Updated: Dec 6, 2020
‘I’m fine’. We all say it. Sometimes we mean it and sometimes we don’t, but we usually know whether we mean it or not. Some people will only ever state they are fine regardless of the chaos unfolding in their life, and they mean it. They feel fine, because they feel nothing much of anything at all.
Alexithymia literally translates as ‘no words for feelings’ and is also known as emotional blindness. It’s characterised by a deficiency in knowledge and understanding of emotions. People with alexithymia have limited emotional awareness and trouble identifying emotions in themselves and others. They may have difficulty describing emotions, and an inability to differentiate between the different body sensations of emotions. In practice, being alexithymic makes it difficult to recognise when you are feeling something, and even more difficult to give it a name. Most people with alexithymia are not aware they have a problem because it’s all they have ever known.
Alexithymia is very common in people with psychosomatic problems, substance abuse, anxiety disorders, PTSD and depression but it is not a mental health condition or a symptom of illness; more it’s an aspect of personality relating to how the person experiences emotions. Understanding alexithymia can however provide a useful framework for working with people’s mental health. For example, if you can identify that someone has alexithymia you have a good idea of where their depression, eating disorder, or anxiety may be coming from. How could someone that has not been able to talk about and discharge their negative emotions over decades not be depressed or have some other psychological issues?
So what causes it? The cause/s are not fully understood but alexithymia is prevalent in people who have had difficult childhoods. Children who lived in households characterised by emotional neglect and abuse simply did not learn how to understand emotions, not least because they had no healthy modelling. Children who were punished for expressing negative emotions such as anger or jealousy generally learnt it is safest to suppress them, and children who had their feelings denied by their parents learned not to trust their gut. Children of narcissistic parents, where emotions in the family were often confused, enmeshed, and manipulated are unlikely to be able to identify their emotions as separate to others. Emotional feelings are ultimately bodily feelings, and when children learn to ignore these physical sensations they do not develop their ability to understand what they are experiencing emotionally.
As with most things alexithymia exists on a continuum; at one extreme are people that live their life with no willingness or ability to tolerate and experience emotions at all, whilst at the other are people that just don’t seem able to express how they feel very easily. The degree of alexithymia experienced by an adult likely depends on a number of things including how much emotional expression was modelled, reinforced, or punished during childhood. It is also likely to be dependent upon the child’s experience at different ages - it is recognised that trauma and neglect cause changes in the developing brain that make it difficult for feel and identify emotions in later life. Alexithymia can also develop in later life in response to traumatic events; where people shut off their emotions in order to cope, and in cases of brain injury as well as illnesses such as MS, Parkinson’s and Alzheimer’s where there are significant changes within the brain.
Alexithymia might not sound like a big deal. It might actually sound quite nice to not feel much because that way you don’t experience the turbulent highs and lows in life; you are always just ‘fine’. However, alexithymia can seriously impact upon a person’s life:
1. We cannot be selective. When we learn to ignore or repress an emotion, we learn to repress them all. This means we are unable to feel happiness, excitement, joy alongside not feeling anger or hurt. Without an ever-changing landscape of emotions life becomes dull, predictable, monotonous.
2. Relationships are hard. People with alexithymia can present as aloof or cold. They may be ‘emotionally numb’ or/and refuse to discuss emotions, which can be hurtful to others. If there is an inability to understand one’s own emotions, combined with an inability to understand other people’s emotions, significant clashes can occur. It is also hard to form close bonds where one person is emotionally absent.
3. Outbursts. The physical sensations of emotion are part of our survival mechanism; designed to get us to move or act to ensure our safety i.e. we feel fear, so we run. Emotions are also designed to be fleeting – we feel them, we act, the emotion is released, and we return to balance. We cannot switch off our survival systems, so whether we consciously ‘feel’ emotions or not the body keeps reacting the same. The difference is we do not act, and the emotions are not released. Instead they build up in the background before finally coming out as extreme outbursts. Many people with alexithymia experience just one main emotion, irritability, which can be both erratic and irrational.
4. Illness. Repressed emotions create stress within the body; a constant form of tension that is never released. It is beyond the scope of this blog to talk about the impact of stress on the body, but suffice to say it's estimated that approximately 90% of illness can be attributed at least in part to stress. Repressed emotions are increasing being recognised as contributing to many physical illnesses – from MS, to endometriosis, to cancer. Serious illness aside, alexithymia can be the cause of all manner of aches and pains within the body.
5. Identity. Having no words for emotions can mean that people have no real story to tell about themselves. Who we understand ourselves to be depends heavily on the story we tell ourselves about who we are, so where there is no story there is no clear identity.
6. Guide. As well as being part of our survival mechanism, feelings are meant to be our guides through life. Emotions teach us about what we want and what we don’t want and steer us towards the things that bring us joy. When we do not feel much at all it’s hard to know which way to go. When our sense of identity and who we are is also weak it is a double whammy – we don’t know who we are or what we want.
So, how to heal. Simply put we need to learn how to feel. Usually this starts with being able to feel the physical sensations in the body which have been ignored for so long. Mind/body practices such as yoga are amazing for this as they teach us to notice what we can feel. We begin to notice heart rate, breathe rate, temperature. We begin to see patterns in what sensations come up together and what they might mean. Over time we can start to notice when these ‘symptoms’ occur i.e. we may notice a gripping in the throat that arrives when we don’t say what we mean, a heat in the back of the neck when we feel angry, a hiking of the shoulders when we feel tense. These important physical sensations become our emotional cues. Meditation and mindfulness practices can be also hugely beneficial in helping us learn how to notice what we feel and why.
For trauma, especially childhood trauma, the process of learning to feel may involve a therapist. We may need help to feel safe enough to speak, to pick through the events of our life, identifying why we have alexithymia, and how it continues to impact our life now. We may need someone to patiently sit with us through hours of therapy, gently nudging us to notice what we feel instead of what we think. We may need help to identify the coping strategies developed to ‘not feel’, then help to work out how to get rid of them.
For most people, the process needs to involve release. There may be decades worth of emotion held in the body that needs to be cried/shouted/stretched/ran out. Alongside things like therapy and yoga people may also find enormous benefit in treatments such as craniosacral therapy, reiki, or acupuncture which are brilliant at releasing long held emotions.
Finally, we need to learn how to identify and express our emotions going forward so we do not continue in the same patterns. This could involve absolutely anything from removing toxic people from our life, to learning how to speak our mind, or learning EFT.
Alexithymia is often subtle and people may not know they have it, yet it continues to silently shape their life. A recent conversation with a therapist summarised alexithymia for me. I was asking her how some people come out of difficult childhoods unscathed, with seemingly no mental health difficulties when by all rights they should have many. Her reply was this: people do not come out unscathed, sometimes it isn’t their mind that took the hit. Instead it breaks their heart. They lost their ability to feel, and with it their ability to live a full life. Freedom comes from learning how to feel.
To me alexithymia is a scar from negative and traumatic experiences, but like all scars with a bit of work it can be softened and released. Only then can we move freely.