A psychophysiological approach to alexithymia involves the search for reliable neural correlates of cognitive and symbolic processes rendering meaningful indicators that can be entered as elements into the diagnostic process, framed within a theory, and tested against the clinical experience. Relevant work on event-related slow brain potentials is reviewed, and some recent data bearing on a psychophysiological differentiation between psychosomatic and psychoneurotic patients are presented and discussed within the framework of a modified concept of activation. In outlining certain research strategies and goals it is contended that they may provide an experimental data base complementing and expanding psychodynamically derived formulations.