To say that Dr. Lewis has had a storied career would be an understatement. He is a university distinguished professor of pediatrics and psychiatry at Robert Wood Johnson Medical School and director of the Institute for the Study of Child Development. He is also a professor of psychology, education, biomedical engineering, and social work at Rutgers, The State University of New Jersey, and serves on the executive committee of the university’s Cognitive Science Center. And those are just a few of Dr. Lewis’s many academic appointments and interests. Born in New York City, Dr. Lewis has roots in St. Petersburg, Russia, but his ancestry goes back further to Amsterdam. The family then moved across Europe as fur traders and immigrated to the United States in the 1800s. His father was an engineering student at Cornell University in 1913. After the death of his mother—leaving him orphaned at age 18—his experiences became the impetus for one of his books, Altering Fate: Why the Past Does Not Predict the Future. “When I got to college, I was alone and struggling to figure out how the world works,” says Dr. Lewis. “Umpteen years later, I’m still trying to figure out how I ended up where I did.” He believes much of his early career has unfolded purely by chance. “Some things are just accidental,” he says. “All of a sudden you discover a phenomenon that transforms your work. Serendipity is important. Look at the biographies of successful academics—they were involved in many different problems.” Dr. Lewis began his career in electrical engineering. He had a professional mentor who introduced him to demography, in looking at mental disease and migration patterns. Dr. Lewis then switched from engineering to demography and epidemiology. That, in turn, led him to psychology. While he has always been interested in research, he was also attracted to psychopathology. “My degree in 1962 from the University of Pennsylvania is in both clinical and academic psychology,” he says. and I edited a book called The Effect of the Infant on Its Caregiver, which changed the word used from caretaker to caregiver and helped develop the field of maternal attachment,” says Dr. Lewis. “I am a believer if the environment changes, your interest changes.” And that became the 50-year theme of his work. “To understand development, you have to understand how the environment gets under your skin,” he says. He formulated models based on the idea that development is always a complex interaction between characteristics of the child and of the environment. “We simply can’t understand both normal and pathological development without appreciating the role of the environment,” Dr. Lewis emphasizes. Those models are now called epigenetic models. The epigenetic model explains how genetic expression is dependent upon the environment, in both normal and deviant development. For example, Dr. Lewis led a 20-year longitudinal study to learn the effects of cocaine exposure on development. “We looked at the central role of the nature of the child’s environment and the risk load of it,” he says. “When a fetus has been exposed to cocaine, it means the mother and others are using cocaine. Thus the environment of the child, independent of exposure, is important to consider if you want to understand the child’s development.” Finding New Ways to Identify Autism O Studying Consequences of the Environment on Children’s Development T he lack of information about child development got his attention. In the late 1950s and early 1960s, very little was known about newborn babies and children. His earliest work involved psychophysiology, in a set of studies that examined the effects of environment on children’s development—right down to gauging its impact on respiration, blood pressure, and heart rate changes. “At the same time, I was interested in how the environment affected the child, ne of the most important breakthrough areas of research focuses on emotional development—understanding and trying to measure emotions in young children as they develop, with an emphasis on the “moral emotions” or “self-emotions” and their origin. Shame, guilt, pride, and embarrassment have been the subjects of several of Dr. Lewis’s books. His most recent work, The Rise of Consciousness and the Development of Emotional Life, won the William James Book Award. It describes a theory of emotional development that includes the rise of self-consciousness. “That leads us to study the development of the brain,” says Dr. Lewis. “Our imaging study work led us into pathology and took us into the study of autism, where we learned autistic children don’t develop a sense of themselves.” In 1979, Dr. Lewis developed a technique that helped identify children with autism based on their response to mirrors. At 15 to 24 months, a normally developed child recognizes himself or herself in a mirror and uses the terms “me” and “mine.” Brain maturation is related to the emergence of personal pronouns and mirror recognition. Autistic children don’t show such self-recognition behavior at that 24 Robert Wood Johnson I MEDICINE