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"It’s not a secret but-- " : predictive testing and patterns of communication about genetic information in families at risk for Huntington Disease Cox, Susan M.

Abstract

The increasing transparence of the human genome has profound implications for how we understand health and illness and perceive our biological and social relatedness to others. Presymptomatic testing for adult onset conditions, in particular, creates the novel situation in which some individuals know in advance of impending illness while others learn that they have escaped such a fate. How families at risk for one adult onset condition — Huntington Disease (HD) — communicate about such information is the topic of this dissertation. HD is often described as a 'genetic time bomb'. It is an autosomal dominant neuropsychiatric disorder characterized by mid-life onset, involuntary movements, cognitive impairment, and depression. There is no effective prevention or cure but with the advent of predictive testing in 1987 it became possible for at risk individuals to learn if they had inherited the mutation associated with HL\ Empirical studies on predictive testing for HD focus primarily on the individual psychological impacts of the test; few studies consider how families understand and attempt to manage genetic information in their everyday lives. This dissertation begins to address these lacunae by examining the stories that test candidates and their families tell about hereditary risk and predictive testing. These stories derive from a prospectively designed study which includes 102 in-depth, at-home interviews conducted in the pre and post-results period with 16 test candidates and 33 family members. Focusing on three narrative 'moments', the dissertation explores how study participants storied their experiences of: 1) learning about the family history of HD, 2) deciding to request the predictive test and, 3) making sense of an informative result. Drawing upon a social constructionist approach, the analysis emphasizes the processual nature of predictive testing as well as the significance of interpersonal communication in producing and reproducing the social realities in which genetic information acquires a particular salience. Given the recent proliferation of genetic tests as well as the absence of an adequate popular discourse on embodied risk, the research underscores lay actors' abilities to reframe existing clinical schema in order to interpret and manage hereditary risk in an intersubjectively meaningful way.

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