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Posttraumatic Response: Related to the ability to express emotion?

Mar 18

G’day all!! Once again I have returned from the LMD. I apologize for not attending to the blog as I promised. I seem to be one of those people who is more interested in what is going on around him/her than on an electrical device. Which reminds me, anyone seen “Bad Boy Bobby P.”? Strangely absent from the spotlight dontcha’ think? Enough small talk….I wish to acknowledge your fallen comrade, Cst. Nolin; who took his life recently in Ottawa, only walking distance from Parliament. What struck me most of all was the Force’s almost immediate response, made through some Dudley Doright commissioned officer (can’t even recall his name) that Cst. Nolin’s death had nothing to do with his work. Do you recall Professor Linda Duxbury’s very thorough study of the RCMP (2009)? I’ll never forget one of her outstanding findings; that anyone (with regard to the organization), Inspector or above “was happy with the status quo, whereas the rank and file feel deeply betrayed by these careerists”. Hmmmm, I wonder? Nothing to do with his work? Has Dudley been in hibernation for the last 10-15 years?

To business….what follows is another article in what has turned into a series of articles related to posttraumatic stress. The usual proviso applies, I am not your therapist!! I am just a voice in the wilderness giving you some things to ponder. I do not intend to compete with your therapist. What I am about to offer to you comes from my association with some American psychologists involved in the treatment of Viet Nam veterans who were hospitalized in VA hospitals in the US. (If you are interested in citations, call me and I will provide them for you.) I had the pleasure of working with these individuals when I was working with the Canadian Forces and tending to members returning from Middle East deployments.

I find merit in the idea that our capacity for symbolizing feelings and expressing them in words, can mediate our response to a traumatic exposure. In this offering I will do my best to present somewhat esoteric thinking in understandable terms.

Chronic posttraumatic responses (you’ll note that I don’t refer to “PTSD”, as I am one of those clinicians who remains unconvinced of its’ “stand alone” existence) have long been linked with the syndrome of alexithymia i.e. a difficulty in the ability to express feelings in words, whether spoken, thought, or written (sound like anyone you know?). There is a body of work supporting alexithymia and its’ relationship to the severity of posttraumatic responses. In general these studies (if you want the references call me) suggest that more severe posttraumatic responses are related to greater alexithymia; whereas the greater ability to express oneself seems associated with somatic (bodily) illnesses and/or affective disorders (i.e. less severe posttraumatic symptomology e.g. depression, anxiety).

Despite all this investigation, the relationship between posttraumatic response and alexithymia still remains under scrutiny. The definition of alexithymia is even in need of some precision. Is it, 1) difficulty in the ability to distinguish emotions from bodily states, 2) difficulty in the ability to verbalize emotion 3) difficulty in the capacity to verbalize inner states, or 4) difficulty in the ability to direct one’s thinking inwardly? Early thinking in this area was heavily influenced by the Freudian perspective; that suggests there will be a fundamental difficulty when there is an inability to represent internal states (emotions) in imaginal forms (i.e. symbolizing capacity). More recent empirical work has pointed to a deficit in lexical (i.e. verbal) representation and away from the analytic perspective.

If you are familiar with developmental psychology (or have paid attention to the development of a child) you may recall that the way we represent internal states (emotions) seems to develop through a three stage process from sensorimotor (e.g. bodily movements and sounds) through symbolic (e.g. drawing, gesturing, hand signals, sign language, and use of shapes) to lexical (e.g. letters and words) in an effort to internally represent and interpersonally express our subjective experiences (e.g. fear, shock, horror, disgust, happiness, pleasure, love, etc.). The latter form (lexical) uses higher, more abstract forms of language that may bear no direct sensory similarity to the object (experience) represented. Human language provides us the ability to label and communicate emotional experiences (e.g. from a horrific response to loving feelings).

Those of us who are more alexithymic and don’t verbalize our emotions well are thought to have difficulty making a connection between bodily states(of emotion) and language, and may be handicapping ourselves in some way. The Freudians proposed that those of us with this difficulty may be lacking in the development of an inner fantasy life referring to feeling states or interpersonal relations. We may retell our dreams without much elaboration, and demonstrate difficulty with elaborate fantasy and free association; including an inability to use expressive language or describe our feeling states. This problem can then lead to (think of “guess who?” here)….a deficit in the ability to symbolically represent experience that ends up in more frequent kinesthetic (bodily) arousal, or in thought (cognition) that is plodding, awkward, concrete, utilitarian, obtuse and tied up in the physical details of what was witnessed (Can you here your partner’s words……”Yes, but I want to know, how do you feel?”….I think I can.)

In posttraumatic responses the kinesthetic level is aroused and highly active as a result of the traumatic exposure. Therefore it follows that the problem must be found in either the symbolic or lexical levels. We can presume (hypothesize) that the traumatic experience has either encouraged alexithymia (by causing a difficulty in the symbolizing or verbalizing functions) or there was a pre-existing problem in one or the other of these functions, that may be contributing to the patient’s inability to work through the event.

Enough for now. I’ll let you process (think about) this. I’ll share with you the upshot of the Americans’ work at some future point……remind me. Think about what I have presented in terms of your personality, your traumatic exposure, your developmental history, your family of origin, your way of dealing with emotion, your belief system regarding the expression of emotion, feedback from those close to you, and how you have dealt with the event (i.e. have you symbolized and verbally expressed your experience to appropriate others who care about you, or do you play the “strong silent type”?). If you need clarification or have questions, I encourage you to send them to the blog so your brothers and sisters may benefit. (Oh yeah, one more thing, alexithymia is not a “disease” that you can be compensated for).

Dr. Mike Webster
Reg’d Psychologist

“One evening Owl spoke up first during the question period and asked, ‘Is there anything we can’t talk about?’
Raven said, ‘We can’t talk about anything’.
Owl asked, ‘Aren’t we doing it now?’
Raven said, ‘It disappeared’.
Owl asked, ‘How can we retain it?’
Raven said, ‘It’s not a matter of retaining. Speak!’
Owl was silent.”


  1. Anonymous permalink

    This leads me to ask how would one differentiate alexithymia from introversion, stoicism, FIDO, ‘suck it up’ etc., and at what point do we cross the threshold of traumatic (emotionally, psychologically, somatically?
    What about flattening of affect in response to chronic stress vs severe or more singular events?


  2. Me again, I got busy tending to my horse and had little time for such matters as you raised, but to answer the rest of your question…..what is traumatic, chronic, or severe is defined individually. What bothers one has little effect on another. Moreover, flat affect just might be a normal human response to an abnormal event. If I have confused you consult Brother Raven.

    Sam S.

  3. “Our greatest glory lays not in never falling, but in rising every time we do.”

    — Brother Raven

  4. “The mind is everything, what you think you become”.

    — Brother Owl

  5. You have a brain in your head. You have feet in your shoes. You can steer yourself in any direction you choose. You’re on your own, and you know what you know. And you are the guy (gal) who’ll decide where to go.

    — Brother Bear

  6. All know the way , few actually walk it.

    — Brother Wolf

  7. Anonymous permalink

    Thanks Coach. Heads up. I’ve fw’d your blog to a group of veterans I’m involved with through my participation in events.
    In our Facebook group we have a discussion thread ’22 days of QnA regarding PTSD and suicide/prevention’, and some are getting pretty raw and open. That’s our goal. We’re trying to help as many as we can find resources to talk to.
    The Facebook group is invite only with 15k potential readers, but only a hundred or so regular readers and posters. It’s not open to the public, and you have to complete an event to get access to the ‘in’ group. There are many current active duty Special Forces guys involved and many of the audience are current, retired, or former military, LEO, and FD members.


    • Hey Geoff,
      Now I know who you are! Thank you for your service and your email. I’m honoured that you would have passed the blog on. I’m at your and the other members’ service. Mike W.


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