Leading Through Psychosis: What No One Talks About (But Should)
- Updated: June 16, 2025
Psychosis isn’t just a clinical diagnosis—it’s a lived disruption.
And when you’re a business owner, it can feel like you’re losing your grip on reality while the world still expects deliverables, deadlines, and leadership.
I’m Denise G. Lee, a healing and leadership coach—and this topic is deeply personal to me. My older brother has experienced psychotic episodes for over 25 years. I’ve seen what it does to a person, to a family, to hope. And I’ve worked with business owners and leaders walking the tightrope of managing mental health while still holding everything together.
This article isn’t a medical treatment plan. It’s a grounded, real-world guide for navigating psychosis as a leader—especially if you’re dealing with schizophrenia or supporting someone who is. We’ll explore the Coordinated Specialty Care (CSC) model—one of the most effective treatment approaches—and how its principles can be adapted for business owners balancing visibility, pressure, and mental health challenges.
If you’re in the middle of it, or love someone who is—this is for you.
What We’re Navigating Together
🧠 When Psychosis Shows Up in Leadership
(Understanding symptoms in a high-pressure business role)
Schizophrenia isn’t just a psychiatric label—it’s a condition that disrupts how a person experiences reality. And when you’re running a business, that disruption can feel like betrayal—from your own mind.
For high-functioning leaders, early signs can be easy to overlook or excuse. You’re still showing up. You’re still making decisions. But something feels off:
You start mistrusting your team—without evidence.
You withdraw from key meetings, unable to explain why.
You hear or believe things that others don’t confirm—and you start second-guessing everything.
These aren’t character flaws. They’re symptoms of psychosis—often seen in conditions like schizophrenia.
🔍 Positive symptoms might look like:
Delusions: Unshakable beliefs not based in reality (e.g., “My team is plotting against me”).
Hallucinations: Hearing voices or seeing things others don’t.
Disorganized thinking: Thoughts that feel jumbled or disconnected when you try to communicate.
Paranoia: Feeling constantly unsafe or suspicious—even around people you trust.
🕳️ Negative symptoms might look like:
Flat affect: No visible emotional reaction, even in high-stakes moments.
Social withdrawal: Avoiding team check-ins, client calls, or even loved ones.
Loss of motivation: Struggling to initiate or complete basic tasks.
Disinterest: Feeling numb toward things that used to energize you—your vision, your team, your why.
Owning a business is not for the weak and faint of heart. It takes a toll.
— Denise G. Lee (@DeniseGLee) December 30, 2024
Trust me on this.
Entrepreneurs are more likely to experience certain mental health conditions:
-2x more likely to suffer from depression
-6x more likely to suffer from ADHD
-3x likely to suffer from…
⚠️ Why This Hits Business Owners Harder
(The collision of responsibility, visibility, and mental health)
Running a business already demands emotional endurance.
Add psychosis into the mix—and now your internal landscape is fractured while your external responsibilities remain.
In a study from UC Berkeley, 72% of entrepreneurs reported struggling with mental health—much higher than the general population. Conditions like ADHD, depression, substance abuse, and bipolar disorder showed up at significantly higher rates. Add schizophrenia, and the pressure can become unlivable without help.
Why? Because you’re still expected to perform.
To lead.
To explain your decisions.
To manage perception.
And when your own brain starts distorting reality, that load becomes unbearable.
But here’s what most people don’t realize:
You can run a business while living with psychosis.
You can stay grounded, supported, and effective—with the right care structure.
That’s where Coordinated Specialty Care (CSC) comes in.
Let’s break down what it is—and how it can help you reclaim stability without stepping away from everything you’ve built.
🛠️ What Is Coordinated Specialty Care (CSC)?
(A framework for healing that adapts to real life)
Coordinated Specialty Care (CSC) is a wraparound approach that helps people recover after a first episode of psychosis.
It’s not just therapy. It’s a blend of medical care, skill-building, emotional support, and real-life structure.
Think of CSC as a team-based recovery plan—one that doesn’t just stabilize you, but helps you re-enter your life with clarity, safety, and tools.
Here’s what it includes (and why it matters if you’re running a business):
🔹 1. Early Intervention
Psychosis is most treatable early on. The sooner you get support, the more likely you are to recover with minimal long-term disruption.
If you’re noticing symptoms—like paranoia, disorganized thinking, or emotional flatness—don’t wait. Early support changes outcomes.
🔹 2. Skills-Based Therapy
This includes cognitive-behavioral therapy (CBT) and social skills work.
You learn to challenge intrusive thoughts
Rebuild communication
Stay emotionally connected—even when you feel shut down
🔹 3. Thought-Testing Support
Delusions can feel airtight. CSC teaches you how to pause and reality-check before spiraling into fear or assumptions.
This can be the difference between emotional escalation—and emotional sobriety.
🔹 4. Stress Management Tools
Mindfulness. Breathwork. Routine.
You don’t have to meditate for 30 minutes.
Even 5 minutes of stillness between meetings can help prevent a full-blown crash.
🔹 5. Medication (With Support)
Antipsychotics aren’t about numbing you. They’re about quieting the noise so you can do the work—therapy, planning, regulating.
And you’ll need a doctor who listens—not just prescribes.
🔹 6. Life Skills for Stability
Things like:
Budgeting
Meal prep
Time-blocking
May sound basic—but they’re your anchors.
These habits become your scaffolding when your mind feels unreliable.
🔹 7. Relapse Prevention
You’ll work with your care team (and support network) to spot early signs before they turn into full episodes.
This is where routines, check-ins, and having a clear “what to do when” plan come in.
🔹 8. Community Support
Being seen by people who get it—especially other entrepreneurs—can shift everything.
You’re not broken. You’re human in healing. And healing accelerates in connection.
🔹 9. Cognitive Training
Memory, focus, problem-solving—these can take a hit during psychosis.
CSC includes gentle mental workouts: puzzles, journaling, even learning new skills.
It’s not about “fixing your brain.” It’s about rebuilding trust with it.
🔹 10. A Supportive Environment
Recovery doesn’t happen in chaos.
That includes:
Clear communication
Flexible expectations at work
A calm, grounded home
Small shifts in your environment can make a massive difference in your nervous system’s ability to heal.
Bottom line?
CSC isn’t one-size-fits-all.
It’s a framework that adapts to your life—including your business, your family, and your emotional reality.
🧩 Applying CSC Without Falling Apart
(Small moves that build structure and safety)
You don’t need a perfect recovery to function.
You need a structure that holds you while you’re healing.
Here’s what that might look like—adapted from CSC principles:
🧱 Keep the Frame Simple
You don’t need to overhaul your entire life.
Pick 3 daily anchors:
A wake-up routine (even if it’s just brushing your teeth and opening a window)
A 5-minute midday reset (breathe, journal, walk)
A wind-down ritual (no screens, calming task, hydration)
These don’t fix everything—but they interrupt spirals.
🫱🏽🫲🏾 Delegate Before You’re in Crisis
Don’t wait until you’re collapsing to offload tasks.
Outsource something small now: bookkeeping, inbox sorting, grocery delivery.
You’re building margin, not weakness.
🧠 Fact-Check One Thought a Day
When your mind says “They’re mad at me,” or “I’m not doing enough,” ask:
“What would I tell a team member who said this?”
If it sounds cruel or irrational, it’s probably not your truth. It’s a flare-up.
Practice interrupting the script.
🧍🏾♀️ Regulate Before Responding
If you feel triggered mid-email, mid-Zoom, or mid-task:
Drop your shoulders
Exhale
Say: “I can respond when I’m back in my body.”
This is leadership. Not delay. Not avoidance.
Regulation > reaction, every time.
🧑🏾🤝🧑🏽 Build Micro-Connections
You may not have capacity for deep relationships right now.
But even one weekly text check-in or a short peer support call can keep you from spiraling into isolation.
You weren’t meant to do this alone.
This isn’t about doing everything.
It’s about doing enough—with care.
And trusting that stability grows in layers.
🙋🏾♀️ FAQ: What If I’m Still in It?
(Answers for the raw, unresolved, or uncertain)
Is it really possible to lead while managing psychosis?
Yes—but not by pretending nothing’s wrong. It starts with support, structure, and safety. You can lead while healing, especially when you work with—not against—your nervous system.
What does “early intervention” actually look like for someone who’s already in business?
It means not waiting for a total collapse. If something feels “off”—your thoughts, energy, or perception—it’s not too soon to ask for help. You can still function and still need care.
How do I tell the difference between burnout and psychosis?
Burnout often feels like depletion. Psychosis distorts your sense of reality. If you’re questioning whether what you perceive is real—or feeling afraid without reason—talk to a provider.
Related: You’re Not Lazy. You’re Depressed. And There’s a Way Out.
What if I don’t want anyone on my team to know?
Privacy is valid—but isolation isn’t sustainable. You don’t need to tell everyone. But you do need a small circle of people who know what to watch for and how to support you.
Are there support groups that won’t make me feel worse?
Yes—especially if they’re trauma-informed or professionally moderated. Try NAMI’s StigmaFree resources or search for groups specific to professionals and entrepreneurs.
Resource: NAMI Support & Education
🕯️Final Thoughts: Healing While Holding It Together
Psychosis may distort your sense of reality—but it doesn’t erase your leadership, your purpose, or your worth.
You’re still the one answering emails.
Still the one managing people.
Still the one showing up—even when your mind feels unreliable.
That’s not weakness. That’s grit.
That’s leadership.
This isn’t about bouncing back.
It’s about rebuilding forward—with tools, with care, and without pretending everything’s fine.
You don’t have to hold it all alone.
If you’re ready to walk through this next chapter with grounded, shame-free support—I’m here.
💛 Work with me, Denise G. Lee – I help high-functioning leaders rebuild trust with themselves after mental health spirals, emotional collapse, or quiet burnout.
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💌 Want to reflect on this privately?
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