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SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

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Alexithymia: an emotional gap hiding under the mask of normality

Alexithymia is a psychological state of a person in which a person, having lost the ability to determine and display his own emotions, is forced to try to look normal in the eyes of others. The psychiatrist Saito Satoru talks about this disorder using examples from his own practice, as well as the example of the heroes of the novel "Man of the convenience store" ( Kombini ningen , by Murata Sayaka), awarded the Akutagawa Prize for 2016.

In psychiatry there is a term "alexithymia". It consists of the negative prefix "ἀ" and two stems: "λέξις" (word) and "θυμός" (feelings, emotions). This term describes a psychological state where a person is unable to evaluate and describe their own emotions. In order to have a holistic view of one's own life, the individual must be aware of and distinguish what he feels. However, there are people who are incapable of this - they do not understand in what situations this or that emotion arises in them. Features of alexithymia appear in such people in those moments when they are overcome by anger, sadness, or any other strong feeling that they are not able to define and express.

In fact, with the exception of babies, there are practically no people in modern society who would cry or scream, completely without restraint. It is understood that an adult member of society should control himself and not show such primitive emotions outwardly. And if he is not able to restrain himself, then he needs treatment.

Young people striving to conform to the notions of "normality" learn from the older generation to suppress the expression of emotions. Over time, some of them lose the ability to recognize their own feelings. Suppressed anger, sadness become the cause of psychosomatic diseases and hypochondriacal disorder. Hypochondriacs are characterized by a clear manifestation of somatic symptoms in the absence of any significant pathological abnormalities. As a result of an anxious set and constant concern about health, the functions of the heart, gastrointestinal tract and other autonomically innervated systems can be disturbed. And this, in turn, leads to the development of arterial hypertension, peptic ulcer, etc. That is why hypochondria is considered a psychosomatic disease.

However, with alexithymia, not only negative emotions are blurred, but also positive ones - a person is not able to experience such feelings as joy or inspiration. The loss of the ability to experience pleasure is called anhedonia. This disorder is characterized by a loss of motivation for activities that the individual enjoyed in the past. The development of anhedonia is an important indicator in the diagnosis of pathological depression.

Under the guise of normality

I have my own psychiatric practice in Tokyo, and I encounter people suffering from depression and hypochondria on a daily basis at work. During the first meeting, most of them show no signs of suffering or despair. And I have to pull off their mask of normality, under which they hide their illness, which needs treatment.

Cover of "Convenience Store Man" (illustration courtesy of Bungei Shunju)

I thought about this when I read the novel "Convenience Store Man" for which Murata Sayaka recently won the Akutagawa Prize. Indeed, in this story we are talking about a person suffering from alexithymia. The heroine, a woman named Kokura Keiko, worked for 18 years as a saleswoman in the same minimarket ( combi) - it is on her behalf that the story is being told. She made it a rule never to show her feelings or express judgment. Instead, she has created a "patchwork personality" by copying the behavior and adopting the habits and mannerisms of the women around her (mostly work colleagues), whom she considers correct and admires for their style. This effective and convenient strategy allows it to adapt to its own environment. The moment she arrives at work shortly before the start of her shift and changes into her work uniform, Keiko becomes a function, a convenience store man. Now all that is required of her is to perform the prescribed duties for the appointed time, using the skills she has learned and the judgments she has borrowed appropriate to the occasion. The school years of the heroine passed under the endless complaints of parents who were dissatisfied with their individualistic daughter, and constant pressure from school teachers. As an adult, she is grateful for the opportunity to hide her identity under a faceless uniform.

However, when Keiko suddenly realizes that those around her feel sorry for her - a single woman who worked as a saleswoman in a minimarket for 18 consecutive years - she becomes extremely worried. At this moment, she meets a new minimarket employee, a man who is the complete opposite of her. He is convinced that society has turned its back on him and that everyone is hounding and persecuting him. So he doesn't even try to appear normal, and very soon he is fired from the convenience store. Keiko invites him to stay with her. At first glance, it seems that they are a very harmonious couple, but their relationship is built on a cold calculation. For a workaholic Keiko, this is an opportunity to create the appearance of a romantic relationship; for a lazy man, life with Keiko is an excellent hiding place from the injustice of a cruel world. But their life together upsets the fragile mental balance that Keiko has maintained and strengthened in herself throughout all these eighteen years.

The caustic remarks of her roommate expose her spiritual emptiness, the gaping emptiness of her personal space, which Keiko had refused to notice for so many years. Refusal, denial is a primitive psychological defense mechanism, a subconscious attempt to ignore the problem, the existence of which is obvious to any outside observer. And the one who denies the obvious looks infantile and eccentric in the eyes of others.

Realizing the hopelessness of his situation, Keiko quits his job and ceases to be a "man of the convenience store". She has no choice but to lie all day under the covers, on the futon, which she spread out inside the closet. I call this phase "bed addiction" and I believe that it is the starting point for the development of other types of addiction: from drug or alcohol addiction to sexual addiction. In fact, both addictive behavior and "show normality" are desperate attempts to get out of the quicksands of the emotional vacuum.

This story has a somewhat happy ending - Keiko starts working at the convenience store again. But I do not think that this will make many readers laugh too much, as they notice the connection between excessive obsession with work and the meaninglessness of the heroine's personal space.

Refusal to feel

"Bed addiction" is essentially a regression to the so-called "primal sleep" - a dream-like state characteristic of infants. This is exactly the state that heroin addicts so passionately desire to achieve. A similar process of regression is also experienced by recluses.0003 hikikomori . Every day this quagmire sucks in hikikomori more and more, and getting them out of it is not an easy task.

Here it is important to pay attention to one point. A baby who falls asleep while nursing and wakes up to find that he has been taken from his mother's breast will feel restless, angry, flushed and crying.

Older babies (between a year and a half) also live in a world of basic emotions such as anger, anxiety, depression, or sadness. But adults hikikomori are deaf to these emotions. At first they themselves refuse to feel anything, and then they simply lose this ability and fall into a state of alexithymia.

Break free from the spell of "normality"

Such people sometimes come to my clinic for help, mistaking their condition for depression. For example, a housewife came to me who told me that after graduating from university she got a job at a firm right away, but worked for only a year, because office work seemed boring to her. She then found a part-time job at a sadomasochistic (SM) club, a place she liked so much that she worked there for four years. Shortly before she turned thirty, she resigned from the club, judging that sooner or later she would have to do it anyway. Some time later, after an active search for a suitable party ( konkatsu ) she got married, had a baby, and began to lead a "normal" life as a housewife. And then she suddenly found that she spends most of the day in bed or in close proximity to it.

Her husband - a typical sissy, who also suffers from atopic dermatitis - quickly realized that his wife would not take care of him to the same extent as his mother did, and divorced her. At the time of her visit to me, about a month had passed since the divorce.

I think some of my colleagues would have diagnosed this patient with depression or adjustment disorder and would have given her antidepressants. But I noticed how strong her desire to be, or at least seem normal. It was it that made her suppress her individuality and doom herself to life in a world that causes nothing but boredom in her.

Everyday work in the SM club was fraught with danger, but at the same time excited her – the idea that she was working in a “non-standard”, “abnormal” job served as a strong source of emotional excitement. Thus, "normality" is just an illusion, an ideal that can be different for different people.

My patient says that she is already thirty-five, the figure is no longer the same, and that "what was in the past cannot be returned." I do not dispute this point of view. But whether she returns to work at the SM club or not, I think she needs to remember and rethink the strong, exciting feelings she experienced while working at the job she loved. My task is to return to this woman the ability to feel strong emotions, restoring her connection with her own eroticism. I have to convince her that she doesn't need to hide behind a mask of normality.

Title picture: Design Pics/AFLO

(Japanese-language article published November 18, 2016)

What is it like to live without emotions?

  • David Robson
  • BBC Future

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Image copyright, Getty

There are people in the world who do not know joy, sadness, love... Sometimes this is due to a violation of brain activity, which has received the name "alexithymia" in modern science. Correspondent BBC Future tried to find out what difficulties those who live with such a disorder have and what benefits it brings.

Caleb tells me about the birth of his son, who is now eight months old.

"Have you heard how parents talk about the feelings of love and joy that came over them at the sight of their newborn baby?" he asks.

"Well," my interlocutor continues after a dramatic pause, "I didn't feel anything like that."

His own wedding didn't touch him much either. Trying to explain his then state, he gives a metaphor for a Broadway show: the audience is sitting in the hall; she is emotionally involved in the theatrical action; and behind the scenes, in the meantime, stage workers are on duty, who, remaining indifferent to the performance on a sensual level, participate only in its technical implementation.

(Other BBC Future articles in Russian)

At his own wedding ceremony, Caleb, unlike most of the participants in this exciting event, did not experience a surge of feelings.

"I played my role purely mechanically," says Caleb (he asked not to be named).

Even as his bride walked down the aisle, the only thing he felt was blood rushing to his cheeks and heaviness in his legs; in his heart he felt no joy, no happiness, no love...

Caleb confesses to me that he never experiences emotions at all, neither positive nor negative.

We met on an Internet forum for people with the so-called alexithymia - a kind of emotional color blindness that deprives a person of the ability to distinguish and express various sensory-emotional nuances.

Photo copyright, Getty

Photo caption,

An unemotional person may find the behavior of other emotional people inappropriate

Of those who suffer from this disorder, about half are autistic. However, Caleb and many other "Alexas" do not exhibit any other autistic traits other than being emotionless, such as compulsive (compulsive) behavior, for example.

What does it mean to "fall in love" for someone who is basically incapable of feeling love or even sympathy for another?

A deep study of "emotional color blindness" can shed light on a number of comorbidities such as anorexia, schizophrenia, irritable bowel syndrome.

The stories told on the forum by members of the Alex community make us rethink the emotional experiences that we all seem to know so well.

Take, for example, being in love. How can a person fall in love who does not even know such basic feelings as tenderness and sympathy? After all, it is they who ignite the spark of love in us...

Multi-layered emotional and sensory sphere

You can understand what "emotional dumbness" means by a good example of a matryoshka doll, a multi-layered toy consisting of several dolls nested in it, each next one is more intricate than the previous one.

At the heart of the emotional and sensory sphere of a person are bodily sensations - for example, when we see a beloved, we feel our heart jumping; and when we are angry, we often experience stomach cramps.

Our brain assigns a certain value to each of these sensations - then you know whether it is positive or negative, strong or weak.

This is how amorphous sensations take shape, and a certain conscious image appears in the emotion.

Emotions can have many nuances and sometimes combine experiences of different colors (for example, light sadness).

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Sooner or later we find suitable words to describe our emotional states - we are able to verbally describe our state of despair or joy, for example, and we can also explain what brought us to a particular emotional state .

In 1972, when alexithymia was first scientifically described, it was assumed that the problem arises precisely at this last, linguistic stage; it was assumed that people suffering from alexithymia at a deep level feel like everyone else and that they are unable to only describe their emotional state in words.

Scientists have suggested that this may be due to a disruption in normal communication between the two hemispheres of the brain, which prevents the transmission of signals from the emotional centers, located mainly in the right hemisphere, to the left hemisphere centers responsible for speech.

We need this kind of transmission in order to verbalize what we feel, explains Katharina Görlich-Dobre of the RWTH Aachen University in northern Germany.

This could be seen when doctors first tried to treat epilepsy by removing the connecting two lobes of the fiber; such surgery reduced the number of epileptic seizures, but the patients who underwent the operation became "emotionally mute. "

Another important, if less sensational, discovery made by Görlich-Dobre herself through tomography is that people with alexithymia have abnormally dense neural connections.

image copyrightSPL

Image caption,

When the fibers connecting the two hemispheres are surgically removed, patients become emotionally mute and unable to express their feelings. connection with emotional zones, respectively, is broken.

Today, scientists already know that there are many different types of alexithymia.

Some "Alexas" have difficulty expressing their emotions and feelings, while others (like Caleb) are not even aware of them.

Richard Lane of Arizona State University offers as an analogy the phenomenon of visual loss in people who have sustained an injury to the visual cortex; the eyes themselves were not affected; nevertheless, the ability to distinguish visual images is lost.

In a similar way, a damaged neural circuit involved in the processing of emotional signals can prevent feelings of sadness, joy, or anger from reaching consciousness (to continue the metaphor of a multi-layered doll, the problem arises at the level of the second "doll": the body reacts normally, but the integration of sensations is not occurs, and, accordingly, an emotional thought cannot be formed).

"It's possible that an emotion is activated and the body responds to it, but the person is simply not aware of their emotions," says Lane.

Recent studies using magnetic resonance imaging (CT) have shown signs of a more basic perceptual problem in some types of alexithymia.

Görlich-Dobre, for example, found a lack of gray matter in the centers of the cingulate cortex responsible for self-awareness, and suggested that this blocks the conscious representation of emotions.

And her colleague André Aleman of the University Center for Medical Research in Groningen, The Netherlands, found deficits in attentional areas of the brain when alexithymic people look at emotionally charged pictures. He had the impression that their brain simply refused to register emotions.

"It seems to me that this is quite consistent with Lane's theory," says Aleman (initially, he believed that the reasons for this phenomenon are different). "We are forced to admit them (Lane and his colleagues - approx. correctness".

This is how Caleb himself describes his gap in consciousness, which prevents the normal transmission of emotional signals to the left lobe of the brain.

In the end, the man in charge lost patience and attacked him with reproaches

Image copyright, SPL

Image caption,

Contrary to the stereotype, not all autistic people suffer from emotional or social problems

"My body reacted in a strange way," recalls Caleb. vision. And then I completely forgot about this situation."

It seems that no event can shake such firm indifference. “The richer the emotion, the brighter, in theory, it should color my thinking,” says Caleb. “But in fact, my thinking is clearer and more prone to analysis.”

There is one slight advantage: Caleb is more comfortable with medical procedures, simply because he does not associate any negative emotions with such experiences and does not experience fear or anxiety.

"I endure all sorts of unpleasant moments calmly, because I know that there are no [negative] emotional associations in my memory," my interlocutor admits. "But this means that positive memories are also washed out of my memory."

Short circuit in the brain

However, this compensation is insignificant - alexithymia is apparently associated with various other diseases, including schizophrenia and eating disorders. Because, probably, it is thanks to emotions that we usually begin to take better care of our physical and mental health.

A more precise definition of alexithymia would help to better understand the nature of comorbid disorders, as well as to learn more about the differences between different types of autism.

Geoffrey Bird from King's College London notes that, contrary to stereotypes, half of autistic people are quite capable of perceiving other people on an emotional plane and of adequate emotional reactions, and those who have difficulty with socialization usually suffer from alexithymia.

Therefore, he believes that the distinction between these two types of disorders will lead to more adequate care and treatment.

In the meantime, remaining misunderstandings in this area often prevent autistic people from getting the help they really need.

"I worked with an autistic woman who wanted to be a nursing assistant," says Bird. no problem with emotions."

Further work in this direction could also shed light on the mysterious association with somatic diseases such as chronic pain and irritable bowel syndrome, which are unusually common in patients with alexithymia.

Lane suggests that the reason is a kind of "short circuit" in the brain, which is a consequence of "emotional color blindness". According to him, conscious perception of emotions helps to dampen the physical sensations associated with a particular emotion.

Image copyright, Getty

Image caption,

Trying to connect with their emotions, "Alexas" often go through life alone brain, then mechanisms are activated that modulate the processes in the body from top to bottom, "says Lane. However, without an emotional outlet, the mind can get stuck in physical sensations, leading to increased reactions.

According to Görlich-Dobre, "they (the "Alexas") are hypersensitive to sensations in the body and cannot focus on anything else, which is probably one of the reasons for the chronic pain they experience."

Some studies have indeed shown that "Alexas" are unusually sensitive to sensations in the body, although the results of other experiments refute these conclusions.

Descriptions of physical sensations often dominate Caleb's stories about difficult moments in his life, such as leaving his family.

"In general, I don't miss people, it seems to me. If I go away and don't see someone for a long time, my life goes according to the principle "Out of sight, out of mind," he admits. I don’t have my wife and child around, then I physically feel pressure or stress.”

Reconnecting with Lost Feelings

It is hoped that doctors will eventually identify the causes of alexithymia and help their patients avoid the "snowball" effect of it on the body.

Caleb believes that his condition was born at birth and could be caused by genetic factors. Features of upbringing and emotional responsiveness of parents can also play a role here.

But there are people who become "alexes" as a result of psychological trauma that impairs their ability to process some or even all of their emotions.

Lane introduced me to one of his patients, Patrick Dust, who was abused as a child by an alcoholic father, so that at one point his life was even threatened.

"One evening, when he returned home, he and his mother had another fight. And then he said: 'I'm going to go get my gun now and shoot you all.' We ran to the neighbors and called the police from their house."

Several decades have passed since then, and all this time it has been difficult for him to understand and interpret his emotions, especially the fear and anger that he still feels towards his parents.

Dust suspects that he developed fibromyalgia - diffuse musculoskeletal chronic pain and weakness throughout the body - as well as an eating disorder as a result.

At first under Lane's guidance, and later on his own, Dust remembered his old experiences and reconnected with emotions that he had always tried to hide deeper. As a result, his fibrogic pains were relieved.

"I discovered a huge anger that I felt without realizing it," explains Patrick. "It's the most important thing I've done in my life." He had just finished work on a book in which he described this process. To better socialize, Caleb also saw a cognitive behavioral therapist, and now, through conscious decision, he can better analyze his own physical sensations and relate them to other people's emotions.

While this process remains largely an exploratory exercise, it allows Caleb to be aware of his wife's feelings and understand why she does what she does.

Photo copyright, Getty

Photo caption,

By making a conscious decision to love, "Alexas" can bring stability to relationships

However, not every alexithymia sufferer has such determination and perseverance. And not everyone manages to find a life partner who would be ready to accept the assumptions associated with this disease.

"It takes a lot of understanding from my wife... She realizes that I understand love and other things in a slightly different way," says Caleb.

On the other hand, he is emotionally stable and not subject to mood swings. "The compensation is that my relationship with my wife is a conscious choice for me," Caleb explains.

He does not act on a whim, but on the basis of a conscious intention to love and care for her. This has been especially important in the last eight months.

"If we are going through some difficult situation - for example, a child does not sleep all night and cries - this will not affect my attitude in any way, because my connection is not based on emotions."

Caleb was not euphoric about his wedding or the birth of a child, but he spent most of his life looking inward, trying to feel and understand the sensations that he and the people around him experience.

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