Not feeling emotion
SAMHSA’s National Helpline | SAMHSA
Solr Mobile Search
Share Buttons
Your browser is not supported
Switch to Chrome, Edge, Firefox or Safari
Main page content
-
SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Also visit the online treatment locator.
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.
Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.
The service is open 24/7, 365 days a year.
English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.
In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.
The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs.
In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.
The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.
No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.
-
Suggested Resources
What Is Substance Abuse Treatment? A Booklet for Families
Created for family members of people with alcohol abuse or drug abuse problems.
Answers questions about substance abuse, its symptoms, different types of treatment, and recovery. Addresses concerns of children of parents with substance use/abuse problems.It's Not Your Fault (NACoA) (PDF | 12 KB)
Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
Explores the role of family therapy in recovery from mental illness or substance abuse.
Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.For additional resources, please visit the SAMHSA Store.
Last Updated
Last Updated: 08/30/2022
Alcohol, Tobacco, and Other Drugs
Solr Mobile Search
Share Buttons
Your browser is not supported
Switch to Chrome, Edge, Firefox or Safari
Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).
Alcohol
Data:
- Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
- Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
- In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
- Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44.
4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH) - The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31.4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
- Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
- Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily
Programs/Initiatives:
- STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
- Interagency Coordinating Committee on the Prevention of Underage Drinking
- Talk.
They Hear You. - Underage Drinking: Myths vs. Facts
- Talking with your College-Bound Young Adult About Alcohol
Relevant links:
- National Association of State Alcohol and Drug Abuse Directors
- Department of Transportation Office of Drug & Alcohol Policy & Compliance
- Alcohol Policy Information Systems Database (APIS)
- National Institute on Alcohol Abuse and Alcoholism
Tobacco
Data:
- In 2020, 20.7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
- Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
- Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses.
The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States - The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes
Electronic cigarette (e-cigarette) use data:
- In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
- Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3.
4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH) - Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
- E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals
Resources:
- Tips for Teens: Tobacco
- Tips for Teens: E-cigarettes
- Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
- Synar Amendment Program
Links:
- Truth Initiative
- FDA Center for Tobacco Products
- CDC Office on Smoking and Health
- National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
- National Institute on Drug Abuse: E-Cigarettes
Opioids
Data:
- Among people aged 12 or older in 2021, 3.
3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH) - Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
- According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose
Resources:
- Medications for Substance Use Disorders
- Opioid Overdose Prevention Toolkit
- TIP 63: Medications for Opioid Use Disorder
- Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
- Opioid Use Disorder and Pregnancy
- Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
- The Facts about Buprenorphine for Treatment of Opioid Addiction
- Pregnancy Planning for Women Being Treated for Opioid Use Disorder
- Tips for Teens: Opioids
- Rural Opioid Technical Assistance Grants
- Tribal Opioid Response Grants
- Provider’s Clinical Support System - Medication Assisted Treatment Grant Program
Links:
- National Institute on Drug Abuse: Opioids
- National Institute on Drug Abuse: Heroin
- HHS Prevent Opioid Abuse
- Community Anti-Drug Coalitions of America
- Addiction Technology Transfer Center (ATTC) Network
- Prevention Technology Transfer Center (PTTC) Network
Marijuana
Data:
- In 2021, marijuana was the most commonly used illicit drug, with 18.
7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people). - The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
- Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
- Marijuana can have significant health effects on youth and pregnant women.
Resources:
- Know the Risks of Marijuana
- Marijuana and Pregnancy
- Tips for Teens: Marijuana
Relevant links:
- National Institute on Drug Abuse: Marijuana
- Addiction Technology Transfer Centers on Marijuana
- CDC Marijuana and Public Health
Emerging Trends in Substance Misuse:
- Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year.
Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia. - Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
- Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors.
It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.
Resources:
- Tips for Teens: Methamphetamine
- Tips for Teens: Cocaine
- National Institute on Drug Abuse
More SAMHSA publications on substance use prevention and treatment.
Last Updated
Last Updated: 03/22/2023
What is it like to live without feeling emotions?
- David Robson
- BBC Future
Sign up for our 'Context' newsletter to help you understand what's going on.
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 provides.
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 so-called alexithymia - a kind of emotional color blindness that deprives a person of the ability to distinguish and express various sensory-emotional nuances.
Image copyright, Getty
Image caption,An unemotional person may find the behavior of other emotional people inappropriate
About half of those who suffer from this disorder 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, falling 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 nesting 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).
Skip the Podcast and continue reading.
Podcast
What was that?
We quickly, simply and clearly explain what happened, why it's important and what's next.
episodes
The End of the Story Podcast
Sooner or later we find the right 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 this or that emotional state .
In 1972, when alexithymia was first scientifically described, it was assumed that the problem occurs 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, though 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 nesting 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, has found deficits in attention-related 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 an experience and does not feel fear or anxiety.
"I endure any 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, the remaining misunderstanding in this area often prevents autistic people from getting the help they really need.
"I worked with an autistic woman who wanted to be a nursing assistant," Bird says. no problem with emotions."
Further work in this direction could also shed light on the puzzling 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 may be 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 the 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 a relationship
However, not every alexithymia patient 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.
He is one of the most caring and conscientious people I have ever had the pleasure of interviewing - a man who knows himself and his limitations through and through.
Concluding the conversation, he emphasizes that "emotional color blindness" does not make a person evil or selfish.
"It's hard to believe, but it is possible to live completely separated from emotions and imagination, although this is precisely the main thing that makes us human," he says. "But this does not mean at all that such a person is heartless or that he is crazy."
Read the original of this article in English is available on the website BBC Future .
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 on the example of cases from his own practice, as well as on the example of the heroes of the story “The Minimarket Man” ( Kombini ningen by Murata Sayaka), winner of the 2016 Akutagawa Prize.
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 disorders. 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 people 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.0231 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.
