Indian culture, inability to express feelings and depression: explaining the complex relationship.

Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It has been studied in relation with medical as well as psychological conditions and has been seen to impact treatment outcomes. A review article published in Indian Journal Of Psychiatric by Rajesh Sagar et al describes the relationship between alexithymia with depression and the impact of culture in this relationship. The main findings of the review were that alexithymia and depression are highly correlated, and severity of depression and gender are independently associated with alexithymia and may interfere with treatment outcomes.

Alexithymia has been described as difficulty in expressing as well as experiencing feelings. It can be perceived in two ways: one as a stable personality trait and the other as a defense mechanism, i.e., primary and secondary alexithymia, respectively.

The most common scale that is used to measure alexithymia is Toronto Alexithymia Scale (TAS-20), which is a 20-item self-report measure consisting of three subscales, namely, difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking.

Alexithymia as a stable personality or otherwise is seen to be present in a wide variety of psychological disorders, namely depression, anxiety and schizophrenia.Depression as a disease state has been seen to be studied widely in association with alexithymia.

Alexithymia as a personality feature:

- Alexithymia has been suggested to be a part of personality with cognitive and affective deficits. Alexithymia is a personality style commonly found in those seeking psychotherapeutic management and is seen with depression. Studies on nonclinical population also found approximately 10% of them dealing with alexithymia, more commonly among males.

- Risk factors of alexithymia in a study were found to be: family and environmental; maternal psychology, inefficient parenting and adverse events in childhood. A study by Gavazzi et al. concluded that alexithymia as a trait was responsible for response inhibition.

Alexithymia and depression:

- In a study on the factors associated with depression in 137 depressed patients, almost half of the patients were alexithymic as measured using TAS-20.

- ]A study on 121 patients with major depressive disorders found that alexithymia features (TAS-20) were common in persons with depression and cluster C Personality Disorders. Further, if alexithymia features did not improve, there was no significant improvement in depression and personality problems.

- Alexithymia and depression are also mediating factors for eating disorders in women..

Culture, alexithymia, and depression

- It has been seen that in South Asian cultures, positive emotions are readily expressed and negative emotions are inhibited. Children are taught by adults how to react in social situations either directly or through observation. They are also taught how to smile and to control themselves if they feel like crying, especially boys. It has been noted that family expressiveness is related to alexithymia and that depressed female patients in India are more likely to have associated alexithymia. In a study conducted on twenty nonpsychotic patients with one medically unexplained somatic complaint in Bengaluru using Diagnostic Criteria for Psychosomatic Research, it was found that 45% of the patients reported alexithymia.

The social construction of emotions is culturally defined, and so in Indian culture, there is emphasis on emotional control, with different norms for males and females. In a study on Indian and American students regarding expression of emotions and control, it was found that Indians' expression of emotions was modulated by others' expectations and maintaining group harmony and avoiding situations in which there is possibility of devaluation of self and family.

In a study on Indian and American students regarding expression of emotions and control, it was found that Indians' expression of emotions was modulated by others' expectations and maintaining group harmony and avoiding situations in which there is possibility of devaluation of self and family.

The review suggests that there is, in fact, a significant relationship between alexithymia and depression and this relationship is more common among females. It was found that alexithymia could be trait based as well as state based. Social construction of emotions according to the culture has a great impact on alexithymia and conclusively, on depression.

Source: Indian Journal of Psychiatry: Sagar R, Talwar S, Desai G, Chaturvedi SK. Relationship between alexithymia and depression: A narrative review. Indian J Psychiatry 2021;63