The author describes a certain type of psychosomatic patient who is conspicuous because of his incapacity for free fantasy. M'Uzan and his co-workers have designated the peculiarities of this type with the term "operative thinking," namely, a neutralized relationship to the therapist as well as to other people in the environment ("relation blanche"), schematic thinking, definitive victory of the reality principle, dreamless concretism. "Operative thinking" frequently precedes and heralds the appearance of somatic disturbances.