Alexithymia has been known concept now for more than a quarter of a century [1]. This construct was formulated as a result of clinical observations about affect deficits in patients suffering from a variety of psychosomatic conditions in Paris and in Boston in the 1960s.

Alexithymia, a term I introduced for better or for worse in 1972, involves a marked difficulty to use appropriate language to express and describe feelings and to differentiate them from bodily sensations, a striking paucity of fantasies and a utilitarian way of thinking which Marty et al. [2]have called pensée opératoire.

Here, I want to emphasize an important aspect of alexi- thymia which to my knowledge has hitherto been overlooked and ignored, namely its association with politics and crime.

First, however, I would like to give a brief historical account of the ideas surrounding the construct of alexithymia.

Following the original clinical observations already mentioned, two international conferences were held in London in 1972 and in Heidelberg in 1976, which established the importance of alexithymia for the investigation of affect deficit states. The London conference pointed to the need for studies about the measurement and biological etiology of alexithymia. Despite the prevailing dichotomy between the views of the clinicians and the nonclinical scientists, for better communication and clarification ‘affect’ was to include ‘emotions’ with their somatic components and ‘feelings’ with their emotion-driven fantasies.

The Heidelberg conference established once and for all the role played by alexithymia in psychosomatic disorders and opened the door for further research about affect deficit states.

During the next 20 years, a great number of clinical research studies discovered the presence of alexithymic characteristics in various percentages in patients suffering from different medical and psychiatric disorders such as PTSD, substance abuse, psychogenic pain, eating disorders, AIDS-masked depressions, panic attacks, somatoform, borderline and sociopathic personality disorders, as well as in individuals in normal populations.

The etiology of alexithymia has preoccupied several investigators for a long time. Krystal and Freyberger attributed these defects to psychological predisposing factors. Nemiah and Sifneos on the other hand favored biological structural defects as being primarily the underlying cause of the alexithymic characteristics.

More recently, the enormous proliferation of neurobiological research has given a much clearer picture of the anatomy and physiology of cerebral structures responsible for emotional arousal, despite the complexity and at times inconclusive results.

The measurement of alexithymia, while waiting for the final results of the neurobiological investigations, relies at present on clinical observations and on self-report questionnaires. The BIQ, which the author has developed, is based on a clinical interview by a trained evaluator. It contains 17 questions, 8 of which depict the classic alexithymic characteristics. Its drawback, however, has to do with the experience of the evaluator. It also lacks reliability studies in a normal population. Andreasen has used a 9-item rating scale which is particularly helpful in assessing a flattened affect, which is common in alexithymic patients.

Self-report questionnaires are numerous, and the most reliable and well validated is the original TAS developed by Taylor et al. [3]. It has been modified twice, but the latest change has eliminated the paucity of fantasies component, which is one of the key factors of alexithymia as it was originally conceptualized, even if its reliability has improved.

Two other measurement scales, the PVIPT developed by Montreuil in France and the Q set alexithymia prototype of Haviland in Loma Linda, Calif., have a promising future.

Of all the measurements, the BIQ coupled with the Andreasen scale, and in conjunction with the original TAS are at present, in my opinion, the best tests to be used for the measurement of alexithymia. On the other hand, one may follow Taylor’s recommendation, namely to use the modified TAS in conjunction with an also modified BIQ.

It is generally agreed that for individuals unable to verbalize and differentiate their emotions from their bodily sensations, with a paucity of fantasies and a utilitarian way of thinking, dynamic psychotherapies are ineffective and at times can be harmful to patients with medical diagnoses. On the other hand, supportive individual and/or group therapies in conjunction with psychotropic medications seem to offer the best results.

A modified psychoeducational therapy has been used by Krystal and should also be considered.

As already mentioned, alexithymic characteristics have been found to be present in various proportions not only in patients suffering from a variety of mental illnesses, but also among those with sociopathic or borderline personalities.

Now, I should like to turn my attention to the possible connection of alexithymia with politics and crime.

I have all along been impressed by media reports about some criminals condemned to long prison terms, life imprisonment or even death, who showed no evidence of any emotional reaction when these sentences were pronounced.

Here is a newspaper report about a serial killer who was condemned to death:

He showed no feelings when the prosecutor described his heinous crimes during the trial. He seemed to be totally apathetic. No muscles moved. His face was a blank screen. A friend of his described him as follows: ‘He was a walking brain. He began drinking and using cocaine when he was 13. He used to say “Before I die, I want to kill someone just for fun”. He would laugh. It was like he was describing going on vacation, or climbing a mountain’.

Such statements are quite common, but because they can be considered as hearsay, I decided that I had to go to the original source and investigate what three of the most famous criminal politicians of the twentieth century had to say about their feelings. I picked Hoess [4], Eichmann [5]and the worst of them all, Hitler [6].

Rudolf Hoess was the commandant of Auschwitz from 1941 to 1944. He wrote a book while waiting for execution in Poland in 1949. Here are some of his comments.

I worked out my problems by myself. My sole confidant was my pony. I was unable to have any feelings for anyone, even my sister. People were always strangers to me. When my father died suddenly, I cannot remember that I was affected at all.

I have been brought up always to be obedient, so when I was in prison [for murder] I did not find it difficult to conform. After two years I became very irritable. I paced up and down in my cell. I could not eat or work. When I was awake all night, I had to get out of bed. I had dreams of being pursued or killed. I wanted to pray but I couldn’t. I had forgotten how to pray. When I attended the first execution it didn’t affect me. A man was condemned to be shot. I led him on. When he was ready, I stepped back and gave the order to shoot. He collapsed and I gave him the ‘coup de grace’. I was so calm.

When he was at Auschwitz he wrote:

Any form of contact with people was repugnant to me. I refused social gatherings. My only desire was to be alone and never to see any one. Alcohol more than anything else put me in a happy mood.

In a 24-page appendix he described the gassing of Jews, gypsies and Russian prisoners of war.

I watched the killings. When the doors of the crematoria were opened and I saw the dead bodies, I felt uncomfortable. The killings did not give me much concern. The gassings set my mind to rest.

On one occasion I saw two children playing, unaware of their fate. I had to act. I nodded to the officer in charge. He picked up the children and carried them to the gas chamber accompanied by their mothers who were crying. I had no trace of emotion whatsoever.

Adolf Eichmann was the SS officer responsible for transportation. He escaped to Argentina from where he was abducted by the Israelis in 1960. Before his trial in Jerusalem he was interrogated repeatedly, and a transcript of his interviews was published in book form.

The interviewer was an ex-German Jew. He described Eichmann as follows:

As I watched him I had a feeling of loathing. It elicited my feelings of outrage because he had no feelings about the monstrosity of his crimes, and did not show the slightest twinge of remorse.

When Eichmann was asked about the transportation of prisoners and Jews he said:

I didn’t give these details any thought, and I never discussed these details. I went to Berlin to report to the head of police about the gassings. I avoided responsibility. I saw without thinking. I once saw a woman being shot. I cleared out. I thought that whether there were one million, or one hundred millions, it amounted to the same thing. I am no statistician but six millions must have been killed. I obeyed orders and that was my job. The Jews were valuable material with their money.

In 293 pages of testimony, Eichmann does not describe or express any feelings. He had no fantasies or thoughts about the horrors which he helped perpetrate. A videotape of his trial was shown on American TV. Here is a report from the New York Times:

Eichmann in a glass cage showing no reaction to the horrors which are being described. He is like a silent movie actor. He said that he sought peaceful solutions acceptable to all parties like Pontius Pilate. He said he was not the right person for these things. He had to obey orders.

Finally, Adolf Hitler. Hundreds of books have been written about Hitler, who has been described from being psychotic to being a genius and everything in between. An extraordinarily important and frightfully boring book of more than 700 pages was published by the Oxford University Press entitled Hitler’s Table-Talk 1941–1944 [6]. It is a verbatim transcribed exposé of Hitler’s monologues in a relaxed atmosphere, during lunch and dinner, with a group of colleagues, party members, military people and secretaries. Martin Borman was the secretary who took notes.

In his long introduction, the expert scholar professor Trevor Roper comments as follows:

He was a systematic thinker. His mind was coarse, turbid, narrow, rigid and cruel. His speeches were well prepared, on the other hand his table talks were spontaneous, and unrehearsed, and therefore give a true and vivid picture of his real mind. The talks were on the whole full of narrow materialistic trivial, and half baked disgusting material. There is a yawning emptiness. No word was ever uttered even so much as touched the human spirit. He was rigid without tolerance.

I carefully scrutinized this book in an effort to investigate how Hitler dealt with his emotions. In 10 pages of his recollections from his childhood at home, there is no word uttered about any feelings. He declared:

I spend ten hours a day thinking only about military matters. My whole life can be summed up as my ceaseless effort to persuade people.... A girl is as malleable as wax and it should be possible for a man to stamp his own imprint on her.

The only comment about his mother whom it was said that he loved was the following:

She loved her husband and children. She gave a son [namely himself] to Germany.

During another dinner he went on as follows:

I don’t believe in idealism. There is no more primitive instinct than love.

Commenting about the possibility of riots he said.

I will execute all commanders irrespective of rank, all leaders, concentration camp inmates and in particular all Jews. I don’t know how many diseases have their origin with the Jewish virus. We shall regain health by eliminating the Jews. It is not worth thinking about, I will shoot the lot of them. It is cold reason that guides my actions. Sentiment plays no role in these matters. We must apply the iron rule with no exceptions.

As the years went by, his tirades against the Jews in particular became more and more pronounced.

He spent hours on subjects about which he had considerable knowledge such as discussions about planes, tanks, guns, oil, highways, construction and technical matters. In sum, all these monologues were long winded and extremely boring, but nevertheless give a clear and vivid picture of Hitler’s mind, a mind devoid of any feelings.

In another interesting book, Hitler’s Mistakes, R. Lewin [7]concludes:

There were no human emotions. He simply could not allow anyone approach his inner being because the core was lifeless, and empty.

It is my opinion that all three, Hoess, Eichmann and Hitler were alexithymic. The implications are clear. The effects of alexithymia on medicine, politics and crime are frightening and dangerous.

In conclusion, it seems that those whom we elect to represent and govern us must not only fulfill our selfish interests, but must possess the ethical qualifications as well as the feelings which distinguish us from the lower animals and which are our most striking human characteristic.

1.
Sifneos P: Alexithymia past and present (Festschrift). Am J Psychiatry Suppl 1996;153:7.
2.
Marty P, de Uzan M, David C: L’investigation psychosomatique. Paris, Presses Universitaires de France, 1963.
3.
Taylor GJ, Bagby RM, Parker JDA: Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge, Cambridge University Press, 1997.
4.
Hoess R: Commandant of Auschwitz. Cleveland, The World Publishing Company, 1959.
5.
Transcripts from the Archives of the Israeli Police: Eichmann Interrogated. New York, Farrar, Straus & Giroux, 1983.
6.
Hitler’s Table-Talk 1941–1944. London, Oxford University Press, 1953.
7.
Lewin R: Hitler’s Mistakes. New York, Morrow, 1984.
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