Abstract
Suicide and violence are prevalent within male prisons in the UK. It has been suggested that alexithymia may be associated with both suicide and violence. Alexithymia can be defined as an inability to identify or discuss emotions. The present study aimed to qualitatively explore male prisoners' experiences of alexithymia and how these experiences may relate to suicide and violence. Fifteen male prisoners were recruited from two prisons in the North West of England. All participants had experienced suicidal and/or violent thoughts and/or behaviors in the past 3 months, and all screened positive on an established measure of alexithymia. Participants took part in a qualitative interview during which they were also given the opportunity to provide drawings of their emotions. Data were transcribed and analyzed using thematic analysis, with a collaborative approach taken between researchers and an individual with lived experience of residing in prison. The results indicated that male prisoners tended not to talk about their emotions with others, due to external pressures of residing in prison in addition to internal difficulties with recognizing and articulating emotions. Not discussing emotions with others was associated with a build-up of emotions which could result in either an emotional overload or an absence of emotions. Both experiences were perceived to be associated with hurting self or others, however, participants also identified a “safety valve” where it was acknowledged that using more adaptive approaches to releasing emotions could prevent harm to self and others. These findings suggest three main clinical implications; (1) a cultural shift in male prisons is needed which encourages open communication of emotions (2) individualized support is needed for those identified as experiencing a difficulty in recognizing and articulating emotions and (3) prison staff should encourage alternative ways of releasing emotions such as by using harm minimization or distraction techniques.
Highlights
Suicide and violence present a major issue in UK prisons
Difficulty Recognizing and Articulating Emotions This study found that male prisoners reported difficulties both with recognizing and articulating emotions
In line with the findings presented here, it has been suggested that a lack of communication of emotions with others may lead to individuals relying on maladaptive ways of expressing their emotions, such as through verbal and physical aggression [60, 61]
Summary
Suicide and violence present a major issue in UK prisons. In prisons across England and Wales in the year 2019, there was a total of 80 self-inflicted deaths (1 per 1,000 prisoners), and 63,328 self-harm incidents (156 per 1,000 prisoners) [1]. In the same year, there was a total of 32,669 assault incidents, of which 3,813 were serious assaults (46 per 1,000 prisoners) [1]. It is frequently suggested that both suicide and violence are related to difficulties with emotion regulation. One specific form of emotion dysregulation which has been found to relate to both suicide and violence is alexithymia. Alexithymia has been found to be related to suicide and self-harm in community populations [7, 8]. A link has been established between alexithymia and violence both in community populations [9,10,11,12,13] and in offenders [14, 15]
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