There is a version of high performance that looks like strength from the outside and feels like drowning from the inside. I lived in that version for a long time. I didn’t call it anxiety. I called it drive. I called it standards. I called it what it takes.

I was wrong.

This is not an easy thing to write. It is not a comfortable thing to publish. But I’ve spent years teaching leaders that vulnerability is not weakness. That authenticity is not exposure. That the things you hide from others are usually the things most worth saying out loud. It would be dishonest to keep this one quiet.

The Signals Were There. I Ignored All of Them.

High-performing leaders are extraordinarily good at one specific thing: rationalizing. We rationalize stress as a byproduct of ambition. We rationalize short fuses as high standards. We rationalize our inability to be present at home as the necessary cost of success at work.

I was exceptional at all of it.

The physical signals came first. My body was trying to tell me something and I wasn’t listening. Then came the relational signals. How I responded when I was questioned. The way I reacted to challenge. The unresolved tension that lived just beneath every interaction with the people who were closest to me. I didn’t see any of it as connected. I was performing at work, so I told myself I was fine.

I wasn’t fine. I was just performing.

That’s the cruelest part of this. The compartmentalization actually works. You can show up clean in the boardroom while everything behind closed doors is fraying. You can deliver results, hit numbers, lead teams, and simultaneously be completely and totally unregulated. Nobody at the office sees it. The people at home see nothing else.

The Tinder Box That Finally Lit.

There are moments and environments in a career, and there were many. Moments that, by any honest measure, had become untenable. Late Friday calls that had nothing to do with performance. I knew it. Weekend requests that blurred every boundary I had left. I knew it. Team chemistry that was, at best, fractured. I knew it. The quiet but unmistakable signal that challenging the status quo made you unwelcome — not wrong, just unwelcome. I knew it. 

And in every instance, every role, I stayed. And every week I stayed, something in me wound tighter. 

I want to be careful here because I understand what that looks like on paper — a leader who couldn’t adapt. That’s not what it was. It was the accumulation of thirty years and everything landing at once. The environments. The physical toll. The isolation. The unresolved things I had never dealt with. And then, the news that I had a heart arrhythmia. 

My body had stopped asking. It was now demanding to be heard. 

I was completely unregulated. Not just professionally frustrated. Not just stressed. Unregulated.
There is a difference. And I didn’t have the language for it yet. 

What Ketamine Opened Up.

I want to talk about this because I think the silence around it does real damage to people who might need to hear it.

I pursued ketamine therapy before I could fully engage with traditional talk therapy. Not because I was looking for a shortcut. Because I was so defended, so armored, so practiced at keeping things beneath the surface, that I needed something to help me see what was actually there.

The best way I can describe it: imagine a wound that has been covered so long you’ve forgotten it’s there. You’ve built scar tissue over it. You’ve learned to move around it. Ketamine, for me, was like removing the bandage and finally being able to look directly at the wound. Not to feel it more acutely. To see it clearly.

That clarity made everything that came next possible. The dialogue. The therapy. The actual work. Without that opening, I’m not sure I would have let any of it in.

What Therapy Actually Taught Me.

Therapy taught me that I had unresolved trauma. That sentence sounds clinical. The experience of it was anything but.

Here is what I didn’t expect: the trauma wasn’t the source of my anxiety as much as my unwillingness to address it was. The cumulative effect of avoidance is its own weight. Every thing I didn’t deal with became something I was carrying. You don’t notice the weight until you can’t put it down.

I learned that the toxic environment I found myself in wasn’t the cause of my crisis. It was the trigger. The match thrown into something that had been accumulating for years. The fuel was already there. I had laid it myself, one unexamined thing at a time.

I learned that how I responded to being questioned, to being challenged, to perceived threat — that was not personality. That was unprocessed fear. That was a nervous system that had never learned to regulate because it had never been given the chance.

I learned that the behaviors I had written off as intensity — the short fuse, the destructive patterns, the things I did at home that I would never have allowed myself at work — were not character defects. They were symptoms. Symptoms of someone who had been running on empty while convincing everyone, including himself, that the tank was full.

What I Want Other Leaders to Hear.

I’m not writing this to perform vulnerability. I’ve spent enough time performing to know the difference.

I’m writing this because I was surrounded by signals and I ignored every single one of them. Because I know that somewhere right now, someone is reading this who is doing the same thing. Holding it together at the office. Falling apart somewhere private. Telling themselves it’s fine. That this is just what it costs.

It doesn’t have to cost this much.

Getting help is not an admission that you couldn’t handle it. Getting help is the evidence that you finally understood what handling it actually means. It means not

white-knuckling your way through your own life. It means not making the people closest to you absorb the damage that your work environment inflicted. It means recognizing that high performance built on an unexamined foundation is not performance. It’s a countdown.

I am more effective now than I have ever been. Not because I am tougher. Because I am more honest. With myself first. With everyone else second.

The signs were there. They are probably there for someone reading this right now.

Don’t wait for the heart arrhythmia. Don’t wait for the Friday 5 PM call that finally breaks something. Don’t wait until the wound is too old to see clearly.

Get help. Do the work. It is the strongest thing you will ever do.

Stop performing. BE.

— Scott Ramey