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For those interested in materialism or psychiatry, the organo-dynamism of Henri Ey certainly constitutes a medical doctrine of a highly sophisticated materialism. Lacan’s critique of it sheds light on the clinical concerns underpinning his approach, as well as the meaning he thinks we should give to the materialist point of view in psychology. A theory of a “causal nexus” linked to the great tradition of metaphysics (Ey) faces then a “causal topic” inherent to empiricism, which grants a new scope to the dimension of speech in clinical practice and of language in his theory.