Two years ago, Mr Nick Jonsson's life hit rock bottom.
He had just reached the summit and landed the job of managing director of EGN Singapore in January 2018.
To all appearances, he seemed to be enjoying the trappings of a successful C-suite executive.
But he struggled with a vague sense of numbness inside and was increasingly isolated from his colleagues as he tried to keep his mental condition a secret for fear of being perceived as a "weak leader".
Away from his parents and young son, who live in Sweden, he turned to alcohol and put on 20kg within three months. His left foot swelled to twice its size and doctors were initially baffled.
Later, it was discovered that the swelling was psychosomatic - triggered by his rapidly deteriorating mental condition.
"I know it is an old cliche, but the saying 'It's lonely at the top' is a great explanation of how it can feel to be the leader of an organisation," says Mr Jonsson, 45, who now lives in Singapore with his second wife, an Indonesian.
"If you are, say, a regional director based in Singapore, you might be reporting to a CEO in the US or Europe. And it's very hard to communicate what is really going on here.
"You probably have a team based all over South-east Asia and you can't talk to them either about your problems because you're supposed to be the 'strong one' who drives the team.
"That means there is no one you can talk to openly about what is ailing you. Taking up the discussion with your family or friends may also not work since they may not understand the unique challenges that you are facing. This can lead to frustration and feelings of isolation."
The problem is likely worse for men as they are not encouraged to show their emotions, he adds.
• National Care Hotline: 1800-202-6868
• Institute of Mental Health's Mental Health
• Singapore Association for Mental Health:
• Samaritans of Singapore: 1800-221-4444
• Silver Ribbon Singapore: 6385-3714
• Fei Yue's Online Counselling Service: www.eC2.sg
Mr Jonsson decided to delve deeper into the subject in January last year after an interview with Singapore Press Holdings' radio station Money FM 89.3, in which he was asked to talk about belonging to a network of peers at EGN Singapore.
EGN is a business networking platform for leaders and specialists. It is a branch of a global group set up in 1992, comprising 13,500 members representing more than 8,000 companies.
"It was a sensitive topic and I remember explaining at great length how difficult it is for a senior executive based in Singapore, managing the Asia-Pacific region with its different cultures, markets and legislations," he recalls.
Most of all, he felt like a fraud - although his work was creating business peer networks, he himself could not confide in a single peer in his Singapore office.
A few months later, his close friend, Mr Simon Greaves, a British executive who was based in Singapore, committed suicide at age 50 after hiking to the base camp near Mount Everest.
"Everyone remembered him as an outgoing and fun-loving personality. Nobody would have even suspected that he was suffering in silence," Mr Jonsson remembers.
This is not atypical, according to Dr Geraldine Tan, principal psychologist and director of The Therapy Room, who sees many C-suite professionals at her Orchard Road clinic.
Executive loneliness leads to varying degrees of depression which manifests differently, she says.
"There is functioning depression and there is also 'smiling' depression. In functioning depression, a patient is able to carry out his work, but may be quieter and exhibit a constantly low mood level which can last for months.
"In smiling depression, people work hard to hide their pain," she says. "Often, you may mistake them for leading a normal life until they open up to you."
Only within the confines of a doctor's consulting room will such patients reveal their pain and begin to emote, which is the first tentative step towards recovery, says Dr Tan, who has more than two decades of experience treating various psychological problems.
"My patients come to me when it gets too painful to bear. Confiding, crying or just talking about the problem is a huge release for them and that process can even save their lives."
NO ONE TALKS ABOUT IT
After his friend's untimely death, Mr Jonsson embarked on a mission to open up about mental health issues. He started posting on social media, planning for his book and doing surveys of colleagues at his office.
In September last year, he polled all EGN Singapore members on the subject of executive loneliness.
Out of a total of 56 anonymous respondents, 30 per cent said that they had suffered work-related depression.
As to whether they found it easy to talk about the subject, 82 per cent answered "Not easy" and "No".
With the findings, he started to write his first book, Executive Loneliness: The Workplace Isolation That People Do Not Talk About, to be released later this year.
He thinks it will be timely as executives additionally grapple with the economic fallout from Covid-19.
American expatriate David Litteken is someone who wrestled with this sense of isolation too.
He is senior vice-president, Asia- Pacific, of BI Worldwide in Singapore, a global agency focused on workforce recognition programmes and sales loyalty events employing more than 1,800 staff worldwide.
Mr Litteken, 53, who has been living here for three years, is responsible for business across the Asia- Pacific, including offices in Shanghai, Singapore, Melbourne and Sydney.
When he was working in Shanghai from 2012 to 2017, he remembers feeling alone in a city of 25 million people.
"I did not know a single person. None of my leaders and none of my staff. I left an environment where I was well-grounded and had to figure it out for myself," he recounts.
He joined a few chambers of commerce and a dining club for executives called Beefsteak & Burgundy and started to build a network of expatriates as well as local Chinese friends.
"That gave me the confidence to reach out further," he recalls.
LONELY AT THE TOP
American Farzana Shubarna, regional director of operations and supply chain for DSM Nutritional Products in Singapore, is another leader who has had to fend off isolation and depression at the top.
Ms Farzana, 46, manages the end-to-end order fulfilment activity for a billion-dollar business.
The Asian-American single mum with two children started her journey in operations and supply chain management more than 20 years ago, when the field was male-dominated.
"I worked for years with a sense of not belonging. Any challenges with people or machinery or finance, I had to, by default, manage, deliver and learn on my own," she says. "I knew I had to prove myself to establish credibility, gain respect and have my peers take me seriously.
"I didn't even have any time - or option - to worry about how lonely I was or how strongly I needed to connect and collaborate.
"Fast forward 20 years to the present and somehow, I have always found myself alone at the top."
She was the first female director of manufacturing for L'Oreal in the United States and the first female regional director of operations in DSM.
"This loneliness has impacted my personal and family life. I could not speak about my struggles and challenges with anyone at work as I was trying to validate my capability and credibility.
"At home, I was trying not to bring home my work burden. It became a heavy weight on my mind and heart and I accepted it as a growing pain, a rite of passage," she says.
She overcame her feelings of depression and isolation when she left the US three years ago and came to Singapore after being offered the role to lead her company's Asia operations.
"I actively reached out to connect and build a network of friends in Singapore," says Ms Farzana, adding she has also tapped into yoga, meditation and Deepak Chopra to "learn to accept that I do not have to be perfect and my shortcomings make me human".
DOING IT WITH OTHERS
Psychologist Maria Micha, who works with patients at her Orchard Road clinic to identify the symptoms and root causes of mental disorders, says developing peer networks is healthy for those at the top who are prone to isolation as they work very long stressful hours and do not have time to experience emotional comfort from loved ones.
"Humans are social beings and they have been living in groups since the beginning of time. "That is how they survived. That is how they evolved and learnt about the world and changed their bodies, their brains and their environment," says the psychotherapist, hypnotherapist and corporate consultant.
The reason one experiences loneliness at the top is that "when you are at the top, you are supposed to have all the answers", says Dr Micha.
"You are supposed to know everything. You cannot expose your vulnerability," she observes.
"You are supposed to be the sovereign, god-like figure that can deal with everything."
But it is especially important for leaders to be transparent that they, too, need help and do not know all the answers.
"That means being vulnerable, but vulnerability does not equal weakness. To be vulnerable means that I allow people to see that I have my own challenges, that I'm being productive about resolving the negative emotions," Dr Micha says.
She suggests talking to a business coach, a mental health counsellor, a mentor, or one's spouse.
Leaders, she adds, need to show that "to have mental and emotional challenges is part of human existence - it is part of life".
Five warning signs of executive loneliness
Mental health disorders can be just as dangerous as physical illnesses, but they are not always as easy to detect, says Mr Nick Jonsson, managing director of EGN Singapore.
Depression can affect anyone regardless of age or job seniority, but manifests in different ways. Watch out for these five danger signs:
1 INTENSE FEELINGS OF ANXIETY AND INSECURITY
Executives may harbour unwarranted suspicions that their employer will fire them at any moment. Or they may turn down new opportunities despite being qualified because they do not feel capable enough.
2 DISTRUST OF COLLEAGUES
Stressed executives may imagine colleagues gossiping about them behind their backs and worry about being back-stabbed.
Sudden withdrawal from social interaction is a definite red flag. Individuals may no longer reach out to friends and family as often as before, which can reinforce feelings of isolation and self-doubt.
4 ADDICTION AND DEPENDENCE ON SUBSTANCES
Corporate leaders may drink or smoke to socialise or relax, but the overuse of such substances to cope with stress may result in poorer health and sleep quality, and lead to a vicious circle of more stress.
5 RECURRING THOUGHTS ABOUT DEATH OR SUICIDE
A sense of impending doom can also compel individuals to give away their prized possessions and make end-of-life plans when they are physically healthy. Immediate psychiatric help is advised when the situation deteriorates to this stage.
• It is advisable to consult a qualified medical professional for any psychological condition that may be of concern.