Alexithymia

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Alexithymia

Alexithymia is a relatively new term which means the inability to express feelings with words. The medical research coming under this term is showing what a lot of us already knew: If you can't express your feelings with words, you are going to have a lot of problems!

Medical Definition

The History of the Term

Why the Term Is Getting More Popular

Alexithymia and Emotional Intelligence

Alexithymia and Decision Making

How to Know if You Are Alexithymic

Where Does it Come From?

Primary vs. Secondary Alexithymia

Alexithmia and Society

Is There a "Cure" for Alexithymia?

Article about Alexithymia and Self-Harm

Emotionally Literate - The opposite of Alexithymic

Darren - A self-harming teenager who realizes he was not brought up to talk about his feelings

External Links

http://www.alexithymia.supanet.com/ - This site seems to be created by a PhD type person. It is a bit complicated, but seems well researched and written. It offers a lot of more detail.

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A Medical Definition of Alexithymia

A condition where a person is unable to describe emotion in words. Frequently, alexithymic individuals are unaware of what their feelings are.

http://www.self-injury-abuse-trauma-directory.info/Alexithymia/Alexithymia.htm

The History of the Term

It seems a medical doctor named Peter Sifneos is the person credited with creating the term alexithymia in 1972. He kept seeing problems with patients who could not express their feelings with words as he talked to them. So he created a term for this based on a few Greek words as follows

a = lack
lexis = word
thymos = emotions

The first time I remember hearing of alexithymia was when I read Reuven BarOn's book which he claimed was a handbook of emotional intelligence. I have strongly disputed that the book had much to do with EI, but I did learn a few things that are at least related to EI, if not actually about EI. Since then I have gone back to my notes from Goleman's 1995 book and discovered that Goleman mentioned alexithymia

Reuven BarOn probably deserves a lot of the credit for making the term a bit more well-known, though, because he put a chapter about it in his book which he titled "A Handbook of Emotional Intelligence." Had he called it a "Handbook of Emotions and Alexithymia" probably almost no one would have bought it, but since he was smart enough to call it a handbook of EI, he sold a lot copies. So I would guess this is the first time a lot of people heard of "alexithymia."

Why the Term Is Getting More Popular

As I mentioned at the top of the page, the term sounds more impressive and more scientific than saying either A) the person is not in touch with their feelings or B) the person can't talk about their feelings. Also, it is more specific than saying they are not emotionally intelligent ( a term which has been used to mean so many things it has almost lost any meaning at all!).

Also, for people who like simplistic answers and who like to label people, they can now say "His problem is that he is alexithymic" in a superior kind of way.

Even people who have trouble with their emotions may feel relieved. They can say "Ah, my problem is that I am alexithymic." This could be more or less helpful depending on what the do next. I need to do some more research but I have found out there is an alexithymic chatroom and forum on MSN where people are calling themselves "Alex's". This gives the term a more friendly feel, and the fact that they have started calling themselves "Alex's" suggests that feelings do matter to even alexithymic people! The chatroom, forum and identifying a common label for themselves surely helps fill an emotional void in their lives, as all forums and chatrooms on the Net obviously do, although I'd say it is better to have connections in real life and our Internet connections are only partially filling our emotional needs. (And obviously not filling our needs for human touch at all.)

Another reason the term may be getting popular is because it makes it sound like it is something out of our control, and as if no one in particular can be blamed. It is a bit like saying a suicidal teen is "bipoloar" when the truth is they are suicidal because of the emotional dysfunction in the home, school and society. We can understand, of course, why parents would prefer to hear that their teen is "bipolar" instead of hearing they themselves are emotionally incompetent, neglectful or abusive parents.

One good thing about the term is that because it is pretty specific, and because it does sound scientific and not judgmental, people are more likely to seek a specific "cure" and not as likely to feel embarrassed trying to get some help. They can also focus in on getting specific help on both identifying their feelings and in expressing them with words.

Alexithymia and Emotional Intelligence

So what, if any, connection is there between alexithymia and EI? First, it depends on which definition you use of EI, if you go with my adaptation of the Mayer Salovey four branch model of EI, then we can see a bit of connection because the first branch of EI is defined as follows

Emotional Perception and Expression - the ability to accurately identify and express feelings

This sounds like the exact opposite of alexithymia.

So does that mean that if a person is alexithymic there are, by default, not emotionally intelligent?

No, it does not.

It doesn't because we don't know *why* the person is alexithymic. Was i some kind of birth defect? Or was it a product of their environment? If I were a betting man, I would be on the latter. So I would say that telling us a person is alexithymic tells us little to nothing about how emotionally intelligent they were when they were born.

As I have written in my history and definition of EI section, there is a big difference between being born with high EI and how well a person manages his or her emotions later in life.

If, though, we talk about emotionally intelligent behavior, it is probably quite fair to say an alexithymic person will not appear to be emotionally intelligent.

This still does not mean, though, that the person is not emotional. A person could go on a tirade and smash things out of anger, thus showing they are very emotional, or they could cry and cry, which again would show their ability to feel emotion, but they still might not be able to put their emotions in words.

So we need to be very clear what we are and are not talking about when we talk about both alexithymia and emotional intelligence.

How to Know if You Are Alexithymic

One website lists these signs. It says you might:

- find it difficult to talk about your own emotions;
- be perceived by others as excessively logical, or unsentimental without being unfriendly;
- be perplexed by other people's emotional reactions;
- give pedantic and long-winded answers to practical questions;
- make personal decisions according to principles rather than feelings;
- suffer occasional inexplicable physiological disturbances such as palpitations, stomach ache, or hot flushes.

There is also this test you can take, but you have to pay for it.

It's called the 20-item Toronto Alexithymia Scale (TAS-20). It is a self-report questionnaire and is said to be a good test, according to the author of the site above. It is evidently avaliable from http://www.gtaylorpsychiatry.org/research.htm if you want to spend 35 dollars.

This, along with all the interest in EI tests makes me think I should be in the test designing, marketing and selling business!

All of the info from this section is from http://www.alexithymia.supanet.com/faq.html

Where Does it Come From?

This is the nature / nurture question. My best guess is that it is a combination of both. I would guess, in other words, it is exactly like emotional intelligence in this way. A baby is probably born with a natural potential. This potential can then be developed, or it can be neglected, or it can be corrupted.

Let's take three home environments.

Home A - The baby never hears anyone talking about feelings. She never even sees much emotional expression. Her parents are very religious and they home school her so they can teach her their religion and she won't be "corrupted" by other children. She lives in the country with almost no contact with other children. Her parents claim to love her but it seems more duty to her than love. She never sees any real signs of love between them. They try to keep their disagreements from her, but she can always tell when something is wrong. If she asks what is wrong, they say "Nothing, darling, now go on and play." She lives this way until he is 18 and moves to the city where she gets a job and seems to be fine, but finds she has a hard time connecting with people on more than a superficial basis.

Home B - The baby lives in a home with a sexually abusive step-father. Her real father left when he found out her mother was pregnant. She is sexually abused as an infant, as a young girl and as a teen. The step father tells her that if she tells her mother, the mother will get very angry. She sees her step-father hitting her mother. The mother has a drinking problem. She frequently shouts at the girl and sometimes hits her. She doesn't have patience for her daughter's feelings. If the little girl tries to express any feelings, she is invalidated in an angry way. She learns to keep quiet and make good grades because she is less likely to get yelled at. She learns to keep all her feelings inside. She lives in fear her entire life. Even when she makes good grades, her mother finds something to criticize her for. Then she begins to cut and self-harm at age 12. Someone from school finds out and tells her mother. The mother screams at her and calls her stupid, then walks away. At age 13 she tries to kill herself. She enters the hospital and has no explanation to offer the doctors. They put her on medication and she stays on it till she goes away to college. There, she finds she is a total failure in relationships.

Home C - She lives in a home where the mother and father talk about their feelings with feeling words. Where they teach her the names of her feelings right along with the colors and the numbers. And a home where they ask her how she feels and give her emotional validation. She sees her parents hugging, and arguing then hugging again. She sees them holding hands and laughing together. She sees the love between them and they have plenty of love and patience for her. She feels confident as teen and is never afraid to be emotionally honest. If people ever make fun of her or hurt her at school, she knows she will get emotional support at home.

So the same baby can have very different experiences as she grows up. At age 35 we might see the woman from Home C and say she has very high emotional intelligence. Everything in her life might be going well. But had she been raised in either Home A or Home B she might be called an alexithymic, or she might be dead from having killed herself.

I have been meeting people from all kinds of home environments. I see the difference that it makes. Therefore, as in the section above, I ask you to be very, very careful when you talk about things like alexithymia and emotional intelligence.

Primary vs. Secondary Alexithymia

As I talked about in the section above about where it comes from, there are two basic possibilities: nature or nurture. The academic people seem to be saying that if it comes from nature, it is "primary" alexithymia. If it comes from nurture (or the lack, or opposite, thereof), it is "secondary." This is a distinction no one in the academic field of emotional intelligence seems to be making, but is one I have been stressing for a few years on this site. Maybe the academic researchers in EI will learn something from the researchers in Alexithymia. One can always hope anyhow! (Not to mention write on one's website!)

Anyhow, here is how the academic people have discussed this:

For Freyberger, primary alexithymia is an enduring feature of a patient's profile, like a personality trait, that changes little over time or with changing circumstances. Secondary alexithymia, on the other hand, occurs in reaction to severe psychological trauma, whereby a patient suppresses painful emotions as a temporary defence against trauma; when the psychological stressor is removed, the alexithymia disappears.

In later years, Sifneos reconceptualized the primary/secondary distinction, basing it on the difference between neurological causes and psychological causes. In Sifneos's terms, primary alexithymia has (by definition) a distinct neurological basis and a physical cause, such as genetic abnormality, disrupted biological development or brain injury. Secondary alexithymia results from psychological influences such as sociocultural conditioning, neurotic retroflection or defence against trauma. Secondary alexithymia is presumed to be more transient than primary alexithymia and hence more likely to respond to therapy or training.

Due to the possible ambiguity of the primary/secondary distinction most contemporary authors prefer not to use it.

This last line really gets me! To me its like saying, "Its too hard to figure out where it comes from, so let's not bother trying." That attitude seems a bit irresponsible to me since it makes a huge difference where this thing called "alexythimia" comes from. Take the examples I gave about the three homes above. Wouldn't society be better served if we knew why someone had the problems the girl's from homes A and B did? If we know why something has happened, we can address the root causes of it.

This is the same with asking why someone shows signs of low emotional intelligence as a teen or adult. And it is also the same as trying to figure out why a teen is suicidal instead of just using the convenient excuse that they have some "disorder", implying it is is all nature and no nurture. It seems that cultures where there is a high rate of teen self-harm and teen suicide, such as England and the USA, prefer not to take a look in the mirror to see what they might be doing wrong. They seem to want to stick their heads in the sand and not even look for any connection between their prevailing values, the school system and teen self-harm/suicide. So I say that in all cases, we must keep trying to make the distinction between things caused by nature and things caused by nurture.

This very issue is addressed in some detail by "Hal" on this site http://www.alexithymia.supanet.com/faq.html

Here is a quote from it, with my interpretation of it below.

Is it psychological or neurological?

This question is often asked of psychiatric syndromes, usually with the aim of attributing responsibility or identifying suitable therapies. There is evidence that alexithymia can be either neurogenic (caused by biological abnormalities) or psychogenic (caused by upbringing or psychological trauma).

If alexithymia results suddenly from a head injury, the cause is probably neurological; if it correlates with a history of abuse or neglect it is probably psychological. But it is rare for the cause to be so readily identifiable. In fact, there is no recognized functional distinction between neurological and psychological strains of alexithymia, and hence no clinical test to ascertain the cause.

Moreover, the brain is continually changing both psychologically and neurologically. A developmental or biological failure may trigger a defensive psychology, which in turn causes the physical brain to develop abnormal 'wiring'. So while psychodynamic therapy may be the obvious choice in working to change secondary alexithymic defences to more healthy ones, it may not be able to correct the years of built-up neural anomalies and brain tissue development. So psychological and neurological causes may be intimately intertwined and inseparable in analysis.

Nonetheless the question is still worth posing. If the neural structures and pathways linking different aspects of emotion processing have sustained damage by injury or atrophy, the alexithymia may be completely irreversible and the focus should be on learning new compensatory coping strategies. However, if the structures and pathways are still intact but underused (perhaps the neural activity is being inhibited by other processes), then there is a greater prospect of reducing the alexithymia by psychotherapeutic intervention. (Accordingly Sifneos—who works with neurological alexithymics—favours compensatory strategies; whereas Krystal—who works with post-traumatic alexithymics—promotes a form of therapy based on personal training and education in feelings and their psychological signficance.)

Basically, he seems to be saying that alexithymia could be cause by a) birth defects b) a physical injury or c) upbrining or d) psychological trauma. To his credit, he says though it is hard to know where it comes from, "the question is still worth posing." He then says it makes a difference in the treatment and he tells us that Sifneos likes one type of plan and someone name Krystal, likes another. Krystal is said to like to try to help the person using "personal training and education in feelings and their psychological signficance." So in other words, he seems to be saying that he tries to get them to learn to talk about their feelings and also to understand why feelings and I talking about them, is important.

Nowhere in this discussion, though, is the idea of needed social change mentioned. It is not mentioned that we might want to look at the whole of society to see why so many people have trouble talking about their feelings I will give you my very short answer to this question in the section called Alexithmia and Society.

This is from the website.... http://www.alexithymia.supanet.com/faq.html

Alexithmia and Society

At several pages on this page I talk about nature vs. nurture, and I encourage us to try to figure out which is more responsible for some thing like alexithymia. And I suggested that we might want to look at the whole of society to see why so many people have trouble talking about their feelings. I will add that is not just people who are somehow "officially" called alexithymics, but I'd say there are a whole lot of people who have this difficulty.

My explanation for this is that the society we have created simply does not place a high value on feelings. Instead, we seem to value nearly everything else. Money, appearances, material things, grades, test scores are a few examples.

It has become painfully obvious to me that children and teenager's feelings are not valued in the typical school around the world. And I have personally been inside schools in many countries. At present, it is more important for children and teens to obey the teacher than to even take time to listen to their own feelings. Students are not asked how they feel about decisions. They are not asked how they feel about what is happening inside the classroom walls. They are not asked how they about one teacher vs. another. As I said in my 1995 book, they are taught the names of plants and insects, not to mention a lot of dead people, but not the names of their own feelings. And teachers are not in the habit of expressing their feelings with feeling words.

Nor are feelings valued at work. Dan Goleman has been making a lot of money talking about emotional intelligence in the workplace, but he does not even include emotional literacy in his "corporate definition" of emotional intelligence. Even the researchers Mayer, Salovey and Caruso have not placed a very high value on expressing feelings with feeling words. They talk a lot about using emotions and managing them, but they tend to skip over actually talking about them.

Another problem is that most of us live in places where it is not safe to show your feelings. It is not safe to be emotionally honest. Children and teens learn it is safer to lie about their feelings.

My basic hypothesis is that our society is so dysfunctional and we are in so much pain most of the time that we could not handle it if we stopped to either really feel our pain or really talk about it. There is just too much of it. If we made time to really talk about things like the death and bloodshed in Iraq, Israel, Palestine; the treatment of the POW's; the fact that students are killing other students in schools in a country that likes to think it is a model for the rest of the world; the fact that teens are cutting, burning and killing themselves....

If we really faced all of this, could we handle it?

I say that people know they can't handle their real feelings. So they learn not to talk about them. Adults don't talk about them, so how could we expect children or teens to learn to?

To have a less, "alexithymic" world, then, will require significant changes, and will surely have fairly dramatic impact on the future of human relationships. I suggest that the time to begin is now, and that the benefits will be worth the difficulties during the transition. I also suggest the place to start is in the schools. More specifically, teach children and teens the names of their feelings, in specific, their negative feelings, since those are the ones that tell us something needs to be changed. Then I suggest we listen ask the students how they feel, and then really listen. And then start to make changes to take their feelings into account.

This is how I see us changing society. If we do this, I predict there will be a noticeable decline in what is called alexithymia.

Is There a Cure for Alexithymia? - My personal story

I say yes. (At least for what some call "secondary" alexithymia.) I say this because I was once unable to express my feelings with words. Now I do it so much it is often annoying! So how did I "cure" myself? It's a bit of a long story but I will give you some bits of it for now.

One of the things I did was to start to read about feelings. This might have started giving me the vocabulary.

Something else I did was I started taking time to think about my feelings. To reflect on them.

Then I also started to write about them in personal journals.

At around the same time I went to some support group meetings where people who were less "alexithymic" than me were talking about their feelings. I was uncomfortable in these meetings at first. They were meetings like AA meetings (Alcoholics Anonymous) and I didn't feel very much at home in them since I wasn't religious (AA meetings have a strong religious base) and I didn't drink and never had. But still, in those meetings, I started hearing people talk about *their* feelings. And I saw people crying. And this is bring tears to my eyes right now to write about it.

So all of this helped me start to eventually *feel* my own feelings a bit more. I also started my own list of feeling words, which as you can see has now grown to be probably the largest in the world.

I also discovered teenagers. I discovered them on the Internet through a website called Opendiary. I discovered that teenagers were very emotional and, especially for the females, nearly constantly talk about their feelings. I started chatting with several teenagers and found I could let myself really open up with my feelings with them. Until I actually started chatting teens, I had no idea they were so emotional, nor did I have any idea they could be so emotionally supportive.

I come from a very emotionally dysfunctional family and it left me as a very emotionally needy adult. As a result I have needed a lot of emotional support and emotional healing. I could never begin to thank my teen friends enough for the emotional support, healing and understanding they have given me over the past few years. They have provided me a safe place to show my emotions. And this is one thing I would say is critical in the recovery process.

So that is a little about my personal story. I wish you well on your journey if this is an issue for you.

Steve Hein
May 2005

Emotional Literacy - The opposite of alexithymia

When a Patient Has No Story To Tell: Alexithymia

by Rený J. Muller, Ph.D.

Psychiatric Times July 2000 Vol. XVII Issue 7

Below are excerpts from a doctor who works with people who have self-harmed and have ended up in the emergency room (ER) of a hospital in the USA. My comments are in italics.

Occasionally, patients who clearly have problems and are in great emotional pain will insist that they have no problems, that life is fine and that they have no idea what is wrong. Their story is that they have no story. These patients seem unable to find the words necessary to describe their feelings.

In 1972, Peter Sifneos introduced to psychiatry the term alexithymia, which (derived from the Greek) literally means having no words for emotions (a=lack, lexis=word, thymos=emotions). Alexithymia is not a diagnosis, but a term useful for characterizing patients who seem not to understand the feelings they obviously experience, patients who seem to lack the words to describe these feelings to others. Identifying this deficit is important because it helps the clinician make a diagnosis and chart a therapeutic course.

Clearly, someone who cannot verbally express negative emotions will have trouble discharging and neutralizing these emotions, physiologically as well as psychically. All feelings, whether normal or pathological, are ultimately bodily feelings. Those with alexithymia lack a lived understanding of what they experience emotionally.

From the perspective of development, alexithymia implies a glitch in the process that permits the expression of feelings in words that capture the body's involvement in these feelings. Perhaps the child's mother failed to sufficiently encourage a language of feelings (surely excluding her from the pantheon of Winnicott's "good enough" mothers).

I would say it is more than "perhaps". I'd also say that the children and teenagers learned it was not safe to be emotionally honest at home. This is a very common theme in the suicidal teens I've known.( I am not sure who Winnicott is but later I will do a bit of research if I remember to.)

Alternatively, emotional trauma later in life may compromise the connection between what is felt and what can be grasped about this feeling and can be put into words, particularly if that link were tenuous to begin with.

If a patient has no story to tell a clinician, even at a time when emotions are stirred high enough to prompt an ER visit, it seems a good bet that person has no story to tell themselves either. Having no story almost certainly implies an impaired identity: Who we know ourselves to be depends heavily on the story we tell ourselves about who we are. The inability to express emotions verbally implies a deficient interior life. Inevitably, those who cannot match words to feelings will live out that deficit in their contacts with others as well. To have no words for one's inner experience is to live marginally, for oneself and for others.

"Kisha," 16, was brought to the ER by her mother after she held a curling iron to the outside of her upper left arm, causing a large, painful burn. Kisha had just started her junior year in high school and also worked as a cashier in a convenience store. She was an average student, but her mother assured me she was one of the most popular girls in her class. Kisha lived with her parents, two sisters and brother. She had never used illicit drugs or abused alcohol. "I'm a virgin," she said easily and proudly when I asked if she had a current boyfriend, which she did not. Kisha denied physical and sexual abuse, and her mother later corroborated her denial. Asthma, occasional bronchitis and seasonal allergies were her only concessions to good health.

Kisha acknowledged feeling depressed recently, although she did not admit to having any of the symptoms of a major depressive episode. Her appetite had not changed, and she was sleeping up to 10 hours a day, the norm for her. My best diagnostic call was depressive disorder, not otherwise specified.

Asked how she felt during the interview, Kisha answered with an easy smile, "I feel fine." It seemed to me the happy face owed more to practice than to spontaneity. When I asked Kisha why she burned herself so seriously, she looked at me blankly and said she did not know. She acknowledged no disappointment or setback, no problems at home or at school. According to Kisha, everything was fine.

The burn that brought Kisha to the ER on the evening I interviewed her was not her first act of self-mutilation. Seven months earlier, she had jumped out of a second-story window. Inexplicably, she did not go to a hospital, either for medical treatment or for psychiatric evaluation. I was the first mental health clinician Kisha had spoken to.

During the previous year, Kisha also had made modest cuts with a razor on the underside of one forearm and on her cheek. "I was just bored," was her explanation. Asked why she jumped out of the window, her only response was, "I have no idea." She denied this potentially lethal act had anything to do with what was going on in her life at the time. Despite my persistent efforts to elicit more information about the reason for Kisha's self-destructive behavior, she did not offer a scintilla of explanation. That she was acknowledging no reasons for what she had done did not strike her as the least bit odd.

Kisha's mother told me with understatement that her daughter "keeps it all inside." Clearly, Kisha was not the only minimizer in this family. The mother also volunteered that Kisha had trouble getting over disappointments. The day before she burned herself with the curling iron, a woman who had promised to take Kisha to a museum in another city abruptly canceled the trip. At the time she jumped from the window, Kisha was having problems with a boyfriend, and the relationship soon ended. Kisha vigorously denied she had difficulty getting over disappointments in general or that a particular disappointment had anything to do with any of her self-destructive acts.

Kisha had no words for the feelings that led her to do these things. But her silence spoke volumes. Clearly, she had emotions she did not acknowledge or understand. This young woman put a smile on her despair. She gave no hint of what was going on under the mask.

Most patients who come to the ER after harming themselves seem eager to discuss the meaning of their behavior. Rather complex issues are clarified, often with startling insight. These patients are willing to have their initial, often self-deceiving explanations challenged and to allow the subtext of their destructive act to be interpreted to them. But after Kisha burned her arm, no words came to name the emotions that drove her to do this. She clarified nothing, for herself or for me. Kisha was alexithymic.

Many patients who mutilate themselves as Kisha have borderline personality disorder. During the interview, and later in a separate conversation with Kisha's mother, I looked hard for borderline dynamics and borderline symptoms. Besides Kisha's obvious, although unacknowledged, proclivity for turning disappointment into physical self-injury, I could not identify any.

Kisha denied any further intention or plan to harm herself. I took her at her word, for the moment anyway. But I knew she was not finished with these self-destructive acts. Kisha did not need to be hospitalized. She did need immediate, intense outpatient therapy with someone who knew how to draw her out and help her put words to the feelings-whatever they were, wherever they came from-that were eating at her from the inside and causing her to mutilate herself on the outside. Fortunately, her parents had insurance. I referred her to a nationally known psychiatric hospital in the city for outpatient care.

Particularly memorable among the many self-mutilating patients I have evaluated in the ER was a 19-year-old college student who had cut marks of various lengths and depths all over her arms, legs and torso. The incision that brought her to the ER was made with a razor blade on the underside of her right wrist. After making the initial incision, several repetitive cuts went deeper than she intended, and she severed a tendon. The hand surgeon who was called in the middle of the night to do the repair had trouble locating the proximal end of the tendon, which had retracted into the forearm after snapping. While he called his supervisor for assistance, I completed my interview.

This young woman, lying on a gurney under bright fluorescent lights, facing a long period of rehabilitation with an uncertain outcome, unabashedly told me about the problems she had, her feelings of anxiety and depression, and how for many years she had tried to counter this emotional pain by cutting her body and watching the blood come.

Unfortunately the doctor didn't tell us more about the specifics of her anxiety and depression. But I can promise you it goes back to her family. And also, if she had been self-harming for "many years", as he says, then it started when she was living at home. Note how the doctor confirms that, as I have said on my site, teenagers self-harm to stop their emotional pain.

Next he talks about a 37 year old named Maureen who also was self-harming and couldn't label her feelings. Then he wrote this:

Although not fully empirically validated, alexithymia is a useful clinical construct. For Kisha and Maureen, this word, so descriptive in its Greek roots, specifies a real phenomenon and identifies a deficit of self. Neither woman shut down or clammed up just for their ER interviews; the disconnect between feeling and words was part and parcel of their daily experience. Both women were personable, outgoing and articulate-except about what they felt. Neither showed any sign of schizoid personality disorder, a diagnosis that needs to be considered when patients seem detached from their feelings and lack insight. Being able to say that Kisha and Maureen had no words for their feelings is a major first step in identifying what is pathological about their worlds. How could anyone who cannot discharge negative emotions over a long time not be depressed? Or have any number of other emotional, as well as somatic, problems?

Identifying a patient as alexithymic opens a door to that person's pathological world and creates a fertile field for exploration in therapy. A workable identity can develop only after the elements of a person's life coalesce into a minimally satisfactory story. Paraphrasing Winnicott, a "good enough" identity requires a "good enough" story. It is the therapist's job to help the alexithymic patient convert a nonstory into a story that is at least partially authentic, so a more authentic identity can evolve from that story.

Further Reading

Kooiman CG (1998), The status of alexithymia as a risk factor in medically unexplained physical symptoms. Compr Psychiatry 39(3):152-159.

Lesser IM (1985), Current concepts in psychiatry. Alexithymia. N Engl J Med 312(11):690-692.

Lumley MA, Stettner L, Wehmer F (1996), How are alexithymia and physical illness linked? A review and critique of pathways. J Psychosom Res 41(6):505-518.

Nemiah JC (1977), Alexithymia. Theoretical considerations. Psychother Psychosom 28(1-4):199-206.

Sifneos PE (1972), Short-Term Psychotherapy and Emotional Crisis. Cambridge, Mass.: Harvard University Press.

Sifneos PE (1996), Alexithymia: past and present. Am J Psychiatry 153(7 suppl):137-142.

Taylor GJ, Bagby RM, Parker JD (1991), The alexithymia construct. A potential paradigm for psychosomatic medicine. Psychosomatics 32(2):153-164.

Zeitlin SB, McNally RJ, Cassiday KL (1993), Alexithymia in victims of sexual assault: an effect of repeated traumatization? Am J Psychiatry 150(4):661-663.

The original article was found here http://www.psychiatrictimes.com/p000771.html

At the end of the article it tells us that:

Dr. Muller works for the Crisis Intervention Service at Union Memorial Hospital in Baltimore. His most recent book, Beyond Marginality: Constructing a Self in the Twilight of Western Culture, is available from Praeger Publishers.

My thanks to Brooke for her help on research for this page