The pressure of wealth

• Shame and fear of social exclusion often prevent wealthy individuals from seeking help.
• NextGens can lack purpose, direction, and emotional connection despite seemingly ideal upbringings.
• Open communication about mental health is crucial for positive change within wealthy families

Jan Gerber is chief executive of Paracelsus Recovery, the world’s most renowned and exclusive treatment centre for ultra-wealthy individuals and families. He is a passionate and well-experienced advocate of compassion and awareness at the intersection of mental health and wealth or fame.

Here he talks to CampdenFB about why ultra-high-net-worth individuals are more than three times as likely to suffer addiction or mental health issues than the general population but are often reluctant to seek help; why significant wealth presents a unique set of problems; and how “humanistic pragmatism” helps patients re-enter life after treatment. 

You have talked to CampdenFB a couple of times in the past (2017 and 2020). What changes have you seen? 

Jan Gerber: Worldwide, mental health has been getting worse. There are growing pressures on ultra-high net-worth individuals (UHNWIs) which creates a significant burden for these families, who feel the pressure to secure their descendants’ financial well-being. We all know that stress has real physiological and mental health implications, and with these additional pressures, it likely translates to a worsening situation for wealthy families, who might have already been more susceptible to mental health struggles. 

Have you noticed a greater openness to discussing mental health? 

Jan Gerber: The past years have witnessed a positive trend in mental health awareness, thanks to individuals sharing their stories. Social media and traditional media are now filled with personal accounts of mental health experiences. This is a significant step forward, but there remains much work to be done.

The conversation around mental health remains particularly difficult for wealthy individuals and celebrities. Many still suffer in silence because sharing their struggles can damage their reputation and potentially impact business negotiations or other ventures. In some parts of the world, the stigma surrounding mental health is even stronger, making it even riskier for these individuals to speak openly. Overall, a significant hurdle remains: wealthy families are still largely hesitant to share their stories or even discuss their mental health experiences with each other, let alone reach out for help.

Wealth is often seen as a shield against hardship and pain, softening the initial impact of mental health issues. It is, however, more like a pressure cooker.

UHNWIs are more than three times as likely to suffer addiction or mental health issues than the general population. But they often don’t seek help. Why are they so bad at acknowledging this?

Jan Gerber: There are two main reasons why wealthy individuals are less likely to discuss their mental health struggles.

The first is the fear of social exclusion. Many wealthy people hold influential positions within society, belonging to clubs and peer networks. The fear of not belonging, the very essence of shame and exclusion, prevents them from speaking openly. This fear extends beyond the individual to their families, who also worry about being ostracised.

Wealth is often seen as a shield against hardship and pain, softening the initial impact of mental health issues. It is, however, more like a pressure cooker. While wealth may prevent an immediate overflow, the pressure builds internally until a much more explosive release later in life. Wealthy individuals tend to seek help for mental health issues, including addiction, depression, anxiety, attention deficit hyperactivity disorder (ADHD) or even more serious conditions like, bipolar disorder, or schizoaffective disorder, etc. much later than those in the general population.

At the same time, wealthy individuals are often discouraged from seeking help. This discouragement can be explicit, coming from family or their social circles. More often, it’s implicit, fuelled by the same fear and shame. The sad reality is that they’re implicitly or explicitly told that seeking help carries negative consequences or “isn’t necessary”. Additionally, those from wealthy families tend to have a lower baseline of trust. They question who they can confide in with sensitive information, from friends, family, advisors, to teachers but even professional therapists. This lack of trust creates a sense of isolation on top of what is already a very isolating condition. 

The combination of these factors contributes to the statistic that wealthy individuals are three to four times less likely to seek help for mental health issues, and when they do seek help, it happens much later in the cycle of the illness.

Do you see cultural differences in the in people that you help?

Jan Gerber: Cultural differences certainly exist, but they tend to be less pronounced within wealthy families. This is likely because these families often cultivate a global lifestyle. Their children, usually referred to as NextGens, frequently attend international schools and universities, developing international peer networks. They generally speak perfect English and consume international media. This global exposure tends to soften the cultural differences that might be more prominent in first-generation families from specific regions. While there are still variations in family dynamics there are also significant similarities. 

Most families who build successful businesses share a common purpose of building a legacy. In essence, a kind of global culture unites wealthy families in this shared value system.

From a therapeutic point of view, have you noticed a difference between the generations? 

Jan Gerber: The second and third generations of wealthy families are not inherently worse people as is often implied. It’s important to dispel this myth. However, the way most family systems function, often influenced by societal expectations, unintentionally sets them up for failure.

Being born into wealth, regardless of whether it comes from a family business or even royalty, creates mental health challenges compared to a middle-class upbringing. An ideal middle-class background, specifically upper-middle class, seems to offer the best foundation for a happy and purposeful life. It allows individuals to pursue their own career paths, make an impact, and have more control over how they structure their lives. While work is necessary to pay bills, there’s also a sense of purpose and motivation.

In contrast, significant wealth presents a unique set of problems. “Succession syndrome” describes the mental health issues commonly observed in the next generation of wealthy families. Even with a seemingly idyllic childhood – loving parents and a good education – challenges arise when these individuals decide on their career paths.

Wealthy children are often told they have the freedom to choose their own paths, even if they’re the firstborn and expected to take over the family business. However, even when everything seems ideal – choosing their own studies and career, even e.g. building a successful company, and selling it for a significant sum – the narrative around their achievements can be skewed.

Imagine someone from a middle-class background building and selling a very successful company. They are admired by teachers, parents, peers, and their entire community. For a child from a family worth billions, however, selling a company for even tens of millions might be seen as a lesser accomplishment. The narrative, both internal and external, might focus on family connections, initial investments from parents, or the safety net of family wealth during difficult times. This lack of full credit for their achievements can lead to feelings of being an imposter – a belief that their success is not genuine or fully deserved.

This is just one example even if emotional needs are met in early childhood. Many wealthy children don’t have a childhood with emotionally available parents. It’s important to acknowledge that this isn’t necessarily a criticism of the parents themselves. Running a large company often demands long hours, travel, and being readily available during crises. Nonetheless, this can lead to a situation called “affluent neglect”. The emotional and mental health consequences are similar to emotional neglect experienced in other demographics.

The core message here is that these children are not inherently bad. The system often fails to prepare them for the real world, leading to feelings of isolation and a multitude of mental health challenges.

People rarely tell UHNWIs that they are wrong. How do you address that as a therapist? 

Jan Gerber: The biggest challenge for therapists working with wealthy families is what I call “cultural competence”. In this context, “cultural” refers to understanding the specific needs and dynamics of this demographic, not a regional concept of culture. Therapists typically don’t receive training in this area unless they gain experience working with this population. Unfortunately, there aren’t many therapists out there who have this specialised knowledge.

The therapeutic process itself presents unique challenges. Therapists need to be compassionate and understanding, but also willing to question certain ingrained views and behaviours if they could be unhelpful for a patient’s wellbeing. Wealthy individuals are often accustomed to projecting a certain image and may not be used to hearing criticism. Building trust and emotional intelligence is paramount. The client needs to feel genuinely understood and accepted, not judged. Only then can a window of opportunity open for real progress. Ideally, therapists working with wealthy clients would be able to take a more open approach, focusing on emotional exploration and establishing a shared understanding of the client’s reality and their goals and motivation. 

What happens next? How do you help your patients re-enter real life? 

Jan Gerber: The core philosophy guiding this clinic, indeed all clinics in the group, is what I call “humanistic pragmatism”. I.e. “whatever works” to alleviate pain (or achieve sustainable results), regardless of personal biases, conditioning, ideals or value systems. 

We understand that therapy can provide valuable insights and initiate healing, but the real challenge lies in what happens when the client returns to their original environment.

The odds are often stacked against them. Wealthy individuals may return to intense family dynamics or demanding business relationships. Ideally, the closer family system can be involved in the therapeutic process. Educating and including family members in family therapy can be incredibly powerful, especially when it leads to an awareness of generational trauma or unhealthy dynamics. When families come together to acknowledge the pain and commit to change, the potential for healing is immense.

However, not everyone is fortunate enough to have a supportive family environment. Some clients return to situations where they are blamed or ostracised. This “problem child” mentality can make it incredibly difficult for the individual to thrive. We’ve unfortunately seen this scenario unfold many times.

How can things change in the long term? Awareness is key. That’s why conversations like this are so important. While some might believe that ingrained patterns can’t be changed, we’ve seen positive transformations even in older family heads. It’s not an overnight process, but simply raising awareness can be a catalyst for change.

Open communication about mental health is crucial for all demographics, but especially for the wealthy.