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Contemporary pathology is adorned with different faces, which can be seen in psychiatric services in the form of identities. Yet, pathological denominations are renewed with the times, which calls into question the validity and relevance of some of the diagnoses our patients carry, as if the malaise inherent to our condition as speaking beings described by Freud in Civilization and Its Discontents were no longer relevant. In this context, questions are raised as to the timeliness of contemporary pathologies and the attribution of a diagnosis, with the identity effect this produces on patients. The work of the psychoanalyst in psychiatry focuses on the place that should be given to the real that patients have to deal with in view of a sinthomatic or sublimatory reorganization enabling a reconnection to the social and a freedom of being.