people that are listening, what are some of the things that they can do to help fix some of this?
Manuel Astruc, MD: If we look at recovery, I think that’s one that’s easy to neglect.
The same way that an athlete can’t just be doing their best workout ever every single day without having some recovery time for their body, recovery for entrepreneurs is important.
Sleep is one of the biggest non-negotiables: getting adequate sleep. Exercise is key for recovery.
What a lot of people tend to do, rather than looking at active recovery processes, is look at passive recovery that’s really a way of disconnecting and numbing out.
Scrolling is not recovery.
Having a couple of drinks at night is not recovery.
Binge-watching a series is not recovery.
All of those things can calm down your nervous system, but they’re not really working to reset it.
There’s nothing wrong with doing any of those things individually, but when we’re using them as a way of calming our nervous systems down, as a way to recover, that’s not going to be effective.
You’re actually building a deficit.
Ross Drakes: So you’re saying sleep and exercise are the two biggest pieces. And then the second one is building an actual recovery. What does actual recovery look like for you? What are the things that people should be thinking about?
Manuel Astruc, MD: For me, the sleep and the exercise are the two biggest levers. They’re pretty easy, they’re pretty straightforward, they get talked about all the time, but they’re also easy to neglect.
Ross Drakes: Hmm.
Manuel Astruc, MD: Sleep, when you’ve got deadlines and you’ve got a lot of things going on, when you’ve got a young kid… We tell ourselves, “I don’t have to sleep eight hours. I can get by on six hours. I can get by on five and a half hours.”
But that’s a drain on the prefrontal cortex, which is the part of the brain that’s actually working to make decisions, emotionally regulate, maintain energy, and sustain attention and focus.
They’re easy, but also easy to give up. Things that are easy to do are also easy not to do.
Ross Drakes: Yeah.
Ross Drakes: What is it? If action followed knowledge, we’d all have six-packs.
Manuel Astruc, MD: No, that’s right. That’s right.
Ross Drakes: Yeah.
Manuel Astruc, MD: That’s exactly right. That’s exactly right.
Ross Drakes: Yeah. Okay. So tell me, come back to your journey in terms of… You identified that you were burning out, you’d started to restructure your business. Tell me about the business journey from selling hours into the business that you have now. What are some of the things that you’ve done?
Manuel Astruc, MD: When I started with EO, I gave up this idea of being a rugged individualist. I’ve been working to hire other practitioners into the practice.
As always, there are stumbles along the way. You try one model, you try another. But it’s the idea of scaling, having other people who can do the work that I used to do.
It’s allowed me to cut back hours here and put more hours into administration.
My workload has gone from probably 65 hours a week to closer to 40 in terms of actual patient-contact hours during the week.
I’ve got three nurse practitioners and have a fourth one that’s going to be coming on here.
One of the things I’ve been very excited about, too, is that I was able to add a technology to the private practice to treat depression called transcranial magnetic stimulation, or TMS.
For people who haven’t heard about TMS, in psychiatry and medicine, what we have available to treat depression besides talk therapy has traditionally been antidepressants.
Antidepressants work about 65 to 67 percent of the time, maybe 70 percent in some studies. But there’s a large group of people who don’t respond well to medications.
Those are the people who come to see me in my psychiatric practice, because if the primary-care doctor has started medications and they’ve worked, I don’t tend to see them.
But for treatment-resistant individuals, for years we’ve been stacking medications together. We’ve been adding different groups of medications. We work really hard with our patients to try to get that 30 percent who haven’t gotten better back to their level of functioning.
TMS came into the scene about 15 years ago. It was developed in England. It’s a form of treatment where we take a very strong magnet, and when you pulse a magnet rapidly, you get an electrical field. We can aim that electrical field very precisely at the prefrontal cortex of the brain.
As a result of stimulating that prefrontal cortex, which is also where burnout lives, about 70 percent of patients who haven’t responded well to medications respond incredibly well to TMS.
That’s been an exciting addition to what we’ve done at the office, to help serve more people, more efficiently, and with the newest technologies available.
Ross Drakes: That’s super cool. I’m trying to remember the name of it. There was a chair that I sat in that had magnets all the way up and down it, and they sort of vibrated at high frequency and put your body into fight-or-flight mode. Then, by the time it was done, there was a deep relaxation that kind of came.
It sounds like a similar thing. Is that how it works?
Manuel Astruc, MD: It’s a little different because, to get electrical stimulation to the very surface of the brain, we have to cross the scalp and then the skull, and then we get to the surface of the brain.
So we’re using a pretty big burst of energy that’s very localised rather than generalised.
The treatments themselves have evolved over time. For most of the time TMS has been around, you needed 36 sessions over 36 days, so it was about a six-week programme.
Stanford developed an accelerated protocol where we could get the same amount of benefit in a five-day course of treatment.
And there’s recently been a protocol where we can get the full benefits after one day of treatment.
So it’s a little different from what you’re talking about.
The effectiveness and safety of this treatment has been pretty remarkable. For depression, it’s still under-recognised. And I think in terms of burnout, I’ve had a handful of my EO peers who I’ve encouraged to try it, and we’ve had some incredible results.
If I can tell the story of one of my friends who was in my forum. Chris has given me permission to talk about this.
Chris was in my forum for two years. He’s the owner of a digital marketing agency and very successful, with big vacations with his family a couple of times a year.
He would talk about having a direction he could take his business in that he knew would be incredibly profitable. But when he talked about this, he would rub his face and say, “I did so much work. And I know how hard it was to get this agency up and running, and I just don’t know that I can do that.”
He talked about that a handful of times, and I would nudge him that this fatigue, this sense of “so much work”, was probably fitting this “I’m fine” entrepreneur who was a little burnt out.
I encouraged him to think about trying TMS, transcranial magnetic stimulation.
And he said no. And he said no.
Finally, to get me off his back, he said, “Okay, let me try it. Let me do this.”
He did the accelerated protocol over five days, and at the end of that time, what was noticed by other people was that he was smiling more. He was more engaged.
He said that this decision that he had found profoundly overwhelming, he was able to lean into, make a commitment to, and get started with.
At home, he said he didn’t realise that he was coming home and, in his words, “couldn’t wait to go to bed”.
After treatment, he said he was interested in everybody’s days. “How was your day?” He wanted to engage with his family in a way that he hadn’t in years.
He’s a runner, and he was running through this “I’m fine” phase of things. But he said that his runs took on a new quality after he got treatment.
He said that all of a sudden he was running and was just amazed by the feel of the breeze on his face, the look of the leaves on the trees, the clouds in the sky. All of a sudden, he was having this different experience of really being in awe and noticing these parts of the environment that he had been kind of oblivious to.
After he finished, he told me that he had wanted to get me off his back. He didn’t want the treatment to work. He just thought, “This is how I am and how things were going.”
But he was grateful to get the benefits.
Ross Drakes: That’s cool. So what I take from this is that I can just run my tank to completely empty and then come and do the 24-hour accelerated programme and bump myself back up again? Or is that the wrong lesson to take from all of this?
Manuel Astruc, MD: Well, I don’t think that you have to get all the way to empty. Maybe three-quarters, right?
But at some point, the availability of whether it’s TMS or coaching… Burnout is not just about suffering. It’s not something that we have to put up with.
You know the analogy of a high-performance sports car engine that you start off with, that you’re just thrilled to be driving, that slowly loses its power.
You just accommodate to this car that was thrilling, that now is getting the job done but is no longer producing at the level that it’s capable of.
That engine can get overhauled, and we can get that performance gap back.
That performance gap between where you are and where you could be, or once were, is something that we don’t have to put up with.
You can wait for that gap to be really large, or you can do it when it’s not quite so large.
Ross Drakes: I love that.
So, if you could go back to that 2008 Manuel and say, “Hey, look, here’s something that I know. Here’s a lesson,” what lesson would you like to share with that version of yourself that you know now?
Manuel Astruc, MD: One of the hallmarks of burnout, and we talk about this with mental fitness, is flexibility.
Flexibility in terms of mental fitness is the ability to see options.
In my state of burnout, and, like I said, it happened over years, I got tunnel vision. I lost sight of the fact that there were options in the way that I was looking at things that would have led to a paradigm shift.
I wasn’t able to see that by myself.
Working with someone, I think, would have helped me to open my eyes to the fact that I didn’t have to feel the way that I was feeling, and that change was possible.
Ross Drakes: A profound lesson. And I guess I love that idea that the door’s right there, that you can open that door and explore that thing right next door. It’s not that far away.
Manuel Astruc, MD: No, that’s right. The adjacent possible is right next to us.
Ross Drakes: And how do you think, if your sister was looking down at you, what do you think she would feel about where you’re at today, the version of yourself that you’ve become?
Manuel Astruc, MD: I think about Magdalena. I have conversations with Magdalena in my head, almost on a daily basis.
I’ll walk out of the house and I’ll say, “Oh, I forgot my cell phone.” And it’s like, “Oh, Magdalena, thanks for reminding me.”
So I think Magdalena’s smiling. She’s glowing. She’s super happy.
Absolutely. Absolutely.
Ross Drakes: Well, I mean, thank you so much for sharing your story.
It’s always lovely for me to see people and meet people who have gone deep on something and spent the time to truly understand it, because I think that’s not as frequent in the world as you often get.
So thank you so much for sharing your expertise. Thank you for sharing your time.
If somebody wanted to get in touch with you and find out about TMS, where would they go to do that?
Manuel Astruc, MD: Two things.
If you’re interested in the journey and what I learned, and some of the ways that I think about getting over burnout, I wrote a book called Happiness Rules. That’s available wherever books are sold.
In terms of getting in touch with me, LinkedIn is probably the easiest platform to just DM me, and I’m happy to talk.
Ross Drakes: And Al, thank you so much for sharing. Thank you for coming on the podcast. Thank you for giving up your tickets to the GRIT conference and sending Catherine there so that I could meet her.
Manuel Astruc, MD: Of course. Of course, yeah.
Ross Drakes: Thank you for listening. If you enjoyed this podcast and you think there’s someone you know who might benefit from listening, please share it.
I believe that sharing actionable knowledge is one of the most generous things that a person can do.
The show is produced by me, Ross Drakes. I’m an entrepreneur. I’m a proud member of EO. And if you’re an entrepreneur and you want more information, go to eonetwork.org.
We’ll catch all of you in the next one.
Manuel Astruc, MD: Thank you.
Ross Drakes: Thank you very much, and bye-bye.