Equifinality, Multifinality, and the Rediscovery of the Importance of Early Experiences: Pathways from Early Adversity to Psychiatric and (Functional) Somatic Disorders

Most current mainstream research, diagnostic assessment, and treatment strategies focus on specific psychiatric disorders—on diagnoses that are based on manifest symptoms within a categorical, atheoretical approach. This disorder-centered approach has been antithetical to psychoanalytic views, which are fundamentally person centered, focusing on the dynamics of individual lives. Growing realization of the high comorbidity among psychiatric disorders has led to the need to include

developmental considerations and hierarchical models in the classification and treatment of psychopathology. In addition, this realization has led to a renewed interest in the principles of equifinality and multifinality—that a given endstate can be the result of different developmental paths and that similar developmental factors may lead to dissimilar outcomes. In this chapter, these developments are illustrated by research on the impact of early adversity, a central domain in psychoanalytic thought. Findings from various strands of research in the neurosciences and genetic research, in particular, suggest that early adversity leads to vulnerability for a wide variety of both psychiatric and (functional) somatic disorders. These findings have contributed to the rediscovery of the importance of early experiences more generally and to the need for a broad developmental perspective. In this context, we also discuss the danger of reductionism associated with the growing influence and popularity of affective neuroscience and genetics as well as the vital role a psychoanalytic perspective might play in countering this reductionism by reestablishing the importance of meaning and meaning making in understanding and treating patients with a history of early adversity. In particular, we focus on the importance of narrative and mental representations in the development of the capacity for mentalization in these patients.