Sixty years after the death of Franz Alexander, it is necessary to investigate what is alive and what is dead in his thought about psychosomatics, focusing in particular on the notions of emotion and vegetative neurosis as central to his model of explanation. It is then worth noting, in the light of the developments after Alexander, the today’s difficulty in supporting psychosomatics as an autonomous discipline, to the point of questioning the legitimacy of the expression itself: Bottaccioli & Bottaccioli’s (2024a) proposal to identify it with Psycho-Neuro-EndocrineImmunology (PNEI) must be measured in this problematic context. In any case, the always valid need remains, already supported by Alexander, for a unitary, “holistic” consideration of the human being, sick and healthy. However, this is a paradigm that has to be justified and clarified conceptually in the actual role it plays as an inspirer of research and specific explanations. [ABSTRACT FROM AUTHOR]