Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth;
Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanted wear; Though as for that the passing there Had worn them really about the same,
And both that morning equally lay In leaves no step had trodden black. Oh, I kept the first for another day! Yet knowing how way leads on to way, I doubted if I should ever come back.
I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.
-Robert Frost, “The Road Not Taken”, 1916
People often ask me if a major childhood event, great or horrible, could be affecting them in their adult lives. This is a hard question to answer because, as Frost suggest in his poem, you never know what would have happened if life took you down a different road, and you can’t really go back. With that in mind, however, I generally answer “Yes, it can.”
This answer is based on concepts of developmental neuroscience. “Developmental neuroscience” is basically a fancy way of saying, “Really smart people studying how genetics and environmental factors interact to make us who we are.” Genes act as a blueprint for what we look like, how smart we are, how strong we will be, and so on. Genes code for the development of systems in the brain that are related to emotions such as sadness, anger, and anxiety. The debate of whether genetic expression in terms of psychological problems can be affected by the surrounding environment was sparked by Freud and has been carried on by his bow-tie wearing protégés since.
Recently in the Journal of Psychology and Psychiatry, John March and James Leckman reported that “A scientific consensus is emerging that the origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life.” They continue, “…there can be a lag of many years, even decades, before early adverse experiences are expressed in the form of disease.”
The importance of these statements cannot be emphasized enough. As this phenomenon becomes better understood, it gives mental health care providers a new way to view psychopathologic outcomes. It helps explain why some people with similar genetic predisposition for a psychiatric disorder such as major depression struggle with depression their entire life while others do not. It additionally helps us understand how some who suffer severe stress in childhood, for example physical abuse, become severely depressed or anxious in adulthood while others do not.
There is a term that is derived from general systems theory that helps summarize this concept. It is called “multifinality”. This is the idea that one etiologic (causative) factor, such as genetic risk for depression, can lead to several different outcomes that could include a lifetime of feeling depressed or no significant struggle with depression.
The reason that I like the concept of multifinality is that it can be applied to help people change the course of their disease or disorder. In other words, just because you have depression does not necessarily mean you have to suffer with it the rest of your life. There are ways to affect the multifinality of depression that include good life habits such as regular sleep schedules and diet and exercise routines. Additionally, learning productive coping and stress management skills as well as reducing or eliminating unneeded stress can change the course of depression. The avoidance of drugs and alcohol will almost guarantee a better outcome in managing depression. The acceptance of professional help is often needed for a person to begin his or her journey down these paths, and to help navigate the proverbial forks in the road.
In my work, I tell people that disorders such as anxiety and depression can make them feel out of control. I urge them, however, to challenge that thought and look at it through a totally different lens. I work towards teaching that they can have the ultimate control, which is deciding what they put in their body and what they do with their body.
Since the days of Freud and probably long before, many providers intuitively believed in multifinality; their beliefs are now being proven biologically. People can change the course of their genetic predisposition to illness in a permanent way. People can also overcome the grip that severe childhood stress maintains on their psyche. This often takes hard work in breaking habits and thought distortions that have deep roots in childhood. It is not only challenging, but often downright terrifying to confront the fears of change or the memories that bring feelings of embarrassment, anger, guilt, resentment, jealousy or terror. It can be extremely difficult work at the beginning, but it is the work that, as multifinality suggests, can change the course of an illness and a life.
If you read Frost’s poem carefully, you will notice the irony in it. He writes that the two roads had nearly equal wear and “that morning equally lay…”, but concludes in the end that he had taken the road less traveled, “and that has made all the difference.” This ironic twist may have been tongue-in-cheek on Frost’s behalf or may have been a literary technique to emphasize a point; that when confronted with a fork in the road, stop and think; make the decision and take the road you do as if it is definitely the best one. Sometimes that may be the more difficult road, or the road less traveled, but ultimately, that journey will be the best you could take.