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April 2017
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ALEXITHYMIA AND EMPATHY



Words and emotions

Many of the earliest leaders of psychosomatic medicine believed that unconscious emotional conflicts were playing a very important role as causes of disorders or psychosomatic illness. Some of them, based on clinical observations and discussions with their patients, speculated that it was a disturbance in the ability to express emotions that predisposed people to classic psychosomatic diseases.

Paul MacLean, for example, noted that many psychosomatic patients showed clear intellectual inability to verbalise their emotions and suggested that, instead of the disturbing emotions being connected to the neocortex and being expressed with the symbolic use of words, these emotions find an autonomic path and were translated into a kind of organic language.
Similarly, Jurgen Ruesch observed a similar disorder of symbolic and verbal expression in psychosomatic patients as well as a set of behavioural and psychological characteristics which made one think of a child's personality.
The following are examples of what puts a stop to social learning or causes it to deteriorate: a tendency to use direct physical actions, physical channels of expression, addiction, passivity, childlike ways to think, the use of imitation, an extremely rigid moral conscience, high and extreme aspirations and an excessive level of social conformity. Marty and de M'Uzan coined the term pensée opératoire (operational thinking) in order to describe a type of thinking that was privy of fantasies, imagination, which was extremely utilitarian, preoccupied with the smallest details of external events and very adherent to reality. These two hypothesised that this type of thinking was typical of a specific psychosomatic personality.

Sifneos coined the term alexithymia to indicate:

a specific disorder to do with emotional and symbolic functions which often makes a psychosomatic patient’s communicative style sterile and bland. 

Currently, and following an initial period of notable controversy, alexithymia is not considered the only possible condition which onsets the susceptibility of this psychosomatic disorders, rather it is one of many risk factors which seem to increase the susceptibility to them.
In fact, it should be noted that not all psychosomatic patients have exhibited clear alexithymic elements and not all psychosomatic doctors have accepted the concept of alexithymia. Furthermore, it is not considered an all-or-nothing phenomenon and every person seems to have the ability to access a relatively asymbolic style of communication, since alexithymic characteristics have been found in patients with substance use disorders, post-traumatic stress disorders and patients with severe emotional disorders or masked depression, who often go to the doctors complaining about physical ailments. Moreover, alexithymia has been described as a secondary phenomenon in patients on dialysis and those who have undergone a transplant, in addition to those who have been in life-threatening situations and are in intensive care units.
As well as having clearly reduced, symbolic thinking, or even absent, alexithymic individuals also show surprising difficultly when trying to recognise and describe their feelings and to discriminate between emotional states and bodily sensations

What can also happen is that these individuals have outbursts of anger or cry uncontrollably, but when queried about the reasons for these events, they are unable to describe what they feel. In addition, the rigidity of movements and lack of expressive movements in the face of these people reveal reduced emotional functioning. Most alexithymic people seem well adapted from a social point of view, despite a lack of not only the ability to get in touch with their psychic reality and with their inner feelings but also the fundamental ability to tune into others' feelings and experiences, elements which make their good social adaptation only superficial. Moreover, these people tend to establish interpersonal relationships which are highly addictive, or they prefer to be alone and avoid others.

How does alexithymia develop?

There is probably no single explanation about the causes of such a complex phenomenon. In fact, in addition to genetic, neuro-physiological and intrapsychic factors, communication styles are influenced by sociocultural factors, intelligence and familiar patterns of conversation.

For example, Leff found that people in developed countries show a greater differentiation of emotional states compared to those living in developing countries and that some languages impose restrictions on the expression of emotions.
According to McDougall, alexithymia is an extraordinarily strong defence mechanism against psychic pain, and Krystal, rather than conceptualise alexithymia as a defence mechanism, attributed it to a stop in emotional development following a trauma during childhood, or a regression in emotional and cognitive function after a catastrophic trauma in adulthood. Some neuro-physiological theories have also been proposed for the etiological origin of alexithymia. We have already seen MacLean's hypothesis that the physical symptoms of alexithymic patients are caused by emotions which are channelled directly into the body through the respiratory organs and neuro-endocrine and autonomic pathways. Nemiah went further with this, arguing that alexithymia is caused by a neuro-physiological dysfunction and that the striatum modulates the access to consciousness of neocortical sensory inputs as well as affect input from the limbic system. In addition, studies on hemispheric specialization, including the manner in which the brain integrates affectionate and proactive language, has led to the idea that alexithymia is caused by a dysfunction of the right hemisphere or a gap in inter-hemispheric communication. This hypothesis appears to be confirmed by Hoppe's observations about the appearance of alexithymic characteristics in patients with split brains who report a lack of dreams and imagination and show a deterioration of symbolic function.
Moreover, as demonstrated by Weintraub and Mesulam, precocious damage to the right hemisphere can seriously interfere with the acquisition of skills, which that hemisphere is considered to be specialised in. They also maintain that, since the left brain controls the development of linguistic competence, the integrity of the right hemisphere may be essential for the emergence of interpersonal skills and what Hymes defined as communicative competence. Therefore, a lacking feature in the right hemisphere may not only explain the difficulty alexithymic patients have recognising and describing their emotions, but also the diminished capacity for empathy.

What does empathy mean?

If alexithymia implies not being able to or it being impossible to perceive one's own and others' emotions, empathy is, conversely, the ability that allows people to tune into their own and others' moods. Not surprisingly, this ability is based on self-awareness: the more you are open to your own emotions, the more skilled you are at reading other people's feelings. This ability allows us to understand how another person feels and enter into various situations ranging from typical ones in our professional life to those in our private lives. Empathy allows us to read and understand not only the emotions that people express in words, but also those which, consciously or not, are expressed through tone of voice, gestures, facial expressions and other similar non-verbal channels.

How does empathy develop?

It is possible to trace the seeds of empathy back to early childhood. In fact, we have seen that from the day we are born, we are disturbed by the crying of another child, and children around 1 year old even imitate the suffering of others, probably to better understand what the other is feeling. In the twenties, Titchener named this the mimicry motor skill and according to this author, it is the precursor of empathy.
Furthermore, it appears that at the bottom of empathy there are tuning and detuning processes which characterise the first phases of the mother-child relationship and which allow the child to feel understood. Not surprisingly, a prolonged absence of emotional harmony between parents and children imposes an enormous cost on the child. When a parent is never able to show any empathy for a particular range of children's emotions - joy, tears, the need to be rocked - the child starts to avoid expressing them and maybe even feeling them. As a result, many emotions allegedly begin to be deleted from one’s repertoire of intimate relationships, especially if, and even after childhood, these sentiments continue to be covertly or openly discouraged. 
Some scholars have suggested that, in addition to an organic dysfunction, which is responsible for alexithymia, there is also a specific social and developmental environment which inhibits emotional expression, a hypothesis that appears to be confirmed by the presence of a growing number of alexithymic men and empathetic women. In fact, most men and women are taught to express their emotions very little and, instead, develop skills related to their practical, working life rather than the emotional sphere..

According to Goleman, empathy and self-control are two social skills which help people to build a rich and emotionally satisfying social life, which, as is well known, also positively affects a person's psycho-physical well-being.

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