This document summarizes an essay by Stanley Leavy on integrating Jacques Lacan's psychoanalytic theory into clinical practice in American clinics. It discusses how Lacanian theory emphasizes that the ego is subject to imaginary distortions and the unconscious is structured like language. The document also notes that Lacanian analysis focuses on the specific words patients use rather than analytic themes or categories. It concludes that the goal of interpretation in Lacanian psychoanalysis is disclosure rather than closure by resonating with the patient's unconscious through brief but meaningful punctuations of their speech.

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CLINICAL NOTES SERIES (September 2016)
STANLEY LEAVY ON JACQUES LACAN
Stanley A. Leavy (1983). ‘The Image and the Word: Reflections on Jacques Lacan,’
Interpreting Lacan, Vol. 6, edited by Joseph H. Smith and William Kerrigan (New
Haven and London: Yale University Press), Forum on Psychiatry and the
Humanities, The Washington School of Psychiatry, pp. 3-20,
INTRODUCTION
When this essay was published in 1983, Stanley A. Leavy M.D. was not only the
Clinical Professor of Psychiatry at Yale Medical School, but also a Training and
Supervising Analyst at the Western New England Institute for Psychoanalysis. The
essays collected in this volume attempt to explain the significance of the work of
Jacques Lacan to American psychoanalysts. They focus on both theoretical
psychoanalysis and the clinical dimensions of the Lacanian doctrine. The
significance of this volume is that it represents an important attempt to relate
Lacanian psychoanalysis to American ego psychology. It therefore includes essays
by clinicians, theorists, philosophers, and literary critics. This particular essay is
focused on the clinical aspects of Lacan; hence its inclusion in this series of clinical
notes. It is relevant from both a historical and clinical point of view. The historical
point of view is important because Lacanian theory is much better known in
America now than ever before; analysts would therefore like to know how it all
began. The clinical point of view is relevant because American analysts still have to
think through how exactly they should go about integrating Lacanian theory with
their clinical practice.1 That is why the contributors to this volume compare the
1 See, for instance, Bruce Fink (2014). ‘Interview: Lacan’s Reception in the United States,’ in
Against Understanding: Commentary and Critique in a Lacanian Key, Vol. 1 (New York and
London: Routledge), pp. 226-231; and Bruce Fink (2014). ‘Interview: Lacan in America,’

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Lacanian clinic whenever they can with that of ego psychology. This volume is
aimed less at full-fledged Lacanians and more at ego psychologists who keep
hearing about Lacan and have finally decided to situate their own practice vis-à-vis
the Lacanian approach. This volume will also be of use to students in departments of
behavioural sciences, psychology, psychoanalysis, and literature. That is because
knowledge of basic Lacanian theory has become important in all these areas.
Needless to say, the editors would like to pitch this volume of essays as an
introductory text for psychiatrists as well since an interest in Lacanian theory is not
confined to analysts. The author of this essay is himself a psychiatrist. His
exploration of Lacanian theory will therefore be useful to a wide range of
professionals in the area of mental health. This essay is excerpted from the first
section of this volume which also includes essays on the relationship between
language, psychosis, and subjectivity by John Muller of the Austen Riggs Center at
Stockbridge; and an analysis of the ‘talking cure’ by Julia Kristeva of the Institute of
Psychoanalysis at Paris.
LACAN IN THE AMERICAN CLINIC
Stanley Leavy’s main preoccupation in this essay is encapsulated in the following
question: ‘What difference might Lacan’s theories make to our clinical work?’ Leavy is not
talking about his personal practice, but is posing the question as including the
community of analysts who are wondering how to put Lacanian insights,
techniques, and theories to work within the American clinic. It is however not his
intention to exhaust the entirety of Lacanian theory (assuming that were possible) in
this brief essay. Leavy would prefer to have this essay read instead as a modest foray
in relating Lacanian theory with the practice of psychoanalysis in the American
clinic. In other words, he is not trying to relate Lacanian theory with Lacanian
practice directly like French analysts usually do. That is because there were few, if
any, Lacanians practicing psychoanalysis in America in 1983. This essay, to put it
simply, then, is trying to make a case for the incorporation of Lacanian theory within
ego-psychology and American psychiatry. It should not be read as a report of what
had already been accomplished by 1983. But, before deploying Lacan, it is important
to be sure that analysts know how to ‘interpret Lacan’ correctly. That then is the task
that Leavy and his fellow contributors have given themselves in this volume of
essays on Lacanian theory. Leavy begins by noting that Lacan was a bit impatient
with those who wanted to understand the clinical implications of his theories before
putting in the requisite effort to understand his work. But, as it became obvious in
subsequent years, Lacan was himself a successful clinician though he did not write a
Against Understanding: Cases and Commentary in a Lacanian Key, Vol. 2 (New York and
London: Routledge), pp. 241-249.

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number of case histories like Freud.2 It is therefore incorrect to maintain, as was the
case for a number of years in America, that Lacan was indifferent to the clinical
implications of his theories. The aspects of the theory that Leavy focuses on in this
essay relate mainly to the function of the word and the image. He hopes that his
exposition of these Lacanian themes will make it possible to provide ‘rational
assurance’ to clinicians that it is not only possible, but necessary to think through
these aspects of Lacanian theory within the American clinic.3
PSYCHOANALYSIS OF LITERATURE
But, before doing so, Leavy explains how psychoanalysis is usually applied in the
context of literary criticism as an analogue to his own endeavours in this essay. That
is because literary criticism influenced by psychoanalysis will need to be clear about
the role played by ‘the word and the image’ in the interpretation of literary texts. A
great deal of literary criticism that invokes psychoanalysis uses only a thematic
approach. It is based on the identification of unconscious conflicts which are then
situated in the locus of the author or the main characters. This approach presupposes
that the author is in full command of his intention and can control the play of
meaning in his text. The author in this model is the conscious source of meaning; the
text is the site of the representation of this meaning. The discovery in recent literary
theory that the author cannot marshal the play of meaning to the extent that he
would like to forced a re-think on what literary critics mean by unconscious conflict.
The revised model of psychoanalytic literary criticism works on the assumption that
the author and the characters are not speaking subjects in the simple sense of the
term. Instead they find themselves spoken by forces that they are not fully conscious
of when they set out to write. This model is analogous to a more structured form of
free-association than is available on the analytic couch. The identification of
unconscious conflicts and other thematic concerns that constitute the staple diet of
literary criticism then is something other than what critics expected it to be. The
intentional and affective dimensions of literary interpretation then are subject to the
2 For a historical background to the work of Jacques Lacan, see the intellectual biography by
Élisabeth Roudinesco (1997). Jacques Lacan, translated by Barbara Bray (Cambridge: Polity
Press). A brief introduction to similar themes is available in Élisabeth Roudinesco (2011,
2014). Lacan: In Spite of Everything (London: Verso Books). See also Catherine Clément (1983).
The Lives and Legends of Jacques Lacan, translated by Arthur Goldhammer (New York:
Columbia University Press).
3 For full-fledged recent accounts of the Lacanian clinic, see Bruce Fink (1997, 1999). A
Clinical Introduction to Lacanian Psychoanalysis (Cambridge, MS: Harvard University Press)
and Bruce Fink (2007). Fundamentalsof Psychoanalytic Technique (New York: W. W. Norton &
Company).

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‘formations of the unconscious.’4 It is not possible to suspend the author’s
unconscious while writing or the reader’s unconscious while reading. There are
many more variables that affect the play of meaning than was originally envisaged
to be the case by literary critics. It became increasingly difficult to correlate the
author with either his main characters or his plots and their resolution in a reductive
sense. In addition to the theme of unconscious conflicts, other analytic categories like
symptoms, dreams, and fantasies had also to be rethought at the level of both form
and content in the literary text.5 So while literary criticism began with the
methodological insistence on reducing complexity to simplicity in Freudian analysis
and experimented with identifying elements that resisted sense in French analysis, it
became increasingly difficult to do that consistently because both the resolution of
the plot and the analysis of the formations of the unconscious are subject to forms of
psychic over-determination.6 Furthermore, it is not possible for a literary critic,
unlike an analyst, to obtain the free-associations necessary to interpret the
formations of the unconscious that is represented in a literary text.7 Psychoanalytic
literary criticism then turned out to be a lot more difficult in practice than Sigmund
Freud thought it would be.8
IMAGINARY DISTORTIONS IN THE EGO
What all these observations amount to is the fact that the ego is not what ego-
psychologists thought it to be. It is not the seat of reason which has to merely process
the perceptions and ideas that constitute the stuff of human thought. Instead, it
4 See Dylan Evans (1997). ‘Formation,’ An Introductory Dictionary of Lacanian Psychoanalysis
(London: Routledge), p. 66. The formations of the unconscious are described in Sigmund
Freud (1900, 1991). ‘The Dream-Work,’ The Interpretation of Dreams, translated by James
Strachey, edited by Angela Richards (London: Penguin Books), pp. 381-651.
5 See, for instance, Juliet Flower MacCannell (1986). Figuring Lacan: Criticism and theCultural
Unconscious (London and Sydney: Croom Helm).
6 The simplicity-complexity dimension of psychoanalytic literary criticism is explained in
Kenneth Burke (1939). ‘Freud and the Analysis of Poetry,’ Art and Psychoanalysis, edited by
W. Phillips (Cleveland and New York: Meridian Books), pp. 412-439. See also Serge Leclaire
(1968, 1998). Psychoanalyzing: On the Order of the Unconscious and the Practice of the Letter,
translated by Peggy Kamuf (Stanford: Stanford University Press), for a description of a non-
semantic approach to clinical interpretation in Lacanian psychoanalysis.
7 Meyer H. Abrams and Geoffrey H. Harpham (2009). ‘Psychological and Psychoanalytic
Criticism (New Delhi: Cengage Learning), pp. 247-252.
8 See, for instance, the essays collected in Sigmund Freud (1990). Art and Literature, Vol. 14,
translated by James Strachey, edited by Angela Dickson (London: Penguin Books), Penguin
Freud Library.

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turned out that the ego was subject to imaginary distortions.9 Therefore, analytic
interpretation had to find a way of minimizing these distortions that emerge within
the context of the Lacanian order of the imaginary. Leavy’s preoccupation with the
word and the image is related to the fact that both the meanings of words and the
structure of the image are subject to distortions. It is not the case that words are
reliable and only images are subject to reflection and distortion during the mirror
phase and after. That is because there are imaginary aspects to the symbolic like there are
symbolic aspects to the imaginary. Lacanians are careful to not essentialize either the
imaginary or the symbolic in a way that ignores the context of the patient’s
utterances on the couch. Furthermore they define the unconscious as that which emerges
in the gap between perception and consciousness in their theory of the subject. If this
turns out to be the correct way of thinking about the unconscious; then, all
perceptions are subject to imaginary distortions before they can be processed by
reason. That is why it is naïve to think that the ego can be the seat of reason.
Furthermore, Lacanians also situate the unconscious in the gap between the statement and
the utterance. The statement is therefore not reducible to the utterance but implicated
in how it is put together. The subject’s use of language is not something that can be
represented objectively; this is because the subject is both inside and outside
language. The subject is inside language to the extent that it pours out of him in any
act of communication, but he has the fantasy that these linguistic processes are
within his conscious control. That is why Lacan is fond of the theoretical
formulation, ‘the unconscious is structured like a language.’10 What this means is
that the structure of the unconscious has to be rethought using the insights of
structural linguistics. The unconscious is not reducible to the realm of the instincts;
that is the main difference between humans and animals. All use of language
necessarily has a symbolic dimension in human beings; they have to be conceived of
as symbolic acts in which the unconscious insists on having its say.
THEMES AND WORDS
That is why Leavy focuses in this essay on the analytic distinction between analytic
themes which recur in most analyses and the actual wording used by the patient to
9 Jacques Lacan (1978, 1988). The Seminarof Jacques Lacan: TheEgo in Freud’s Theory and in the
Technique of Psychoanalysis 1954-1955, translated by Sylvania Tomaselli, notes by John
Forrester, edited by Jacques-Alain Miller (Cambridge: Cambridge University Press), passim.
10 See the essays collected in Paul Cobley (1996). The Communication Theory Reader (London
and New York: Routledge) for an introduction to general linguistics and the role that it plays
in Lacanian psychoanalysis. The Lacanian theory of the subject is available in Bruce Fink
(1995). TheLacanian Subject: Between Languageand Jouissance (Princeton: Princeton University
Press).

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represent these themes. It is not possible to cure a patient by invoking formal categories
since the patient’s unconscious is not responsive to the metalanguage of
psychoanalysis. The patient can be cured – if at all – only within the stock of words
that he produces in his discourse.11 The main takeaway from the Lacanian approach
is to spare the patient the technical terms and analytic categories from
psychoanalysis and concentrate instead on why he might have chosen a particular
word, trope, or metaphor in specific acts of free-association. That is the point at
which psychoanalysis bears a resemblance to literary criticism. Close reading of
literary texts provides the practice necessary to be attentive to how the patient
speaks in addition to what he chooses to talk about. The former refers to the function
of the word and the latter to the function of themes. Lacanian analysis demands a
willingness to take the patient seriously rather than indoctrinate him in analytic
categories under the guise of interpretation. Another dimension of the actual
wording relates to the function of the phoneme since the unconscious is affected by
sounds, puns, and the play of figures. Likewise, Leavy’s advice to ego psychologists
is that the defences that constitute the ego must also be allowed to have their say.
That is different from the traditional approach of trying to work-through defences in
the attempt to restructure the ego by making friends with that part of it which is
least subject to conflict and distortion.
CONCLUSION
The therapeutic results of analysis depend then on getting the patient to put his
conflict into words of his own choosing. This is where many analyses go wrong
because the analyst winds up formulating the conflict in his own words rather than
attempt to punctuate the patient’s speech. This is a Freudian insight about the
difference between the patient’s knowledge and the analyst’s knowledge that Lacan
takes to its logical conclusion. The analyst cannot cure the patient; he can only
structure the patient’s attempts to cure himself. Furthermore, the function of a
Lacanian interpretation is to resonate in the patient’s unconscious; ‘interpretation
does not nail down meaning, it rings bells, or, as I like to put it, interpretation aims
not at closure but at disclosure.’12 A good example of such an interpretation relates
to a patient who was preoccupied with his eye. The analyst’s intervention was an
attempt to get the patient to consider that he is probably asking ‘Who’s I?’ rather
11 See also John Forrester (1990).‘Whatthe Psychoanalysts Does With Words: Austin, Lacan
and the Speech Acts of Psychoanalysis,’ The Seductions of Psychoanalysis: Freud, Lacan and
Derrida (Cambridge: Cambridge University Press), pp. 141-167.
12 See also Bruce Fink (2014). ‘Interview: A Psychoanalyst Has to Speak Like an Oracle,’
Against Understanding: Commentary and Critique in a Lacanian Key, Vol. 1 (New York and
London: Routledge), pp. 217-225.

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than ‘Whose eye?’ These forms of interpretations do not have to be verbose; they are
usually brief but resonant nonetheless. They take the form of punctuations where the
analyst re-orders the actual phrase at stake in the interpretation without bothering
the patient with terms from Freudian meta-psychology.13 Leavy concludes this brief
foray into Lacanian theory by arguing that ‘the duty of the independent analyst…is
to bend consistency of theory to the exigencies of practice and to remain open to
change of point of view.’ In other words, analytic doctrine as Jacques Lacan
describes it cannot attain theoretical closure; since, given the emphasis on speaking,
‘the science cannot be completed, and every new generation of analysts stands
before a new world.’
SHIVA KUMAR SRINIVASAN
13 For an introduction to meta-psychology, see Sigmund Freud (1991). On Metapsychology:
The Theory of Psychoanalysis, Vol. 11, translated by James Richards, edited by Angela
Richards (London: Penguin Books), Penguin Freud Library.