In the previous post we learned how the dissociative form of PTSD - in which people manifestly underreact to reminders of past trauma - results from a damping down of emotional activity in the brain.    

This dissociative process points toward an even stranger condition, one known as alexithymia (pronounced “alex-uh-THIGH-me-yah”). The term describes people who seem not to understand that they even have feelings. Whereas, for the PTSD patient, feeling distant or numb may be troubling and unpleasant, it’s not characteristic of their lives. It comes and it goes. The person with alexithymia, however, seems permanently lacking in the ability to describe what he or she is feeling. Even their scariest or most trying experiences are apt to be recounted impassively, as if what happened to them made little or no difference. It will come as no surprise that the facial expressions of a person with alexithymia are typically wooden and his or her posture stiff. (These are reflections of their felt state.) And they will never indicate that what happened to them felt like anything.

Neural evidence suggests that people with this condition are the lowest of the low reactives. Their medial prefrontal structures have no need to suppress emotional activity in the limbic region because there is a dearth of bodily and emotional input to begin with. An alternate (and more charitable) view is that the person with alexithymia does indeed have sensory and feeling input to draw upon but cannot because his or her cognition is so fundamentally separated from what is being felt. The individual, in other words, is severely dis-integrated.

How does alexithymia develop? As with the dissociative form of PTSD, it may take root in early childhood – except that no particular trauma and no recurring danger is needed in this scenario. If a young child’s expression of emotions finds no validation on the part of his or her caregivers, so the explanation goes, he or she will be threatened by unbearable tension – and to become alexithymic is to foreclose on the possibility of such tensions arising. Never owning up to one’s feelings, nor even to the fact that one has feelings, is a way for the developing child to protect him- or herself. Inexpressiveness will then become a way of being in the world. In adulthood, the person’s tendency to intellectualize, keep their body stiff and be highly organized will rigorously and routinely keep feelings at bay. (The plight of people in this state is poignantly captured in the lyrics of Warren Zevon, the late singer-songwriter, who declared “I’m gonna hurl myself at the wall/Cause I’d rather feel bad than not feel anything at all.”)

If PTSD is a disorder of feeling - with the dissociative or alexithymic form on the one hand and the more common high-reactive form on the other – then we clearly have here two distinct reactions to the scary, threatening occurrences that cause PTSD in the first place. We have people with different neural dynamics and, fundamentally, different ways of feeling. The differences in how people literally feel are, in my estimation, reflected in the distinctive brain patterns and not vice versa. The brain is part of an entire ‘bodymind’ encompassing our rudimentary sensations along with the material aspects of ourselves that allow us to process sensory input and ultimately feel things – namely, our skin, muscles, organs, and nerves. It is the interconnections between brain and body, head and heart, psyche and soma that, in their totality, make us who we are and the quality of those interconnections that distinguishes how one person feels from the way any other person feels. (The pioneering discipline of psychoneuroimmunology is doing much to illuminate how these connections work.)

It will be ultimately fruitless to seek the basis of individual differences in the brain alone. While we can see differences encoded there, the brain is not the source of those differences. Likewise, it is erroneous to think that an approach to alleviating PTSD that works for one person will necessarily work for another. Hearkening back to Hippocrates, we need to know what sort of person has PTSD. More specifically, how do they feel? I mean literally: what are the bodymind dynamics involved? If there were a way to illustrate, fairly simply, the qualitative differences in bodymind functioning between one person and another, it would greatly illuminate conditions such as PTSD and point the way toward treatments that would help the different kinds of people who are afflicted by different forms of PTSD.

Such an approach will be outlined in my next post.

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