“Give sorrow words. The grief that does not speak

Whispers the o’erfraught heart and bids it break.”

(Machbeth, act IV, scene III. Shakespeare)

“It’s hard to tell you what I feel”: how many times did we say this words to a friend or partner? How many times did we have a hard time telling our darlings how we feel about them? Giving emotions a name and expressing our mood seem so natural that it’s hard to believe someone finds it complicated. Sometimes, though, translating feelings into words is difficult. This inability can be associated with fear of lack of courage, but other times it can be the manifestation of a personality-based phenomenon that hinders people from verbalizing their emotional experience. These people suffer from alexithymia.

Some people can’t recognize emotions, indeed “alexithymia” (from the Greek a: lack of; lèxis: word; thimos: emotion) means “lack of words for emotions”, a sort of “emotional illiteracy”, a difficulty in recognizing, exploring and expressing emotions. The construct of alexithymia is based on clinical observations conducted on patients who suffered from psychosomatic disorders. In psychosomatic disorders, anxiety, sorrow and other negative emotions that are too strong to be felt find a way out through the body.

The first to actually talk about alexithymia was Sifneos, who used it to indicate a specific disorder of affective and symbolic functions that often makes psychosomatic patients’ speech style dull and colorless. This confirmed the patients’ troubles in expressing their subjective feelings and their tendency to adopt a communication style characterized by a strong attention to external events and an absence or strong reduction of fantasies based on drives.

Alexithymia has some peculiar characteristics:

• Difficulty in identifying feelings and distinguishing them from somatic sensations;

• Difficulty in describing and communicating emotions and feelings to other people;

• Restricted imaginative processes;

• Outwardly directed cognitive style.

Alexithymic sufferers show lots of difficulties in verbalizing their emotions, but most of the times they are not aware of that. They can have emotional outbursts (e.g. of rage), but they don’t connect their emotions to a specific event or memory.

The subject is confused about his emotions, especially the ones like anxiety, sadness and anger. They also somatize emotions and minimize affective components. Alexithymia sufferers express their emotions through the physiological component because they can’t elaborate the subjective dimension. They could tell you about a certain event in detail, for example a fight with their partner, and then be astonished if someone points out that he probably felt angry in that situation. This is also explained by the fact that the alexithymic person tends to report somatic feelings without understanding that anger itself includes all of those feelings (such as tremors or muscle tension).

The lack of imagination and related functions is observable during oneiric activity. We are all used to dreaming and aware of the emotional load dreams can have. Alexithymic dreamers, instead, seem unable to remember their dreams. When present, oneiric activity has archaic content (e.g. violent scenes or sexual perversions) or is characterized by the stereotyped repetition of events happened during the day. Daydreams follow the same pattern: they are poor qualitatively and quantitatively and they always focus on the same themes.

Alexithymic people are more focused on what happens outward. They describe their experiences without any emotional involvement, like they were viewers and not actors of their own life. They focus on details, but they don’t show any emotional participation. Also, they aren’t very good at tuning with others’ emotions and they have a hard time forming and maintaining interpersonal relationships over time. (Krystal, 1979).

Among the possible theories related to the development of alexithymia, Bowlby’s attachment theory is surely one of the most relevant, especially the insecure-avoidant style. Lots of alexithymic people experienced lack of affection from their caregivers and often their mothers suffered from depression or personality disorders. Alexithymia could be considered a defense against psychological suffering or an affective block caused by childhood trauma. Lots of studies have shown children who are separated from their parents, even for short periods of time, tend to fall ill more and have a hard time regulating their emotions.

Alexithymia can also be developed after a big trauma – war veterans and people subjected to abuse showed alexithymic traits – or after life-threatening diseases such as cancer or organ transplant.

Addicts, such as heavy drinkers or drug abusers, can show some characteristics related to alexithymia. But why does this happen? Probably, alexithymic people try to compensate the lack of emotional quality and quantity through experiences that can alter their state of consciousness. This compensatory behavior prevents somatization, which in some cases can be a serious problem. In his theory about the development of alexithymia (1997), Grotstein says that, confronted with the danger of being overwhelmed by an avalanche of uncontrollable affection, the person would organize very general and strong defenses against affectivity”.

What are the consequences of alexithymia in everyday life?

People who have an affective relationship with the alexithymic sufferer play an important role in his life and also experience most of the consequences. Alexithymic people tend not to recognize others’ feelings, despite saying they do. This can not only lead to suffering, but also constant chasings by people who surround them. At the beginning of a relationship, they can be caring, but at the same time they can suddenly disappear without any reason.

Poor communication is one of the most significant elements of alexithymia and also the one that causes the most conflict in the family. In a romantic relationship, the lack of emotional exchange and sharing can turn into a serious problem for the couple. The alexithymic person will try to bear all the problems outside the couple, without being able to feel internal conflicts and to catch emotional signs. Therefore, the partner perceives this behavior as a lack of interest, misinterpreting their frame of mind.

These people usually have few contacts with others, that range from a strong dependence from someone they turn to and rely on to a voluntary isolation, avoiding any contact with others and preferring emotional isolation.

In conclusion, it’s important to state an important characteristic of alexithymia. These people feel the same emotions we do, but they are not aware of them. Alexithymic people only experience emotions with their bodies, for example feeling their heartbeat or a lump in their throats, without knowing how to give a meaning to these sensations. LeDoux (1996) said: “The brain states and bodily responses are the fundamental facts of an emotion, and the conscious feelings are the frills that have added icing to the emotional cake”. The alexithymic person doesn’t inhibit or deny emotions, he just has no words to describe them; in other words: he can’t express them.

So we can’t talk about “heartless” or “cold”, less emotional people, but just “unaware” people.

Paola Auricchio

Translated by Silvia Sanzò

Bibliography

Campione, G., Nettuno, A. (a cura di) (2007) Il gruppo nelle dipendenze patologiche. Franco Angeli

AA. VV., (2011) Le parole senza voce. Il costrutto alessitimico tra disturbi del comportamento alimentare e dipendenze: Il costrutto alessitimico tra disturbi del comportamento alimentare e dipendenze. FrancoAngeli.

Phoebe E. B., Julie D. H. (2007) Alexithymia, somatization and negative affect in a community sample.