Al was one of my substance abuse clients at the methadone clinic where I used to work. I knew he was a Type 5 because I managed to persuade every single one of my clients to complete an Enneagram questionnaire. With his shaved head (usually covered by a baseball cap) and multiple tattoos, Al was a little off-putting, appearance-wise. He had spent more than one stint in San Quentin where he joined an Aryan Brotherhood gang. As he—and several other ex-con clients—explained to me, you had to belong to some group in prison in order to survive. He never seemed very committed to the white supremacist thing, and being a 5, he certainly wasn’t part of any gang on the outside.
Somewhere along the way, Al had encountered a psychiatrist who diagnosed him as having Antisocial Personality Disorder. I’m not sure what the psychiatrist was thinking. Did he believe that because Al had committed antisocial acts, he must therefore have Antisocial Personality Disorder? I don’t know. And I wouldn’t have cared, except the doctor was so convincing Al took on the diagnosis as part of his identity. It was almost as if he introduced himself by extending his hand and his diagnosis, “Hi, I’m Al. I have Antisocial Personality Disorder.”
The disconnect for me was that Al was unfailingly prompt for his counseling appointments and far more considerate of me than many of my less-sinister-appearing clients. He’d knock softly on my door and stick his head into my office after the client ahead of him had left. “I just wanted you to know I’m here,” he’d say. “Take your time. If you need a break, I’ll wait.”
He knew I was a big San Francisco 49ers fan when Steve Young was the quarterback (possibly because of the red jersey with the huge number 8 I wore to the clinic every game day). So when he came across a used set of 49ers sweats at a thrift store, he got them for me.
He once spent a few months in an East Bay correctional facility, during which he wrote me several droll letters. He also sent a card with a kitten in a wicker basket on the front. On the inside it said, “Just want you to know how much I miss you!” In pencil (the only writing implement allowed), he’d added, “I’m out before you can say ‘meow!’”
After months of weekly counseling sessions, I figured that if Al had a mental health diagnosis it was probably Avoidant Personality Disorder. Although I’ve never been in prison, joined a gang, gotten tattooed (something I’m still threatening to do), or committed any felonies, based on Enneagram type alone I’m a much better candidate to develop Antisocial Personality Disorder than he was.
Eventually, I pulled out the DSM IIIR (a version of the Diagnostic and Statistical Manual of Mental Disorders), and during one of our sessions we read through both diagnoses. It seemed clear to me he met the criteria for Avoidant Personality Disorder—which also fit with his Enneagram type—and he agreed.
To some extent, it was a matter of exchanging one label for another. What difference did it really make? Well, it was subtle at first, but once Al started to see himself in that different light, he began to open up more. He developed some insight into his behavior and especially into his feelings. Before I left the clinic, he got involved in a relationship with a woman who had a young daughter, and I saw him access the healthy side of Type 2, which is part of his triad. It was a wonder to behold.
The Enneagram gave me another lens to look at my clients through—ultimately one that was more humane and more useful than some of the other lenses through which they’d been seen.