I want to switch gears for a moment. Some time ago I wrote this post–Affective Deprivation Disorder and Alexithymia in Marriage. According to my stats, this is the most widely viewed post on my blog. That is telling. I had never heard of alexithymia until I stumbled across the term while trying to find a name that might adequately describe a feature of my husband’s behavior. Once I discovered the term, the world opened up to me because once you have a name for something, then you are connected into a larger more common experience. In short, I felt validated.
Something recently occurred around this post. Someone commented. And then another person commented. Then, another. Soon, a dialogue started, and what I observed was again common experience. We had all been or were currently married to essentially the same man. The patterns of behavior were all the same. The relational trends within the marriage were almost identical. It was eerie. In my mind, as I read the comments, the only explanation was a pathology.
It must be stated that I am not a fan of the current direction that the therapeutic model in psychology is moving. A medical model is being applied. For example, a diagnosis like PTSD is pathologized and made to look almost like a disease process rather than a very normal response to trauma. Overlaying a medical diagnosis to a non-medical condition does not equip and heal people.
That being said, when I speak in terms of pathology regarding human behavior, I am referring to a commonality of “symptoms” that meet a set criteria. When there is a group of people who display similar to matching symptoms that repeatedly match a set criteria, then one is wont to look for pathology; pathology in this context means a set of features considered collectively for diagnostic purposes.
The pathology, therefore, that I believe is most likely present in my husband and quite possibly in other people often presenting with alexithymia (when there are other features present as well) is schizoid personality disorder. That’s a leap, I know. Allow me to explain. The most common diagnosis that presents with alexithymia is an autism spectrum disorder. There have been more than a few psychiatrists and therapists who have leapt to that conclusion when hearing of my husband’s behavior. I even went there. Alas, no, he is not on the autism spectrum. There has been, however, something wrong. Here is the criteria for schizoid personality disorder as listed by the World Health Organization:
- Emotional coldness, detachment or reduced affect.
- Limited capacity to express either positive or negative emotions towards others.
- Consistent preference for solitary activities.
- Very few, if any, close friends or relationships, and a lack of desire for such.
- Indifference to either praise or criticism.
- Little interest in having sexual experiences with another person (taking age into account).
- Taking pleasure in few, if any, activities.
- Indifference to social norms and conventions.
- Preoccupation with fantasy and introspection.
One must meet four of the nine criteria to be considered on the schizoid spectrum based upon WHO’s description. My husband meets eight.
To make matters more complicated, there is a comorbidity in those with schizoid personalities and autism spectrum disorders. The reason for this, I suspect, is that schizoid personality disorder seems to run in families where there are schizophrenia spectrum disorders present. And, where there are schizophrenia spectrum disorders present you will find autism spectrum disorders because autism and schizophrenia spectrum disorders are genetically related. So, I am going to make another leap and suggest that some people diagnosed with autism, particularly the high functioning variety, have, in fact, been on the schizoid spectrum simply because the criteria for schizoid personality disorder reads like a high functioning autism spectrum disorder. In the end, it gets very confusing for the clinician with little to no training in abnormal psychology and very confusing for everyone else. Furthermore, since ASDs and SCZ are both biologically based brain disorders, it begs the question: is alexithymia a brain-based response? In other words, what is the neurology behind something like an alexithymic expression? If we are looking for the truth, it’s a question that must be asked.
Here is the question that led me to post this. “Why is my husband so amazing at work, so skilled there, and such an asshole at home?” This is my husband. In something like an autism spectrum disorder, deficits are generalized. One struggles at work and at home. An AS adult cannot go to work and turn it on, so to speak, only to return home and derp it up. There is, however, a known phenomenon called the Secret Schizoid:
Many fundamentally schizoid individuals display an engaging, interactive personality that contradicts the observable characteristic emphasized by the DSM-IV and ICD-10 definitions of the schizoid personality. Klein classifies these individuals as “secret schizoids”, who present themselves as socially available, interested, engaged and involved in interacting yet remain emotionally withdrawn and sequestered within the safety of the internal world.
Withdrawal or detachment from the outer world is a characteristic feature of schizoid pathology, but may appear either in “classic” or in “secret” form. When classic, it matches the typical description of the schizoid personality offered in the DSM-IV. It is however “just as often” a hidden internal state: that which meets the objective eye may not match the subjective, internal world of the patient. Klein therefore cautions that one should not miss identifying the schizoid patient because one cannot see the patient’s withdrawal through the patient’s defensive, compensatory interaction with external reality. He suggests that one need only ask the patient what his or her subjective experience is in order to detect the presence of the schizoid refusal of emotional intimacy.
Descriptions of the schizoid personality as “hidden” behind an outward appearance of emotional engagement have been recognized as far back as 1940 with Fairbairn’s description of “schizoid exhibitionism,” in which the schizoid individual is able to express a great deal of feeling and to make what appear to be impressive social contacts yet in reality gives nothing and loses nothing. Because he is only “playing a part,” his own personality is not involved. According to Fairbairn, the person disowns the part which he is playing and thus the schizoid individual seeks to preserve his own personality intact and immune from compromise.” (online source)
This is why a person with schizoid personality disorder could go to work and be a superstar yet come home and be a completely different person. This is why a man like my husband was engaging, charismatic, charming, and enthusiastic before I married him. This is why no one can imagine what he’s like behind closed doors. This is why I was terrified that no one would believe me when I decided that the marriage had to end. I was going to have to decide within myself that it didn’t matter. I had to be okay within my own narrative of events.
It is too easy to drive yourself crazy trying to find an explanation for crazymaking behaviors. Autism? I can make sense of autism. Theory of mind deficits? Well, a theory of mind deficit isn’t just a problem in autism spectrum disorders. I know neurotypical adults who struggle with theory of mind. Many people on the personality disorder spectrum will struggle with theory of mind because theory of mind is about mind-mapping. It’s about perspective-taking and anticipating needs. It is cognitive empathy, and one of the hallmarks of many personality disorders is a lack of cognitive and even emotional empathy. This is where many clinicians get stuck and smack an autism diagnosis on a person who is really in no way autistic. It is unfair because said patient will receive a woefully inappropriate treatment plan (if they receive one at all), and their families will then come to believe something that is not true. In that scenario, no one gets the necessary help.
It must be stated that I am not trying to stigmatize alexithymia or invalidate the emotional experience of anyone who finds themselves experiencing it. I do my best to avoid stigmatizing language. This is, however, a blog, and blogs are written with a bias. My natural tendency is to be empathetic and compassionate to everyone, and I am actually annoyed with the larger therapeutic community in North America for bringing so little to the table on this specific topic. I have yet to meet one clinician who has ever heard the term ‘alexithymia’, and that’s a damned shame. What can be done to increase the emotional spectrum and repertoire for those who have it, and what can be done to equip those who love them and want a relationship? It’s simply not enough. People deserve more. All people.
In the end, for all of us who have lived with individuals struggling with alexithymia, it is important to note that alexithymia is a piece of a larger puzzle. We must find our locus of control and internalize it. Our lives are not just happening to us. What can we accept? What can we not accept? What do we need to be happy and fulfilled? Do we believe that we are responsible for the happiness of our partner? Does their happiness come at the expense of our own? Is that appropriate? What should the boundaries look like? What should be normalized and accepted and what should not be in terms of human expression or lack thereof? It’s hard to answer these questions when so little information is available, but we must try anyway.
What course do we have to set so that we can be happy, too? Then, do it.