Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states
“She was a thirty year old married woman who had lost her job for no reason she could understand. In fact, while still working other people shunned her, never inviting her to lunch or other social events connected with the office. She never understood the reasons for this but was aware of feeling lonely. She did want to belong. Things at home were much the same. She had a loveless and sexless marriage primarily because she had no interest in sex. In therapy she seemed flat, uninterested, silent and spoke in a way that was monotonous. She reported having nothing to talk about and nothing to say. Ultimately, the therapist started to engage her in casual conversation about very mundane and concrete things. For example, how was her dog, did she walk him today, did she speak to her mother, did she see her younger sister? The question about walking her dog stemmed from the fact that she avoided leaving the house as much as possible. She did not want to see people and felt very uncomfortable around them. She was depressed and was able to acknowledge that fact but only if asked.”
This patient was a good example of someone with Alexithymia.
What is Alexithymia?
Alexithymia is a personality characteristic in which the individual is unable to identify and describe their emotions. The main feature of Alexithymia is an emotional unawareness, lack of social attachment, and poor interpersonal relating. Furthermore, those suffering from Alexithymia have difficulty recognizing and understanding the emotions of others.
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Alexithymia means there is:
1.Difficulty identifying feelings and distinguishing between feelings and the bodily sensations.
2.Difficulty describing feelings to other people.
3.Limited imagination and, therefore, little or no fantasies and limited dreams.
4.An unawareness of what is happening in their own mind and a very concrete way of thinking.
To illustrate these types of problems, this patient would occasionally report dreams but have no interest in them other than that. In a way, she illustrated the saying that, “a cigar is just a cigar,” which was what was said of Freud’s interpretation of the meaning of dreams. To her, there was no meaning to her dreams. In another example, I suggested she do I role play in which she imagine she was speaking to her father in an empty chair next to her. The idea was that she have the opportunity to tell him more about herself. She thought the entire idea was ridiculous and would not give it any more thought. She also had many somatic problems. At one time it was thought that she have Fibromyalgia because of all of her complaints about being in pain and of being chronically tired. Chronic Fatigue Syndrome was under consideration but that would not account for her pains. All of her medical tests were negative. Asked if she thought there might be a connection between her depression, social isolation, and lack of sex that could cause her to feel ill, she rejected the question as being ridiculous. Her body was shouting at her but she could not hear the message.
Ultimately, her husband left her and sued for divorce. She was completely shocked. Yet, she could never grasp the notion that her husband could be sexually frustrated. She seemingly had no understanding of him at all. In point of fact there were many things that frustrated him. In addition to the lack of sex there was the inability to go out to dinner, the movies, have friends over the house for entertainment or do any of the things couples do to enjoy married life. In coping with losing him she had no insight into any of these things.
There are some suggestions that Alexithymia is connected to the Autism. It’s an interesting theory because her father fell on the autism spectrum. Coming to many of the family sessions that were conducted, he was unable to maintain eye contact. He was a successful man whose career had been in physics and engineering. He described his ability to concentrate on his work in college. He was able to focus his mind completely on his studying and block out any noise around him. He did the same during his examinations, being free of distractions of other students, noises, movements or the environment. Unfortunately, this ability to focus did not help him in raising his daughter. He was an absentee father, always at work and away from the family. However, his success was probably due to the fact that, on the autism spectrum, he suffered with Asperger’s Disorder. Socially, he did not function well but his keen intellect and brilliant understandings of the most difficult concepts in physics made him an invaluable member of any engineering team.
This patient began to make slow progress after she was referred to an intensive program that set about teaching her how to relate socially and how to think about her physical sensations and how they are different from her emotions.
Those with Alexithymia have a sad and lonely existence. It is as though, in a world of multiple and beautiful colors, they can only see black and while. As psychiatry begins to make progress on learning about and treating this disorder, new treatment methods are being developed to help these people.
While they are able to marry, most end up in divorce situations because of their inability to interact with their partner.
Do you know someone who might have Alexithymia?Does this sound familiar? Help them reach out for help.
Your questions and comments are encouraged.
Allan N. Schwartz, PhD
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