Welcome to Issue 315 of Institute Inbrief
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Issue 315 // Institute Inbrief
Dear Pedro,

Welcome to Edition 315 of Institute Inbrief. This edition's featured article explores why men don't seem to express their emotions as easily, as well, or as much as women do - and how that impacts their mental health. The article is the first of a two-part series (the follow-up article will be published in our next edition, 316). 

Also in this edition:
  1. The Eclectic Therapist
  2. Building Shame Resilience in Clients
  3. Identifying and Replacing Stress-inducing Attitudes in Clients
  4. On Hope and Heroes
  5. Quotations, Seminar Timetables & More!

Enjoy your reading!

AIPC Team. 
Diploma of Counselling
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The Eclectic Therapist
Expand your knowledge and understanding of 7 “must have” therapeutic modalities for any practitioner or student. 

You’ve done a thorough assessment of the client’s symptoms and presenting issues, identified their goals for therapy, and determined that you can work with them. Now what? Which therapy will be most effectively in helping the client attain their goals and get their life back on track?

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  5. Creative Therapies
  6. Acceptance and Commitment Therapy, and
  7. Mindfulness-based Cognitive Therapy.
The purpose of this e-book is to help not only practitioners, but anyone who may benefit from the concepts and techniques that have helped millions enhance their mental health, happiness and wellbeing.

For a limited, you can purchase your copy for just $9.95 USD (usually $49.95).

Go to www.counsellingconnection.com to purchase your copy today. 
Men, Emotions and Alexithymia
Men don't seem to express their emotions as easily, as well, or as much as women do. Why is that - and what's the impact? 

So what’s happening there; are we merely talking about normal gender differences, or should we be assigning pathology to the supposedly “strong, silent” sex for this apparent deficit? This article looks at the question of alexithymia and the debate that still rages decades after men were first accused (by a guy, no less) of falling prey to it at almost clinically significant (that is: subclinical) levels.

Alexi – what?

In case you haven’t run across the term yet, the Merriam Webster online dictionary offers a medical definition of alexithymia, calling it: “inability to identify and express or describe one's feelings” (Merriam Webster, 2019). The dictionary adds a note from the American Journal of Psychotherapy (Ogrodniczuk et al, 2004, in Merriam Webster, 2019) that people with alexithymia often display a lack of creativity and imaginative thought. They tend to have difficulty distinguishing between emotions and bodily sensations, and engage more in logical (externally-oriented), mundane thought than emotionally-focused, inner orientation.

Characteristics

Dr Samantha Rodman (2017) fleshes out the condition a bit further, adding that alexithymia, present in nearly 10% of people, is also the inability to understand others’ emotions. Alexithymics can feel emotions, she explains, qualifying that with “although not a wide range” (2017), but they do not know how to verbalise them. She offers the felt experience of partners of alexithymics that the alexithymics seem to have no empathy, acting self-centred and seeming completely unaware of their partner’s deeper feelings. When conversations involving emotions are initiated, alexithymics seem to be bored or distant. They are typically unaware that certain sensations are actually emotions: denying, for example, any true anger they may feel, or assuming tears flow because of fatigue or a blocked tear duct rather than sadness. 

The effect on relationships

“Frustrating” would be a gross understatement to describe what happens for partners, who tend to assume that the alexithymic is passively aggressively lying about his feelings or hiding his emotions for deeper reasons; most partners would not even entertain the possibility that the person was unable to feel or express the feelings. Alexithymia is linked with poor quality marital relations and high rates of divorce, with partners typically becoming angry, sad, lonely, and desperate when continually denied emotional validation and support. The alexithymic individuals themselves, however, become angry and confused when accused of being unwilling to give emotional support, because they genuinely do not know what it means to do that, and often believe that the partner asking for it is the one with the problem (Rodman, 2017). 

First coined by psychotherapist Dr Peter Sifneos in 1972, alexithymia is not classified as a disorder in the DSM. We said above that it is normally found at subclinical levels, so it is more like a personality trait that places people at risk for other medical and psychiatric disorders, while decreasing the likelihood that such individuals will respond to conventional treatments for their other conditions. Anxious with intimacy and preferring some distance in relationships, alexithymics can have either primary or secondary alexithymia, with primary alexithymia being inherent in a person’s personality and the secondary version occurring when a person has gone through a traumatic or horrifying experience; it is often a temporary or transient condition (Schexnayder, 2019). 
Now comes the $64,000 question: what does this have to do with male emotions? Are we somehow implying that all men have alexithymia? The short answer is no, but here’s where the conversation gets interesting.

Guys and their emotions: Normative male alexithymia

As we noted above, alexithymia affects about 9-10% of the population (Schexnayder, 2019; Rodman, 2017) and obviously men make up about half the population, so clearly not all men can be alexithymic, nor would it be fair to suggest that all women easily identify and express emotion. Yet most people would agree that many more men than women seem to be restricted in their expressiveness. So how shall we regard this experience of the male members of our species? Dr Ron Levant, psychology professor and former president of the American Psychological Association, came up with the phrase “normative male alexithymia” several decades ago to refer to the situation that traditional masculine role socialisation tends to channel many men into ways of being such that their masculine identity conflicts with many emotions they feel and what they believe that they are allowed to express (the resultant sense of restriction comprising the “alexithymia” part of the phrase). But the socialisation is so profoundly pervasive in society that it is, says Levant, the norm (hence, the “normative” part). 

Psychology professor Gregg Henriques explains that in typical male socialisation, expressing feelings of vulnerability, dependency needs, or perceived weaknesses brings shame and a sense of not being a “real man” (because “everyone” knows that “real men” don’t cry!) (Henriques, 2014). Psychotherapist Joshua Miles (2017) points out that from an early age, boys are systematically socialised in education and in society to be emotionally undermined. They are told that certain aspects of their personality are not acceptable, they are taught not to cry or to express in words how they are feeling. There are certain games they should play and activities they should take part in (and others not), and they are rarely, if ever, encouraged to engage in their feelings.

Miles largely blames television and advertising for the problem. Due to their bombardment of both sexes with images and perceptions of what “real” masculinity is – all muscles and bravado – men are caused, through oft-repeated presentations, to believe that to act in ways that don’t tick the advertisers’ boxes renders them not “man enough”. The resultant shame which permeates most of the male population disregards the reality that the projected images are outdated and “ridiculous” (Miles, 2017). More than that, though, they are harmful. 

Men and mental health

Citing Australian Bureau of Statistics figures, a news agency reported in 2018 that the number of suicides in Australia had increased by 9% from 2016 to 2017, and that, of the 3128 people who killed themselves in 2017, 2349, or 75%, were men (News.com.au, 2018). Similarly in the U.K., 76% of the suicide deaths in 2014 were men, with suicide being the single biggest cause of death in men under the age of 45 in both Australia and the U.K. (Miles, 2017; News.com.au, 2018). In the U.S., the suicide rate for middle-aged white men, especially rural men, rose by 43% between 2015 and 2016 (Keller, 2018). Mental health professionals such as Miles are clear that these statistics relate directly to the pressure on men to be less in touch with their emotions, to feel that they should not access support, or that they are “weak” if they do not uphold their invulnerable image of the strong one (Miles, 2017). 

It would be hard to argue – and we haven’t found any mental health professionals who do – that there is no relationship between these sad statistics and the way that Western men, at least, are asked to be in life. Here’s what the research is saying.

Normative male alexithymia (NMA) and associations with relationship satisfaction, intimacy, and communication quality

Levant himself, along with Emily Karakis, published the results of a study in 2012 which investigated the associations between NMA and relationship satisfaction, intimacy, and communication quality. Noting that previous research had found a moderate negative relationship between NMA and relationship satisfaction, they hypothesised that NMA would negatively correlate with relationship satisfaction and communication quality, but would positively correlate with fear of intimacy. With a sample of 175 male volunteers from university and community sources, all three of their hypotheses were supported. 

NMA, gender role conflict, male-male (non-romantic) relationships, and men’s wellbeing
A doctoral dissertation by Kan Guvensel (2016) noted the empirical support for the idea that concepts about masculinity could affect men’s psychological wellbeing, but also that there was little research looking at the intersection of gender role conflict, NMA, and men’s friendships with the wellbeing of men. Thus the dissertation collected the data of multiple surveys from 216 male participants. Bivariate correlations revealed significant correlations among all four variables, although some of the correlations were small.

The Finnish study: Men are more alexithymic

We said above that the conversation was going to get interesting. Another dissertation looked at alexithymia in 5454 Finnish adults of both sexes aged 30 or greater (Mattila, 2009). Results from the 20-item Toronto Alexithymia Scale (TAS-20) showed that men were significantly more alexithymic than women (9.9% versus 8.1%). Of the three dimensions of alexithymia measured, two dimensions – difficulty expressing feelings and externally-oriented thinking – were significantly higher for men, but the third dimension – difficulty identifying feelings – was not; on this there was no difference between the sexes. That is, Mattila’s findings were that men can identify (read: feel) their feelings just as well as women do, but that they do not express them as much. Moreover, the study showed that, the older the study participant was, the stronger this effect was. In other words, this finding was just what we might predict as people move through the life cycle and become more fixed in their socialisation or way of being in the world: that those who have been taught to be “masculine” in a certain way – that of not expressing feelings – become more so as they age.

Controversy: Thompson, Kiselica, and the conflation of factors

James Thompson, writing about NMA (Thompson, 2010), acknowledges that Levant and others could be right in their claims that men are generally less skilled in their ability to describe/express feelings, but cites the above Finnish study as support for the idea that it is incorrect to say that men cannot identify/feel feeling states – which is a criterion that would need to be met for it to be alexithymia in the true clinical sense. Rather, says Thompson, what men do is “thoughtfully act to modulate the intensity of emotions” rather than engaging in “lengthy descriptions of the feelings they have successfully identified” (2010). Thus, male emotional empathy might look like taking a distressed friend to the movies rather than the typically female way of coming together with the friend to process what’s happening through chatting. To say that men are alexithymic because they don’t indulge in a lot of verbal expression of feelings is to miss the mark; they do, he insists, feel them.

Moreover, Thompson cites New Jersey psychologist Mark Kiselica, who claims that most men are not alexithymic; it is not “a norm”, and most studies do not show sex differences in the prevalence of the disorder, with the overall rate of one in ten persons of either sex developing it. Rather, Thompson says, we can understand men’s reticence to express their feelings verbally as cultural encouragement toward stoicism, which includes positive and sometimes emotionally helpful traits such as forbearance, tolerance, and (healthy) capacity for emotional control in stressful situations. Thompson concludes that conflating alexithymia with culturally socialised “maleness” is not helpful, and that, perhaps, Levant’s normative male alexithymia could be belatedly re-named “normative male stoicism” (Thompson, 2010).

Where to from here?

So where does this leave us in terms of understanding men and their emotions? We agree that calling our fellows “alexithymic” simply because they have absorbed traditional societal teaching about what constitutes “manliness” is unfair; it is on par with Freudians 100 years ago pathologising women who expressed emotion in session as “hysterical” (read: neurotic). On the other hand, no one is disputing the notion that the 3:1 male-female suicide rate is closely associated with the induction for men to restrict emotional expression. Neither is there much argument that, as empirically demonstrated (above), doing so makes for poor quality relating, because the partner of a person restricted in expression is unable to experience feeling seen, understood, and valued when a man is unable to express his feelings to her emotionally, in words. 

We say, socialisation may be strong, but therapy can help. It can offer men the opportunity to experience the “both and”: that is, that they may experience being both strong, confident, and stoic and being vulnerable, stressed, and anxious. They can come to appreciate the rich tapestry of needs, feelings, and challenges – in all the pain and the glory – that can comprise a deep understanding of what it means to be a man. There can be honest therapeutic conversation about the sad myths of masculinity – so convenient for popular stereotypes – that have stultified men’s growth. These can be replaced by courageous exploration of new paradigms for how a fully-functioning man may think, feel, behave, and express. Just how we as mental health professionals can help bring that about is the subject of our next, follow-up article.
 

References

  1. Guvensel, O. (2016). The Relationship Among Normative Male Alexithymia, Gender Role Conflict, Men's Non-romantic Relationships With Other Men, and Psychological Well-being. Dissertation, Georgia State University, 2016. Retrieved on 18 July, 2019, from: Website.    
  2. Merriam Webster. (2019). Alexithymia. Merriam Webster, Inc. Retrieved on 17 July, 2019, from: Website.
  3. Henriques, G. (2014). Why is it so hard for some men to share their feelings? Psychology Today. Retrieved on 16 July, 2019, from: Website.    
  4. Karakis, E., & Levant, R. (2012). Is Normative Male Alexithymia associated with relationship satisfaction, fear of intimacy and communication quality among men in relationships? The Journal of Men’s Studies: 20(3), 179-186, from: Website.    
  5. Keller, J. (2018). The U.S. suicide rate is at its highest in a half-century. Pacific Standard. Retrieved on 17 July, 2019, from: Website.
  6. Mattila, A. (2009). Alexithymia in Finnish general population. Doctoral dissertation. Retrieved on 18 July, 2019, from: Website.    
  7. Miles, J. (2017). Why do men struggle to express their feelings? Welldoing.org. Retrieved on 16 July, 2019, from: Website.    
  8. News.com.au. (2018). The men’s mental health crisis Australia can no longer ignore — six male suicides a day. News.com.au. Retrieved on 17 July, 2019, from: Website.    
  9. Rodman, S. (2017). Alexithymia: Does my partner feel anything? Huffington Post. Retrieved on 17 July, 2019, from: Website.
  10. Schexnayder, C. (2019). The man who couldn’t feel. Brain World. Retrieved on 17 July, 2019, from: Website.   
  11. Thompson, J. (2010). Normative male alexithymia. In search of fatherhood. Retrieved on 18 July, 2019, from: Website. 
Building Shame Resilience in Clients
Jungian analysts have called it the “swampland of the soul”. Other psychotherapy writers have observed how it originally served to keep us safe; the tendency to shame has been a universal one in which our desire to hide our flaws from others has saved us from being kicked out of the group (the society), which evolutionarily would have meant death (Sholl, 2013). So which is it? Is shame totally pathological, or is it ever helpful to us? And how shall we deal with it in the therapy session, especially when we are faced with a highly self-critical or otherwise shame-prone client? 

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Identifying & Replacing Stress-inducing Attitudes
As a therapist, you can initiate the discussion by asking clients about negative, unhelpful attitudes. Which attitudes or beliefs do clients identify for themselves as problematic? Provide them with a copy of the list below and invite them to go through by describing how often they engage these attitudes/beliefs. How does the client currently deal with these distortions? How stressed does the person make him/herself as a result of them?

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More articles: www.aipc.net.au/articles