L'Information Psychiatrique


Operative thinking Volume 96, issue 2, Février 2020

Psychiatre, praticien hospitalier,
Centre hospitalier d’Orsay,
Domaine du Grand-Mesnil
2, voie Kastler 91440 Bures-sur-Yvette
* Correspondance

Alexithymia currently dominates the clinical field in discussions about the absence of emotion in pathology. It has spread into a broad variety of fields, creating a conceptual portmanteau that conceals other heuristic modes of reflection. This makes it part of operative thinking, a concept introduced by Marty, de M’Uzan and David in the 1960s. Taking psychoanalytic theory as a guiding thread, authors have described it as a specific clinical case involving a lack of mentalization, a “blank relationship” with interlocutors, and speech that lacks emotion. Operative thinking falls within the realm of psychosomatic pathology. In his extensive theoretical review, Marty adopts a monistic approach to psychological functioning, while drawing inspiration from Jacksonian evolutionism. What also makes operative thinking interesting is that it describes a particular mode of psychological functioning seen in somaticizing patients. Treating these patients is challenging and requires psychiatrists to have a perfect command of countertransference. From Marty to Smadja and Szwec, the theoretical model is enriched by descriptions of self-soothing behaviors.