The Enneagram and Medicine
About our work - Shadrach Smith, MD
Fresh from my residency, I entered the medical world eager to improve the length and richness of the lives of my patients. After a month or two, clouds came over the sun. I saw that my patients' lifestyles were killing them. I saw the usual: diabetes, high blood pressure, high cholesterol and depression. Some had all four. For all four of these pervasive chronic diseases, the only therapy is simply to change the way they live.
So I told them plainly, "Make these few changes in your life and you will be healthy. You won't need any further medical help."
They could see I was a bright young doctor. They respectfully, even gratefully responded, "Thank you, I know you are right." Then they continued, unabated, to kill themselves by their lifestyle! Now people are not stupid, so I had to find out what was so precious that they were willing to die for it. Slowly die, but die.
I am, by training and preference, a scientist. I submit to data with reverent docility. So I know that if something doesn't make sense on one level, it must on another. For example, if I see a man rush into a burning building, I might infer he is stupid or crazy. Instant diagnosis: self-destructive tendencies, possibly suicidal. But if I learn his baby daughter is in the building, I switch to admiring a hero. Empirical evidence without motivation is incomplete, I note to myself. Once I understood his motivation, his behavior is logical and utterly sane. The same is true of Gwen in our opening story. Once we both knew she would carry 40 extra pounds around all day long if that was necessary to nurture her family, we could reinterpret her virtuous but self-destructive actions and proceed to deal effectively with her problems.
What is the Motive?
While I looked for motivational explanation of why people eat to death, I discovered the Enneagram. The Enneagram is a practical, well-observed, empirical system that describes nine personality styles and their central motivations. It was enormously helpful to learn that when people eat to their detriment, they are eating because of their Enneagram styles.
The Enneagram describes nine personality styles and it describes them in terms of their inner focus, their dominant energy patterns, their view of life and the strategies they develop to deal with the first three.
It begins with focus. Each of us has a narrow focus that is right below our level of usual attention. We unconsciously ignore parts of our environments and our lives and attend with some rigor to other parts. What we focus on profoundly affects our lives.
For example, if I focus on what can go wrong in life, I develop a series of strategies to make as sure as possible I prevent the expected disasters. I may do some external things like buying lots of insurance, driving large cars at safe speed, and eating my vegetables. However, I may also deal with my inner feeling that the world is dangerous by eating sweets because when I was a child and cried from fear, my mother gave me candy. An outsider, seeing me rotund and reaching for candy may think me stupid. But within my internal soothing strategy, candy makes a lot of sense.
When you discern someone's inner focus, energy, worldview and strategies, you drop a lot of medical labels and try to understand why one's eating habits make a great deal of sense, even at the expense of their health.
What an Enneagram Style Predicts
I learned from the Enneagram that in addition to all the usual reasons people overeat or eat in self-destructive ways, they eat because of the central concerns of their Enneagram style. I understand that people eat and overeat for nine different, partially or wholly unconscious reasons. Each reason for eating expresses an inner world with a belief system, some central preoccupations, personally dominant energies and ways they process information.
This deep level of Enneagram motivation provides our best source for helpful suggestions.
To preview coming attractions, here is a one line summary of the nine Enneagram motivations. This is what motivates each personality style.
- One: the Perfectionist: To have the perfect body-to be the perfect patient.
- Two: the Caregiver: To help others and receive appreciation for helping.
- Three: the Achiever: To accomplish and be recognized.
- Four: the Tragic Romantic: To be special and unique.
- Five: the Observer: To be wise, to understand the world from a distance.
- Six: the Loyal Skeptic: To be loyal and secure.
- Seven: the Adventurer: To fill life with pleasant options and possibilities.
- Eight: the Boss: To be powerful and in control.
- Nine: the Peacemaker: To avoid conflict and stay connected to others.
These may seem simple, and in one sense they are. Hitting a home run in baseball is simple, too. Just swing the bat hard where the ball is. In the following chapters we'll look at how complex eating is and how each Enneagram style meshes with all of that complexity.