Some Clinical Contributions of Jacques Lacan

Jacques Lacan was a French psychiatrist and psychoanalyst who created an original metapsychology based on a close reading of the work of Sigmund Freud combined with the structural linguistics of Ferdinand de Saussure. Lacan's concept of the unconscious is that of a highly structured entity consisting of interlacing chains of signifiers (sounds, printed words, and images) based on principles of metaphor and metonymy. In this review article, the author provides a brief biographical summary of Lacan's formative years, his education, and his career, followed by a discussion of some of his major theoretical concepts. Lacan's three registers or orders of existence, the Imaginary, the Symbolic and the Real, and their relationship to normal and psychopathological mental functioning are described. Lacan's major structural diagnostic categories are defined as well as his proposed etiology for the development of each of them. Lacan's formulation of need, demand, and desire are described as well as his late concept of le sinthome. Brief clinical vignettes are used to illustrate some of Lacan's theoretical concepts, and some clinical recommendations are provided. Lacan's theories and practice were controversial over his almost 50-year career, and his work is largely unknown to psychiatrists and psychoanalysts in the United States. This article is an effort to fill a small part of this lacuna.