The psychoanalytic approach to depression and its cognate states, including despair and mania, sees them to be parts of our human repertoire of responses to loss, the painfulness of conflicts of love and hate, and the god-like omnipotence not only of our destructive impulses but of our constructive ones as well. Although in ways that may not always be obvious, or often may be hidden and denied, most of these will be seen ultimately to relate to our great difficulties  and struggles with matters of family, love and sex, birth, babies and death: issues that in fact are of the most profound importance to us, both as private individuals and as a species.

Detailed psychoanalytic work with patients across all parts of the lifecycle has led to advances in our knowledge and our ways of working. We have a better understanding both of depression and, in a different way, of mania. Generally, we understand them as fundamentally psycho-somatic states of both psyche and soma. An excess of painful loss and a predominance of paranoid schizoid feelings of physiological fight-flight can make forms of development that are based upon facing fact and reality very difficult. Instead, they can lead to complex alterations and deformations of the psyche. Without these being understood, they will limit and constrain what is possible for the individual concerned.

Despair is clearly an important element in many forms of mental illness as well as underpinning many societal forms of malaise. However, it can take many more reticent forms. We may sense their existence but subtly avoid them because of our anxiety that we cannot miraculously cure them. Nor can we. However, this avoidance weakens our capacities to address them more realistically.

Therefore, this year’s UCL Psychoanalysis Conference will examine the macroscopic and the microscopic anatomy of these states, and of defences against them, in their multifarious forms across the lifecycle. Understanding the workings of what is a matrix of inter-related states offers great potential benefits. It can open up the value of facing reality. Mourning is a meaningful personality-changing process: by working through loss and grievance, conflicts of feeling, the reality of unpleasant facts, including those of living and dying, we arrive at deeper perspectives on what is good and bad, on what life offers and on what it requires. The extent to which we live either in fear of the demands of our own omnipotence or intimidated by that we fear in others becomes a little more known and a little less projected. Our capacities for realistic reparation, renewal, adaptation and creativity correspondingly increase.

All of this, in many ways, defines what it is to be human.