Words don’t come easy: How male prisoners’ difficulties identifying and discussing feelings relate to suicide and violence.

Suicide and violence are prevalent within male prisons in the UK. It has been suggested that 10 alexithymia may be associated with both suicide and violence. Alexithymia can be defined as an 11 inability to identify or discuss emotions. The present study aimed to qualitatively explore male 12 prisoners’ experiences of alexithymia and how these experiences may relate to suicide and violence. 13 Fifteen male prisoners were recruited from two prisons in the North West of England. All 14 participants had experienced suicidal and / or violent thoughts and / or behaviours in the past three 15 months, and all screened positive on an established measure of alexithymia. Participants took part in 16 a qualitative interview during which they were also given the opportunity to provide drawings of 17 their emotions. Data were transcribed and analysed using thematic analysis, with a collaborative 18 approach taken between researchers and an individual with lived experience of residing in prison. 19 The results indicated that male prisoners tended not to talk about their emotions with others, due to 20 external pressures of residing in prison in addition to internal difficulties with recognizing and 21 articulating emotions. Not discussing emotions with others was associated with a build-up of 22 emotions which could result in either an emotional overload or an absence of emotions. Both 23 experiences were perceived to be associated with hurting self or others, however, participants also 24 identified a ‘safety valve’ where it was acknowledged that using more adaptive approaches to 25 releasing emotions could prevent harm to self and others. These findings suggest three main clinical 26 implications; 1) a cultural shift in male prisons is needed which encourages open communication of 27 emotions 2) individualized support is needed for those identified as experiencing a difficulty in 28 recognizing and articulating emotions and 3) prison staff should encourage alternative ways of 29 releasing emotions such as by using harm minimization or distraction techniques.