Unsupported Success: The Health Cost of the Unfunded Middle

In July, reporting on the unfunded middle described the years between building something real and becoming legible to capital. The founders in that story measured the waiting in cash. Ana María Serrano, a licensed professional counselor and Ph.D. candidate in mind-body medicine, measures it in blood pressure.

“I’ve seen the unfunded middle leave {young} women chronically tired, sleeping poorly, eating inconsistently, more irritable, and with less emotional control in their everyday lives,” she said. “The insidious part is that they are absolutely still performing extremely well at work.”

That is unsupported success: a founder who is the sole financial and operational engine of her company, still hitting every deadline, and coming apart underneath the numbers. Serrano’s rule for spotting it is blunt. “Performance is such a poor measure of wellness in high-achieving women. Being able to keep functioning does not mean you are actually doing well.”

Rest Is Not the Fix

Serrano separates burnout from structural burnout. “Burnout is depletion. Structural burnout is when the way your life is set up leaves you chronically depleted.” If a vacation works for three weeks and the exhaustion returns, rest was never the problem.

The scale is documented. McKinsey and LeanIn.Org’s Women in the Workplace 2025 report found six in 10 senior-level women reporting frequent burnout, the highest reading in the survey’s history, and it singles out Black women in leadership for exceptionally high burnout. Serrano reads that finding as close to eight in 10 for senior Black women, with a caveat: “What it cannot tell us is what is happening in their lives outside the workplace, including caregiving, household responsibilities, financial obligations, sleep, relationships, support.”

That load is where the founder version gets expensive. Researchers call the cumulative physical cost of chronic stress allostatic load, and a 2022 meta-analysis found people carrying a high load had a 22% higher risk of dying from any cause. Education narrows the gap without closing it: in a national study of more than 4,000 Black women, college graduates had the lowest rates of high allostatic load, about 32% against nearly 43% for women without a high school diploma. Arline Geronimus’s weathering research found the racial differences were not explained by poverty.

“A founder may have more control than an employee,” Serrano said, “but if the business stops when she stops, ownership can create a different kind of chronic pressure.”

The Decisions It Costs You

Chronic stress degrades the exact faculties a business runs on. A 2018 review of chronic stress and executive functioning found it interferes with working memory, planning and the ability to change course, and pushes people toward familiar habits instead of goal-directed choices.

Serrano translated that into a P&L.

“She keeps the client she knows she should fire because losing predictable income feels too risky. She puts off raising her rates. She keeps doing work herself because finding, hiring, training, and supervising someone feels overwhelming.”

The founder is not bad at business. She is choosing what feels manageable today because the alternative costs more cognitive effort than she has left.

Serrano’s first intervention is an accounting exercise. If a woman is functioning as CEO, salesperson, administrator and marketing department, Serrano has her put a realistic cost beside each job. “If the business appears profitable only because she is donating thousands of dollars of her own labor every month, then the P&L is not telling the full story.”

Stop Saying “Ask for Help”

The wellness advice Serrano would retire first is the one everybody gives. “Ask for help” assumes the asking is the easy part. Studies of the Superwoman Schema, the pressure to appear strong and succeed without resources, have found that greater resistance to vulnerability predicts lower intentions to seek help. “Telling a 35-or 45-year-old Black woman who has been rewarded her entire life for being self-sufficient to just ask for help skips the actual challenge.”

What she recommends instead sorts by cost. Hiring help costs money. Saying no, handing household work to another capable adult, and no longer answering every call immediately cost nothing but emotional comfort. “If everybody has to be happy with your decisions, you are going to keep making decisions that make everybody comfortable except you.”

Serrano built a November retreat in Fort Lauderdale around 24 hours of guided silence, and she anticipated skepticism about a four-day fix for a structural problem. The silence is not the cure, she said. It removes talking as a way to dodge discomfort long enough for a woman to hear what has to change when she goes home. Meta-analyses of meditation show measurable drops in blood pressure and cortisol, which is the floor she is aiming for.

She has lived the other side of the argument. Running a practice, building a second company, writing a dissertation and caring for aging parents, she started nearly passing out on morning walks and developed bald patches. She took a month off and cut her caseload. “Sometimes something really does need to stop.”

The unfunded middle was always going to be paid for by somebody. Serrano’s argument is that it does not have to be paid for in the founder’s body, provided she is willing to let a few people be unhappy with her.