Driving is the quintessential twentieth century phenomenon and has become an instrumental activity of daily living for the majority adults in the developed world. In America, the driver’s license has been the de facto identi¨cation card for years and from a self-psychology perspective, the automobile in contemporary society might be interpreted as the outermost shell of our fragile personality structures (Kohut, 1972). Yet psychiatrists have historically shown only a passing interest in driving ability as an example of human interaction with machines. Application of driving simulators in psychiatric research is a recent development, as the impact of mental illness on functional abilities such as driving or work performance is increasingly appreciated. še term “accident” has long fallen out of favor in the medical and human factor/error literature, as this term would see a collision as a random/unpredictable event, as opposed to a possible predictable and/or preventable entity, based on particular risk factors (O’Neill, 1998; O’Neill, 1993; Haddon, 1968). šese risk factors might be driver/operatorspecific, machine/vehicle-speci¨c, or relate to the humanmachine interface. še concept of “accident proneness” in an industrial setting was ¨rst described in 1919 (Greenwood & Woods, 1919), although this was not extrapolated to tra¬c safety research for several decades. An article entitled “še accident prone automobile driver” appeared in the American Journal of Psychiatry in 1949 which attempted to correlate individual psychopathology with driving records in taxi-drivers (Tilman & Hobbs, 1949). However, research into the epidemiology, psychology and neurophysiology of driving is slowly emerging, and this chapter will focus on potential relevance to driving simulation.