We often talk about physical, mental, social and even systemic health, but we don’t often think or talk about the health of our personalities. Our personalities are shaped by our self-esteem, our values, our truths, our needs, our struggles, our instincts and our gifts. They impact every part of our lives, relationships and interactions with the world at large and although we give some focus to understanding them through tools like Myers-Briggs, the Enneagram and Strengths-Finder, (perhaps to make us more successful), we give little thought to how healthy we are when it comes to this subject.
Now, what is particularly interesting to me as a doctor are 2 things related to this. Firstly, our personality type is hugely linked to the kind of mental health problems we might be more likely to develop. I wonder how often clinicians see the presentation of a mental illness and are able to talk with the person in front of them about which aspects of their personality might need therapy in order to help their mental health improve? As the whole area of positive psychology develops, it is vital that there are learning environments in which clinical teams can learn about innovative approaches in psychology that avoid the over prescribing of medication, especially in our younger population.
The second area of interest is to do with how we can be more self-aware of how healthy we are or when we have reached a point at which we can no longer really help ourselves but need others who love us or care about to to intervene. Below is a chart (of sorts) which I learned about during a weekend on the Enneagram. It helps to explain aspects of personality health. I recognise that at times I am functioning more healthily than at other times, due to a combination of internal and external factors. I think there are behaviours we can be aware of, or ways in which we are operating in relationships and situations which should serve as a WAKE UP CALL to us. When we notice more negative patterns, we need to take stock of where we are and work out our lines of responsibility to help us back into a more healthy state. However, if we don’t, things can continue to worsen until we reach a point at which we need others to intervene on our behalf and rescue us from our self-destructive and damaging sickness.
We can make a comparison with heart disease. For much of the time, our hearts 
function healthily. However, through a mixture of internal and external factors, our hearts can become less healthy. When this occurs, our body will fire some warning shots to us, giving us a chance to change before something more serious occurs. This might be signs and symptoms do do with our weight, nutrition, fitness, level of breathlessness, vague chest pains, markers in our blood tests – like high cholesterol and high sugar, rising blood pressure etc. However, if we ignore the opportunities to change and continue with our unhealthy choices, eventually we will reach the point at which we have a significant event, e.g.the start of angina, a heart attack, a stroke, the development of diabetes. At that point we need the help of someone else – we can no longer do it on our own. Of course, we still have choices and can reject the help on offer, but if we do, we risk our own demise and ultimate death.
My point is this. If we do not take the health of our own personalities seriously, there are serious and significant consequences, not only to ourselves but those around us and the world we live in. Many of us reach a point when we need help, but might not even face up to this, due to the poor health we are in. In those times, we need those who love and trust to be brave enough to reach in and offer us a life line. We may have even reached the place where we need resuscitation, when all our pride has gone. When we have ignored the red flag, we need those around us who will risk our total rejection of them to love us enough to offer us a way back to health. We need to take the health of our personalities seriously – it actually has a huge bearing on all the other aspects of our health. We also need
HEALTHY
- 1. Level of Liberation – Ego transcended – balance/freedom – i.e you become a gift
- 2. Level of Psychological Capacity – Ego as particular mode of being – choice of how to be
- 3. Level of Social Gift – Ego operating in constructive way – sublimating ego
Wake up Call – need to listen to internal warning bells
AVERAGE
- 4. Level of fixation – Ego role assumed – falling asleep (not self-aware) – losing contact with presence
- 5. Level of interpersonal conflict – Ego controlling environment to support self – manipulative/defended
- 6. Level of overcompensation – Ego inflation, demanding others and reality support it – aggressive defence
Red Flag – need of help from others
UNHEALTHY
- 7. Level of violation – Ego willing to violate self and others to maintain itself – abusive/desperate
- 8. Level of Delusion and compulsion – Ego loses touch with reality – out of control – personality disorder
- 9. Level of pathological destructiveness – Extreme pathology and/or death
feeling low/down/hopeless/sad/apathetic/bored/exhausted, I might invite you to imagine what life might be like if you weren’t feeling that way. You might tell me that you’d feel happy and then I would ask you to tell me what ‘happiness’ might be like for you. I’d ask you to describe in as much detail as possible how you would know that you were happy – what would be different? I’d get you to put as much colour on that as possible. And once I understood how you would know you were happy, I would ask how others around you would know – what your partner/children/friends/pets would notice about you…….suddenly your mind is alive with an alternative reality to where you are currently and although things won’t be suddenly better, your mind has been awakened to another way of being! And that brings a beautiful thing – it brings possible solutions to the problem.
There is no doubting that the problems in the NHS are vast. One of the things I have found is that if you try and enable someone to think about the solutions without allowing them to tel you what the problems are, you won’t get very far. A certain amount of catharsis and expression of the issues is important. So here goes: here is a picture of the problems the NHS faces (and these have already been stated many times over, but let’s just be clear):
The NHS is under-funded. Cuts to other services, like social care have also had a massive impact on the NHS as a system being able to work and targets are being missed as a result. People are living longer and this means more complex health problems and a rise in dementia. There is more obesity and diabetes and this has a huge impact in the cost of healthcare. The way the NHS is funded is ludicrous and puts parts of the system that should be working collaboratively in direct competition with each other. Teams across the NHS are clumsy and clunky with little ability to work smartly due to constraints of historic ways things were set up. Demand and expectation are extremely high and yet there are multiple missed appointments. And I could go on!
eat moany pie together and complain about the issues. Throwing mud and finger pointing, blaming everybody else but ourselves will solve nothing. The awful tribalism and over politicization of the NHS is preventing us from finding a way forward. What might health and social care in this country be like if open our mind to new possibilities? What if we stopped focusing on all the problems and dreamed of how things might be in 5, 10, 50, 100 years time? We’ve been doing this in Morecambe Bay and we’re moving from not only dreaming but to doing something different!
We’re working with our communities to help us all live more healthy lives, thinking about health as a social movement. 97% of all health monies are spent once people are ill. We’re taking prevention seriously! We are breaking down walls between our organisations and sharing our budgets. We’re building relationships between clinicians and managers across many diving lines. We’re collaborating to share our resources and using our budgets in a way that makes sense for our communities. We’re unashamedly talking a new language of love, building trust and establishing infrastructures of positive peace. We’ve worked out where we are being inefficient and sharing our conundrums with our communities (we do actually have to be responsible about what we spend – the NHS is not carte blanche). We’re working out how to work differently and more smartly. We’re sorting out our IT. We’re redesigning care so it makes more sense for our patients. We’re working on our consultation and communication skills. We’re being more proactive in getting positive messages out there. We’re building for the next 100+ years not just the next political cycle. This is better care together!
have huge health inequalities. There are major issues with housing, economic policies that are not working for huge swathes of our population, with more people having to use food banks, struggling with fuel poverty, living in damp houses and unable to make ends meet. Yes, our kids are spending more time on screens and less time in activity. Yes, the sugar lobby, alcohol lobby and advertising giants have far too much power. Supermarkets are designed deliberately so that we buy things that are bad for us. And sometimes, we just make poor choices (if you can call them choices, which for some people, they aren’t always) – we do not all live as healthily as we could – we eat the wrong stuff, work highly stressful jobs, and exercise less than we are recommended to. Mental health issues are on the rise, especially for teenagers, due to crazy targets and league tables, with all the pressures they face. We are less happy and more separated than we ever used to be, despite the rise in social media…..(or maybe because of it……)…..Man, I can paint a negative picture – it’s like storm clouds and darkness everywhere……..
But what if it wasn’t that way? What if we got a bit angry about it, but instead of finding someone to blame and pointing the finger; instead of getting all tribal and throwing stones at others, we chose to use our energies creatively to find solutions, to work together and make positive changes?! Let’s put away our pointing fingers and our ranting tongues and let’s work together for a better future for everyone! Doesn’t that sound good?! It’s what we’re trying here in Morecambe Bay, and I’m hoping it spreads like wild fire so that we can become a place where health abounds and beauty surrounds (that’s the motto of this place!). That doesn’t mean we stop speaking truth to power, but we also let our actions (and maybe our votes) speak louder than ever before.
We’re talking together, taking time to dream about what it would be like if we were the healthiest area in the UK. We’re training up many people to host conversations, so that we break down walls and learn to collaborate for the sake of everyone. We’re not just dreaming about physical health, but mental, social and systemic health as well. We’re encouraging those who want to rise up and take some leadership, to be pioneers in the stuff they are passionate about. Even in my little town, we now have a mental health cafe that is literally saving people’s lives, because a lady called Jane wanted to make a difference. We have a cafe for all the people who have circulation problems because one of our nurses wanted to break people’s isolation and improve their healing rates at the same time. 
We’ve got a carers cafe, a dementia cafe and will soon have a breathing cafe for those who have severe COPD, sharing ideas and diminishing anxiety. We’ve got exercise classes to help with pain, a community choir, dog poo wardens to help us take more pride when we walk down the street and food banks to help those who can no longer afford to eat.![image[1]](http://reimagininghealth.com/wp-content/uploads/2016/03/image1.jpg)
We have 2000 kids aged 4-11 running a mile a day at school with staggering results for our children here in terms of physical, mental and educational health. We’re hoping over time, this becomes the Morecambe Bay Mile, part of a cultural shift towards being more active. We are working with local chefs and supermarkets to enable people with pre-diabetes or weight struggles to eat more healthily. We’re choosing to lead by example in the NHS to work well and flourish in our work places. We’ve made a commitment to see the 5 ways to wellbeing in every NHS organisation and we’re hoping many other systems and businesses will follow us in this. We’re finding radical ways to help people who are struggling with alcohol and drug addiction, get free and stay free with amazing results. We’re helping people live well with and beyond cancer.
We’re changing the way consultations happen in the NHS to enable people to make more informed and better choices about their own health and conditions, so they feel empowered to make changes that work for them rather than beaten up when they go for an appointment! We’re launching the Morecambe Bay Poverty Truth challenge, learning from those who are lived 
experts in poverty to help us work together and care better for those most struggling in our society. We’re having difficult conversations about death to help people be prepared for every eventuality.
will be awakened? What other partnerships, collaborations and relationships might be formed? Being all tribal and accusatory of others saps our energy and stops us being creative. Mud slinging and blame will achieve little. We have to work from where we are. We have to build bridges and work together. We have to build a future of positive peace and that means binary thinking is over! The future doesn’t have to be full of doom and gloom. It is alive with hope! What resources might we find? What talents might we discover? What might we see develop over the next 12 months/years/decades as we look for solutions together for a better future for everybody? Don’t you feel just a little bit excited?
Last weekend, I spent the weekend with my wife and a bunch of close friends, immersing ourselves in the enneagram. It’s something I’ve done a bit of before and highly recommend it! The enneagram is an ancient way of understanding the human personality, our instincts, gifts, struggles and strengths. There are several different perspectives on it. There are similarities between the enneagram and various other approaches to understanding ourselves and each other better, like the Myers-Briggs, Strengths Finder etc, all of which I have found really helpful. On Myers-Briggs, I’m an ENFP. My core strengths are ‘believer’, ‘activator’, ‘communicator’, ‘achiever’ and ‘woo’ (the ability to win others over). I love knowing this stuff, especially in team dynamics because it allows each person to play to their strengths and to some extent, cover each others weaknesses.
What I love about the enneagram is that it helps me, more than anything else I know, to face up to my struggles, my shadow, my ego and my unhealthy behaviour patterns without leaving me feeling ashamed or condemned. It helps me get to grips with my blind spots when it comes to my raw instincts and enables me to draw on others for support and help in making healthy changes. For those of you, who have never read anything about it, there are basically 9 personality types, each with 3 basic instinct types attached to them. Understanding your type and your instinct (especially your blind spot) can really help you on a journey towards freedom, wholeness and peace. It made me reflect so much on how I practice as a doctor and how often I might actually try and medicate someone or ‘therapy’ them, to try and soothe their pain when they might just be at a monumentally important moment of transition, discovery or realisation.
actually my blind spot – I’m just not that great at being disciplined in taking care of my basic needs e.g. diet and exercise, or my motivation for doing these things is not self-care!), social adaptation or sexual attraction (that’s my prime driver – rather unfortunately termed, as it doesn’t mean I’m some kind of sex fiend!). Being a type 7 is actually awesome (of course). It means being an optimist, an activator, an enthusiast, a visionary and an adventurer. I see potential in people and possibilities and carry a strong belief that things can and will change for good. For me, life is fun and full of joy and I love to assimilate loads of interesting knowledge, being a generalist (suiting my work as a GP, rather than a specialist)……What’s not to love, right?! But here’s the thing…..
conversations with people, as I hate causing pain in others. I love to find the next new thing, but this means I get easily distracted, my head is full of new ideas and lots of wonderful imaginings so I find it hard to focus, to stay in the present moment and be at peace. My visionary side can easily lead to idealism and when things don’t turn out the way I had imagined, I can verge towards anger or resentment. Even though I know this about myself, when I am not doing so well, when I am not as healthy as I could be, I see these patterns emerging. And my root struggle (and this is entirely true!) is gluttony! When life is painful, instead of embracing the pain, exploring it and confronting it, I take comfort in eating – (type 7’s often have yo-yo-ing weight or other addictions). I’m on a quest to lose a stone at the moment, but because self-preservation is my blind spot, this isn’t as straightforward as it sounds!
most important person in my life, deliberately fools me into suppressing the vulnerable or shadow part of me, which if I embrace, can actually allow me to become a great deal more healed. If I can face up to the little person inside me, that I hide away and try to squash, who feels worried at times that I don’t have enough and that I’m feeling a bit overwhelmed by the build of issues on the inside of me; if I can recognise when I have entered the realm of fake joy and anticipatory energy and instead of veering towards trying to control everything and make everything feel happy but rather admit where I’m really at…..then and only then can I find a place of true contentment, where simplicity is restored, where I can focus, be present and know things are ‘perfect just as they are’…..then I can let go of idealism and enter the realm of sober joy, where truth resonates with hope and allows me to be the very best version of me.
