Type Two's War with Fat
Shadrach Smith, M.D. and Clarence Thomson
Here's how I (Shadrach) came to the Enneagram integrations by Clarence Thomson.
A Doctor’s Discovery
Gwen was living the American dream. She taught second grade, was happily married to a bank vice president and was mother of three healthy children. She devoted her busy life to her socially active husband, some church activities and three children with their hamster-like school activities. Husband, church and children were flourishing, much to her delight.
But Gwen was also living the modern American woman’s nightmare. She was 40 pounds overweight and gaining. She was tired and depressed. She might have only one problem, but it was making a big negative impact on her life.
Apparent Self-Interest
Gwen was sure that her weight gain was caused by metabolic problems. it must be her thyroid, she thought, because Oprah had described her symptoms exactly. Gwen came to see me because I run the Truman Medical Center in Kansas City, a center specializing in weight management. She expected me to tell her the exact nature of the problem and what medication she should take to correct it.
Of course, I ran the proper tests. Her metabolism was fine. No thyroid imbalance. But I did notice that her weight gain was causing some blood pressure problems and she was pre-diabetic. So I told her what to do—what any good doctor would tell her: “Eat less, eat better and exercise. Get some more rest, too. Your fatigue and high blood pressure probably stem from stress.”
I gave her some medication for blood pressure and elevated glucose. She came back later and the medications had worked: blood pressure and glucose were fine. I asked her to return in three months to follow up.
She didn’t return in three months. But nine months later, she came back with a sinus infection and her glucose levels and blood pressure were worse. She had also gained another 10 pounds. When my nurse called the pharmacy to renew the medications, it turns out she had discontinued them.
Well, I had told her what to do and she didn’t do it. My advice was mainline medical practice and if she had followed my professional instructions, she would have been fine. But she ignored my expensive professional advice completely!
Gwen was intelligent, emotionally healthy, and motivated. But she was also non-compliant. Why? Why would she come for help, receive it and then ignore it? Why would she act against her apparent self-interest?
I didn’t know. But I did know that when something doesn’t make sense on one level, it usually does on another. I wanted to get to the bottom of Gwen’s problem. There must be some way. What was it?
Shortly after this experience, I learned about the Enneagram in church, Then I studied further with Clarence T. The Enneagram taught me how to refine what I knew about motivation—how to look at motivation at more than one level. It helped me unravel the mystery of why people sometimes act in a way that seems to be against their self interest. And why I was unable to help Gwen lose weight,
Learning the Enneagram helped me refine not only my approach with Gwen, but my entire approach to weight management. Here’s Gwen story and how it helped me understand the power of the Enneagram.
Enter the Enneagram
Gwen is an Enneagram Two. So she’s a giver, but sometimes the giving gets out of hand. There’s too much focus on meeting the needs of others and not enough on acknowledging and fulfilling her own needs.
When I realized that Gwen was a Two, I changed my approach considerably.
I realized that Gwen did not come to lose weight, not really. She came to be happier (less depressed) and have more energy (less fatigue) in order to do more of what she was already overdoing: meeting the needs of her family and community. When I saw she was a Two, I knew I needed to address not just the apparent reasons for weight gain (poor eating habits and lack of exercise), but the underlying motivations that actually created the impetus for weight gain.
Fortified with my Enneagram insights, I called Gwen to come in for a new health plan. This time we addressed her real problems (her presenting complaints were only symptoms). She was working so hard, was stressed and did not have time or energy to prepare healthy meals. That was part of the physical problem. Some of her fatigue was predictable: long hours of hard work for others with little time for herself. This is not a medical problem, it is a life-style problem. The depression related to a lack of appreciation for her tireless service which also caused her fatigue. I felt that she was using food, especially comfort food, as a way to reward herself each evening for all the service she had rendered that day.
Based on this understanding, I helped her work out a plan for some self-nurturing. Gwen was to share her situation with the family and ask for their support. This was not easy for her. But what helped was the understanding that if she stayed overweight, tired and depressed, she could not serve them. That double bind (if she kept on serving, she couldn’t serve) enabled her to ask for their cooperation. She eased back a little and attended to her own previously unacknowledged needs and desires.
New Results
At Gwen’s next visit a month later, I saw that her blood pressure and glucose levels had improved, she had lost six pounds, and her energy levels had risen. In another six months she lost 20 more pounds.
She was ecstatic. “Doc, you saved my life! I’ve been dieting for 25 years and this is the first plan I can continue for a lifetime because I am not doing this by myself.”
I was elated by these results: I had helped cure depression, blood pressure, glucose levels and obesity. Not bad for a few hours work! I even felt sort of “two-ish” myself, being so helpful.
But my elation was tempered by the understanding that while my medical training prepared me to diagnose medical problems like diabetes and hypertension, it left a few things out. It did not really equip me to diagnose and treat someone feeling overwhelmed and unloved, which was the real problem.
The experience helping Gwen had forced me to question my technical approach to healthcare. The academic education had taught me to prescribe treatment based on objective-measurable and reproducible-findings. Treatment was based on validated double-blind, placebo controlled studies that statistics supported. In medical training, the personal relationship between doctor and patient are deliberately and effectively screened out. But Gwen’s medical problems—depression, elevated glucose levels and obesity—could not be treated unless Gwen’s central motivation (i.e., service to others) could be part of the treatment plan. My most prestigious traditional medical treatment procedures were not enough. They needed one more element, and that element was the Enneagram.
Traditional approach to illness:
Gwen’s case made me do a lot of thinking about the medical model, both its strengths and its weaknesses.
I already knew that traditional medical care focuses on acute problems, not chronic disease. So it’s good for treating ailments that require drugs, but less effective at addressing problems that require lifestyle modifications.
However, the leading health problems of America—heart disease, obesity, hypertension and diabetes—can’t really be cured simply by taking drugs. The usual medical goal is to prevent complications and disease progression.
Gwen is a poster child for someone with a chronic life-style disease and we don’t have chemicals she could take to “fix” her in 10 days.
But when I took another approach and understood her real motivation, it made it much easier to address the lifestyle problems that were contributing to her medical problems. Preaching about non-compliance wouldn’t have helped. The approach needed to be informed by greater insight into underlying motivations. Gwen needed to change her lifestyle and not just a chemical adjustment. It was important to realize that her lifestyle had an unconscious central motive, an energy that could be harnessed once it was understood. That’s why the Enneagram information was central.
What my medical education assumes (and so does not address), is the issue of motivation. Despite mountains of literature to the contrary, health care providers assume people will act in their own best medical interest. The crippling corollary of this assumption is that people will follow medical instructions without any support, reward or follow-through on the part of the professional. But often people don’t stick to diets and don’t take their meds. Just like Gwen, they continue to eat food that’s physically unhealthy for them. Let’s see why.
Motivation First,
“Why do you want to lose weight?”
When someone comes to us wanting to lose weight, that’s never all they want. They want to lose weight in order to get something else.
But both patients and many doctors often skip the question, “Why do you want to lose weight?” When asked, patients give answers their doctors expect: “I want to be healthier,” or “I want to lower my blood pressure.” Such reasons sound rational. But are they the real reason? The teachings of the Enneagram suggest otherwise.
Lacking an understanding of the Enneagram, Gwen did not know that she wanted to lose weight to serve her family more. Like most people, she looked to popular weight loss books, theories and strategies to help her devise a weight loss strategy.. While such sources provide useful information, that information is at best general in nature. Also, it focuses mainly on physical reasons for losing weight. It does not address individual differences in motivation..
Here’s why the usual formulae have to be personally tailored, either by you or by a professional. People simply vary too much for any one formula to provide a definitive solution to weight loss. The regimen that works for a math teacher 50 pounds overweight differs sharply from the regime that a young mother needs to shed 30 pounds after pregnancy. What’s more, three mothers with three different Enneagram styles, metabolisms and environments may also need different strategies.
And What Are These Motives?
Most weight loss programs assume similar motivation, metabolism and eating habits. Because those assumptions are shaky or wrong, we see that most diets work but the people don’t. Diets will usually work, IF—and that’s the big if—people can stick to them. A few can, they become the poster children, most can’t. They become discouraged and turn to comfort food for consolation, then tell their friends or therapists they suffer from lack of self-esteem.
Although people fail at weight control for a variety of reasons (e.g., metabolic barriers, childhood habits, the desire to avoid appearing too attractive, or the need to use food for stress reduction), many of these reasons stem from deeper motivations that are limited in number.
The Enneagram helps us understand these motivations, which is why it can be a powerful tool in any weight reduction plan.
How the Enneagram Contributes
Gwen’s case illustrates the importance of the Enneagram. She felt an obligation to be available 24/7 for her children, husband, community and boss. When I properly told her to exercise, I added to her burden. When could she add that to her already overloaded schedule? Same for preparing healthy food, that would be just one more task and rob her of precious time to serve her loved ones! Her deepest desire—her driving motivation—was to be a better mother, wife, and worker. My medical advice did not take this into account. So instead of it helping Gwen lose it, it actually sabotaged her motivation.
Gwen knew she shouldn’t eat that ice cream at night, but she did not know she was eating because she was unappreciated. On one level she knew how hard she worked without being really recognized for her heroic efforts. But she was not able to see the connection between that and the lovely feeling when polishing off the pint of Homemade Vanilla Flavored self-reward. As a Nurturer she had long learned to suppress her own needs, so she did not see that they show up in strange containers.
The Enneagram and Medicine
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 obscured 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 and won’t need any further medical help.”
They could see I was a bright young doctor and respectfully, even gratefully responded, “Thank you, I know you are right,” then continued unabated to kill themselves by their lifestyle! People are not stupid, so I had to find out what was so precious they’d be willing to die for it,slowly, 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. Once I understood his motivation, his behavior was logical and utterly sane. The same was true of Gwen. Once we both knew she would carry 40 extra pounds around all day if t necessary to nurture her family, we could reinterpret her virtuous but self-destructive actions and deal with her problems.
What is the Motive?
I looked for motivational explanation of why people eat themselves to death. And I discovered the answer in the Enneagram.
The Enneagram describes personality styles in terms of inner focus, dominant energy patterns, view of life and the strategies developed to deal with the first three.
It begins with focus. Each of us has a narrow focus right below our level of usual attention. We unconsciously ignore parts of our environment or 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 prevent the expected disasters. I may do some things like buying 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 I’m stupid, but within my internal soothing strategy, candy makes a lot of sense.
What an Enneagram Style Predicts
Aside from the usual reasons people overeat or eat in self-destructive ways, they eat because of the central concerns of their Enneagram style — nine different, partially or wholly unconscious reasons. Each reason expresses an inner world with a belief system, some central preoccupations, personally dominant energies, and ways in which they process information. When we know our Enneagram style—and those of our patients—it helps us look beyond overly-general assumptions about what motivates people. It helped me come up with a weight loss plan for Gwen that finally worked.
__________ Enneagram Monthly, Issue 148, May 2008
A Doctor’s Discovery
Gwen was living the American dream. She taught second grade, was happily married to a bank vice president and was mother of three healthy children. She devoted her busy life to her socially active husband, some church activities and three children with their hamster-like school activities. Husband, church and children were flourishing, much to her delight.
But Gwen was also living the modern American woman’s nightmare. She was 40 pounds overweight and gaining. She was tired and depressed. She might have only one problem, but it was making a big negative impact on her life.
Apparent Self-Interest
Gwen was sure that her weight gain was caused by metabolic problems. it must be her thyroid, she thought, because Oprah had described her symptoms exactly. Gwen came to see me because I run the Truman Medical Center in Kansas City, a center specializing in weight management. She expected me to tell her the exact nature of the problem and what medication she should take to correct it.
Of course, I ran the proper tests. Her metabolism was fine. No thyroid imbalance. But I did notice that her weight gain was causing some blood pressure problems and she was pre-diabetic. So I told her what to do—what any good doctor would tell her: “Eat less, eat better and exercise. Get some more rest, too. Your fatigue and high blood pressure probably stem from stress.”
I gave her some medication for blood pressure and elevated glucose. She came back later and the medications had worked: blood pressure and glucose were fine. I asked her to return in three months to follow up.
She didn’t return in three months. But nine months later, she came back with a sinus infection and her glucose levels and blood pressure were worse. She had also gained another 10 pounds. When my nurse called the pharmacy to renew the medications, it turns out she had discontinued them.
Well, I had told her what to do and she didn’t do it. My advice was mainline medical practice and if she had followed my professional instructions, she would have been fine. But she ignored my expensive professional advice completely!
Gwen was intelligent, emotionally healthy, and motivated. But she was also non-compliant. Why? Why would she come for help, receive it and then ignore it? Why would she act against her apparent self-interest?
I didn’t know. But I did know that when something doesn’t make sense on one level, it usually does on another. I wanted to get to the bottom of Gwen’s problem. There must be some way. What was it?
Shortly after this experience, I learned about the Enneagram in church, Then I studied further with Clarence T. The Enneagram taught me how to refine what I knew about motivation—how to look at motivation at more than one level. It helped me unravel the mystery of why people sometimes act in a way that seems to be against their self interest. And why I was unable to help Gwen lose weight,
Learning the Enneagram helped me refine not only my approach with Gwen, but my entire approach to weight management. Here’s Gwen story and how it helped me understand the power of the Enneagram.
Enter the Enneagram
Gwen is an Enneagram Two. So she’s a giver, but sometimes the giving gets out of hand. There’s too much focus on meeting the needs of others and not enough on acknowledging and fulfilling her own needs.
When I realized that Gwen was a Two, I changed my approach considerably.
I realized that Gwen did not come to lose weight, not really. She came to be happier (less depressed) and have more energy (less fatigue) in order to do more of what she was already overdoing: meeting the needs of her family and community. When I saw she was a Two, I knew I needed to address not just the apparent reasons for weight gain (poor eating habits and lack of exercise), but the underlying motivations that actually created the impetus for weight gain.
Fortified with my Enneagram insights, I called Gwen to come in for a new health plan. This time we addressed her real problems (her presenting complaints were only symptoms). She was working so hard, was stressed and did not have time or energy to prepare healthy meals. That was part of the physical problem. Some of her fatigue was predictable: long hours of hard work for others with little time for herself. This is not a medical problem, it is a life-style problem. The depression related to a lack of appreciation for her tireless service which also caused her fatigue. I felt that she was using food, especially comfort food, as a way to reward herself each evening for all the service she had rendered that day.
Based on this understanding, I helped her work out a plan for some self-nurturing. Gwen was to share her situation with the family and ask for their support. This was not easy for her. But what helped was the understanding that if she stayed overweight, tired and depressed, she could not serve them. That double bind (if she kept on serving, she couldn’t serve) enabled her to ask for their cooperation. She eased back a little and attended to her own previously unacknowledged needs and desires.
New Results
At Gwen’s next visit a month later, I saw that her blood pressure and glucose levels had improved, she had lost six pounds, and her energy levels had risen. In another six months she lost 20 more pounds.
She was ecstatic. “Doc, you saved my life! I’ve been dieting for 25 years and this is the first plan I can continue for a lifetime because I am not doing this by myself.”
I was elated by these results: I had helped cure depression, blood pressure, glucose levels and obesity. Not bad for a few hours work! I even felt sort of “two-ish” myself, being so helpful.
But my elation was tempered by the understanding that while my medical training prepared me to diagnose medical problems like diabetes and hypertension, it left a few things out. It did not really equip me to diagnose and treat someone feeling overwhelmed and unloved, which was the real problem.
The experience helping Gwen had forced me to question my technical approach to healthcare. The academic education had taught me to prescribe treatment based on objective-measurable and reproducible-findings. Treatment was based on validated double-blind, placebo controlled studies that statistics supported. In medical training, the personal relationship between doctor and patient are deliberately and effectively screened out. But Gwen’s medical problems—depression, elevated glucose levels and obesity—could not be treated unless Gwen’s central motivation (i.e., service to others) could be part of the treatment plan. My most prestigious traditional medical treatment procedures were not enough. They needed one more element, and that element was the Enneagram.
Traditional approach to illness:
Gwen’s case made me do a lot of thinking about the medical model, both its strengths and its weaknesses.
I already knew that traditional medical care focuses on acute problems, not chronic disease. So it’s good for treating ailments that require drugs, but less effective at addressing problems that require lifestyle modifications.
However, the leading health problems of America—heart disease, obesity, hypertension and diabetes—can’t really be cured simply by taking drugs. The usual medical goal is to prevent complications and disease progression.
Gwen is a poster child for someone with a chronic life-style disease and we don’t have chemicals she could take to “fix” her in 10 days.
But when I took another approach and understood her real motivation, it made it much easier to address the lifestyle problems that were contributing to her medical problems. Preaching about non-compliance wouldn’t have helped. The approach needed to be informed by greater insight into underlying motivations. Gwen needed to change her lifestyle and not just a chemical adjustment. It was important to realize that her lifestyle had an unconscious central motive, an energy that could be harnessed once it was understood. That’s why the Enneagram information was central.
What my medical education assumes (and so does not address), is the issue of motivation. Despite mountains of literature to the contrary, health care providers assume people will act in their own best medical interest. The crippling corollary of this assumption is that people will follow medical instructions without any support, reward or follow-through on the part of the professional. But often people don’t stick to diets and don’t take their meds. Just like Gwen, they continue to eat food that’s physically unhealthy for them. Let’s see why.
Motivation First,
“Why do you want to lose weight?”
When someone comes to us wanting to lose weight, that’s never all they want. They want to lose weight in order to get something else.
But both patients and many doctors often skip the question, “Why do you want to lose weight?” When asked, patients give answers their doctors expect: “I want to be healthier,” or “I want to lower my blood pressure.” Such reasons sound rational. But are they the real reason? The teachings of the Enneagram suggest otherwise.
Lacking an understanding of the Enneagram, Gwen did not know that she wanted to lose weight to serve her family more. Like most people, she looked to popular weight loss books, theories and strategies to help her devise a weight loss strategy.. While such sources provide useful information, that information is at best general in nature. Also, it focuses mainly on physical reasons for losing weight. It does not address individual differences in motivation..
Here’s why the usual formulae have to be personally tailored, either by you or by a professional. People simply vary too much for any one formula to provide a definitive solution to weight loss. The regimen that works for a math teacher 50 pounds overweight differs sharply from the regime that a young mother needs to shed 30 pounds after pregnancy. What’s more, three mothers with three different Enneagram styles, metabolisms and environments may also need different strategies.
And What Are These Motives?
Most weight loss programs assume similar motivation, metabolism and eating habits. Because those assumptions are shaky or wrong, we see that most diets work but the people don’t. Diets will usually work, IF—and that’s the big if—people can stick to them. A few can, they become the poster children, most can’t. They become discouraged and turn to comfort food for consolation, then tell their friends or therapists they suffer from lack of self-esteem.
Although people fail at weight control for a variety of reasons (e.g., metabolic barriers, childhood habits, the desire to avoid appearing too attractive, or the need to use food for stress reduction), many of these reasons stem from deeper motivations that are limited in number.
The Enneagram helps us understand these motivations, which is why it can be a powerful tool in any weight reduction plan.
How the Enneagram Contributes
Gwen’s case illustrates the importance of the Enneagram. She felt an obligation to be available 24/7 for her children, husband, community and boss. When I properly told her to exercise, I added to her burden. When could she add that to her already overloaded schedule? Same for preparing healthy food, that would be just one more task and rob her of precious time to serve her loved ones! Her deepest desire—her driving motivation—was to be a better mother, wife, and worker. My medical advice did not take this into account. So instead of it helping Gwen lose it, it actually sabotaged her motivation.
Gwen knew she shouldn’t eat that ice cream at night, but she did not know she was eating because she was unappreciated. On one level she knew how hard she worked without being really recognized for her heroic efforts. But she was not able to see the connection between that and the lovely feeling when polishing off the pint of Homemade Vanilla Flavored self-reward. As a Nurturer she had long learned to suppress her own needs, so she did not see that they show up in strange containers.
The Enneagram and Medicine
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 obscured 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 and won’t need any further medical help.”
They could see I was a bright young doctor and respectfully, even gratefully responded, “Thank you, I know you are right,” then continued unabated to kill themselves by their lifestyle! People are not stupid, so I had to find out what was so precious they’d be willing to die for it,slowly, 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. Once I understood his motivation, his behavior was logical and utterly sane. The same was true of Gwen. Once we both knew she would carry 40 extra pounds around all day if t necessary to nurture her family, we could reinterpret her virtuous but self-destructive actions and deal with her problems.
What is the Motive?
I looked for motivational explanation of why people eat themselves to death. And I discovered the answer in the Enneagram.
The Enneagram describes personality styles in terms of inner focus, dominant energy patterns, view of life and the strategies developed to deal with the first three.
It begins with focus. Each of us has a narrow focus right below our level of usual attention. We unconsciously ignore parts of our environment or 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 prevent the expected disasters. I may do some things like buying 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 I’m stupid, but within my internal soothing strategy, candy makes a lot of sense.
What an Enneagram Style Predicts
Aside from the usual reasons people overeat or eat in self-destructive ways, they eat because of the central concerns of their Enneagram style — nine different, partially or wholly unconscious reasons. Each reason expresses an inner world with a belief system, some central preoccupations, personally dominant energies, and ways in which they process information. When we know our Enneagram style—and those of our patients—it helps us look beyond overly-general assumptions about what motivates people. It helped me come up with a weight loss plan for Gwen that finally worked.
__________ Enneagram Monthly, Issue 148, May 2008