i didn't remember Melfi describing alexithymic, but even at the dinner party she rejected the facile categorizing of Tony as a sociopath (and even the sociopath label itself). And she has an interesting take, when we remember how many times Tony just loses his words when they have emotional content. And, of course, the anxiety attacks.
Weren't there a buch of psychiatrists in the 60's who put forth the idea that improving the function of the individual can be detrimental to society? Not in the build-a-better-sociopath sense, but more specifically Tony's dilemma. As Melfi works with Tony to heal bits and help him function better, does he become a better criminal? Of course, the shows end might indicate it made him a slightly better person, but a less effective boss.
Paulie is clearly a sociopath -- the differences between him and Tony are pretty dramatic to me.
Anxiety,in the classical sense, is itself a symptom, in Tony's case it happens when he is flooded with emotion he cannot verbalize or must suppress. Defenses are all about fending off intolerable anxiety. I might be conflating some of the commentary on Tony with what Melfi said, but I do remember thinking that alexithymia fits him perfectly. I think Joyce McDougall, a French psychoanalyst, was one of the first to write about this problem.
A colleague of mine once treated a guy who was a major marijuana dealer who was caught by the Feds. It posed an interesting problem because clearly he was not intending to give up his business and he had issues he wanted to work on in therapy. The problem ended when he was sent to federal prison, but it could be argued that therapy could have helped him become a better dealer.
However, ultimately, therapy would lead to an overall examination of one's life and re-evaluation of how one does things. This might lead Tony into some considerable danger if he decided to move away from the criminal activities and compatriots. That would take a very long time of more intensive work that he showed interest in.
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