title: Affective agnosia: Expansion of the alexithymia construct and a new opportunity to integrate and extend Freud's legacy.
abstract: We describe a new type of agnosia consisting of an impairment in the ability to mentally represent or know what one is feeling. Freud the neurologist coined the term "agnosia" in 1891 before creating psychoanalysis in 1895 but the term has not been previously applied to the domain of affective processing. We propose that the concept of "affective agnosia" advances the theory, measurement and treatment of what is now called "alexithymia," meaning "lack of words for emotion." We trace the origin of the alexithymia construct and discuss the strengths and limitations of extant research. We review evidence that the ability to represent and put emotions into words is a developmental achievement that strongly influences one's ability to experience, recognize, understand and use one's own emotional responses. We describe the neural substrates of emotional awareness and affective agnosia and compare and contrast these with related conditions. We then describe how this expansion of the conceptualization and measurement of affective processing deficits has important implications for basic emotion research and clinical practice.
authors.affiliation: Department of Psychiatry, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5002, United States; Department of Psychology, University of Arizona, 1503 E. University Avenue, Tucson, AZ 85721, United States; Department of Neuroscience, University of Arizona, 1040 E 4th St., Tucson, AZ 8521, United States. Electronic address: lane@email.arizona.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lane
authors.affiliation: Department of Psychiatry, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5002, United States; Department of Family and Community Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5052. Electronic address: weihs@email.arizona.edu.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Weihs
authors.affiliation: Department of Psychiatry, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5002, United States; Department of Psychology, University of Arizona, 1503 E. University Avenue, Tucson, AZ 85721, United States. Electronic address: anneherring@gmail.com.
authors.forename: Anne
authors.initials: A
authors.lastname: Herring
authors.affiliation: Department of Psychiatry, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5002, United States; Department of Neurology, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5023, United States. Electronic address: ahishaw@neurology.arizona.edu.
authors.forename: Alex
authors.initials: A
authors.lastname: Hishaw
authors.affiliation: Department of Psychiatry, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5002, United States; Department of Psychology, University of Arizona, 1503 E. University Avenue, Tucson, AZ 85721, United States. Electronic address: rssmith@email.arizona.edu.
authors.forename: Ryan
authors.initials: R
authors.lastname: Smith
mesh_terms: D000342:Affective Symptoms / Q000503:physiopathology*; D000377:Agnosia / Q000503:physiopathology*; D000818:Animals; D001921:Brain / Q000503:physiopathology*; D004644:Emotions / Q000502:physiology; D005619:Freudian Theory; D006801:Humans; D008959:Models, Neurological; D012649:Self Concept
keywords: Agnosia; Alexithymia; Anomia; Brain; Emotional awareness; Psychotherapy