Jacques Lacan: The Psychoanalyst of Lac(k)


Lacan’s teachings have continued to generate interest and controversy since his death in 1981. Here’s why.




Jacques Émile Marie Lacan (1901-1981) was a Parisian psychoanalyst who based his teaching and writing on the metapsychology of Sigmund Freud (online Oxford Dictionary definition of metapsychology: “speculation concerning mental processes and the mind-body relationship, beyond what can be studied experimentally”) combined with the work of early 20th century linguist Ferdinand de Saussure. Lacan’s teachings have continued to generate interest and controversy since his death in 1981.1

What is it about Lacan that has engaged his many adherents and enraged his detractors over the decades since his death? I believe the most important answer to this question is the element of lack, or what is not there, that Lacan emphasized in his work. For a synopsis of some of Lacan’s main ideas, see my previous article on Lacan published online in Psychiatric Times.2

We are often more interested in what we do not know, cannot see, and do not have, than what we do. This is the basis of all research, mysteries, and even greed, envy, and jealousy. We all want to know what is going to happen and how the story will end. The small child in the back seat of the car cries out: “Mommy, mommy, are we there yet?” The advertising industry desperately tries to make us want to possess that which we do not have. The past is known, the present instantaneously becomes the past, and the unknowable future is constantly anticipated with curiosity, joy, fascination, and at times fear and terror.

Multiple aspects of Lacan’s work involved the unknown and this, I argue, is what has had held everyone’s attention over the decades since his death.

The Unconscious

For Lacan, the unconscious consists of chains of repressed signifiers—acoustic images of words that we hear that become inscribed in our minds. A signifier (or word) by itself means little, and it is only in its relation to other words in a sentence (ie, embedded in a chain of signifiers) that it becomes anchored in meaning. To quote Lacan, a signifier is “that which represents a subject for another signifier.”

This has important implications for the practice of psychotherapy. We must always listen to the last word in the sentence to know what the patient had in mind. This means tolerating not knowing—ie, tolerating what is lacking—until the idea is complete.

For Lacan, we are our words—our words make us who we are. Repressed signifiers are, by definition, those that are not allowed into consciousness. Instead, these repressed signifiers will express themselves in slips of the tongue, mistaken actions, forgetfulness, in psychiatric symptoms, and are bound up in the structure of our patient’s character.

Telling the Truth

Lacan remarked that “all language is meant to be misunderstood” and that “one can never tell the whole truth.” While the signifier is the acoustic image of the word that we hear, the signified is the mental concept that we associate with the signifier. For example, when we hear the word “car,” each of us will associate this signifier to a somewhat different car in our mind. Even if it is the same model and year car, each of us will have a slightly different idea of what this car is like in our mind.

By its nature then, language will be at least somewhat misunderstood by the listener all the time. There will always be an element of lack in our conversations when we speak to one another. An important task of psychotherapy is to get as close as possible to the meaning of what our patients tell us. Paradoxically, we do this by paying more attention to the words they speak, rather than to what they meant to say. Asking the patient to elaborate on a word just spoken (Lacan called this “punctuation”) helps us do this and is a crucial part of what we do in psychotherapy.

The reason we can never tell the whole truth is because, whatever we say, there is always more that is left unsaid, ie, an important element of lack, and there is always more that can be said in an effort to attempt to fill in this lack. We delude ourselves when we believe that we have heard the whole truth or completely understand what we have been told. But this delusion allows for discourse with its false sense of continuity between individuals and allows society itself to operate.

The Register of the Real

Lacan initially proposed 3 registers of human existence: the Imaginary, the Symbolic, and the Real. He later added a fourth, the Sinthome.

The Imaginary, made up of “images,” is the first register experienced by pre- and post-natal human beings, and is the register of sensory images, primarily visual, but also auditory, tactile, etc. The Imaginary register gives the infant a false impression of wholeness and completeness when it contemplates its image in a mirror beginning at around 6 months of age. Lacan called this the “Mirror Stage” of development. The Imaginary register contributes to comparing ourselves with others, to envy and jealousy, and to paranoia.

The Symbolic register is the world of language primarily but also culture, laws, religion, and rituals into which we are all born. It is the register for which symbols are used as representations for something else. The Symbolic register is both internal and external since it includes language with the words that we internalize and make us who we are, but it is also the outer world of “the big Other” that is waiting for us and into which we are born.

The Real register is based on lack that was left over from the first 2 registers. The Real register consists of everything that is outside of the Imaginary and Symbolic registers, and therefore it cannot be seen or described in words. Paradoxically, the Real register is all that is “not real” in common parlance. The Oxford Dictionary defines real as: “Actually existing as a thing or occurring in fact, not imagined or supposed.” Lacan’s Real register has been described as “the state of nature from which we have been forever severed by our entrance into language.”

The Real is the register of lack, par excellence. The Real is all that we cannot see and do not know. Whenever we give words to our experiences, we make a cut in the Real and it becomes a little smaller. When we experience strong affect—joy, sadness, rage, or ecstasy—none of which can easily be put into words, we can say that we have touched the Real. In psychotherapy, when our patients experience strong emotions—when they have touched the Real—these are often the moments of therapeutic change.

Lacan has 3 major structural diagnostic categories: neurotic, perverse (characterological), and psychotic. The first 2 result from problems existing in the Imaginary and Symbolic registers, whereas psychosis results from the Imaginary and Symbolic registers becoming detached from one another and the Real register is given free reign. Here, unrepressed signifiers and images break into consciousness, creating a state of fear, terror, and sometimes ecstasy.

Desire and the Petit Objet a

We all have needs, wishes, demands, and desires. Needs are biological—for food, water, and air, but also for love. Wishes are things we want to possess—a new car, a new house, or 5 avocados (like those I purchased today). Demands are vocalized requests for what we imagine will leave us feeling fulfilled. For example, a baby’s demand to be nursed, or my demand to have my party seated at a particular table in a restaurant. Needs and wishes both have an element of lack that we are looking to fulfill.

Desire, on the other hand, for Lacan, is the Desire of the Other—that is, what society (the “big Other”) dictates that we should want. Lacan hypothesized the existence of Le Petit Objet a, also called “the object cause of desire,” that does not exist in reality but that unconsciously drives all desire. Desire is unconscious and its expression can only be deduced in dreams, in slips of the tongue, in mistaken actions, and in the rebuses that are psychiatric symptoms.

Lacan analogized “the object cause of desire” to Alcibiades’s wish to sexually seduce Socrates as described in Plato’s “Symposium.” Alcibiades imagined that the ugly Socrates contained something precious and valuable within him that was called an “agalma.” Agalma is an ancient Greek term for a pleasing gift presented to the gods as a votive offering. The agalma was intended to woo the gods, to dazzle them with its wondrous features and so gain favor for its bearer. The agalma, therefore, was endowed with magical powers beyond its apparent superficial value.

We are all driven by unconscious desire that drives us and motivates us in our lives, but that we can never totally or permanently fulfill. One aspect of desire can be the desire for even greater desire.

This idea is operationalized in the dopamine reward hypothesis. Dopamine, the reward neurotransmitter that gives us the sensation of pleasure, is only secreted in the anticipation of receiving a reward. Once the reward is achieved, its secretion shuts off cold and only gets secreted again when we become desirous of receiving another reward. Hence, all of our behaviors are driven by the lack of the desired object that we strive to obtain.

Variable Length Sessions

An important aspect of Lacan’s technique (and that repeatedly got him into hot water with the International Psychoanalytic Association) was his use of the variable length session, usually lasting from 20 to 40 minutes. Lacan would cut sessions short to emphasize an important point that he wanted his patient to be left with, to avoid prescripted sessions, and decrease the likelihood of patients leaving the best for last. This was another element of lack in Lacan’s practice.

Concluding Thoughts

Lacan’s work and legacy remain influential in much of the psychiatric, philosophical, and literary world. I have proposed in this article that the element of lack has been an important reason that Lacan’s work has continued to engage his followers and frustrate his detractors.

Until our psychiatric science is considerably further along than it is, and the anatomic and neurophysiologic location of our patients’ problems are more fully localized, along with associated effective biological treatments, we will continue to engage our patients in the “talking cure.”

Lacan, following Freud, provided us with a map to guide us in our therapeutic journey. It is a map full of holes, a map full of lack and lacunae, but, as the saying goes: “Getting there is half the fun.”

Dr Perman is clinical professor in the Department of Psychiatry and the Behavioral Sciences at the George Washington University Medical Center in Washington, DC.


1. Ackerman S, Rizzolo G, Wilson M. Lacan in America: a special issue. J Am Psychoanal Assoc. 2023;71(5):769-776.

2. Perman GP. Jacques Lacan: the best and least known psychoanalyst. Psychiatric Times. 2018;35(12).

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