Affects, Trauma, and Mechanisms of Symptom Formation: A Tribute to John C. Nemiah, MD (1918–2009)

Abstract

John Nemiah was interested in the impact of emotionally traumatic events on mental and bodily processes and in conceptualizing the psychological defenses and deficits that contribute to the development of psychological and somatic symptoms. He viewed dissociation as the central psychological mechanism in the formation of a spectrum of symptoms, and conceptualized alexithymia as a deficit in the cognitive processing of emotion such that stress-induced arousal could bypass the psyche and produce somatic symptoms. This article briefly reviews some of Nemiah’s conceptual ideas and relates them to several new theories and concepts and findings from empirical research. His concept of the ‘psychic elaboration’ of emotion is consistent with contemporary theories of the cognitive processing of emotions that emphasize the importance of imagery and linguistic symbolizations. Alexithymia is inversely related to mentalization and is associated with insecure attachment styles and emotional trauma, which influence the capacity to regulate affects induced by stressful events. A multiple code theory of emotional information processing links psychological and somatic symptoms to various degrees of dissociation within and between the elements comprising emotion schemas and to compensatory attempts at repair. Recent studies support Nemiah’s view that alexithymia and intrapsychic conflicts may both contribute to the pathogenesis of panic attacks. There is also substantial evidence of an association between childhood trauma and the development of somatic disease in adult life. Secure attachments and well-developed capacities for symbolization and affect regulation seem to render individuals more resilient to the traumas and stressful events of everyday life.

Alexithymia and Tissue Inflammation

“…However, the underlying mechanisms for these inflammatory changes may differ and should be explored in future studies. These findings widen the concept of a connection between stress and alexithymia [31,36,37]. …”

Alexithymia in Cancer Patients: Review of the Literature

“…Despite the fact that alexithymia, especially secondary alexithymia, is of clinical importance for the psychiatric and psychotherapeutic approach to cancer patients, the literature on this subject is still very scarce. As noted in a recently published tribute to the work of the co-founder of the concept of alexithymia, John C. Nemiah, the importance of life events in the development of psychological processes intimately related to the formation of psychological or bodily symptoms is widely recognized, but investigating this process has proven to be challenging [47]. A recent study with cancer patients has shown that a multicomponent psychological intervention was able to reduce alexithymia [44], and other studies are currently under way to further evaluate whether psychotherapeutic approaches can influence alexithymia in cancer patients [48].…”

Suvoktas Smurto Patyrimas, Emocijų Reguliacija Ir Somatiniai Sunkumai Ankstyvojoje Paauglystėje

“…Skirtingi tyrimai rodo, kad prasta emocijų reguliacija vienaip ar kitaip siejasi su skirtingais psichikos sveikatos sunkumais (3). Be to, manoma, kad psichosomatiniai sunkumai gali būti susiję su prastesniu emocijų supratimu ir emocijų reguliacija (13). Karkhanis ir kolegų (2016) atliktoje apžvalgoje teigiama, kad vaikams ir paaugliams somatiniai sunkumai, kurių negalima paaiškinti medicininėmis priežastimis, dažnai atsiranda dėl sunkumų reiškiant emocijas ir jas reguliuojant (14).…”