The human face, arguably the most obvious object of psychiatric study, has been overlooked by psychiatry. Perhaps it is because Freud and many of his followers have had an obsessive dislike of looking people in the eye and have preferred to keep faces out of sight on the couch (1). Ekman and Friesen (2) picked up on Darwin’s observations of similarities between the expressions of humans and great apes and devised a scoring system for the major affects plus surprise and disgust, which physicians might consider somewhat more autonomic. Beebe and Lachman (3) investigated the facial affective rapport between infant and mother. If Freud had looked a bit more at faces, he might have solved one of his great enigmas: the nature of love.

Suzi Malin, the author of Love at First Sight, is a portrait painter in London; she is a colleague of Freud’s grandson Lucien. (Lucien Freud’s latest show [in New York through May 2004], by the way, featured scabrous and florid humans and sleek animals.) This is a book of astonishing photos of mostly beautiful and all famous people in pair bondings. It purports to demonstrate the ways we fall in love visually with our lover’s face. The first way, called "harmonism," involves shared facial proportions—"the relative distances between the forehead and bridge of nose, base of nose and mouth, and mouth and chin" (p. 10). An example given is Charles and Diana. The second way is "echoism," an echoed shape of the upper eyelid line, the upper lip line, and the sweep of the eyebrow. Yoko and John had echoism, as do Brad and Jennifer; Marilyn had harmonism with Robert but both echoism and harmonism, and probably a stronger bond, with Jack. In addition to these two ways, which one might suggest are narcissistic mechanisms because they involve loving aspects of one’s own image, Malin terms a third way "prima copulism"—falling in love with one’s first bond: the mother or nanny for men and the father or other close male relative for women. Leonardo and Mona, Charles and Camilla, and John Jr. and Carolyn are examples. Liz resembles Dick’s much older sister Cecilia, who brought him up when his mother died when he was 2. Strong love attraction occurs when all three ways of falling in love at first sight are present, as in Bill and Monica and Elton and David.

One might object that a little girl’s first love object is her mother or nanny, not her father. Maybe men are more visually determined than women, but girls’ crushes on movie stars and boyfriends are intense. Malin provides instructions on scaling and comparing photos. Fortunately for those who might not fit the theses, she offers a nonvisual category called "slow love" in which the basis is warmth and friendship and shared interests and lifestyles, a more "rational" love, "grounded in reality" (p. 11).

One critique might be that the photos may be highly selected and atypical. Or limited to the superficialities of popular culture, which includes not just movie stars but the similarly envied and misbehaving European royalty. Would it work for genius and high art—beyond the Leonardo speculations? Balanchine was a man who looked constantly at a lot of women. A photo from 1967 shows him holding Suzanne Farrell’s hand, she in her Diamonds costume for his then new ballet masterpiece Jewels, and both facing forward. The arch of the brows and the line of the mouths, the elegant noses—inescapable! Scientific claims for this book would be premature, but it will be difficult for me to view a couple from now on without thinking of it, and the hypotheses are testable.

Any psychiatric interest in the face would be welcome and overdue. The genetically determined and fixed aspects of physiognomy shown in this book are the basis of facial identification as well as object choice. Security concerns have prompted the development of recognition software for these static data. Beyond this, facial movements, expressive or merely indicative, are exquisitely connected to affective and cognitive brain function. They more truly convey personality in relationships and remain the largest and most vital trove of unmined physiologic data in humans for psychiatry and neurology.