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Lacan defined the symptom in several ways: as a metaphor, as "that which comes from the real," as "that which doesn't work," and at the end of his teaching, as a structural fact, whose necessity must be questioned. In 1953 (2002a) Lacan emphasized that the analytic symptom—a neurotic, perverse, or even psychotic symptom; a dream; a slip; and so on—was sustained by a linguistic structure, by signifiers, and by the letters that serve as their material element.