Alexithymia: What’s That Feeling?

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It’s as if the addict is so accustomed to just acting on impulse that he/she has lost touch with the source of the impulse — ordinarily a negative emotional state such as anxiety, anger, sadness, etc.

iStock_000011300526XSmallThe other day I asked a client in group to discuss his obvious (to me, anyway, and to the other group members) unresolved anger that seemed to bubble up with just about every topic.  I was floored when he frowned at me and snapped, ‘What anger?  I’m not angry!’  The group laughed, but he really believed he wasn’t angry.  What gives?”

It’s long been observed that newly recovering people have difficulty identifying emotions. It’s as if the addict is so accustomed to just acting on impulse that he/she has lost touch with the source of the impulse — ordinarily a negative emotional state such as anxiety, anger, sadness, etc.

So that when the addict experiences these emotions (or even the small beginnings of them), it’s quickly subsumed in an intense desire to use. Other potential responses aren’t considered. At some point, the addict loses awareness of the emotion altogether. It’s become simply a trigger for an automatic response.

I don’t know how many thousands of times I’ve heard people angrily insist that they’re not angry. Traditionally, we attributed it to denial. But I’ve come to wonder if the alcoholic even recognizes the emotion. Maybe he/ she really doesn’t know.

There are cultural factors involved, of course. In some cultures, men traditionally suppress any emotion associated with vulnerability, while women suppress feelings of hostility. But that applies to everyone, not just addicts.

If you can’t identify the emotion as it happens, how can you possibly change your response to it? I heard one psychologist use the term alexithymic, meaning ‘without words for emotions’. Implying a chronic problem identifying how you feel and also describing it in words to other people.

How to address this in counseling? Usually through feedback, and usually in group. One method asks participants to agree in advance to point out strong negative emotional states to one another, as they occur. The idea is to develop a ‘real time’ feedback system — something that doesn’t exist in everyday life.

Example: Mike has spent five minutes in the group describing his recent problems with his 15 year old daughter.

Mike: I’ll tell you, I’ve had about enough of her crap.

Mary: You sound really angry.

Mike: Angry? No. Frustrated, maybe. Not angry. Just frustrated. Who wouldn’t be?

Mike hasn’t self-diagnosed as a dangerously pissed off dad, so he’s far more likely to mismanage his anger in the heat of the moment.

Eddie: If that was my daughter, I’d be ready to blow. I mean, explode.

Mike: You’re not me.

Eddie: No. But I’ve had teenagers.

Mary: When my husband gets that annoyed, I know I better keep the kids away from him for a while.

Mike: You people are overreacting. I’m frustrated. Anybody would be.

Therapist: They’re just saying how they would feel in a similar situation.

Mike: Like I said, they’re not me.

Mike will probably resolve to avoid the subject in subsequent groups (“they don’t understand”), but he won’t be able to stick to the resolution because in fact, he’s too angry. Our hope is that by increasing his awareness, we’ve introduced a consideration that could hold back an explosion when, in the very near future, the next conflict with his daughter inevitably erupts.

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