Asked how he is feeling, a man says fine. Pressed, he says he does not know. This is often taken as evasion — by partners, by clinicians, sometimes by the man himself, who assumes he is being difficult or emotionally lazy. In a substantial number of cases it is nothing of the kind. He genuinely cannot tell. He knows something is wrong, that his chest feels tight and his jaw is clenched and he wants to leave the room, but the step from that to the word anxious, or hurt, or ashamed, does not happen.
There is a name for this. Alexithymia describes difficulty identifying and describing one’s own emotional states, often accompanied by a tendency to experience emotion physically and to think in concrete, external terms rather than inward ones. It is not a mental illness in its own right and it is not a character flaw. It is a trait, present to varying degrees, and it is measurably more common in men.
What It Looks Like From the Inside
The most common description is of a general, undifferentiated bad feeling that does not sort itself into categories. Anger is often the exception — many men can identify anger clearly while everything else stays vague, which means grief, fear, shame and disappointment all get expressed through irritability, because that is the one channel with a label on it.
Emotions often register as body states instead: stomach problems, headaches, chest tightness, disturbed sleep, fatigue, muscle tension. This is one reason men with significant psychological distress arrive first at a physician’s office with physical complaints, and why an assessment can reasonably investigate both. Others notice it in relationships. A partner asks what is wrong and the honest answer is nothing, said with visible tension, which is heard as stonewalling. Over years, this erodes closeness on both sides.
Where It Comes From, and What It Interferes With
Some of it appears to be constitutional. Alexithymic traits occur more frequently alongside autism, and after significant trauma, where a numbing of emotional awareness that once served a protective purpose remains long after the danger has gone. Much of it, though, is straightforwardly learned. Boys are frequently raised with a narrow permitted emotional vocabulary and clear feedback about the rest. Emotional literacy is a skill, and skills that were never taught and never practised do not develop on their own.
The practical cost is real. Depression and anxiety are harder to detect, in oneself and by a clinician, when the person cannot report internal states. Distress that cannot be named tends to be handled by whatever reliably reduces it — alcohol, overwork, isolation, escalating anger — which is how substance use and relationship breakdown enter the picture. And treatment that depends on talking about feelings can feel useless or humiliating when the words are not available.
It Can Be Worked On
This responds better than most people expect, but the entry point is different. Rather than starting with what are you feeling, useful work often starts with the body: where in your body do you notice something, what does it feel like physically, when did it start, what happened just before. From there, feelings are gradually paired with situations and then with words. Some clinicians use a written list of emotion words, which sounds elementary and is genuinely effective when the vocabulary was never installed.
Approaches that do not depend heavily on introspection — behavioural activation, structured cognitive work, mindfulness-based body awareness training — often suit better in the early stages. It is also worth telling a clinician directly that you find this hard. It changes how the work is conducted, and it is far more useful information than fine.
Dr. Isaac Klein works with men on emotional awareness, mood, anxiety and trauma at Grande Prairie Men’s Medical Clinic, including those who find talking about feelings unnatural or pointless. Appointments can be arranged at gpmm.clinic or by calling (587) 416-8296. If you are in immediate danger, call 911; the 988 Suicide Crisis Helpline is available across Canada by call or text, 24 hours a day. This article is general information and not a substitute for individual assessment.