Overview
Alexithymia literally translates from Greek as “a lack of words for emotions,” coined in 1973 by the Greek-American psychiatrist Peter Sifneos. A similar description of a phenomenon had been created by earlier French clinical psychoanalysts like Pierre Marty who noticed some patients presented with physical illnesses but couldn’t articulate their internal emotional reactions to it, instead speaking almost entirely in literal operational terms (“pensée opératoire”). Sifneos similarly observed that some patients struggled immensely with traditional psychotherapy that came to a standstill if emotions couldn’t be identified and processed.
Just two years later in 1975, Henry Krystal formally discussed alexithymia in his research into the internal world of people with substance use disorders, arguing that they tended to experience emotions as chaotic physical states rather than psychological feelings. Under this framework, drugs were a physical chemical shield that substituted for the cognitive mechanisms responsible for managing intense emotional experiences.
This led Edward Khantzian to propose the oft-cited Self-Medical Hypothesis in 1985, which has worked its way into general public discourse through “self-medicating.” Khantzian used Krystal’s connections from alexithymia to substance use as evidence that addiction is generally a self-regulation disorder where individuals learn that substances are predictable solutions to coping with unmanageable internal states. How often do we hear someone say “I need a drink” after a stressful day at work? That’s arguably a mild form of self-medication that addresses stress with an external substance.
In the 1980s, Graeme Taylor, Michael Bagby, and James Parker proposed the Toronto Alexithymia Scale (TAS) as a tool to empirically measure degrees of alexithymia. Early surveys shows that it presents in about 5-10% of the general population, but up to 78% of people seeking treatment for substance use disorders. Since then, modern neuroimaging through fMRIs have shown that presenting with high alexithymia scores correlates with reduced activity in the anterior cingulate cortex (ACC), which is responsible for connecting bodily states with emotional awareness.