This comment on Bottaccioli & Bottaccioli’s (2024a) article critically analyzes Franz Alexander’s role in developing contemporary psychosomatics in both its innovative aspects and limitations. On the one hand, Alexander contributed to emancipating the explanation of physical symptoms from the classical approach of the early 20th century stiffened on the model of hysterical conversion and promoted the organization of the international psychosomatic movement, including the Italian one. On the other hand, his limitations mainly concern the theoretical approach typical of 20th century psychoanalysis: adopting a one-dimensional model centered on intrapsychic conflict and the indeterminacy – necessary for the time – of a biological “X” factor as mediator. Instead, in the second half of the 20th century, a deficit-centered model of explanation (e.g., alexithymia) and complexity (e.g., biopsychosocial model) emerged, in which various moderating biomedical, psychological, and socio-cultural factors assume different relative weights in the explanation of physical illnesses and the clinical management of patients. [ABSTRACT FROM AUTHOR]