Chapter 2 54 Affective agnosia implies a fundamental deficit in the processing of emotions. This condition goes beyond being simply a problem of lacking vocabulary to label emotions. It concerns a fundamental lack of a higher order conceptualization of emotion. individuals who have affective agnosia are unable to represent on a conceptual level all ‘percepts’ (physical sensations, ‘gut feelings’) of the emotion construct. According to Bucci [94], these people lack “symbols for somatic states”. Anomia is a less severe deficit, corresponding to what the original Greek name of the concept implies – the individual cannot find the words to express the felt emotion, but does experience the emotion. Naturally, in the case of affective agnosia, words for emotions are also missing, however, this lack is due to a deeper lying cause as it concerns deficits in the basic processing of emotions. When placed within the Levels of Emotional Awareness theory [91], anomia would grossly correspond to emotional awareness functioning at level 2, bordering on level 3. With anomia, an individual can report felt behavioral tendencies and provide a description of feelings in terms of valence and tension (“I feel good/unpleasant”, “good/bad”, “I experienced a lot of/no tension”). In case of affective agnosia, emotional awareness is at the level of the integration of somatosensory information or, at best, at the level of the conceptualization of affect, due to very early stagnation in the affective-cognitive process. In terms of the model of emotional awareness, individuals with affective agnosia function at level 1 or level 2; they perceive the rudimental physical sensations and/or might be aware at times of their tendencies to act, but the representation of emotion in their consciousness is not present. Ironically, despite the semantic match with the original term, some scholars have stated that anomia does not involve ‘real’ alexithymia. According to them, anomia could very well be more about ‘repression’, a psychological defense mechanism where the emotion is kept out of consciousness, because this evokes too much anxiety (see, for example [95]). Yet, theoretically, explicit awareness would be possible. Alternatively, (a state of) anomia could also result from ‘emotional overload’, during which an individual (temporarily) has no reflective capacity left to adequately identify the emotion (Lane, personal communication, 9 July 2020). This is also referred to by some as ‘secondary alexithymia’ [96, 97]. The basic capacity to have an emotional experience is there but is temporarily unavailable. If this assumption is correct, and anomia is rather the result of defense mechanisms or temporary emotional overload, it bears important implications for clinical practice. Some general tell-signs for anomia (as these are generally said to result from psychological defense mechanisms) are: dissociation, affective lability, more ‘neurotic’ defenses (e.g., rationalization, isolation of affect), affect phobia and other types of experiential avoidance.
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