01/07/2025

The Contemporary Relevance of Lacanian Psychoanalysis 

Why does Lacanian psychoanalysis deserve renewed attention in a scientifically-oriented society and within today’s mental healthcare system?

Let us begin with the following statement:
The human mind cannot be reduced to a variable or a number, a sum or a checklist of symptoms, a biological substrate, or an algorithm.

And yet, this reduction seems to be the dominant trend in contemporary healthcare. Psychotherapy is increasingly being reduced to a standardized “intervention” aimed at so-called “problematic behavior” or “dysfunctions.” The process of diagnosis is being simplified and standardized through the use of step-by-step protocols, questionnaires, checklists, and other tools that tell healthcare providers what to look out for , all in the name of speed and efficiency.

Treatments are broken down into modules or sessions based on, for example, evidence-based manuals marketed as ‘recipes for the human soul.’ The person is perceived as deficient, in need of a fix or a solution.
In many countries, from Belgium and the Netherlands to the UK and the United States, this mode of working is embedded in both policy and financing. Just think of the diagnostic systems used by mental healthcare providers, such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) or the ICD-11 (International Classification of Diseases, 11th Revision). These systems help clinicians to make uniform diagnoses and to facilitate communication among professionals. However, both systems impose a reductionist view of the human being: the suffering individual becomes a patient with a label, which grants access to a limited number of therapy sessions or reimbursement rights, including for medication.

What are the consequences of this?

Although there is increasing advocacy for a more ‘holistic’ approach, one that focuses not only on symptoms but also on the story behind them in practice, the emphasis remains firmly on symptom management. The core of psychological suffering often remains untouched. Solutions are handed out to temper symptoms (medication, advice, tips), but we often see clients returning either with the same problem in a different form or with new symptoms. The therapist is assigned the role of a kind of ‘mechanic,’ expected to fix loose wires while the engine keeps failing. It’s a movement toward standardization and generalization aimed at (self-)control and efficiency.
Although this approach aims to reduce long waiting lists, it is ironically not proving to be efficient in practice. On the contrary:

• Waiting lists are increasing, people wait months or even years for help.

• There is a major shortage of psychologists and psychiatrists, while the number of people with mental health struggles continues to grow.

• More and more individuals are dealing with depression, anxiety, suicidality, and feel lost in a world full of performance pressure and digital overload.

Society is at a loss, and this is palpable everywhere. There is a longing for quick solutions which, if we really want to look at the statistics, sadly do not suffice. In this context, the demand for ‘measurable outcomes’ and ‘evidence-based practice’ collides with the unruly, unpredictable nature inherent to the human experience,  an experience that cannot always be neatly resolved in the short term.

Why, then, does this approach remain so attractive and dominant?

This is not mere coincidence. Political and economic factors help explain the appeal of this method.
First of all, standardized care offers a sense of manageability. Organizing diagnoses and treatments according to fixed protocols makes it easier to structure and fund healthcare. Standardization keeps care processes transparent and as efficient as possible, a key concern for policymakers and insurers. The illusion of efficiency also plays a significant role: treatments that deliver quickly measurable results appear cost-effective and successful. This creates the impression that care is improving and becoming cheaper, even if it often fails to do justice to the complex reality of mental health.

Furthermore, this approach aligns well with the way treatments are positioned in the market. Therapies are increasingly presented as evidence-based products that are easily marketable. Take, for example, trends like EMDR (Eye Movement Desensitization and Reprocessing), a form of therapy that has become popular for trauma treatment due to its relatively short duration and ‘measurable’ effectiveness. Other examples include Cognitive Behavioral Therapy (CBT) and mindfulness-based therapies, which are also offered via standardized protocols and can be easily implemented into care pathways aimed at fast results. These therapies are often marketed as ready-made packages, with clear step-by-step plans and measurable outcomes, making them attractive for insurers and treatment centers.

Finally, the demand for measurability and standardization fits within a broader cultural tendency to eliminate uncertainty and ambiguity. In a world increasingly focused on control, optimization, and predictability, the human mind is also subjected to this logic. We all naturally seek grounding in the intangible, striving for clarity and certainty in something that is, at its core, unpredictable and complex. I myself got caught up in this dynamic during my first internship, only to be quickly confronted with its painful consequences (I will dedicate a separate post to this experience under the section “encounters & thoughts”, for those interested).

It is therefore unsurprising that the urge for measurability and control is so dominant within mental healthcare, even though this need often fails to align with the actual lived experience of human suffering and healing.

How does Lacanian psychoanalysis fit into this picture?
Lacanian psychoanalysis offers a radically different perspective on the human subject and suffering. Unlike dominant approaches, it refuses to reduce the irreducible complexity of the human being to a product that can be sold or managed. Instead, it places the fundamental lack at the center, the manque, that defines and constitutes us as human beings.

Freud described the unconscious as something that speaks but is never fully transparent; it cannot be entirely known or understood. Lacan built on this idea by stating that the subject is structured by language, but never completely coincides with the meaning that language attempts to fix. There is always something left over, something that escapes meaning: the Real, le Réel. This Real is that which cannot be symbolized, predicted, or controlled. It constantly reappears as a crack in the order, the same order we humans try to impose on our experiences and our reality.

Paradoxically, precisely this acknowledgment of the elusive, the ungraspable, opens the space for a deeper understanding of the human psyche and offers possibilities within therapy. Whereas dominant systems aim for control and measurability, Lacanian psychoanalysis invites us to embrace the discomfort of the lack and to recognize that not everything can be explained or solved.

In an age where protocols and statistics are prevailing, it is essential to make room for what does not fit within those frameworks. The rising numbers of burnout, depression, and anxiety point to structural issues that cannot be addressed through quick, standardized solutions. Particularly among young people, we see struggles with identity, decision paralysis, and a constant pressure to perform and present themselves in an increasingly complex and demanding world.

Moreover, the rapid development of artificial intelligence and algorithms forces us to confront questions about freedom and responsibility. Can we truly predict and control everything? And do we really want to? At the same time, economic interests increasingly determine who gets access to care, how fast that care is delivered, and according to which standardized template. These developments demand a critical and nuanced view of what care should actually be.

In such a climate, Lacanian psychoanalysis offers a valuable counterpoint. It doesn’t provide a ready-made solution but instead creates space: a space to listen to that which doesn’t fit into the system, space for the uniqueness of each subject, and space to take discomfort and uncertainty seriously rather than erasing them.
Psychoanalysis reminds us that the human experience is not manufacturable, predictable, or fully controllable and that precisely in that unpredictability lies our freedom.

The average patiënt

Let me be clear right away: “the average patient” does not exist. It seems like a simple statement, one many will agree with. Unfortunately, mental healthcare appears to have forgotten this lesson in its propaganda for evidence-based practice. Policy, funding, and even treatment methods are increasingly designed for the average.

Let me give a concrete but simple example from practice. Take two clients who have both recently received the diagnosis of “depressive disorder.” Both can’t get out of bed, feel listless, have sleep problems, and ruminate constantly.

One says:

“I just can’t see the point anymore. I feel so worthless. I can never do anything right.”

The other says:

“I just can’t see the point anymore. So much pressure. Everyone is counting on me.”

They carry the same label, are both referred to the same psychologist specializing in depression, but their inner logic is fundamentally different. The first might be struggling with a lack of recognition, love, and meaning: a personal sense of lack that drains him. The second is suffocating under an excessive demand, an insatiable call to responsibility and duty that consumes him.

The protocol-driven approach responds with standard advice and pre-scripted interventions like behavioral activation. The logic goes: plan more activities step by step, and you’ll automatically feel better. It sounds appealingly simple.

But that ignores the question: for whom is the person supposed to do this? In relation to which imaginary Other is this entire scenario playing out?

For the second client, who says “I want to die because everyone is counting on me,” the world is already a stage of demands and obligations. Why would he get out of bed for another who already expects so much of him? Why would he subject himself even further to the very expectations that suffocate him?

Such a standard intervention misses the essential point: that suffering follows a unique logic arising from the relation to the Other, from desire and lack. Psychoanalysis begins precisely there: not by prescribing a generic recipe or patching over symptoms, but by listening to what someone’s speech reveals about their desire, their fear, their relation to the Other’s demand. No universal solution, but an encounter with the radical singularity of the individual, where “speaking about” can work on the very core of the psyche.

Incidentally, the first client might gladly accept the therapist’s step-by-step plan and follow it without much friction. But the second might react with strong resistance, because the entire intervention feels to him like a repetition of the same oppressive demand that already suffocates him. He then falls outside the scope of the technique’s effectiveness and becomes part of the percentage for whom the method “doesn’t work.”

How far does evidence-based practice really reach when it comes to such a complex, language-based creature as the human being? How meaningful is it to claim statistical effectiveness when precisely that which is least standardizable, the unique logic of someone’s desire and speech,falls out of view?

The Subject Is Not a Machine

The drive toward standardization starts from the assumption that the human mind is predictable, controllable, and manageable. As if the subject were a mechanism that, if properly calibrated, would function as intended.

This idea is deeply rooted in an outdated, Newtonian worldview: if only we know enough about the causes, we can control the outcomes. Symptoms are then seen as defects in a system, and therapy as the right sequence of actions to make the system run “correctly” again.

But even the natural sciences have long abandoned such simplistic models. Chaos theory shows how simple rules can produce extremely complex and unpredictable patterns. Quantum mechanics teaches that uncertainty is not the result of ignorance but a fundamental feature of reality. And yet much of psychology still behaves as if it’s stuck in the 18th century. For example:

• When someone is depressed, we listen to their story, but ultimately, we always follow the protocol and do “behavioral activation,” “mindfulness,” “psychoeducation and advice,” or “cognitive restructuring,” because that statistically gives the best chance of “recovery.”

• When someone has a phobia, we prescribe exposure. Period. The script is ready before the actual speaking has even begun.

• When someone has trauma symptoms, we immediately deploy EMDR because it is “proven effective,” even though we often don’t know exactly why it works or what it means for this person to evoke those images.

• When someone ruminates, we teach them to challenge thoughts and formulate helpful ones, without asking whose demands they are actually meeting or for whom these thoughts are supposed to help.

• When someone is psychotic, our first focus is usually medication…

Of course, I don’t want to paint every psychologist with the same brush. But the protocol reflex remains a striking tendency in care. It sounds attractive, both for the client and for the practitioner: clear, orderly, evidence-based. And yes, it can help. But the manual doesn’t tell us why it helps, nor why it sometimes does nothing at all or even backfires.

That uncertainty is something many practitioners struggle with themselves, often without naming it. Some try to quell that discomfort by clinging even more rigidly to protocols, adopting an even firmer stance as the one who knows and can explain everything. Others hit their limits, burn out, carry their cases home in their heads. Still others turn to new methods and techniques that promise the solution, sometimes forgetting yet again to simply listen.

Listening without knowing, without controlling, without immediately wanting to solve: that requires more than a technique. It asks us to tolerate not-knowing and to trust that precisely there something essential can appear.

Symptoms as Answers

In many contemporary treatment models, symptoms are seen as defects that need to be corrected or eliminated. The idea is: if we can name the problem and address it technically, we can solve it. The symptom then appears as a kind of malfunction in a mental system that should, in principle, work well.

Lacanian psychoanalysis opposes this idea of the symptom as merely a defect. The symptom is not noise, but a message, a form of language. It is an answer to something unbearable, to something in the unconscious that finds no other way to make itself known. It is a unique solution, an invention of the subject themselves, even if it is sometimes painful and flawed.

The symptom is signifiant: it means something, but not in an immediately transparent way. It speaks in riddles, in a cryptic logic that does not address the conscious “I,” but the unconscious desire.

Example 1: Panic attacks in small spaces

Take the example of a woman who has repeated panic attacks when she is in small spaces. At first glance, the symptom seems purely “irrational,” as if the body is simply “going haywire” for no reason. But in conversation, she describes a recurring dream in which she falls into a dark tunnel.

That image, a narrow tunnel, being swallowed up, finding no way out, carries something of her unconscious fear. As she talks further, it turns out she recently had a birthday, reaching the exact age at which her brother suddenly died of a heart condition. Her mother had also unexpectedly died of an illness shortly before.

She herself did not spontaneously make these connections until after some while. The panic attacks say something: they give bodily expression to an unbearable thought: in her case it was something about her own mortality, the suddenness of loss, the identification with her deceased brother and mother. The symptom says: “I’m suffocating, I’m dying,” precisely the thing she could not speak about at the time.

It is not a random malfunction. It is an unconscious answer to the confrontation with death, something she could not or dared not talk about. The symptom gives voice to something, but in the language of the body, in the overwhelming panic.

Example 2: Self-harm as working on the Real

Another example is self-harm or cutting. Many caregivers understandably want to stop that immediately. But Lacanian thinking asks: “What does this symptom do for that person?”

There was a case of a young girl in an institution with a psychotic structure that one of my professors regularly talked about. She was forced to speak about her traumas in a group. For her, this talking did not work the way it did for others. It pushed her toward the Real: the raw, unthinkable, traumatic dimension for which no words exist. Speaking was not a relief for her but a source of disarray.

Because of her psychotic logic, her psychotic structure ( by the way there weren't any "typical symptoms" like hallucinations or delusions present), the boundary between inside and outside, between the Self and the Other, was often unclear. Speaking itself made her “open,” vulnerable in a way that was unbearable. The Other was a threat to her self, a constant risk of destruction by that Other. There was the danger she would completely lose herself.

By cutting herself, she quite literally worked something onto her body. The cutting created a boundary, a mark, a limit on what would otherwise be unbounded and unbearable and could lead to the unthinkable. It was an attempt to control or localize the Real.

From a Lacanian perspective, this is not just “sick behavior” to be corrected, but an extreme, desperate yet meaningful solution to tame something of the Real. As long as it is not life-threatening, it may also be necessary as a provisional stabilization.

Example 3: Compulsive cleaning rituals

Another example is the compulsive act of obsessive cleaning.

At first glance it seems banal: “Someone just wants things to be clean.” But often there is a specific logic behind it. For example: someone spends hours cleaning the house to “keep the dirt away,” but in conversation it becomes clear that the dirt is a kind of metaphor for the Other.

It can be about the desire to keep the Other at a distance, their gaze, their judgment. The cleaning is not a useless tic but a way to manage the fear of invasion, of being overwhelmed by the desire or demands of the Other. It is an attempt to symbolically banish the Other from one’s own territory.

The symptom is thus a way  to organize something of the relational, the intersubjective conflict. The subject creates a kind of order with it, a way to arrange their position in relation to the Other.

The standard clinical reflex sees such symptoms as targets for corrective techniques. But anyone who only tries to remove the symptom, without listening to what it says, risks destroying the entire compromise the subject has made with it. The symptom holds something in place, often something that would otherwise be unbearable.

The Lacanian analyst does not try to suppress the symptom, but to hear it. What is the symptom’s own logic? What specific relationship does the subject have with their symptom? How does the symptom shape desire, guilt, enjoyment?

The goal is not to preserve the symptom, but to create space for another answer—one that is not imposed from the outside but emerges from the person’s own speech. Because only through that speech can the subject make a new connection to their desire and to the Other and thus also to their suffering.

Instead of saying: “This is the technique that works for most of the patiënts,” psychoanalysis says: “Tell me. What do you want? What does your symptom say about you?” That is why the analytic treatment is not a place where one learns to function correctly, but where one can try to find another answer, an answer that truly comes from the individual themself.

Speech and the Real: the power of speaking

The symptom is a signifier, a carrier of meaning, but it also points to something that precisely resists meaning: the Real. The Real is that which cannot be fully symbolized, that which escapes the grasp of language yet insists, often in the form of suffering, somethimes as anxiety, bodily sensations, or compulsive repetitions without apparent reason...

The patient’s words are not simply representations of thoughts or feelings that are already fully formed. They shape those thoughts and feelings. In speaking, something of unconscious desire emerges, something of the subject’s truth. But at the same time, speech always runs up against a limit: there is something that cannot be fully said, something that withdraws: the Real core of the symptom.

Yet words are not empty shells. They carry something of that Real with them. Words cannot fully capture the Real core or the lack around it, but they can approach it, circle around it, make it more manageable. It is precisely in speaking, in directing words to an Other, that the subject can shift their relation to the symptom.

Speaking is not mere venting. It is an attempt to structure one’s suffering, to give form to what is otherwise unspeakable.

But this process does not happen automatically. It requires an Other who listens in a specific way. Not by immediately interpreting in the sense of explaining or decoding from their own knowledge, but by making space for the unconscious speech of the analysand (the cliënt).

The psychoanalyst functions as a special kind of Other: not the Other who prescribes what one should do, but the Other who makes speech possible and invites an encounter with one’s own desire.

The analyst listens not to correct, but to hear how the symptom speaks, what logic it contains, what knot of desire and enjoyment it potentially maintains. Through that speaking, the client can say something different, hear something different from themselves. In this way, the symptom can shift from being a blind necessity to becoming an invention that truly belongs to the subject and is bearable. In the end we are all humans, with are own 'solutions',  trying one way or another to make the best out of our living experience. 

Healing in psychoanalysis is not about eliminating symptoms as malfunctions, but about enabling the client to formulate a different response to their own Real core. It's about finding a new kind of response that is not prescribed, but found in speaking, and thanks to the presence of a new kind of Other, different then all the ones he/she met through life: the psychologist, the analyst, who's only desire is to make you speak.