%A Maxson J. McDowell %J Behavioral and Brain Sciences %T The Image of the Mother's Eye: Autism and Early Narcissistic Injury %X Autism results from a pervasive cascade of developmental failure. Prevailing theory is that the primary deficit in autism (primary cause of the cascade) is a biological or genetic abnormality in the brain. This paper challenges that theory. Though a primary cause should be both necessary and sufficient, none of the biological or genetic factors which are statistically linked to autism is either necessary or sufficient to cause autism. Another objection derives from the logic of cascades. A cascade?s primary cause is the same in kind as the events which comprise the cascade. Autism is a cascade of psychological failures. The associated biological and genetic factors must, I argue, increase the incidence of a primary psychological deficit. I hypothesize: (1) The acquisition of the image of the mother?s eye is a critical very early step in development. Because the image symbolizes psychological containment, it is an essential element in the self-organization of the personality. (2) Failure to acquire (or retain) that image is the primary deficit in autism. I show that these hypotheses are consistent with Holland?s paradigm of self-organization in complex adaptive systems. The paper uses clinical data to illustrate the hypotheses. It then synthesizes evidence from experiments on infant vision, from Stern?s observations of infant-mother pairs, and from observations on the incidence of autism in infants with cranial nerve palsy, or congenital blindness, or severe early deprivation. To this it links evidence from studies of evolutionary changes in the primate eye and from experiments on the visual behavior of mildly autistic adults. Theories of a biological cause have been undermined by the recent dramatic increase (273% from 1987 to 1998) in the incidence of autism in California. This increase was recently (October 2002) confirmed by Robert Byrd and co-workers; previously it had been widely dismissed as an artifact of measurement. The increase cannot be explained by genetic factors. It is unlikely that the physical, chemical or biological environment in California deteriorated sufficiently in one decade to account for such a large increase. It is more likely that a change in social behavior (affecting a psychological factor) could be sufficiently rapid. Because of the significance to public health of the rapid increase in autism, there is likely to be a vigorous new effort to identify its cause(s). The problem should be debated across disciplinary lines. This paper is a timely contribution to that debate. If the primary deficit is psychological then, to some extent, research should be redirected towards exploring autism at the psychological level. Scientists may need to evaluate suggestions derived, for example, from psychoanalytic data. My paper attempts this difficult collaboration. It shows that the image-of-the-eye hypothesis leads to a testable prediction: that autism is statistically linked to the early use of daycare. %N ted %K Autism, Narcissism, Image, Eye, Kohut, Stern, Primary deficit, Primary cause, Self-organization, Eye contact, Asperger's syndrome, Developmental cascade, Congenital blindness, Intersubjective, Theory of mind, Face recognition %E Professor Barbara L. Finlay %E Doctor Jeffrey A. Gray %V Submit %D 2002 %I Cambridge University Press %L cogprints2593