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The concept of pensée opératoire (operational thinking) was introduced by French psychoanalysts in 1963 and a decade later was included as an essential component of the alexithymia construct as formulated by the U.S. analysts John Nemiah and Peter Sifneos. Despite a large body of research on alexithymia, the pensée opératoire component is not well understood, especially among clinicians and researchers who are not familiar with French psychoanalytic literature. In this article we clarify the definition and metapsychological conceptualization of the concept, review findings from some relevant empirical studies, and critique a recent proposal for redefining the alexithymia construct that departs from the original understanding of pensée opératoire. We also discuss some clinical implications of the concept and some strategies that psychotherapists can employ in the treatment of patients with this mode of thinking.

The psychoanalytic concept of an "anal universe" is a type of alternative universe in which reality is denied and falsehood prevails. This essay demonstrates how this concept illuminates much of the confusion and distortion of truth generated by the Trump administration. The author comments on several behaviors of President Trump and his administration including perverse thinking and lying, mocking disabled people, demeaning women, labeling journalists as enemies of the people, encouraging regressive forces in groups, and promoting policies that cruelly affect immigrants and refugees. The author also comments on the primacy of the male phallus in American politics. He contrasts the spatial metaphor of an "anal universe," where there is distortion of language and an absence of moral constraints and ethical principles, with the metaphor of a feminine psychic space, which enhances the capacity for symbolic thinking and the generation of creative ideas and solutions.

Although Freud considered castration to be one of the two major anxieties of human life, the castration complex has been relatively neglected in contemporary psychoanalytic writing and is insufficiently discussed in presentations of clinical cases. This article discusses the relevance of the concept to contemporary psychoanalysis and psychodynamic psychotherapy, in particular the important contributing role of castration conflicts in the pathogenesis of a wide range of clinical symptoms. The author begins by briefly reviewing some classical and contemporary psychoanalytic ideas about castration to show how the concept has broadened and is currently used not only to signify fear of damage to or loss of the genital, but also metaphorically to indicate a threat to or loss of any valued human characteristic or function. He outlines Brenner's distinction between castration anxiety and castration depression, and reviews the role of childhood trauma in intensifying castration conflicts. He then illustrates the clinical application of these ideas by describing aspects of his psychotherapeutic work with three male patients who presented with a variety of symptoms and distressing psychological experiences that were gradually resolved through the analysis of underlying castration anxiety and/or castration depression. Although castration anxiety is frequently intermingled with separation anxiety, the author concludes that with many traumatized patients castration conflicts are in the foreground and the therapist needs to focus on the patient's proneness to humiliation, powerlessness, and shame.

Although patients with medically unexplained chronic pain are sometimes referred for psychiatric consultation, it is rare for them to be recommended for a psychoanalytically informed treatment. Moreover, because they experience their distress as primarily physical, it is difficult to engage such patients in psychoanalysis. Nonetheless, the psychoanalytic understanding of conversion symptom formation, and of how childhood trauma and adverse attachment experiences impact on the mind-brain-body-complex, can be integrated with the current neuromatrix theory of pain and thereby offer a comprehensive theoretical model and guide for the psychoanalytic treatment of some patients with chronic pain syndromes. The author illustrates this approach by reporting the analysis of a patient with chronic pelvic pain who had obtained no relief from a host of medical and psychiatric therapies. The analytic process of linking the pain with emotional trauma and pathologic internal object relations, and thereby symbolizing the pain, allowed the patient to discover multiple meanings for the symptom and make important life changes as the pain subsided.

The terms somatization and conversion are used descriptively to define specific diagnostic entities, and phenomenologically to denote pathologic processes that underlie somatic symptom formation. There is a lack of clarity, and even controversy, however, as to whether somatization and conversion should be considered distinct or overlapping constructs, and whether they contribute to the pathogenesis of certain organic diseases or solely to medically unexplained somatic symptoms. This article attempts to resolve some of this confusion by reviewing the origins of the terms somatization and conversion, and describing how their meanings and uses have evolved over the last century. Whereas some psychoanalysts and psychiatrists adopted Stekel's view that somatization involves a psychological process analogous to conversion, others maintained Freud's distinction between the psychoneuroses and the actual neuroses and view somatization as a physiological process. Recent psychoanalytic attempts to understand somatization are based on a modern theory of emotional processing, which is rooted in cognitive science and open to empirical research. Maintaining a conceptual distinction between somatization and conversion has important implications for psychoanalytic therapy.

The usefulness of psychoanalysis to psychosomatic medicine has been limited by the longstanding assumption that the psychological disorder in psychosomatic patients resembles the conflict-based psychopathology that Freud identified in psychoneurotic patients. Recent investigations of the alexithymia construct, and the discovery that social relationships can influence health over the entire life span, have challenged this assumption and created an opportunity for a new and active involvement of psychoanalysis with psychosomatic medicine. In this contribution, I offer a synthesis of contemporary psychoanalytic observations and theories with concepts and research findings from developmental psychology, developmental biology, and the biomedical sciences. The proposed synthesis is consistent with the view that living organisms are self-regulating cybernetic systems; it also extends an evolving new psychosomatic model that conceptualizes illnesses and diseases as disorders of psychobiological regulation. A modern psychoanalytic approach to physically ill and disease-prone individuals focuses less on the resolution of neurotic conflicts, and more on correcting deficits in these patients' self and object representations and capacity cognitively to process emotions.