How Does It Make You Feel? Alexithymia Pt.1

 

One of the most irritating questions I find myself asking clients is that old standby: 'And how does that make you feel?'

The reason I hate it is I never know how to answer it myself!

Firstly, I have to work out what the question means in terms of physical sensation or emotional 'feeling'. Like many autistic people, it sometimes seems my senses and feelings aren't wired up right. My instant reaction is to tell the person how I feel physically - so I'll say, 'I'm cold' or 'I have hayfever'. But I quickly remind myself that that is probably not what they're asking (unless they're my doctor) so I scrabble about to think of plausible feelings to mention.

Again, like many autistic and neurodivergent people, a feeling of anxiety is my constant companion, so I may mention that. Or if I'm trying to impress, I will guess what answer the person is expecting (an aspect of 'masking' ie autistic or ADHD people covering up their natural traits to be more acceptable to their audience). 

As I read on LinkedIn today, 'Neurodivergent people don't mask because they don't accept themselves, they mask because others don't accept them'

We Really DO think differently!

An autistic friend of mine volunteered for an experiment, a few years ago, where they put him in an fMRI machine to see what his brain did with various questions. As they were settling him in, they asked for his name (he answered, his brain was quiet) and his date of birth (easy answer; a little bit of brain activity around number processing), and then the nurse asked him how he was? Well, his brain lit up like a Christmas tree! This simple, socially polite question seemed to him to be like quantum physics, and his brain struggled to interpret it and work out the appropriate answer. He did eventually come out with a weak 'Fine', but only by looking at the fMRI could they tell how difficult that question had been for him.

So, what makes that question, 'How do you feel?' so difficult for many autistic people to answer? Partly the problem is that the answer is different in every context. If you are admitted to hospital with a heart attack, and the doctor asks how you feel, he's expecting an answer like 'I have an awful pain on the left side of my chest', not 'Fine' (which is ironically the answer many older people, as well as autistic people, tend to give).

Having disentangled the physical sensations from the emotional ones (not an easy task when you suffer sensory hypersensitivity, like myself) you are then left with a bundle of emotions, trying to decide which ones are expected in this context. To put it bluntly, and not very politically correct, I'm trying not to come across as nutcase. The last thing that occurs to me is just to say how I actually feel (emotionally) but even if it does, I can rarely verbalise what that feeling actually is.

Alexithymia

Psychologists call this emotion-identification problem 'Alexithymia' (literally 'unable to put feelings into words'). And if you're someone who gets your emotions muddled up, that's 'Dysthymia'. Neither of these terms denote a medical condition - they're more symptoms, or I'd say traits, that some people have.

As soon as I came across the term 'Alexithymia' I knew that described a problem I, and other Neurodivergent people, had. It is commonly found with autism, ADHD and dyslexia, but is extremely common with autistic people. My next question was, 'What causes it?'.

If you've met me, you know I have a problem with people blaming everything on neurology. A lot of research papers I've seen seemed to assume that alexithymia is caused by our unique, neurodivergent brain structures or brain chemistry. And they may be right. But I also notice that many Neurodivergent people had great difficulty learning anything as small kids, due to being permanently stressed-out.

Learning social-emotional skills as a Neurodivergent kid, especially if you are undiagnosed, like myself, was like trying to learn your Green Cross Code in Picadilly circus, in rush hour, while the Salvation Army band rehearses Christmas carols. And with people shouting contradictory instructions at you! I challenge anybody to learn anything with sensory and cognitive overload - the sort many autistic and ADHD kids experience every day in school. It isn't surprising, considering, that the basics of so-called 'Emotional intelligence' might have passed us by.

Overcoming Alexithymia

So, what did I fail to learn that could have helped? Firstly, I was well into my counselling training before I learned that human beings often have more than one emotion at one time. Maybe it's obvious to other people, but when I discovered that - a person who was angry, sad, resentful and optimistic all at the same time, for example, it blew my mind! So that sensation of a swirl of emotions - all mixing and colliding in a random pattern - is possibly 'normal'? (As in, found in both neurotypicals and neurodivergents).

This was my first lightbulb moment: Asking 'How does it make you feel?' is an extremely complex question, which confuses us because used socially, it is nothing more than a ritual that says, 'I care about you', and that is all. When a doctor uses the term, they are probably talking about your physicality (unless they're a psychiatrist). And when a counsellor or therapist uses it, maybe they are trying to look deeper... maybe my counsellor actually wanted me to explore the swirling mess of contradictory emotions? Or maybe, sometimes, just like myself when working with a client, it's the 'counsellory' thing to say?

[Note: You can see from this how being autistic equates to chronic over-thinking about everything in my world!]

The second thing that helped me was recognising that I can overcome this 'deficit' in emotion-recognition by using reason and observation. For example, I don't know how I feel, but I have noticed my heart racing, my breathing has speeded up and I feel cold and clammy. This is a sensation I often associate with anxiety. Could I be anxious? If so, what is likely to have triggered the anxiety? Perhaps I've unintentionally upset a colleague?

Intellectualising?

When I was training as a counsellor, I sensed negativity around the idea that clients were 'intellectualising' their problems. I knew I did this, but since this was my major coping strategy, I kept quiet about it. When I started to work with neurodivergent clients, I found that most of them did the same as me - and many had been told by previous counsellors that it was unhealthy, and they were 'disconnected' from their emotions.

Through my own therapy (as a client) and my work with Neurodivergent people, I realised that this 'cognitive processing' did actually work pretty well. Just like my colleagues' Neurotypical clients, my clients made discoveries about the sources of their pain and learned to understand their emotions. I started to feel that just as people who've had a stroke have to learn to use a different part of the brain to walk, neurodivergent people had found a way round this 'alexithymia'.

As autistic people we are often incredibly observant about the people around us. It might not seem it - autistic special interests and ADHD hyperfocus don't seem to be all that suited to noticing those around you, but we're sneaky. I can be in full throttle, talking about my favourite subject (Neurodiversity usually) when someone walks past looking irritated. I notice. I probably don't know what to do about it, but I notice. Once a Neurodivergent person begins paying attention to emotions - their own and others, we often learn fast. It's a different way of learning, but it works.

So, if you were a fly on the wall for one of my sessions with my personal counsellor, or as I work with neurodivergent clients, it might seem that we are doing nothing more than having a philosophical debate about which emotion we are feeling at this moment, and if there are other emotions round it, and if we are repressing or denying some emotions because of masking and feeling they are 'inappropriate'... But you see, this is us using our brains to get round the alexithymic roadblock.

Thirdly, by dropping the 'mask', sometimes it's OK to say, 'I don't know how I feel', or 'I don't feel anything, but I have a lot of thoughts about this'. It doesn't make you callous, or a monster just because your emotions are not clear - 'Still waters run deep,' I like to say (meaning that for a thoughtful person, sometimes it isn't easy just to give a feeling a quick label and leave it at that). If you don't feel anything, allow yourself to be. As my supervisor always says, if we pay attention 'something will emerge'. Don't prejudge what your own mind will come up with - sometimes it will surprise you!