The value of Charles Brenner's ideas regarding depression is assessed, focusing on the significance of castration depressive affect. His discussion of whether depression is an affect, a signal affect, or an illness is examined, with special emphasis on his failure to sufficiently address depression as an illness or disorder as defined by psychiatry. Clinical material from the analysis of a man who suffers from severe depression suggests that incorporating psychiatric concepts (biological and pharmacological) with modern conflict theory can be a useful way to understand and treat some patients with depression. Theoretical and clinical controversies associated with combining psychiatric/biological and psychoanalytic views of depression are examined.