Longitudinal formulations of psychiatric illness have long been familiar. In the 19th century, Thomas Clouston wrote about developmental insanity in young men, presaging modern views of schizophrenia as having some of its origins or first manifestations in early life (Clouston, 1891; O'Connell et al. 1997). At the same time, Sigmund Freud was creating his system of psychoanalysis to understand hysterical conversion and other aspects of adult psychology as sequelae of early psychological events. Now, within an epidemiological and neuroscientific framework, we are beginning to understand that a variety of psychiatric disorders, including those of later life, such as cognitive decline and dementia may be the final common pathway of a long chain of mutable events (Richards et al. 2004). Just as in clinical neurology, where one is taught to place the causal lesion as high as possible so, too, in psychiatry we should look for the seeds of causality earlier rather than later in life.