Ep. 054 | What is Alexithymia?

Today, we chat with Yana Ramos about Alexithymia and how music therapy can support emotional understanding and expression.

TRANSCRIPT

Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. My name is Erica Lee, and today we chat with Yana Ramos about alexithymia, and how music therapy can support emotional understanding and expression.

Yana is a music therapist whose personal and professional paradigm is grounded in disability justice, wonder, and playfulness. Yana shares space with children, families, and adults, where they strive to co-create in bravery and trust. As a neurodivergent and disabled person of color, Yana hopes to embody the belief that everyone is worthy of dignity, agency, care, and rest. Yana holds a Bachelor’s in Humanities, a Bachelor’s in Music Therapy, and is currently pursuing a Master’s in Music Therapy.

[Podcast intro music plays]

Erica: Well, welcome back to the podcast, Yana. It’s been a minute since you’ve been on the podcast.

Yana: It’s been a few, yeah.

Erica: Um, I’m curious - I asked Colby this question, and I would like to ask you the same question. Music therapists can work in a variety of settings - there’s lots of different places to be a music therapist. Why did you decide to work for a nonprofit, and what about the Music Project specifically - why work here, of all the places you could work?

Yana: I think finding my way to the Music Project was really auspicious. I actually didn’t know it existed until March of 2019, when I was already beginning my internship search. Um - and then I met some cool people from SCMP at the regional conference in Oregon. There were. - there were things, because of like school situations - like, the school I started at closed, and so like, I was already at a place of having reexamined - I mean, still do - but like, is this even the right field for me? Um, there’s so many things that I don’t align with in this field. But then I met Vee, Cassie, and Colby at the conference, and, you know, we got to talking, and - and just like finding like those connections and the shared beliefs I guess -it was just like refreshing - um and kind of inspiring I guess.

Erica: Mmm.

Yana: And then I was very fortunate to be able to come here for internship. And I was also very fortunate to be offered a position here um to work after internship. And like, the same things are true - like, being connected to cool people who - um a lot of our like values and things that we care about align here. Um —

Erica: Mmhmm —

Yana: And I think like a space where we can all like try to grow together. Um, so yeah. It’s cool.

Erica: Cool! Well, we’re glad you’re here. So, last April, we talked about the double empathy problem. It’s episode number 10 - I went back and listened to it because there was some connections I made between the research I was doing for this episode and that episode - it was interesting to think about the connections between the two things. But we’re gonna talk about alexithymia, which we, off-podcast have had an extensive conversation about how to pronounce it, so we hope that is the correct pronunciation. Um, Yana, can you tell us about what is alexithyma?

Yana: Alexithymia uh loosely translated means a lack of words for emotions. It’s when people have a difficulty in identifying, verbalizing, and/or processing emotions in themselves or others. It also can include like a difficulty in distinguishing between the sort of physiological uh responses of having an emotion, and your body’s uh physical sensations of like thirst and hunger- um, and also a difficulty in even identifying those things.

And then, that can also lead to I guess what’s clinically known as externally-oriented thinking - so, processing what’s going on inside by focusing on things outside of you. Um, and because alexithymia also deals with the words for emotions, um, it can also come as the result of trauma, when - when things affect the speech area - the Broca’s area of the brain.

There are a lot of different ways, alexithymia can show up. And people will experience different aspects of it to different like degrees. So it’s kind of multi-dimensional in that way. That’s kind of an overview of what it is.

Erica: Thanks for that overview. I’m curious: it sounds like it impacts a wide number of people - there’s not just one or two different ways that you maybe like would inherit it, or it would um start to develop. I’m curious: because it impacts a wide variety of people, what is the general impact on a person’s wellbeing?

Yana: I think it’s one of those things - and I’m - I’m speaking like - I guess to know, like this is the way I understand alexithymia, and I also like have experience with it, so a lot of where I’m coming from is drawn from like my own experience, and then reading like accounts of uh mostly other autistic people —

Erica: Mmm —

Yana: With alexithymia. Um, I think for me, growing up and sort of, you know, experiencing my emotions the way I experience them, I thought like, oh, that’s just the way it works. And, I mean, it is - for me. But uh when I found out that there was like this word for the sort of disconnect I would often feel - this disconnect between like from me to like - to the emotions in my body I guess, it was really helpful. Um because then I could begin to like get to know my like personal - for some reason, the term emotional landscape is coming to mind - like, what do my emotions physically feel like in me?

I was thinking about like just briefly talking about how emotion processing happens. Um, because with alexithymia, that’s primarily what is effected - um one or more parts of the way people process emotions. So, emotions are basically like really [snaps finger] quick uh reactions/responses to stimuli in the environment. Like the immediate responses - physiological - so, like your heartrate will speed up, or like your um blood pressure will go um up or down. And then that will effect like your posture or your facial expression - so those sort of more external behaviors, like your voice might get tighter or something like that, depending on the emotion. And then, from that - that’s sort of when the like experience and the cognitive part of emotion processing happens. So you then begin to like put those physiological and external responses into context. So like, physiologically, something happens - that effects the like extern- uh your gestures, your voice, your posture - and then, you begin to synthesize that into, okay, I can talk about this feeling in this way, and relate it to this thing. And then, from there, we respond to the synthesized information.

All of the things I’ve mentioned so far basically happen [snaps] in that quick response, and a lot of them happen without you really having to think about it. Um, and then, after all that has happened, your sort of subjective response - um, when you appraise the emotion, you’re like, is this meaningful for me? Will it - like does it matter? Does this feeling that I’m feeling, will it help me? What do I need to do to respond to this feeling? All of that to say, there’s like this disconnect somewhere within that, which can contribute to someone’s experience with alexithymia. Um —

Erica: Mmm —

Yana: So, like when those physiological changes happen, it’s like, oh, my heartrate is going up up up, but not - not like connecting it to: perhaps this means uh that I am stressed/perhaps this means that I am anxious.

Erica: Yeah.

Yana: Or like, sometimes not even mmm being able to notice those physiological changes. Um, and that has to do with uh our sense of interoception, which is basically the sense of like what’s going on in your body. And when you have a sort of decreased uh interoceptive sense, then, well, that kinda contributes to that aspect of emotion processing, where hmm, my stomach is feeling weird. Period. Versus my stomach is feeling weird - oh, I also noticed this about my body - oh, maybe this is I’m feeling anxious, or oh, maybe I’m hungry. It’s just a lot of like disconnections, or like crossed uh crossed wires, I guess you could say?

Erica: Mmm.

Yana: And when - you know, when all of that happens, then, when you’re your body isn’t able to respond or work through various emotions, that leads to like a lot of confusion, or a lot of stuckness in your body. Uh, it’s kinda like when trauma builds up, and you’re not able to sort of release it or work through it.

Erica: And so, as a music therapist, if you have a client coming to you that has alexithymia, what strategies, or what sort of activities do you do to support that person?

Yana: So, for me, with like my own - like my personal experience, um, I have found that music has been - like I’ve used music, and I didn’t know I was like doing it, you know, growing up and —

Erica: Mmhmm —

Yana: And things like that. Um, where I would be able to sort of connect like - and this is what I was talking about earlier with the externally-oriented thinking: so, connecting stuff outside to help make sense of what’s inside of you.

Erica: Mmhmm.

Yana: I grew up listening to a lot of showtunes, and sort of using them subconsciously uh to help myself um sort of understand - like, you know, because our music is - is is, you know, based on, you know, western constructs, you - you sort of get conditioned like major things sound happy, and minor things sound sad —

Erica: Mmm —

Yana: But like, between that, and like beyond that, using the  what’s called prosody - so like, the sort of contours/melody of the speech to process the oh, when this person sings something like this, that probably indicates like sad, or afraid, or - like taking the cue I guess um from the music really. Um, and so, say, if I’m at the piano, and someone is saying, I feel frantic right now, - like - maybe the feeling is frantic, but what they can say is like, um I have noticed that my heartrate is beating really quickly/um maybe I feel like buzzy or tight or like. I want to crawl out of my own skin - or something - like these various descriptors, but frantic isn’t there. Um, so I would try to play that on the piano, and see if like we could find sort of that feeling on the piano, and then, you know, we could talk through it, and say like, oh, maybe -maybe it’s this feeling or that feeling.

Or another thing - sometimes I think of a emotion theme song kind of. So like - I had this assignment in class once, where we were given five emotions, like happy/sad/excited… Um, and we had to say the song that fits with that emotion for us.

Erica: Mmm.

Yana: And like, that was really hard for me [chuckles]. Because, first I had to like figure out what that feeling in myself was. It’s almost like learning your body’s language, I guess. And sort of working backwards on that angle or something. And so, like figuring out like, oh, so that feeling is sad - connecting that to oh, when I hear that song… For me, uh sad is “When Somebody Loved Me” from Toy Story 2.

Erica: Mmm, that’s such a good song. But I see how that could be really sad, yeah.

Yana: And - and I connected that to, again this like externally-oriented -- I connected that to way back when I was nine, watching Toy Story 2 for the first time, and um like realizing like, oh… that was sad - that was sad.

Erica: Mmm. Yeah —

Yana: Um, yeah.

Erica: Yeah. Um, we have talked about before, affective and cognitive empathy. Um, my understanding is affective empathy is like, when you can feel something quote unquote in the air. Um, like something’s happening, or that emotion’s really strong. Versus cognitive empathy is when you can like read it on somebody, either from like something you’re hearing, or like facial expression, or like that kind of thing. Is that…

Yana: Mmhmm

Erica: Accurate to what your understanding is?

Yana: Uh, yeah.

Erica: Yeah. So I’m curious then: if that’s what cognitive empathy is, and you have a hard time processing emotions - especially when you really need that external to make the connection - does having alexithymia have an impact on cognitive empathy?

Yana: So cognitive empathy is like understanding the why of someone else’s feelings —

Erica: Mmhmm —

Yana: Um, and like the sort of, you know - breaking it down in your mind of like, oh this happened, so they must be feeling this. And that is kind of a lot of that externally-oriented like thinking I guess - like, finding those patterns, and kind of logic-ing into making sense of the emotion. And - and also like, having alexithymia doesn’t mean that we - it might, but it doesn’t always - mean that like we don’t feel the emotion uh or the - you know, sense the emotion I guess.

Erica: Mmm —

Yana: Um, it just means that we don’t always know - well, I can know the concept of a something that I haven’t seen before, even though I’ve not seen it before, because of like other information that I - that I learned about it, you know? But I have to make sense of it through that other information.

Erica: Mmhmm.

Yana: Sometimes with alexithymia, it’s just not being able to verbalize the feeling. So like, you have the feeling, you feel the feeling, but the words don’t happen. Um, I think that’s. kind of a part of that - it could - it can be a part of that affective empathy: like, you still can sort of sense or feel the feelings, but like, the like name for them, or the how to describe them, or —

Erica: Mmhmm —

Yana: Things like that aren’t always - they’re more of a learned thing.

Erica: Okay. So it’s more - yeah, it’s that they’re felt, but there’s maybe a hard time with identification or verbalizing about them —

Yana: Yeah —

Erica: Yeah. Um, if you have a friend that you think has alexithymia, or has said that they have alexithymia, what can you do to support your friend?

Yana: I think one of the ways is really like listening to the way they process, or have come to process, their emotions. And sort of understanding like, sometimes, asking questions, like how are you doing, might not always get like the response of like” feel: blank.

Erica: Yeah.

Yana: I think when you’re [chuckles] really, just when you’re supporting anybody - but really understanding the way that they’re communicating the things that they’re trying to communicate, you know? Yeah, just like - I think the biggest thing is - is uh listening and learning the way that emotions happen for them, or the way they experience they’re emotions.

Erica: Yeah. We are running to the end of time for today. Is there anything - any words of wisdom or other thoughts that you want to share?

Yana: Because alexithymia is - has to do a lot with interoception, like medically, they’re - they’re realizing like people can like not always - I guess like under-report or over-report certain - like, if someone has pain - like, the perception could be different, um because of interoceptive sense.

Erica: That’s interesting to think about, how that impacts pain management.

Yana: Mmhmm. Because, with interoception, like, you know, if you can’t always tell if you are tired, or if you have to pee, or if you’re hungry, like that will also effect like things with your emotions. Because like the connection between your - your physiological state and your like emotional responses um they’re very much connected, you know.

Erica: Yeah. Um, so - thanks for sharing. I appreciate you.

Yana: Yeah.

Erica: Yeah.

Yana: Cool, well thanks.

Erica: If you’d like to know more about the Music Project, please visit our website at S as in Sam - C as in cat - Music Project dot org (SCMusicProject.org). On our website, you can also find transcripts for every podcast episode. We encourage you to connect with us on social media @SCMusicProject on all social media platforms. Never miss notifications for new episodes and other projects.

Thanks again to Yana for being here today. Thank you, listeners, for listening. And we will talk to you next time.

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