In Praise of Productive Delusion

In Germany, there is a saying: "Wenn du Visionen hast, geh zum Arzt.” If you have visions, see a doctor. A punchline, yes, but also a worldview—orderly, sober, engineered for reliability. It's a good attitude for bridge-building or train schedules. But it’s a death sentence for ambition.

Founders, by necessity, live in violation of this norm. Building a company from scratch—particularly in a sector as high-friction and slow-burn as healthcare—is not an act of balance. It is a controlled fall toward the future. For better or worse, the path to market-shifting impact begins with the decision to suspend disbelief. Not forever. Just long enough to build something real.

Call it the founder’s paradox: to convince others of a vision that isn’t yet true, you must believe it hard enough to make it so. Steve Jobs, whose own team spoke half in reverence and half in fear, was said to emit a “reality distortion field.” It wasn’t metaphorical. It was management-by-incantation. The iPhone, a device once thought absurd for lacking a keypad, exists because someone refused to believe that tactile buttons were sacred.

Full disclosure: I am not an iPhone user. I run Linux. I like freedom, not fashion, and I’m allergic to what is charmingly referred to as the Apple Tax—a luxury surcharge for believing in the sheen of minimalism. But that doesn’t mean I can’t admire the cult-building architecture behind it. Reality, after all, is overrated. Especially early on.

A less admired but no less illustrative example is Adam Neumann. In 2016, during a whirlwind 12-minute tour of WeWork’s headquarters, Neumann captivated SoftBank founder Masayoshi Son with visions of spiritual capitalism. By the time they reached the car, Son had offered $4.4 billion. The message was clear: think bigger. Neumann obliged. He told staff they were building the “world’s first physical social network,” laid plans for WeGrow schools and WeLive apartments, and declared that WeWork’s destiny was to “elevate the world’s consciousness.”

When SoftBank hesitated, Neumann pushed harder. In one meeting, Son told him to “be more crazy.” Neumann didn't blink—he doubled down. In WeWork's internal forecasts, he projected $500 billion in revenue, more than Goldman Sachs, and a footprint larger than Manhattan. It was less a business plan and more a metaphysical manifesto. It worked—until it didn’t.

The IPO filing revealed a company hemorrhaging cash, riddled with conflicts of interest, and driven more by vibes than viable unit economics. The valuation collapsed, SoftBank staged a bailout, and Neumann departed with a golden parachute and a Silicon Valley scarlet letter. But for a brief moment, he had warped capital markets around shared desks and free kombucha. He summoned billions through sheer charisma and cult-building flair. It was performance art, wrapped in spreadsheets.

I’ve had my own brush with this. When we began building Capital for Cures, I knew we could make it sustainable—an enduring platform for convening healthcare innovation. A good business, even. But I didn’t stop there. I want the $10 million valuation. The $100 million one. I want to make the platform indispensable for investors and founders alike. Not because it's reasonable. But because it’s necessary.

If you’re founding a startup with the goal of earning your previous salary plus 20%, you’re better off staying in industry. This is not a career path. It’s a casino with long feedback loops and illiquid exits. And yet—this is precisely where wild swings pay off. The asymmetry of outcomes means that those who refuse to settle, who persist beyond rationality, are often the ones who bend luck into structure.

Statisticians call them Black Swans—rare, unpredictable, high-impact events. But there’s a deeper lesson from Nassim Taleb’s formulation: you must expose yourself to the possibility of non-linear upside. That means pursuing ideas that look delusional. That means aiming not just to survive, but to tilt the board entirely.

Delusion, of course, is a dangerous drug. But taken in carefully calibrated doses, it’s also a superpower. The job of the founder is to believe in things the market cannot yet price. And to be convincing enough to drag reality, kicking and screaming, into alignment.

Just maybe see a doctor every once in a while. Or at least a CFO.