Alexithymia and the Secret Schizoid

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:

  1. Emotional coldness, detachment or reduced affect.
  2. Limited capacity to express either positive or negative emotions towards others.
  3. Consistent preference for solitary activities.
  4. Very few, if any, close friends or relationships, and a lack of desire for such.
  5. Indifference to either praise or criticism.
  6. Little interest in having sexual experiences with another person (taking age into account).
  7. Taking pleasure in few, if any, activities.
  8. Indifference to social norms and conventions.
  9. 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.[8] Klein classifies these individuals as “secret schizoids”,[8] 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.[8]

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.”[9] (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.

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Therapy Homework: Disgust and Vulnerability

Therapy Tuesday has come and gone.  It was my longest session yet.  Almost a full two hours.  I don’t know why he lets them go on for so long.  I drank so much water during the session that thoughts of Niagara Falls started rushing through my head near the end.

I really wanted to discuss all my awesome homework around my reflections around anger, but he’s too smart for that, I guess, because he zeroed in on something entirely unexpected.  I said in passing that my husband had stopped coercively kissing me.  Yes, this is something that he does.  My husband has been withholding sex since mid-2012.  We’ve had sex about 18 times since then.  It’s 2015.  18 times from mid-2012 to April 2015.  That’s…bad.  My husband is completely fine with it.  I am so not.  And, that has set the scene for subtle and not so subtle behaviors on my husband’s part that are harmful to our relationship and erode trust.  Most of his physical abuse has been sexual.  I find it a bit ironic actually since the biggest hurdle I’ve had to overcome in my life is a history of sexual abuse.  And, here I am in a long-term relationship where sexual abuse is on the table.  I’m disgusted by that.

And that’s what my therapist observed in me.  Disgust.  I have a very strong disgust reaction when my husband makes me kiss him.  His habit has been to completely avoid sex and sexual scenarios for over two years while demanding some sort of privilege of intimacy like hugs and kissing.  In the beginning, I was so confused but hopeful (and desperate) that I, of course, went along with this.  Anything I could get, right? But, as time went on, I began to see that this was the new normal.  He would use psychosexual or even physical abuse to control sexual situations in order to control his anxiety, which is almost a disability at this point.  He also experienced a decrease in libido due to taking an SSRI.  This is common, but what is not common is his response to me.  No matter how much I asked him to do something about it he did nothing.  He had no empathy.  ‘I don’t want to,” became the response du jour.  The response de l’année.  My pleads seemed to make him angrier, and that is what triggered his reactionary emotional expressions that fueled his behaviors.

One can’t take a few years of this sort of thing without finally feeling it.  I had compartmentalized it all until I went to therapy.  I knew that it would all have to come out of the boxes I had so neatly put them in.  When I did the anger work, I knew there would be repercussions.  I would feel what the anger was protecting me from.  I consequently felt disgust.

Why? It took almost two hours to get at it.  I wasn’t dodging.  I wasn’t even not answering.  I was trying to figure it out just as much as my therapist.  I did disgust work in EMDR with another therapist a few years ago.  As I sat there in the “hot seat” trying to collaborate, he finally asked me: “Do you need to have control in certain situations?”  I thought about it.  I don’t need to control other people.  I’m well beyond needing control over everything now, but I don’t like feeling like I don’t know what’s going to happen next particularly with a person who I have learned not to trust.  Feelings of uncertainty put me on edge.  I feel hypervigilant, and hypervigilance sets off my limbic system.  And, if someone does something that startles me when I’m in a hypervigilant state, then I will freeze.  When I freeze, I can’t speak or act.  That means I can’t defend myself.  If I can’t defend myself, then I’m easily victimized.  And this absolutely disgusts me.  The thought of being sexually victimized again.

And this is what my therapist was trying to get at.  The root.  And I felt my defenses go up.  I pushed my back into the chair.  My eyes glassed over.  I did not want to start crying.  He leaned in and said, “Oh, I see.  I understand it now.”  He went on to gently validate me.  As much as I like validation, there is a part of me that does not like it when people speak to me gently.  I am not used to it, and I feel strangely when it happens.  Like I need some sort of special care.  I notice that it causes defensive feelings to arise, and that is how I felt.  Defensive.  When he leaned in he said, “This must be very traumatizing for you to go through all this.”

Durrrrrrrr…

Well, of course, it is, Sherlock! ::she says sarcastically::

All of this is to say that many of our feelings and emotional responses are rooted in something else.  Something unexpected.  Something we don’t want to talk about.  Ah, therapy.

So, my homework this week is to observe that sense of vulnerability I feel before I freeze if I can.  The point in doing that is to de-identify with it.  Become separate from it as I did when I did the anger work.  I feel much less angry now after I did the anger work.  The point in trying to become an observer of the feelings of vulnerability is eventually to lessen their power so that I won’t freeze.  Ultimately, this disgust was about me.  Not about him.  Not exactly wonderful but important nonetheless.

I’ve said it before.  i’ll say it again.  If you are in a less than great relationship, then go to therapy.  If you are in a relationship where any kind of abuse is present, then go to therapy.  It’s hard, but it’s so worthwhile.  Truthfully, I am not enjoying it, but I am enjoying not feeling so angry this week.  I will enjoy not being so disgusted soon.

Should I Stay or Should I Go?

This is the title of a book I just started reading by Lundy Bancroft, a well-known therapist who specializes in working with women in domestic violence and/or abusive relationships.

Should I Stay or Should I Go?: A Guide to Knowing if Your Relationship Can--and Should--be Saved

click image for link

The title didn’t thrill me.  It scared me, but the premise intrigued me.  How do you know when your relationship is no longer working? Is it obvious? Is it obvious to everyone around you except you? What if I just expect too much? What if my relationship is really not that bad and I’m just one of those persnickety people who holds others to a ridiculous standard?

How do I know that the problem isn’t me?

Yesterday, as I was reading the introduction to this book, I came upon this:

The issue we address right away in Chapter 1— because we think it will be at the forefront of your mind— is whether the difficulties you are having are just the typical ones that all relationships go through, or whether they are symptoms of something deeper. We’ll ask you to examine your expectations, to answer the question “Do I just expect too much from a relationship?” (We’re already guessing that you don’t; we meet more women who expect too little than too much.)

My heartbeat started to quicken.  Yes, this is exactly what I wanted to know.  Do I expect too much? Is the problem me? Bancroft goes on to say:

We believe there are basics that all relationships need to have, indispensable elements such as:

  • love, affection, and kindness
  • mutual respect
  • freedom of both partners to express their true opinions and feelings
  • safe, loving physical intimacy
  • equality
  • making each other a high priority (though not necessarily the only priority)
  • accepting responsibility for one’s own actions
  • each partner caring about how his or her actions affect the other person

Nothing on this list is pie-in-the-sky. If your relationship is missing any of these elements, you have good reason to want that gap to be attended to— and to insist on it.

In Chapter 1, Bancroft describes elements of a healthy relationship.  The first element of a healthy relationship is respect:

You must be treated with respect. No partner should call you names, make fun of you , roll his eyes at you in an argument, humiliate you, or mock you. Period. It doesn’t matter if he’s had a bad day or a bad decade, if he’s drunk, if he’s under tremendous financial stress, if he’s furious at you, or if he feels that you were disrespecting him. There’s simply no excuse for disrespect. There’s always another option.

The second element of a healthy relationship is safety:

You must feel safe. You should never have to worry that your partner will hurt you physically or sexually. If he behaves in ways that make you feel that an assault might be coming— even if it never actually does— or if he behaves in ways that lead you to have sexual contact with him that you don’t want, you are not in a safe relationship. Safety can also disappear if you have to be concerned that he might cause you serious harm in ways that are not physical or sexual, such as if he threatens to reveal important secrets, tries to deliberately cause you financial harm, says he will take custody of the children away from you, or exhibits other kinds of cruelty.

The third element of a healthy relationship is feeling loved:

You should feel loved the great majority of the time. Every relationship has its periods when everything seems to turn into a squabble, or where distance and disconnection take over and passion fades. But these times should be the exception, not the rule. And even during hard times, your partner should be capable of finding ways to get the message across to you that you are valued and appreciated. Although he might not be able to literally say, “I’m mad at you but I still love you,” that message should come across. If the times when you feel loved are few and far between, and if your partner completely changes his attitude toward you anytime things aren’t going his way, you deserve better.

The fourth element of a healthy relationship is passion and intimacy:

You should have passion and intimacy. Not everyone craves physical passion and sexuality, but most people do, and if these matter to you, you have the right to expect them to be a lively part of your primary relationship . Partners who care about each other and are committed to their connection can find ways to keep sexual energy and excitement kindled year after year. The notion that the passing of time inevitably makes a man lose his desire for a woman is false, a product of immature views of relationships and sexuality. Equally false is the view that monogamy deadens sexual energy and that infidelity is the only way to keep passion alive . If you want a sexy, faithful relationship, you are only asking for what you have every right to expect.

The fifth element of a healthy relationship is feeling truly known and understood:

You should feel seen. Consider these questions: Does your partner really know you ? Does he like you? (It’s possible to feel that your partner loves you but doesn’t really like you.) Does he understand your dreams and ambitions? Does he grasp what your deepest loves are—whether those are people, or places, or hobbies? Do you feel that he’s on your team in life, that he’s got your back? Does he value what you give to the world? Is he a good friend to you?

After I read through Bancroft’s list, I felt ill.  This in no way describes the relationship within my marriage.  This is the foil to my marriage.  Furthermore, the list felt somehow impossible.  Fantastical even.  Once again, it felt like Mr. Bancroft was in my head when he elaborated:

As you read through this list, you may be thinking, “Oh , I couldn’t possibly find a partner with whom I could have all that.” But this list describes the minimum a relationship should have, not pie in the sky. Expecting too little can keep you trapped in an unhealthy relationship. You will tend to keep second-guessing yourself, feeling that you are to blame for having unreasonable desires.

This is the minimum?! Frankly, I was stunned.  I sat at the table and tried not to openly weep.  I have never experienced this in my marriage! Upon reflection, I realized that I had never experienced this sort of relational climate in my family.  Maybe one of these criteria at one time or another but never all at once. Reading them again is still shocking to me.  These criteria, aside from passionate intimacy, applies to all our close relationships.  Respect, safety, feeling loved, and feeling understood are all qualities that should be a part of all our relationships be they with our friends, siblings, or parents.  His final word on it once again:

Expecting too little can keep you trapped in an unhealthy relationship. You will tend to keep second-guessing yourself, feeling that you are to blame for having unreasonable desires.

This is incredible validation.  It also takes off the blinders.  “Hey, I haven’t been expecting too much! I don’t have unreasonable desires! I’m not crazy! I don’t think I should be blamed for all this!”

This is just Chapter 1.  I highly recommend reading this book if you are in a relationship that isn’t working or if you feel crazy in your relationship.  It is designed largely for women although men should read this if they suspect that they are in an abusive relationship.  The book has a website of its own with bonus material for potentially abusive partners so that the women (or men) reading the book will not give the book itself to their partners.  Mr. Bancroft knows his stuff.

Be brave! Read on…

Resources:

Epilogue:

It should be said that I did end my marriage.  A little over a month after I wrote this post, my husband and I came to an agreement that our marriage was truly over after almost twenty years together.  We separated three months later.

A year later I can say that it was by far the best decision I could have made.

September 2016

Therapy Homework: Anger

I had Tuesday Therapy last week as usual but not this week.  This week is Spring Break, and I was with my family in a cabin in the woods on the North Shore of Lake Superior.  Duh duh duuuuuuuh…(my husband only stayed a day while the girls and I stayed for four).

I was given homework.  Therapy homework! I am a go-getter when it comes to homework.  I have, therefore, put my entire self into doing it.  My therapist observed that I was angry.  Really? You don’t say.  Truthfully, I didn’t like his observation. I immediately felt angry about it.

I knew what he was doing intellectually.  He was trying to name my feelings for me.  In so doing he was going to help me get in touch with them and parse them.  What am I angry about? Anger is an energizing and protective emotion.  It’s not sinful as so many people would have us believe.  It’s a feeling like any other feeling.  Anger, happiness, sadness, euphoria, frustration, excitement.  These are all feelings on the huge spectrum of human emotion.  What I did not like is that he merely named it.  He did not validate me.  I know why I’m angry.  I am in therapy so that I can figure out what is necessary and useful and what needs to go.  I need validation dammit!

Of course, this is why he gave me my homework.  I was to “reflect on my anger” so that I might look at what anger I needed so that I could maintain a good course and what anger might be preventing me from taking good action.  What anger might be entrenching me in a position that would be unhealthy? This is actually a good exercise albeit unpleasant.  I recommend it to anyone looking to progress and untangle themselves emotionally.  So, I did it.  I am a self-aware and mindful person.  I took my laptop to a familiar place where I’m comfortable and reflected on my anger.  I initially wrote eight pages.  I have added to it as I have continued to reflect.  I now have ten pages.  Ten pages of reflections on my anger.  One page for every two years that I’ve known my husband.

What I have noticed is that after I wrote it all out I was less irritable.  I was also much more prone to crying at odd times during the day.  My anger was enabling me to function.  It was like armor.  Not much could pierce it.  I feel far more vulnerable now.  There is a well of pain and grief under that anger.  And fear.  Doing anger work while living with the person at whom you are angry is really difficult.  It would be so much easier were I angry at him for cheating.  I am not making light of adultery.  That is a nightmare by itself.  It is the fear, however, that is getting to me.  I’m constantly anxious and on the verge of panic.  This is what I mean.  Fear is not typically an element in adultery.

When you live with someone with a history of violence who denies it things get dicey.  Abusers, be they emotional, sexual, verbal, or physical, are predictably unpredictable.  That’s the one thing you can be sure of.  You will not know what they are going to do although this is what I know for sure: Past behavior is the best predictor of future behavior.  I do not subscribe to the opinion so prevalent in certain faith communities that abusers change.  In my experience, they do not.  Abusers abuse.

Once the effects of abuse have passed from one generation to the next, permanent damage has been done.  Once actions have to be taken to intervene in the spiritual, emotional, and physical lives of children in order to heal and correct their well-being due to previous abuse, then it’s clear that an abuser is no longer someone who “means well” or someone who “is trying”.  They have crossed over into a different place regardless of the etiology of their maladaptive behaviors.

My 18 year-old daughter told me during our time on the North Shore that as soon as she leaves for college she will be cutting her father out of her life as much as she possibly can.  She told me that to her and her friends I am a “saint”, an “angel”, a “woman who deserves so much better”, and (this made me laugh) a “warrior goddess who is not be trifled with”.  Her father, she said, can just disappear for all she cares.  Her 16 year-old sister agreed.

This hit me hard.  I thought that I had done a better job protecting them, but they are too smart to miss anything.  Looking back on my own childhood and adolescence, I didn’t miss much either.  I knew everything going on in my house.  Why wouldn’t they? It’s not the validation I wanted.  “Yeah, Mom, we don’t like him either.”  I wanted them to love him.  He’s their father.

Alas, this is the process of telling the truth.  This is what happens when you open up your life to it.  Your children will start being honest with you.  Your therapist will ask you to look inward with integrity.  A lot is required of you when you want truth in your life.

Having come out of an abusive family of origin, I can tell you for certain that truth and abuse do not go together.  The truth teller usually receives the most abuse in an abusive environment.  Bringing the truth back to an abusive and invalidating relationship takes courage, support, and hope.  I encourage you to do it.  I don’t know where this is going, but I can assure you that we are moving forward.  As painful as it is.

I’m burning the ships.

Resource:

Go Forth in Anger 

Third-Party Credibility

Tuesday is therapy day for me.  I’m supposed to have a fifty minute session.  I had a two-hour session.  In fact, my prior sessions were about ninety minutes each.  My therapist just lets them go on and on.  He then looks at the clock and says, “Wow! I should really pay more attention to the time, but we are doing really important work here.”

Tuesday’s session was not as intense as the prior session.  I didn’t leave feeling as raw or amped up.  I deliberately chose a therapist in the same practice as my husband’s therapist.  That sounds funny to me–my husband’s therapist.  That implies that he regularly attends therapy.  He doesn’t.  He’s seen his therapist a few times and without any sort of regularity.  Therapy was a condition of mine.

I issued an ultimatum last summer or, at least, I think it was last summer.  My sense of time feels skewed somehow.  I told him that he must see a psychiatrist for his medication management rather than an internist.  Internists have their favorite drugs or drug rather.  They all seem to favor Zoloft.  Zoloft seems to be the cure for all that ails a person.  Zoloft will not cure much if one has severe depression or profound anxiety.  If one needs a little tweak, then perhaps Zoloft will do the trick.  A psychiatrist should ultimately be the clinician managing one’s neuropharmaceutical medications.  Not a GP.  Do you really want a doc who removes hemorrhoids and diagnoses strep infections treating your mental illness? I don’t.

I also told my husband that he must see a therapist consistently if I was going to think about staying in the marriage.  My therapist asked if I was bluffing.  I wasn’t really bluffing.  Had he refused, then I would have had to seriously assess my options.  After about six months my husband decided to comply.  He is slow to make decisions.  He doesn’t respond well to threats or ultimatums, and we are a good match in that.  I am not one to make threats or issue ultimatums.

My therapist offered me good advice on Tuesday.  He observed that we are in different places emotionally, spiritually, developmentally, and intellectually.  He may be intimidated by me, and this may be another reason we fail to connect and effectively communicate.  He may be right.  I expect my husband to be able to keep up with me and my ability to process and understand emotions when, in fact, he cannot.  He lacks the cognitive ability to do so.  We discussed other factors that may contribute to his categorized behaviors, but, in the end, I am still where I started.  I am at a crossroads.  What can I radically accept, and what can I not? What is too fundamentally broken to fix? What can be changed?

This is most likely why people avoid therapy when it comes to marriage.  Who wants to go to therapy only to have a therapist tell them that they are 1) being abused 2) possibly incompatible with their partner and 3) in need of a major reality adjustment?

It is not for the faint of heart, but I am finding that I sort of like it.  I am feeling a sense of strength begin to awaken in me, and it’s long overdue.  I haven’t spoken the truth in my marriage in a long while, and I actually did this week.  I told the truth.  I asked truthful questions of my husband, and he answered honestly.  Nothing is fixed and yet I feel better.  I told the truth, and he did not gaslight me.  He listened, and he looked stricken.  Why? He has indeed been abusive, and I told him so.  I used the ‘A’ word.  Abuse.

“That behavior can be called abusive.  That’s what my therapist said.  I think he might be right.”

Third-party credibility is very helpful when it comes to telling the truth in a relationship.  A therapist is not the same as a girlfriend.  “Deandra says that when you yell at me that’s abusive,” is not the same as when a therapist makes a similar observation.  Gravitas matters.  There’s something about that PhD after the name that just might make a difference to people.

There’s another reason to go to therapy.  Third-party credibility.  When we start taking the risk to tell the truth to someone we might fear, we need that back up.  We need that extra dose of credibility.  That evidence.  That extra opinion.  It got my husband’s attention.

I highly recommend it.

The Importance of EMDR

I want to talk about EMDR.  What is EMDR? Eye Movement Desensitization and Reprocessing (EMDR)1 is a comprehensive, integrative psychotherapy approach. It contains elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies. (online source)  When it comes to abuse in general and domestic abuse in specific, it is important to look for a therapist trained in EMDR and DBT.

I’ve done EMDR, and, in my experience, EMDR essentially dislodges biologically lodged traumas from the body and memory so that you can finally get past them and heal.  It’s very effective.  After all the work I’ve done on past trauma, I believe that it is virtually impossible to heal and progress without some element of EMDR in your treatment plan.  One will stay physically and emotionally ill because the trauma will continue to affect the body in the long-term.

For example, what caused me to seek out EMDR a few years ago was an interaction with my mother over the phone.  The moment I heard her voice, I got a migraine.  A classic migraine with aura.  I was well and truly ill.  I had to take my prescribed medications, go to bed, and ride out the headache just as I would have done with any other migraine.  I hated to admit to myself that my mother’s voice was actually causing a migraine, and I wasn’t even sure how this was happening.  Alas, it was.  I, therefore, sought the help of a therapist trained in trauma and EMDR.  We did some basic EMDR work, and it was successful.

The most notable observation, however, was that my relationship with my husband was paralleling my relationship with my mother, and this was triggering latent PTSD symptoms.  I actually met the criteria for PTSD at the time of my treatment a few years ago.  The EMDR work I did helped with a few memories associated my mother, but, as I shared more about my life with my then therapist, my marital relationship became the real concern.  She very bluntly stated, “This is not sustainable.  Your PTSD is most likely activated by your husband.”

Not something I was able to process at the time.  Not at all.  Who can fight a battle on two fronts?

The EMDR work is essential, however, because it cleans up toxic neural connections and allows new ones to grow.  This may be, in fact, why I can now take a fresh look at my marriage.  Everything we do in therapy builds a foundation for what we do in the future.  If you were hurt by a past spouse or a friend or a parent, then it’s vital that you deal with those wounds so that you stop bleeding out in order to be more present to current relationships and circumstances.  The more present you are, the stronger you are.  The stronger you are, the less susceptible to manipulation you are and the more likely you are to ask for help from others who can actually offer it.

If there is one thing that is absolutely essential when it comes to problem-solving while living in a marriage where there is some sort of abuse, you must not give in to victim thinking or behaving like a martyr.  This is where cognitive behavior therapy (CBT) and EMDR are very helpful.  I have found that is tempting to believe that we have no choices.  There are many seductive beliefs that come to us in moments of despair which result in feelings of desolation and helplessness.  We are not helpless.  Why is this important to remember? If we believe that we are helpless, then we will not take action to do what is within our power to do.  If we do not take action to differentiate from our partners, then we will forever wait upon them to change in order to meet our needs rather than learning to validate ourselves and change ourselves in order to meet our own needs.  I think that this is the most important thing to do in any long-term relationship wherein there is some kind of abuse.

We can’t wait for permission.  We must do for ourselves because it’s right.  As Rabbi Hillel once said, “If we are not for us, then who will be?”

Affective Deprivation Disorder and Alexithymia in Marriage

I have written somewhere in here that my marriage has been difficult.  If you’re married for nearly two decades, then I think, at some point, there will come hard relational times.  It’s inevitable and normal.  I am someone who doesn’t like to put up with hard times.  I feel driven to fix them.  I want to know what’s behind the problem.  If I am experiencing what I feel is pointless suffering, then I will do whatever it takes to either end it or, at least, add meaning to it.  I am the opposite of passive.

I seem to be married to my foil.  If I am a hare, then he’s a tortoise.  Nay, a rock.  I run around him.  Over and over again.  This can be good if it creates stability in a relationship, but it has created inertia and so much more.

After a while, one must ask: What is going on? Why am I in such pain? Why am I sick all the time? Why does he say that he’s happy when I feel like a black hole has opened up in my chest?

Let me introduce you to Affective Deprivation Disorder:

Affective Deprivation Disorder (AfDD) is a relational disorder resulting from the emotional deprivation sometimes experienced by the partner (or child) of persons with a low emotional/empathic quotient or alexithymia.

Coined by researcher Maxine Aston, AfDD was first applied to partners of adults with Asperger Syndrome, many of whom showed disturbing physical and psychological reactions to the lack of emotional reciprocity they were experiencing in their relationship. Maxine was later to broaden AfDD‘s applicability to include disorders other than Asperger’s such as depression, eating disorders, posttraumatic stress disorder, personality disorder, and substance abuse disorder in which the same low emotional intelligence or alexithymia is a key relational factor.

To qualify for a diagnosis of AfDD some or all of the following indicators in each category must be present:

One Partner must meet criteria for a diagnosis of one or more of the following:
• Low Emotional Intelligence
• Alexithymia
• Low Empathy Quotient

Relationship Profile includes one or more of the following
• High relational conflict
• Domestic abuse: emotional and/or physical
• Reduced marital or relationship satisfaction
• Reduced relationship quality

Possible Psychological Symptoms of AfDD
• Low self esteem.
• Feeling confused/bewildered.
• Feelings of anger, depression and anxiety
• Feelings of guilt.
• Loss of self/depersonalisation
• Phobias – social/agoraphobia
• Posttraumatic stress reactivity
• Breakdown

Possible Psychosomatic Effects
• Fatigue
• Sleeplessness
• Migraines.
• Loss or gain in weight.
• PMT/female related problems.
• ME (myalgic encephalomyelitis).
• Low immune system – colds to cancer.

Similar symptoms experienced by the SAD sufferer, are experienced by the AfDD sufferer. Yet there is an even more damaging effect for the AfDD sufferer insofar as it is another human being, they probably love, who is unintentionally responsible for their emotional deprivation. Emotional reciprocity, love and belonging are essential human needs, if these needs are not being met and the reason why is not understood, then mental and physical health may be affected. Awareness and understanding can eliminate this.

AfDD is a consequence of the relational situation a sufferer is in, therefore it is possible to find ways to rectify this. Just as sunlight restores the balance in SAD – emotional input and understanding can restore the balance in the person affected by AfDD. Relationships when one partner has alexithymia can work if both partners work together to understand their differences and develop a better way of communicating, showing emotional expression and loving that works for both of them.

The following treatment issues can be explored with those suffering AfDD:
• Rebuilding Self Esteem
• Having a voice
• Looking at negative responses.
• Looking at self image.
• Building confidence.
• Becoming assertive.
• Attending a Workshop.

Finding Self
• Identifying Parent – Child roles.
• Changing learned helplessness.
• Rebuilding self.
• Rebuilding family and relationships.
• Rebuilding a social life.
• Finding support.  (Maxine Aston)

What is alexithymia?

Alexithymia/ˌlɛksəˈθmiə/ is a personality construct characterized by the sub-clinical inability to identify and describe emotions in the self.[1] The core characteristics of alexithymia are marked dysfunction in emotional awareness, social attachment, and interpersonal relating.[2] Furthermore, individuals suffering from alexithymia also have difficulty in distinguishing and appreciating the emotions of others, which is thought to lead to unempathic and ineffective emotional responding.[2] Alexithymia is prevalent in approximately 10% of the general population and is known to be comorbid with a number of psychiatric conditions.[3]

Alexithymia is defined by:[9]

  1. difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal
  2. difficulty describing feelings to other people
  3. constricted imaginal processes, as evidenced by a scarcity of fantasies
  4. a stimulus-bound, externally oriented cognitive style. (online source)

My husband is alexithymic.  He also has crippling anxiety combined with what looks to be disturbances in his personality.  He has low emotional intelligence to be sure and poor cognitive empathy.  He cannot name his emotions, and he has no idea why he does things.  We are not able to have meaningful discussions about anything.  We have never been able to do this.  When we were in the first year of our marriage, I thought he was being difficult.  I had never encountered another human being who could not name their own emotions.

“How do you feel?”

“I don’t know.”

“Well, I understand not being sure about something, but…”

“No, I mean I don’t know what I feel.”

He couldn’t identify or describe any of his emotions outside of feeling “depressed” or very angry.  He had constant feelings of getting sick (somatic complaints).  He lacked empathy, and he didn’t understand why I expected him to be able to anticipate needs or intuit things.  I assumed that he was capable of that.  As an example, when I was pregnant with our first daughter, I was put on bed rest for the last few weeks of my pregnancy due to an inability to walk from pelvic instability.  I had no friends where we lived as I hadn’t lived there very long.  I was, therefore, unable to go to the kitchen and prepare food.  I would have to sort of slither up the hall on my side to make it to the bathroom.  I literally could not walk or stand.  I was famished when he would get home.  He was never able to remember that I was home and unable to meet my needs.  One evening, he came home with food and ate in front of me.  He didn’t ask how I was, talk to me, or even engage.  He just sat there, glazed over, and ate his food while playing computer games.  He rarely greeted me.  I was so frustrated and angry.  He looked at me with wide-eyed innocence and asked, “What’s wrong with you?”  Obviously, nineteen years later I can see the flaws in my much younger self’s hidden expectations.  Just call him and ask him to bring food for you, younger self! He can’t read your mind! The point I am making is that he was completely unaware of the “other” in almost all circumstances.  Pregnant wife on bed rest unable to walk? He just didn’t get it or understand why that had anything to do with him or why he had any responsibility there.  It bewildered him.

That is, however, a typical interaction.  It has played out over and over again in different contexts over the years from him not visiting our baby and me in the hospital when she was thought to have meningitis to his bringing the Lord of The Rings trilogy to my labor and delivery because, “There will be a lot of waiting around.”  It ranges from the comical to the spectacularly hurtful.  For years and years, our daughters and I have observed this very obvious lack of emotional response and wondered why he didn’t like us.  What had we done wrong? My oldest daughter has spent the last six months coming to me in tears over her feelings of loss where her father is concerned.  She has wondered if something is wrong with her.  She has asked the classic question:

“If he loved us, then why doesn’t he try?”

Last night, I sat on the edge of my bed and cried.  I felt like I was crazy.  It is so hard to describe what it feels like to be married to this.  I told myself yesterday that if I could make myself more like him, then maybe it would be better.  If I could remove all emotional desire from myself, then I would be able to do this.  I actually asked God to make me like Spock.  That has to be one of the weirder prayers to ascend.  Like some warped psalm.

“Oh God, make me like Spock.  Purge me of emotion.  Oh my soul, shut the hell up so that only my brain will speak and my heart will sleep a thousand years.”

Poetic but not possible.  I found a better thing to ask.  I asked for a sense of being accepted and validated by someone.  I felt so misunderstood.  Like not one person understood the exact nature of what I was experiencing, and this was so isolating.  This sense of isolation is intolerable to me.  This morning, I found all this.  I just stumbled across the word ‘alexithymia’ and AfDD.  I then immediately found a paper about AfDD.  Read this:

The lack of empathy in these relationships is one key to their impacts. A lack of empathetic attunement disables the individual’s ability to recognise, interpret and to verify subtle emotional signals expressed by intimates and contributes to an impoverishment of emotional interaction. The interaction becomes further compounded when the unverified partner or family member reacts negatively to feelings of being misunderstood or neglected. In this sense the affective deprivation experienced in such relationships refers to the deprivation of emotional-attunement, emotional validation, and intelligent emotional responding. To the extent that people look to their significant other for validation, the lack of such validation can corrode their sense of self and lead to a discouragement of self expression whereby large portions of the individual’s emotional repertoire become deleted from the relationship (Goleman, 1996b). In Asperger’s relationships this tendency to eradicate emotionality and take on Asperger’s characteristics has been labelled becoming “Aspergated” (Stanford, 2003). The failure to understand and validate legitimate emotional experiences or behaviours of the other typically creates or exacerbates negative emotional arousal in the invalidated individual/s, potentially leaving each member of the relationship displaying some measure of dysregulated affect (Fruzzetti, A.E., & Iverson, 2006). (Affective Deprivation Disorder: Does It Constitute A Relational Disorder?)

This phenomenon does not just apply to intimate relationships with certain people on the autism spectrum.  This would apply to other contexts as well.  I cannot tell you how validating this paragraph was for me, and I see just how important my being in DBT with my daughter was.  I was there to learn to self-validate.  The notion was introduced to me two years ago in David Schnarch’s landmark book The Passionate Marriage in which he says that self-validation is the key to differentiation in marriage and, thus, success particularly if there is gridlock.  That struck a chord in me then.  I learned how to self-validate in DBT.  I learned on a much more practical level how to be mindful, how to suspend judgment, and how to be effective in relationships without sacrificing self-respect.

This has been my greatest downfall.  I have slowly given up pieces of myself.  I truly have deleted large pieces of my emotional repertoire in this relationship because of repeated rejection.  How can one not do that? Knowing, however, that I am not the only person to experience this is tremendously validating.  Knowing that there is a white paper written about this very dynamic tells me that there is a common experience out there, and common experience means that I’m not isolated.  I am part of a group.  I may not know anyone else who is experiencing this, but I now know that others know exactly what I know.

The interesting thing about alexithymia is this.  It is a trait that can be comorbid with other psychiatric disorders:

Alexithymia is considered to be a personality trait that places individuals at risk for other medical and psychiatric disorders while reducing the likelihood that these individuals will respond to conventional treatments for the other conditions.[6] Alexithymia is not classified as a mental disorder in the DSM-IV. It is a dimensional personality trait that varies in severity from person to person…

Alexithymia frequently co-occurs with other disorders. Research indicates that alexithymia overlaps with autism spectrum disorders.[8][41] In a 2004 study using the TAS-20, 85% of the adults with ASD fell into the impaired category; almost half of the whole group fell into the severely impaired category. Among the normal adult control, only 17% was impaired; none of them severely.[41][42] Fitzgerald & Bellgrove pointed out that, “Like alexithymia, Asperger’s syndrome is also characterised by core disturbances in speech and language and social relationships”.[43] Hill & Berthoz agreed with Fitzgerald & Bellgrove (2006) and in response stated that “there is some form of overlap between alexithymia and ASDs”. They also pointed to studies that revealed impaired theory of mind skill in alexithymia, neuroanatomical evidence pointing to a shared etiology and similar social skills deficits.[44] The exact nature of the overlap is uncertain. Alexithymic traits in AS may be linked to clinical depression or anxiety;[42] the mediating factors are unknown and it is possible that alexithymia predisposes to anxiety.[45]

There are many more psychiatric disorders that overlap with alexithymia. One study found that 41% of Vietnam War veterans with post-traumatic stress disorder were alexithymic.[46] Other single study prevalence findings are 63% in anorexia nervosa,[47] 56% in bulimia,[47] 45%[16] to 50%[48] in major depressive disorder, 34% in panic disorder,[49] 28% of social phobics,[49] and 50% insubstance abusers.[50] Alexithymia also occurs more frequently in individuals with acquired or traumatic brain injury.[51][52][53]

Alexithymia is correlated with certain personality disorders,[54]substance use disorders,[55][56] some anxiety disorders,[57] and sexual disorders,[58] as well as certain physical illnesses, such ashypertension,[59]inflammatory bowel disease,[60] and functional dyspepsia.[61] Alexithymia is further linked with disorders such as migraine headaches, lower back pain, irritable bowel syndrome, asthma, nausea, allergies, and fibromyalgia.[62]

An inability to modulate emotions is a possibility in explaining why some alexithymics are prone to discharge tension arising from unpleasant emotional states through impulsive acts or compulsive behaviors such as binge eating, substance abuse, perversesexual behavior, or anorexia nervosa.[63] The failure to regulate emotions cognitively might result in prolonged elevations of the autonomic nervous system (ANS) and neuroendocrine systems which can lead to somatic diseases.[62] Alexithymics also show a limited ability to experience positive emotions leading Krystal (1988) and Sifneos (1987) to describe many of these individuals as anhedonic.[5] (online source)

I’ve discussed personality disorders at length on this blog, but I’ve never discussed alexithymia.  I have never had a therapist discuss this with me either.  Many of us leave families where there has been abuse or trauma with symptoms of AfDD, but those clusters of symptoms have never been named.  It’s all been lumped together under depression, or anxiety, or PTSD, or “Stop whining and get over it.”  I would like you to read this:

Emotional reciprocity, love and belonging are essential human needs, if these needs are not being met and the reason is not understood, then mental and physical health may be affected. (Maxine Aston)

Yesterday, I asked someone if it was normal to want reciprocity and belonging in a marriage.  I didn’t know if that was a normal thing to want.  I felt extremely confused.  Was it something that was bad to want?  Reading this statement this morning has been a powerful validation for me.  It has been the plumb line that I have needed so that I can see where long-term exposure to wrong thinking and unhealthy behaviors and beliefs have landed me.  I also asked these questions when I was emerging from my family of origin.  You will find yourself on shaky ground if you are in a relationship with someone with a Cluster B personality disorder.

If any of this rings a bell for you, I encourage you to look through the resources at the end of this post.  One of my takeaways has been that I didn’t get here riding his dysfunctional coat tails as it were.  I helped.  I participated in creating the current atmosphere, and I will be the one to rebuild my own happiness.  It has always been this way.  Knowing, however, that my experiences have names is powerful.  Knowing that what I want is legitimate is equally powerful.

Validation is healing.  I hope I have provided some for you should you need it.

Post script: This post has numerous comments some of which are very brave and personal.  I would ask that people who comment refrain from judgment and psychoanalysis.  The comment section is a place to share thoughts, ideas, and common experiences.  It is not a place to “concern shame”, judge, and go on the offensive out of a defensive posture.  Thank you for civil and kind discourse.  Remember, everyone is trying to heal.  So, let’s contribute to that process–not hinder it.

Resources:

Endnote: As of 2016, I have been separated from my husband; we are divorcing.  An excellent resource is Lundy Bancroft’s book Should I Stay or Should I Go: A Guide to Knowing if Your Relationship Can–and Should–Be Saved.

Related blog post: Should I Stay or Should I Go?