Whitmarsh Ian, Davis Arlene M, Skinner Debra, Bailey Donald B
University of North Carolina, Chapel Hill, NC, USA.
Soc Sci Med. 2007 Sep;65(6):1082-93. doi: 10.1016/j.socscimed.2007.04.034. Epub 2007 Jun 11.
Klinefelter, Turner, and fragile X syndromes are conditions defined by a genetic or chromosomal variant. The timing of diagnosis, tests employed, specialists involved, symptoms evident, and prognoses available vary considerably within and across these syndromes, but all three share in common a diagnosis verified through a molecular or cytogenetic test. The genetic or chromosomal variant identified designates a syndrome, even when symptoms associated with the particular syndrome are absent. This article analyzes interviews conducted with parents and grandparents of children with these syndromes from across the USA to explore how they interpret a confirmed genetic diagnosis that is associated with a range of possible symptoms that may never be exhibited. Parents' responses indicate that they see the genetic aspects of the syndrome as stable, permanent, and authoritative. But they allow, and even embrace, uncertainty about the condition by focusing on variation between diagnosed siblings, the individuality of their diagnosed child, his or her accomplishments, and other positive aspects that go beyond the genetic diagnosis. Some families counter the genetic diagnosis by arguing that in the absence of symptoms, the syndrome does not exist. They use their own expertise to question the perceived certainty of the genetic diagnosis and to employ the diagnosis strategically. These multiple and often conflicting evaluations of the diagnostic label reveal the rich ways families make meaning of the authority attributed to genetic diagnosis.
克兰费尔特综合征、特纳综合征和脆性X综合征是由基因或染色体变异所定义的病症。在这些综合征内部以及不同综合征之间,诊断时间、所采用的检测方法、涉及的专家、明显的症状以及可得的预后情况差异很大,但这三种综合征都有一个共同点,即通过分子或细胞遗传学检测来验证诊断。即便不存在与特定综合征相关的症状,所确定的基因或染色体变异也能确诊一种综合征。本文分析了对来自美国各地患有这些综合征儿童的父母和祖父母进行的访谈,以探讨他们如何解读一个已确认的基因诊断,该诊断与一系列可能从未出现过的症状相关。父母的回答表明,他们认为综合征的基因方面是稳定、永久且权威的。但他们通过关注已确诊兄弟姐妹之间的差异、已确诊孩子的个性、其成就以及其他超出基因诊断的积极方面,来认可甚至接受病症的不确定性。一些家庭通过辩称在没有症状的情况下综合征不存在来反驳基因诊断。他们利用自己的专业知识质疑基因诊断的确定性,并策略性地运用该诊断。对诊断标签的这些多样且常常相互冲突的评估揭示了家庭理解基因诊断权威性的丰富方式。