C U R R E N T A N T H R O P O L O G Y Volume 42, Number 2, April 2001

2001 by The Wenner-Gren Foundation for Anthropological Research. All rights reserved ooii-3204/20oi/4202-ooo3$3.oo

The Kin in the Gene

The Medicalization of Family
and Kinship in American
Society^
by Kaja Finkler
In the past several decades there has been an explosion of research in genetics and on genetic inheritance. This new genetics
is part of contemporary biomedicine and forecasts great advances
in alleviating disease and prolonging human life. It also encompasses notions about biological family and kinship relations. I
propose that with the advent of the new genetics, family and
kinship are being medicalized. I explore the ways in which explanations of the inheritance of genetic disease influence people's
understandings of family and kin and both reflect and conflict
with broader current sociocultural processes. The discussion includes a brief overview of the anthropological study of kinship,
the meaning of family and kinship in contemporary society, and
the concept of medicalization and its implications for people's
lives as seen through narratives and concludes with an analysis
of the significance of the medicalization of family and kinship in
present-day society.

Tbe past several decades bave seen an explosion of researcb in genetics and on genetic inberitance.^ Tbe new
genetics is part of contemporary biomedicine and promises great advances in alleviating disease and prolonging
buman life, leading us into tbe medicine of tbe future.
Tbe present perspective on genetic inberitance is a feature of tbe past four decades, altbougb tbe bereditarian
concept of disease appeared in tbe mid-i9tb century (Rosenberg 1976, Straban i984[i9O2]), wben tbe Darwinian
revolution of tbe i9tb century and tbe Mendelian principles introduced in tbe early 20tb gave rise to tbe discovery of tbe genetic assortment of individual traits
transmitted from generation to generation. Tbe notion
of genetic inberitance as we know it today came into
existence in tbe mid-2otb century witb tbe blossoming
of molecular biology. As genetic inberitance increasingly
becomes the prevailing causal explanation of affliction
and of buman bebavior in general, it is appropriate to
ask bow sucb explanations influence people's understandings of family and kin and bow tbey reflect and at
tbe same time conflict witb broader social processes.

KAJA FINKLER is Professor of Anthropology at the University

of North Carolina, Chapel Hill (Chapel Hill, N.C. 27514, U.S.A.
[kxf9438@email.unc.edul). She has taught at Eastern Michigan
University (1973-84) and has been a visiting scholar at the National Autonomous University of Mexico, the University of
Newcastle, and the University of Freiburg. Her publications include Spiritualist Healers in Mexico (Salem, Wis.: Sheffield,
1994), Women in Pain (Philadelphia: University of Pennsylvania
Press, 1994), Experiencing the New Genetics (Philadelphia: University of Pennsylvania Press, 2000), and Physicians at Work, Patients in Pain (Boulder: Westview Press, 2d edition, 2001). The
present paper was submitted 11 i 00 and accepted 21 viii 00.

To address tbese issues, I will briefly describe antbropological debates about tbe meaning of kinsbip from
cross-cultural and bistorical perspectives and tben examine current conceptualizations of family and kinsbip.
I will go on to discuss wbat I call tbe medicalization of
family and kinsbip, pointing out tbat tbis pbenomenon
impacts individuals differently, depending on tbeir experience, and illustrating tbis witb narratives of bealtby
individuals witb a family bistory of breast cancer and
bealtby adoptees wbo bave searcbed for tbeir birtb parents. I will conclude witb a discussion of tbe theoretical
and practical implications of tbe medicalization of family and kin. On tbe assumption tbat medical concepts
open a window to tbe understanding of a society's culture, I will suggest tbat contemporary conceptualizations
of bereditary transmission build on American cultural
conceptions of kinsbip and tbat tbe medicalization of
kinsbip reflects and promotes a traditional notion of family and kinsbip relations tbat is counter to tbe cbanging
patterns of tbe late 2otb century and tbe new millennium.

I. I thank the four informants whose narratives enrich our understanding of the phenomena discussed in this paper for freely giving
me their time and receiving me with patience. I owe a special debt
to Cecile Skrzynia of the Division of Hematology and Oncology of
the School of Medicine at the University of North Carolina, Chapel
Hill, for introducing me to Eve and Maya (pseudonyms). I thank
Robin Miller for introducing me to the adoptees and Lynn Giddens
for assisting me in meeting Kristen and Eric (pseudonyms) and sharing with me the wealth of her experience as an advocate for adoptees. The entire project was supported by a fellowship from the
Institute of Arts and Humanities, University of North Carolina,
Chapel Hill, and by grants from the University of North Carolina
Research Council and from the University of North Carolina Graduate School. I especially thank Rick Ezell for giving the manuscript
a close reading and for his invaluable demand for clarity.

2. The mass media are saturated with reports of this work. Television series such as Turning Point and Dateline feature issues
related to genetic inheritance. National Public Radio's Eresh Air,
Morning Edition, and Talk of the Nation Science Eriday have presented recent developments in genetic inheritance, as have the ffew
York Times (Jones 2000) and a multitude of other publications and
programs. All Things Considered on National Public Radio has
discussed the usefulness of mastectomies to save lives for women
"who've seen their mothers or sisters die an early death from breast
cancer." While some reports question the new emphasis on genetic
inheritance, including Siebert (1995), Begley (1996,1997), TheEconomist (1996), Marty (1996), and Turning Point (February 12, 1996),
the majority of these reports are enthusiastic about the achievements of the new genetics (Blakeslee 1997; Carey and Flynn 1997;
Elmer-Dewitt 1994; Freundlich 1997; Grady 1994; Jaroff 1989,1994,
1996; Seligman 1994; Wade 1997; Glausiusz 1995a, b, i996;Higgins
1997; Brownlee and Silberner 1991; Brownlee et al. 1994; Nash
1997; Sack 1997].
2.35

236 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

Studied, kinship is estahlished hy the sharing of hlood

(hut see Weismantel 1995, Witherspoon 1975, and, of
course, Schneider 1965, 1972, 1984; for discussion see
The study of family and kinship has been a major con- Finkler 2000a). In fact, the role of family and kinship
cern of anthropology since the discipline's formal incep- has served to demarcate premodern from complex sotion in the 19 th century. While kinship studies have cieties. Scholars have suggested that in premodern or
waned in the light of postmodern concerns, most an- "primitive" societies all human endeavors are emhedded
thropology textbooks usually include at least one chapter
on family and kinship beliefs and practices the world in kinship networks, including economic, political, and
over. With the invention of new reproductive technol- religious activities (Fortes 1970; Giddens 1991; Sahlins
ogies, the concepts of paternity, maternity, and sibling- 1968, 1976)." For instance, according to Sahlins (1976),
ship are taking on new meanings, and a new language is primitive societies are defined hy kinship, whereas conbeing developed to reflect this change (cf. Yoxen 1986, temporary bourgeois society is differentiated hy its focus
Carsten 2000).^ New genetic categories of people are be- on the economy and the production of goods and, most
ing created, and tbus there has been renewed interest in recently, on the production and transfer of information.
the meaning of family and kinsbip (Dolgin 1997; Frank- In premodern societies, one's identity is defined by one's
lin 1997; Strathern 1992(2, b; 1995). In fact, a good ar- family and kinship relationships; in complex societies
gument could be made that the new reproductive tecb- and especially modern ones, it is circumscrihed hy the
nologies have done more than anytbing else to call into presence of a nation-state (Giddens 1991), hy separate
question our traditional understanding of family and kin- economic, political, and religious institutions, andhy the
sbip (see Franklin 1993:128; Stratbern 1995; see, for dis- diminished importance of kin relationships. Significussion, Dolgin 1997, 2000; Finkler 2ooofl). My concern, cantly, Giddens emphasizes that in premodern cultures
bowever, is not with kinship and reproductive technol- kinship "provides a nexus of reliahle social connections
ogies but with tbe ways in which people's experience of which, in principle and very commonly in practice, form
family and kin is influenced by tbe widespread belief in an organizing medium of trust relations. Kin people can
the new genetics that medicalizes family and kinship.
usually he relied upon to meet a range of obligations
Early studies of family and kinsbip cross-culturally re- more or less regardless of whether they feel personally
garded biological relationships as a starting point for de- sympathetic towards the specific individuals involved"
veloping conceptions about kinship (Lowie 1948:57). (1990:101). In modern societies, these relationships of
Schneider, however, in several ground-breaking works trust have heen replaced hy "friendship, sexual intimacy
(1965, 1972, 1984), called into question the basic as- as means of stahilizing social ties" (p. 102). Strathern
sumption tbat family and kinsbip relations are univer- (19920) wisely ohserves that, however complicated the
sally established by reproduction and biological ties. He kinship systems of non-Western peoples are. Westerners
argued persuasively that kinsbip is a Western construct understand them as inherently primitive. In nontradiand that people the world over may not necessarily give tional societies, individuals are separate entities divorced
primacy to ties established through reproduction and from their kinship and family units (Strathern 1992a,
blood. Various scholars (Holy 1996, Keesing 1975, Peletz Finkler 1994).
1995, Scheffler 1991) have questioned Schneider's assertions. While I agree with him that people may not uniViewed cross-culturally, kinship-oriented societies
versally sort out family and kin on the hasis of hlood usually stress unilineal descent, emphasizing either the
ties, nevertheless they usually do identify what I call a maternal (matrilineal descent) or, more often, the pater"significant same" group of people who are regarded as nal side (patrilineal descent). Descent defines how propfamily and kinwho perceive themselves as similar and erty, status, and social obligations are transmitted and
who consider themselves related on grounds of shared how marriage is contracted. "Descent . . . confers crematerial, he it land, hlood, food, saliva, semen, or ideo- dentials for status and, hence, for capacities, rights, and
logical or affective content. Most important, member- duties, [and] . . . a specified parent is both a parent and
ship in a "significant same" group carries moral obli- the repository, as it were, and transmitter, of structurally
gations and responsibilities.
significant ancestry" (Fortes 1970:281-82). In discussing
In American society, the popular construal of this the Nuer, Tallensi, Tiv, ancient Romans, and Chinese,
group was hased, at least until recently, on a belief in Fortes declares that "the paradigm of patrilineal descent
hiogenetic connections estahlished hy procreation. Thus, is not just a means of picturing their social structure; it
according to Schneider (1980), consanguinity defines ge- is their fundamental guide to conduct and helief in all
nealogical relations in the United States. Generally areas of social life" (pp. 290-91).
speaking, in most societies that anthropologists have
Even in societies that stress unilineal descent, arguahly, people recognize that hoth mother and father con3. Yoxen (1986:8-9! provides the example of an embryo created by tribute to the formation of the offspring, hut that they
fertilization outside the woman's body and donated by another couple and then transferred to the womb of an infertile woman's sister, do so is less significant than the line of descent to which

Anthropological Studies of Kinship

who would carry the developing fetus to term. With this example
Yoxen shows that it is possible for a baby to have three fathers and
three mothers.

4. Although Fortes (1970) would argue that kinship also played an

important role in ancient Rome, as it does among British royalty.

FINKLER The Kin in the Gene \ 237

the offspring belongs,^ For example, among the Melpa,
the paternal substance is shared hetween males through
the patrilineal line (agnatically related). While the
mother provides the hlood, the father supplies the
"grease" (i,e,, semen) that gives strength to the sons (A,
Strathern 1972:13), Daughters inherit their strength from
the mother. Among the Baraya, the mother is not regarded as the parent whose substance forms the fetus
(Strathern 19920:6r). The Zande, as descrihed hy EvansPritchard (1962:247), hold similar heliefs: "The spiritsoul [is] , , , what is derived from the father, in spite of
what is said ahout the mother's co-operation in its creation, and this is what makes all children, irrespective
of sex, members of their father's clan," Thus, "there is
a tendency to emphasize the father's part in procreation
heyond that of the mother just as the father's side of the
family is stressed socially to a greater extent than the
mother's side of the family" (p, 248), By contrast, in matrilineal societies such as the Trohrianders, the father may
simply "open the way" for the child to he horn (Parkin
i997'i38). In fact, according to Malinowski the Trohrianders believe that children result from the return of
an ancestor through the hody of a woman, largely ignoring the father's contrihution. Here rank, memhership
in social groups, and the inheritance of possessions descend through the maternal line. In Malinowski's (1922:
71) words, "The real kinship, the real identity of suhstance is considered to exist hetween a man and his
mother's relations,"

conceptions kinship is hiogenetic (Schneider 1980:25);

the child is made up of hoth the mother's and the father's
material, Biogenetic suhstance is a symhol of oneness in
American culture (p, 52), and "hiological unity is the
symhol for all other kinds of unity including, most importantly, that of relationships of enduring diffuse solidarity" (p, 53), According to Schneider, hlood relationship is a relationship of identity (p, 25), and while
hiological ties define identity, love gives them their diffuse solidarity. The family is the paradigm "for how kinship relations are to he conducted and to what end" and
"specifles that relations hetween memhers of the family
are those of love" (p, 50), Living in the same household
gives meaning to hiological ties (p, 34); hiologically related individuals who do not reside together may not he
regarded as family. In sum, hilaterality is the norm shared
hy all Americans, hut affect and choice define who precisely are kin. In contemporary American society, where
the ideology of choice rules, the notion of choice is extended to hiogenetic ties and whom we regard as kinfolk
and family (Giddens 1992),
We saw earlier that complex societies are defined hy
loosened kinship ties, a phenomenon that was also noted
hy Tocqueville (1980(1840]), In fact, in contemporary
times, a lack of kinship attachments may even he a sign
of modernity. Excepting among elites (Bellah et al, r985,
Domhoff 1983, Marcus and Hall 1992), strong kinship
and family ties are usually regarded as a mark of specific
ethnicity (Arensherg and Kimhall 1965)* and traditionIn a minority of world societies, including most West- alism. With the arguahle exception of the nuclear family,
ern societies, hilateral descent is the norm, meaning that the mark of a modern individual is autonomy, indepeople give equal weight to the mother's and the father's pendence, and detachment from kinship ties (Bellah et
descent lines and that identity is derived from hoth pa- al, 1985; Giddens 1990, 1991; Redfield 1941; Taylor
rental lines. Bilateral kinship appeared in Europe with 1989), "Kinship has narrowed and the sphere of individthe law of Emperor Justin in the 6th century A,D,, chang- ual decisions has grown" (Bellah et al, 1985:89), I expect,
ing the old pattern of emphasis on patrilineality (see however, that in practice loss of kinship ties is more
Finkler 2000^), although Galen's theory that semen orig- common in urhan than in rural areas and varies hy reinated in the blood and also nourished the mother and gion, even though people everywhere may have hecome
the fetus persisted until the i8th century (Singer 1997), dependent on other linkages estahlished hy friendship,
The new law decreed that consanguines included all at work, at church, and through volunteer organizations,
those related hy hirth in the paternal and the maternal support groups, and many other types of nonkin-related
line up to the seventh degree; those related more closely associations.
than the seventh degree were forhidden to marry. The
During the 1960s family and kinship acquired new
consanguinity category "now fully included the matri- meanings and ceased to organize people's existence or
lateral kin" (Pomata 1996:59) and may even have priv- define their identity. The modern family of sociological
ileged them.
theory and historical conventionan intact nuclear
household unit composed of a male provider and a female
housekeeper and their children and estahlished hy procreation, consanguinity, and marriageno longer preFamily and Kinship in Contemporary
vails
in the United States (Dolgin 1997, Popenoe 1993,
American Society
Stacey 1990), Stacey (1990:6) notes that "historians place
Contemporary American society follows the pattern of the emergence of the modern American family among
medieval Europe, However, whereas in England, as white middle class people in the late eighteenth century;
Strathern (1992^:52) reports, "reproducing one's own did they depict its fiowering in the nineteenth century and
not literally mean one's genetic material: one's own flesh chart its decline in the second half of the twentieth,"
and hlood were family memhers and offspring legiti- The postmodern family is characterized hy uncertainty,
mated through lawful marriage," in American cultural insecurity, and douht; its arrangements are diverse, fluid.
5, This point has heen vigorously dehated in the anthropological
literature; see Leach (1961) and Malinowski (i962[i929l).

6,1 have even heard social workers call Mexican-Americans' close

kinship and family ties dysfunctional.

238 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

and unresolved, opening the way for an array of kinship

relations. Stacey observes that "no longer is there a single
culturally dominant family pattern to which the majority of Americans conform and most of the rest aspire"
(p. 17). The routinization of divorce and remarriage has
generated diverse patterns of family structure and conceptualizations of its meaning. Along with other scholars
(e.g., Gottlieb 1993, Thorne 1992), Stacey concludes that
the traditional family is no longer a viable unit because
it distorts the variety of kinship possibilities that are not
founded in blood bonds. Separation and divorce generate
a diversity of new kin connections that are ever-changing
and subject to negotiation. Today a family may be a group
established more on the basis of choice than on the basis
of biogenetic ties, including single-parent households
and blended, adoptive, and gay families. Gottlieb perhaps
sums it up best when she says that "although it is impossible to overlook kinship as a force in people's lives,
it is also impossible to pin it down" (1993:200).' What
is more, whereas in premodern American society people
inherited their status, rights and duties, property and
power, and poverty from their kin, today fam^ily and kinship relations are usually not expected to confer on people any particular status except among the very wealthy
(Marcus and Hall 1992). In fact, the majority of middleand lower-class families may have little to transmit to
their descendents other than ephemeral moral values
(Finkler 1994).

The Medicalization of Family and Kinship

Medicalization (Freidson 1970, iUich 1976, Tomes 1990)
is, of course, not a recent phenomenon. With increasing
secularization in the i8th and 19th centuries, suicide and
homosexuality in England, for example, came to be
viewed as diseases rather than as moral transgressions
(Hansen 1992, MacDonald 1992). It is, however, difficult
to establish precisely when the term "medicalization,"
defined as the expansion of medical jurisdiction to cover
forms of deviant behavior that could alternatively be understood as sins, crimes, or moral faults (Estes 1988, Halpern 1985, Mayall 1990, Englehardt 1986), acquired cultural currency. Alcoholism, domestic violence, criminal
behavior, social problems, child abuse, certain undesirable personality characteristics, learning disabilities, and
even gambling, once considered religious, ethical, or
moral transgressions or matters of character, have been
reinterpreted as diseases (Gabe and Lipshitz-Phillips
1984, Rosenfield and Erchak 1988, Tiefer 1994). Bauman
(1992) suggests that even death has been medicalized, as
is evidenced by the search for its causes in defective
genes rather than a recognition of it as merely part of
the human condition.

Although men have not escaped the grip of medicalization, as with, for example, impotence and male pattern baldness (Tiefer 1994), it is women whose bodily
processes have been most subject to medicalization.
Notwithstanding the fact that connections with others Menstruation, menopause, childbearing, and reproducthan kin define the modern or postmodern individual, tion have all been brought under medical scrutiny (Gurparadoxically, we also hear a wistful lament in American evich 1995; Johnson 1987; Kaufer and Gilbert 1986; Kohsociety for the loss of kinship and family ties, and the ler-Riessman 1983,- Martin 1987; Markens 1996;
ideology of kinship and family bonds continues to carry Ritenbaugh 1982; but cf. Bransen 1992). Women are
a powerful symbolic load. While politicians mourn the treated medically for even slight discomfort during mendecline of "family values," the business world, arguably struation, especially when such discomfort is labeled
the most dominant domain in modern life, has appro- Premenstrual Syndrome (PMS). Menopause and, of
priated kinship, if only symbolically, in its incessant ref- course, childbearing require close medical supervision
erence to companies as families. Investment vehicles (Davis-Floyd 1996, Johnson 1987, Kohler-Riessman 1983,
Martin 1987, Ritenbaugh 1982). Aesthetic sensibilities,
(such as mutual funds) designate groups of similar funds too, have been medicalized, the emphasis on a thin body
as "families" of funds. We may still invoke kinship re- and a youthful appearance often requiring cosmetic surlations when in need, as in the song from the Depression, gery (Gilman 1999, Rodin 1992, Ritenbaugh 1982, Sul"Brother, Can You Spare a Dime?" Unions refer to their livan 1993). New technologies have extended the medorganizations as "brotherhoods," and some religious ical gaze to the fetus, making it visible, and with this
groups identify their members as siblings. Biomedicine, visualization through sonography even the unborn is
yet another major institution in modern life (Foucault treated as a patient (Haraway 1997, Neustadter 1992, Pet1975, Freidson 1970), has also turned its gaze on family chesky 1987, Rapp 1999). Lastly, as Witzig (1996) points
and kinship, defining them in traditional ways based on out, race is medicalized when an association is made
blood or genetic ties, contrary to contemporary changes. between such groupings and specific diseases (see also
Wailoo 1996).
7. Not all scholars agree that family and kinship relations have
Medicalization, translating sets of problems into medbecome diluted in contemporary times (see, e.g.. Shorter 1975 and
Segalen 1986). Segalen, examining European data, suggests that ical terms, changes people's perspectives on reality, on
family and kin ties may be more powerful than before. She sees their being, and on how they experience the world (Enthe family as "powerful, a refuge and the special focus for our feel- glehardt 1986). When seen as medical problems, behaving" (p. 21 and argues that relationships within the nuclear family iors are usually characterized as circumstances that deand among close kin have intensified. From Segalen's perspective, viate from physiological or psychological norms
the crisis rests with society and not with the family. Finch and
Mason (1993) also regard family and kin relations as continuing to regarding proper levels of functioning, freedom from
be based on genealogical ties, perhaps reflecting somewhat different pain, and achievement of expected human form. For expatterns in Europe and America.
ample, discussing the medicalization of homosexuality

The Kin in the Gene | 239

in the 19th century, Hansen (1992) points out that a new
type of person was created and a new core identity given
to such a person: now a homosexual might he regarded
as having a particular genetic makeup. Previously, homosexuality was viewed as a type of hehavior, alheit an
aherrant one,- with medicalization, the homosexual hecame a new "species" of person.
Medicalization restructures reality hy intruding on the
world people take for granted. Aspects of hehavior or the
hody that are tacitly understood as normal are transformed into ahnormal, disconcerting states, separating
the individual from others. Like all human actions, medicalization is a two-edged sword. While it may relieve
afflicted individuals of one set of devalued lahels, it hurdens them with another. When drug addiction, crime,
and alcoholism'* are converted from moral transgressions
to diseases, the persons affected are ahsolved of responsihility and hlame, and this may provide them with a
sense of coherence and meaning (Broom and Woodward
1996, Englehardt 1986). A diagnosis of chronic fatigue
syndrome, for example, helps to provide a rational, discrete explanation for an incoherent and disorderly experience (see the case of Margarita in Finkler 1994). At
the same time, persons may he turned into deviants and
stigmatized in the process, and the underlying causes of
the prohlem (including the experience of a sense of meaningless in their lives) may he ignored. Again, with the
medicalization of women's reproduction, contraceptive
technologies have given women greater freedom hy enahling them to control conception and relieving them of
the fear of unwanted pregnancy. Simultaneously, these
technologies have made women dependent on the medical profession and often adversely affected their health
(Bunkle 1993; Doyal 1979, 1995; Finkler 1994; Marieskind 1980; Yanoshik and Norsigian 1989).
Not everyone, of course, emhraces the notion of medicalization (Finkler 2000a). Some scholars have questioned the degree to which the concept of medicalization
has penetrated popular consciousness, pointing to an apparent loss of dominance of the medical profession (Williams and Calnan 1996).' Nevertheless, medicalization
is a powerful force. To the array of human experiences
that have hecome medicalized, I suggest that we must
now add the family and kinship. Understood as hiogenetic, they have come under close medical inspection
through the prevailing hiomedical understanding of disease etiology. Beyond issues associated with gender, family and kinship relations have heen given a new dimension that stresses faulty genes rather than social status,
position, or even poverty. Cultural significance is given
to genetic transmission, for hetter or for worse.
Giddens (1992) has proposed the notion of "toxic par8. But see Appleton (1995), who argues tbat alcoholism was medicalized not by biomedicine but by Alcoholics Anonymous. Which
institution first medicalized alcoholism is less relevant than tbe
fact that the culture is prone to regard any "deviant" condition in
medical terms. Arguably, in the 15 th century alcoholism would not
have been considered a medical problem by anyone.
9. Approximately 33% of the U.S. population seek alternative therapy (Eisenberg et al. 1993; see also 1998).

ents," parents who harm their children hy damaging

their sense of personal worth. "Toxic parents" are emotionally inadequate and either have ahdicated their responsibilities to their children or insist on controlling
them. Alcoholic parents and verhal or physical child
ahusers are examples. Although Giddens argues that
those who wish to rework their involvement with toxic
parents through therapy may come to recognize that
"you are not responsihle for what was done to you as a
defenseless child" (p. 107), one cannot declare independence from one's genetic parents. As Bohinski (1996:80)
observes, "information ahout genetic makeup is gotten
from examination of a person's medical record and analysis of his or her family genetic history. A family history
of a particular disorder, for example, would mean that
there was an elevated risk that the individual might he
a carrier who could pass the condition on to a new
generation."'
If Schneider is correct, love cements hiogenetic kinship relations in American society and allows for a degree
of choice in deciding whom a person will love within
the family and kinship group. With the medicalization
of family and kinship, a connection must exist irrespective of love and choice. Biomedicine insists on uniting
those who may not choose to he connected. Family and
kin connections are framed in terms of genetic inheritance from parents, grandparents, and other relatives.
More than 5,000 medical conditions have heen attributed
to genetic inheritance, and with the work of the Human
Genome Project we daily learn of another disorder that
is traceahle to genetic transmission. The role of inheritance through our genes is widely accepted (Fox Keller
1992:283). Both the doctor-patient encounter and the
mass media tend to imprint on people's consciousness
the emphasis on hiological kinship and the notion that
families and kin pass on disease. People hecome conscious of their family and kinship connections and the
potential harm they may cause when their physicians
first ask for a family medical history." Taking a family
medical history reinforces the notion that there is an
association hetween kinship and health.'* Good medical
procedure requires physicians, in addition to doing a
physical examination, lahoratory tests, and other tech10. Science (1993) describes how the BRC-i gene for breast cancer
was discovered through the examination of blood samples and family histories from numerous extended families (see also Clark 1999).
11. On my first visit to a physician for a minor condition, for example, I was asked for a family medical history. I indicated that
one of my aunts had died of cancer. (I did not specify and tbe doctor
did not inquire about the precise genealogical tie; she was an aunt
by marriage.) Upon hearing this, the doctor insisted that I needed
a complex and costly examination because I was "predisposed" to
cancer and my condition could eventually develop into the disease
from which my aunt had died. Another poignant example is that
of a student who told me that her future might be in jeopardy
because alcoholism was part of her genetic heritage; botb ber parents were alcoholics, and she was convinced that it was inevitable
that she would suffer the same fate.
12. The doctor-patient encounter is an especially powerful means
by whicb societal ideologies are instilled in individuals' consciousness, cutting across class, race, and gender lines (Finkler 1991, Phillips 1997, Waitzkin 1991I.

24O I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

nical diagnostic procedures, to take sucb a bistory (McAuliffe 1978, 1979). Tbus, to resist tbe medicalization of
family and kinsbip one would bave to reject biomedical
treatment.
Tbe medicalization of family and kinsbip reverberates
in tbe mass media. A program presented on CNN's Your
Money on February 15, 1997, instructed viewers to track
down tbeir family bistories to acquire "useful bereditary
information." Tbe Chattanooga Times (December 12,
1996) reports tbat people are searcbing vigorously for
family trees to learn "tbeir ancestors' causes of deatb to
clue tbem in on genetic diseases." Fincb (1996:92) reports in Health tbat "tracing your roots to learn your
family's bealtb bistory may be tbe single most important
tbing you ever do to bolster your well-being" and instructs tbe reader on bow to go about doing a family tree.
Daus (1999) sbows bow "tracing your family medical
bistory can save your life" (see also Adato 199s). Some
articles focus on adoptees seeking access to tbeir genetic
bistory (Park 1997, Cool 1994) and advocate open adoptions and open medical records. A beadline in tbe August
IS, 1996, Wall Street fournal calls attention to "One
Family's Searcb for a Faulty Gene," and anotber on tbe
same page announces tbat "Doctors Recommend Every
Family Make Its Own Medical Tree" (see Nelkin 1992).
Family magazines suggest tbat individuals work out genograms and family bealtb pedigrees as a way of predicting
tbe future of tbeir cbildren. Some Motber's Day cards
remind tbe motber tbat "it's all in our genes" (Siebert
1995)References to people's predisposition to inberited disease are made frequently on talk sbows and in tbe print
media. Siebert (1995:74) writes, "Genes are suddenly
tbougbt to be responsible for everytbing from poverty to
privilege, from misdemeanors to murder. I seem to recall
watcbing television one nigbt and seeing a man up on
bomicide cbarges offer as a defense tbe presence of a
'criminal gene,' wbicb be claimed ran in bis family." He
reports tbat tbe Institute of Medicine's Committee on
Assessing Genetic Risks "recently concluded tbat 'multiplex genetic testing based upon a single blood or tissue
sample' will become standard medical practice early in
the next century. Clearly, tbe day is not far off wben a
doctor's visit will yield personal genetic report cards,
indicating wbicb disorders we may be destined for and
bow to tailor our lives accordingly" (p. 52).
Tbe notion of tbe medicalization of family and kinsbip
would tend to predict sucb current pbenomena as tbe
recent law enacted in Oregon tbat requires open adoption, meaning tbat adoptees can learn tbe names of tbeir
birtb parents and gain access to tbeir medical records
witbout tbe need to resort to tbe courts.'^ Not coincidentally, too, tbe searcb movement among adoptees
came into bloom in tbe 1960s, around tbe same time
13. The Oregon Adoptee Rights Initiative, passed by a vote of the
people of Oregon on November 3,1998, restores the right of adopted
adults (age 21 and older| to request and receive a copy of their
original birth certificates with no amendments, no restrictions, and
no exceptions (see http://www.barysoftware.com/orelegl.htm).

tbat our collective consciousness concerning genetic inberitance came to tbe fore and notions about diseases as
genetically programmed began to take root in biomedicine. Moreover, tbe current intense interest in genealogies (see, e.g., Hornblower 1999, Mitcbell 1999) is arguably connected witb tbe necessity to provide tbe
family trees tbat are "tbe basic tecbnique of tbe clinical
geneticists" (Ricbards 1996).

Experience of the Medicalization of Family

and Kinship
In my recent study of tbe issue based on interviews of
3 5 women wbo bad experienced breast cancer or came
from families witb a bistory of tbe disease and 15 adoptees wbo bad been searcbing for tbeir birtb parents (see
Finkler 2000a), it became apparent tbat tbe medicalization of family and kinsbip significantly influenced people's daily experience. Eve, for example, lives witb anxiety because of ber family medical bistory. A scientist
witb a Pb.D. in biology, married and cbildless, sbe bad
lost ber 34-year-old motber to breast cancer wben sbe
was a teenager. Her motber's 84-year-old sister bad cancer. One of ber two brotbers bad died of salivary gland
cancer and tbe otber of prostate cancer. Her aging fatber
also bad cancer. Botb ber paternal and maternal grandparents bad died of beart disease, and Eve added, "Tbat
too is familial, and so it's a double wbammy," particularly since tbe predisposition to bigb cbolesterol is
genetic.
Eve said, "I am 59. My aunt and grandmotber developed tbeir cancer between 59 and 65, so now I am in
that age-range, and my sister, wbo is 54, is rigbt behind
me." Neitber she, her sister, nor her cousins bad developed cancer, but Eve felt tbat sbe was "sitting on a time
bomb" because, she said, her family history placed her
at "extremely high risk": "an early onset of menses, no
children, and being the offspring of a parent that developed cancer, and that's wbere we fit. And we are Ashkenazy Jews." Because she regarded herself as at high
risk and firmly believed that cancer was inherited, she
lived in constant dread of falling ill. When she moved to
her current residence she immediately contacted and set
up a cancer team:
I am extremely anxious. I go for my mammograms
twice a year and I want to have a breast surgeon
that I am comfortable with, so I have a team. I do
everything now to monitor myself and knowing that
data, I'd only be more anxious than I already am if it
came out to be tbat way. And if I ever needed insurance, I could be bard pressed to get it. You know,
tbere's tbis big computer in tbe sky and those data
seem to find their way into that. I am not going to
have a prophylactic mastectomy, which I bave been
urged to do.

The Kin in the Gene | 241

Eve noted that she felt closer to her sister and hushand
and her father hut had also hecome closer to her cousins:
Knowing that they share the same genes provides
the occasion for discussion. When I think I know
something that's useful, I pass it on to the others. So
hasically the occasion for my cousins is a har mitzvah we might all go to, but we are connected
through this exchange of information. Otherwise,
we have very different lives. The fact that they have
the same genes has created a close hond. We seem
to have a very clear and good and accepting understanding of who the family was. Let me just say that
this [disease] really has provided a lasting and a continuous hond.

The major theme of Eve's narrative was her profound

fear of becoming afflicted. Despite the fact that she was
healthy and vihrant, she acted like a patient hecause of
her unwavering faith in the notion of the inheritance of
disease and the associated risk factors that she was convinced she possessed. Impelled hy her understanding of
her family medical history, she acted on these fears hy
having frequent mammograms and arranging for a cancer
team to stand ready for her eventual illness. Eve recognized a lasting hond with her hlood kin hecause of a
shared genetic inheritance, although, refiecting the postmodern family pattern, she emphasized that she had very
little else in common with them. Furthermore, her heliefs ahout the adverse effects of genetic transmission
had infiuenced in part her decision not to have children.
Eve had not contemplated prophylactic hreast removal,
hut like the other women I interviewed she was what I
call a perpetual patient, someone who has entered the
medical stream despite the fact that she is healthy. Her
understanding that she might fall ill hecause of her family and kinship relations infiuenced her day-to-day
experience.
Maya had similar fears. She was a 5 o-year-old hiologist,
horn in South Asia, married with two children. Being of
dual cultural background, she had considered the possihility that the illnesses that had hefallen her family
were due to witchcraft. She identified herself, however,
as an American and had internalized American values
of mastering the situation. Coming from a society in
which large extended families were the norm, she lived
in a nuclear family hut remained in close contact with
her siblings in various parts of the United States. She
had sought genetic counseling hecause she wished to
undergo hormone replacement therapy but feared it
would increase her risk of ovarian cancer hecause her
mother and a 4 5-year-old sister had died of the disease
and her 22-year-old hrother had recently succumbed to
colon cancer. She believed that colon and ovarian cancers
were closely associated hut especially feared ovarian
cancer.
Maya said that, as a hiologist, she could only think

that cancer was an inherited disease, unless of course it

was "hewitchment of our family," a possihility she
quickly discounted. She volunteered that she had heen
separated from her family in South Asia hut had heen
hrought closer to them hecause of the possihility of their
sharing a disease. In fact, she wished to have her sisters
and oldest daughter tested, hut they refused to take the
test. She helieved that if one knew one was carrying the
gene, the disease could he prevented hy a vegetarian diet.
Having her relatives genetically tested would have given
her some control over the future hy knowing her risk of
inheriting the disease. We see here how genetic ideology
motivated her to seek genetic testing, requiring the cooperation of her family, to whom she hecame closer hecause of the fear of the disease. Seeking genetic testing
converted her and her family into patients. It is not surprising that Maya's relatives, who may have helieved in
witchcraft, resisted the medicalization of their family
history hy refusing to he tested, an option she did not
possess. As a hiologist and a Westerner she could not
consciously sustain a view that would place her in the
category of the superstitious and uneducated, even
though, I suspect, she may still have maintained the helief at some level.
My interviews with adoptees who had searched for
their hirth parents also reveal the power of the medicalization of genetic ties. The recurring reason they gave
for their searches was to obtain their natural families'
medical histories. With one exception, all the adoptees
I interviewed indicated that they felt like "aliens" hecause of the lack of a biological family medical history.
Every time they went to a physician they were questioned ahout their family medical history, and they could
not provide one.
Kristen, 31 years old and married with three healthy
young children, had hegun her search for her hirth
mother when she was 21 years old and found the woman
ahout eight weeks prior to our meeting. She had started
searching shortly after her first child was horn, primarily
to ohtain a medical history hut also to know from whom
she had inherited her personality and why she had heen
given away. Kristen claimed that she was ohsessed with
procuring her medical history hecause she suffered from
Raynaud's disease, which she descrihed as a circulatory
disorder characterized hy muscle aches and weight gain
or loss. (She had gained 20 lh. in the past year.) In her
understanding, in at least 3 5 % of cases Raynaud's disease
was the precursor of lupus.'* Kristen commented, reflecting the sentiments of almost every adoptee I met, "When
you go to the doctor you do not have a medical history
and you are not a person."
Kristen said that hecause she lacked a medical history
it had taken two years for her health insurance company
to approve her hysterectomy. She was heing treated for
14. The eause of Raynaud's disease is unknown. It is a condition
in which arterioles, usually in the fingers and toes, go into spasm,
often triggered by cold, causing the skin to hecome discolored. Sixty
to 90% of Raynaud's disease cases occur in young women {Merck
Manual 1997:136).

242 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

endometriosis, and her doctor wished to perform a hys- all these disorders from her hirth mother, and she had
terectomy, hut the company would not authorize the become a perpetual patient.
procedure. She maintained that had she had a medical
She lamented that she had not learned sooner that she
history she would have received the procedure imme- originated from a family with lupus, because it would
diately,'' Furthermore, she ohserved that it was very im- have explained her circulatory problems, such as her cold
portant to have a family medical history so that she fingers and toes, especially in wintertime. Had she
would know what she was passing on to her children. known that this condition was part of her family heriShe said, "You don't know what I could have given them tage, she said, she would have heen assured sooner that
that would hurt them,"
she was not crazy,- the doctors had not taken her sympKristen had contacted the agency that had handled her toms seriously until she was able to show that others in
adoption to advise them of her Raynaud's condition and her family had suffered from the disorder. The medical
to request her medical history. The staff memher who history not only recounted for Kristen her family history
found her file said, "Well, do you know that your ma- but also, significantly, affirmed her sanity. She had also
ternal grandmother died of lupus?" Kristen continued, discovered that she had a half-sister with cerebral palsy,
"And I was like, what? whoa, wait a minute, you're sit- and she wished that she had known that before sbe had
ting on this information, you never told me, I got very children. She observed, "I would have at least been tested
upset, "When she told her doctor that she was adopted when I was pregnant. It wouldn't have changed anything,
and that her maternal grandmother had suffered from hut I would have been prepared emotionally,"
lupus, the doctor "got real quiet, and said, 'You need to
Kristen's biomedical understanding of genetic inherifind your family. You need to he getting physical docu- tance required her to be on an annual recall schedule of
ments ahout your family history,'" The doctor also told medical visits and to take certain medications. More imher that there is a strong maternal genetic link hetween portant, her medical history linked her with those who
Raynaud's disease and lupus, "All on the same hranch shared her genetic heritage rather than with those who
of diseases," said Kristen, "After I found out I was like had raised and educated her. Her emphasis on medical
a demon, I was not only dealing with my children's history anchored her identity in her patienthood and also
health, my curiosity, but I was dealing with my health," tied her to a world of relatives in the past. For Kristen,
She was on a one-year recall visit schedule for hlood tests as for the other adoptees, kinship meant biological confor lupus hecause of the information she had gathered nectionvalidated by the medical history that firmly
ahout her genetic hackground.
estahlished her continuity with the past and preHaving found her hirth mother, Kristen had learned sentwith her birth mother and her family. The medical
that her maternal grandfather had died of a heart attack history, by recapitulating genetic inheritance, turned
when he was 34 years old. She commented.
into a kinship history and a mental map of the past.
When I found my birth mother, she's opened her en- Importantly, too, having her biological family's medical
history affirmed her sanity for Kristen, Only when she
tire life to me, her medical records, my grandcould demonstrate a genetic history did her doctors take
mother's medical records, my great-grandmother,
her
symptoms seriously and acknowledge that her ills
who's 93 and still alive, had gotten her doctor to get
were
not "in her head,"'*
up stuff for me. And my great-aunt Lois has done
Eric was 51 years old, married with two children, a
the same. And the whole family is riddled with arcollege graduate, and employed in a managerial posithritis, my grandmother died of lupus, my mother
tion,"" He had begun the search for his birth mother eight
has connective-tissue muscle disorder, and so I was
months prior to our meeting, shortly after the death of
able to call my doctor back and say, "This is what
hoth his adoptive parents, to whom he had felt very close,
I've got in my hackground," And the doctor started
laughing, saying, "God, no wonder you're gonna test I found Eric's narrative especially poignant because,
sadly for him, the woman he was certain was his hirth
positive for lupus, you're always gonna test positive
mother had not responded to his several letters of introfor lupus,"
duction. He wanted to meet her primarily because he
wished to obtain his medical history so that he might
The doctor, a rheumatologist, told Kristen that with her
hackground and genetic makeup, "You're asking for a lot 16, It is especially^ common for women to he told that their sympof problems," The doctor told her that she would become toms are "in their heads" if their condition cannot he assessed
afflicted with arthritis later on and that the Raynaud's hiomedically (see Finkler 1994),
disease would get worse, Kristen continued, "I was 17, The ratio of women to men seeking their hirth parents is 9:1
(head of the search support group, personal communication). The
started on medication for that, I was also told, 'You will reasons
for the disparity are not clear. The head of the support group
have to watch yourself, because of the genetic back- attrihutes it to the fact that women are "more sensitive to hirth
ground there,'" She was convinced that she had inherited and pregnancy issues than men" and "men's lesser ahilities to con15, According to the head of an adoption search chapter, if an adoptee lacks a medical history the doctor will often refuse to order
various procedures hecause the insurance companies claim a lack
of documentation to justify them.

nect to the hirth process," There may he other reasons, including

the fact that since women seek treatment more often than men
(Finkler 1994, Verhrugge 1990) they are more exposed to medicalization. This interesting disparity requires further exploration, hut
with the ongoing medicalization of family and kinship it is likely
to disappear.

FINKLER The Kin in the Gene \ 243

learn what health problems to anticipate for himself and

his children. Eric said.
The one thing that a lot of adoptees who are looking
say when they go to the doctor's office and they
take a medical history, and they are asked, "Has
there been any history of high blood pressure or
heart disease or diabetes or glaucoma or whatever in
your family?" And, of course, I, like they, always
have had to say "I have no idea, because I was
adopted, I have no medical background," and heredity plays such a big part. I mean I think it's become
more evident every year as to how much heredity affects your genes, and DNA and all that affects your
well-being throughout your whole life and what
kind of diseases or whatever you are prone to possibly get. So, it was important for me from that perspective, the medical perspective, but not just for
me, but for my children, because they have the
same missing pieces in their medical background because I have them and I'm half of what they are.
And as I matured and as I got older and, of course,
the older you get, the more likely you are to come
down with something or have something develop,
whether it's your eyesight or whatever it is. And I've
never liked doctors. I try to stay away as frequently
as possible, not go, but the older I get the more I realize that it's an important thing that I need to be
aware of and plan for the future and my children
need it. And when and if they have children, that'll
be something thatif I had that missing piece of the
puzzle, or at least part of the missing piece of the
puzzle that I would be able to pass along to them,
the knowledge that, yes, your maternal grandmother
was prone to this problem or that or your greatgrandmother or whatever.
Eric was also curious about his birth mother because, he
said.
It's a part of me that I don't know where it came
from. I think the other part [apart from the medical]
is just probably as much of a driving force in my
search for beginning; it was just natural curiosity. I
like to know, so many people compare, I mean, how
many times have you gone and seen a new baby and
heard people say, "Oh, she looks just like so-and-so"
or "He looks just like his dad" or whatever. And I
don't look like either one of my [adoptive] parents.

have, more than likely, a high probability of having

the correct information about the hirth mother.
Whether or not the birth father information is correct is much less likely.
Eric believed not only that he would recapitulate his
birth mother's medical history but that he inherited from
his birth parents certain characteristics that he had not
shared with his adoptive parents. He reported,
I used to amaze my parents with my ability to, or
inquisitiveness about taking things apart, figuring
out how they work, and putting them back together.
Two of the things that I did a lot of as I was growing
up and even into adulthood that my father would
never do, my adoptive father, is if something broke,
I'd try to fix it. He'd call a repairman. One of the
things that I have oftentimes said, halfway in jest
and halfway in reality, is "I wish I could turn the
clock back and say to hell with going to a university
for four years." I would have been a lot happier person, I think, if I had gone and taken six months'
worth of community college courses in plumbing
and another six months in electricians and learned,
because I admire very much the ability of someone
to do things like that, to actually be able . . . not to
just have to write a check and say, "Gome fix it."
And I get a real feeling of satisfaction about replacing the brakes on my car or repairing the television,
not that I can repair televisions. The other thing
that was so much different was my enjoyment of
the outdoors from a sports standpoint. I love to fish,
and I did hunt a little bit. I haven't in years, but to
the best of my knowledge my father never hunted,
and about the only time he ever went fishing was
when he took me out to a pond somewhere and
watched me fish. And actually I went fishing with
my mother's only brother, my uncle, on several occasions. I even camped out with him and went canoeing on the river down near my mother's hometown. I went deer hunting with him, and I've been
on the river with him before, and that's just not
something my father ever had any interest in. I
think an awful lot of what a person is comes from
their parents. From their birth parents, yeah. From
the genes and the DNA and all of that; that's what
made them up.
For Eric kinship relations implied

He wanted to find his birth father as well, but, in his

words,
I am a novice in searching and it has consumed
enormous amounts of time on the Internet reading
other people's thoughts and emotions and anger and
guilt. It's probably as important as my mother to
learn about my father; it's just that my mother
would be the easiest one to find. It's a beginning
point because anybody's birth certificate is going to

friendship as part of the relationship, of enjoying the

same things but also biological unity. Kinship is a
feeling of togetherness or bonding or being part of.
. . . You know you enjoy the same things that I do,
you love the same things that I love, whether it be
the ocean or animals orI think that, to me, that's
something else that you may have inherited. I mean
your love of animals or your dislike for animals, you
know. I love cats. My wife loves animals. My par-

244 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

ents could have cared less. They always allowed me

to have animals, hut they neverI never perceived
any real affection to my dogs and my cats from
them. I think you can be related hy way of kinship
and not he hiologically related.
He conflated shared interest with hlood ties, as most of
the adoptees did, arguahly reflecting hoth the postmodern notion of kinship hased on shared hehavioral characteristics and the hiomedical notion of hiogenetic ties.
As it was for Kristen, the medical history was the chief
reason Eric had initiated the search for his hirth mother,
hut he had other reasons as well. This calculus reflected
his confusion ahout whether his real family was the people for whom he felt affection and with whom he shared
experiences or the people with whom he shared a genetic
inheritance that embodied medical and genealogical
memory.

Consequences of the Medicalization of Family

and Kinship
We can envision myriad effects of the medicalization of
family and kinship, hut what is most important is that
it differentially influences people's lives depending on
their experience. The dissimilar effects of medicalization
on people's daily existence can he gleaned even from only
four narratives. Generally speaking, the foreseeable consequence of the medicalization of kinship for all of us is
that people may no longer need to present complaints
to he regarded as sick. They may he considered sick simply hecause they come from families with particular diseases. Those who have relatives who have suffered from
hreast cancer, colon cancer, Alzheimer's disease, or one
of the many other diseases helieved to he transmitted hy
inheritance will he assumed to have inherited it in an
autosomal dominant fashion. Jonsen (1996:8-9)" suggests that
persons could he designated patients in an anticipatory sense. Some with monogenic disorders will he
patients without symptoms, hut sure to have them
in the future. Others, with the genetic patterns associated with polygenic or multifactorial disorders,
will he known as a schizophrenic or cardiac or cancer patient long hefore any illness is felt or any pathology damages the organism; indeed, they may
never be affected at all, yet still he marked. Persons
will hecome patients hefore their time: They will he
descrihed in disease terms hut "feel fine" and "he
fine" for years, perhaps always.
The notion of genetic risk for a disease has now hecome
almost a disease in itself, as has the notion of "predisposition" (Nelkin 1996), despite the fact that scholars
18. See also Huhbard and Wald (1997), who speak of the "healthy
ill."

here and ahroad (Hoedemaekers and ten Have 1999) recognize that predisposition does not necessarily lead to
disease." The concept of the inheritance of a predisposition extends the medicalization of family and kinship
to encompass almost everyone, converting most people
into potential perpetual patients. People's realities will
encompass a future that is incessantly punctuated hy
worry. Indeed, the medicalization of family and kinship
alters people's perceptions from "if I get hreast or colon
cancer" to "when I get hreast or colon cancer" or any
one of the many diseases helieved to he inherited.
Moreover, the medicalization of family and kinship
creates a new dynamic within the family. Some have
suggested that it may lead to guilt for parents and resentment for their offspring (Serhan 1989, Richards
1996). Healthy memhers of a family or kin group may
resent heing told that they are potentially at high risk
for developing a disease (Green, Murton, and Statham
1993)- Lynch, Lynch, and Lynch (1979:223) found that
"family memhers manifest anxiety, fatalism, denial and
even accusation directed toward the spouse, parents, or
other family memhers who have 'caused the disease among us.'" But Wexler (1979:207), discussing
Huntington's disease,^" ohserves that "remarkahly few
interviewees expressed conscious anger toward the parent who had given them this legacy. Compassion and
grief were hy far the most common feelings. It was considered in particularly had taste to harhor hostility toward a parent who was already hroken and ill." Wexler
(1992) was surprised, as was I (Finkler 2000a), that people
failed to express anger with their families for having
passed down a lethal disease.
Most important, with the medicalization of kinship
the individual is no longer the sole patient. We read that
"genetic counselors are heginning to ask questions such
as 'who is the patientthe individual? The familythe
spouse, the sister, the hrother, or the child?'" (Nelkin
r992:i8o). In contrast to the hroader societal process, in
which individualism and freedom of choice are emphasized, the medicalization of kinship creates a tension
hetween individualism and choice and an orientation to
family and kin. As I noted earlier, individualism insists
on an autonomous person, standing outside any one socially defined unit and selecting his/her life course,
whereas kinship relationships hased on genetic inheritance call for connectedness and circumscription of
choice. If Edwards and Strathern (2000) are right, forgetfulness plays an important role in delineating kin heyond
the nuclear family. But the medicalization of family and
kinship unites people wittingly or perhaps unwittingly
and jolts their memories. Whereas in modern society
individuals may choose their kin on the hasis of affective
ties, paradoxically, the new genetics prescrihes one's kin
19. See, e.g., the work of Lisheth Sachs in Sweden (1995, 1996) and
Adelsward and Saehs's (1996) work on the ways in which hiomedicine's assignment of numerical values to risk creates in people a
state of being neither healthy nor diseased.
ao. Huntington's disease is caused by a single dominant gene, and
the odds are 50-50 that the individual will inherit the disease,
which becomes manifest at 35-40.

The Kin in the Gene \ 245

relations on the basis of birtb. Tbe medicalization of
kinsbip tbus subverts botb tbe ideology of choice and
the new family patterns based on factors other than
"blood. "^' In an interesting contradiction, witb tbe medicalization of family and kinsbip freedom and cboice, so
profoundly embedded in American consciousness, must
confront genetic determinism.
It can even be said that the medicine of the future will
be the medicine not of the individual but of the family.
The traditional biomedical model is based on a pbysician/patient dyad. Witb tbe medicalization of kinsbip,
tbe individual may no longer make medical decisions
independent of his/her family. Family members must
cooperate in order for a pbysician and geneticist to assess
tbe patient's condition, especially witbin tbe domain of
genetic testing for disease. Family and kin of different
generations must be drawn into tbe diagnostic process
(Jonsen 1996, Wexler 1992). Wexler goes so far as to say
(p. 228) tbat
anybody in a family with a genetic diseasethis
probably includes everybodysbould tbink about
storing samples of DNA from relatives whose genotype would be essential to know for a diagnostic
testing. The most important relatives to you are
those in the family with the illness and those
clearly unaffected, parents of these individuals and
your own parents. If you bave a genetic disorder,
banking your own DNA could be critical for your
descendants. Eacb family might have its own genetic variation, its own "genetic fingerprinting" of
tbe gene in question, and it is best to preserve a
sample of tbe particular gene tbat plagues your family ratber tban extrapolate from tbe genes from
otber families.
Tests are currently being prepared for breast cancer, colon cancer, heart disease, Alzheimer's, manic-depressive
disorder, and schizophrenia (Wexler 1992).^^
The medicalization of family and kinship may not affect all people adversely. Undoubtedly it reassures some
people to know that, if no one in the family past or
present has suffered from a particular disease, they, too,
are protected from becoming afflicted. Moreover, medicalization offers a sense of mastery; knowing a family
medical history allows one to do something about it. It
may furnish tbe person witb a feeling of security, albeit
perbaps illusory, and it makes it possible to take preventive measures, such as mammograms (but see Kauf ert
and Gilbert 1996) and blood tests, in anticipation of potentially falling ill. Significantly, in contrast to most biomedical explanations, tbe medicalization of family and
kinsbip explains not only the how but tbe why of a dis21. It is interesting that medicine has moved from the visible to
the invisible, from blood to the gene, arguably promoting greater
awe.
22. Given the medicalization of family and kinship, it can be predicted that one family member will eventually sue another for unlawful disclosure of a medical condition.

ease. Tbe answer to tbe question "Wby me?" rests in

one's family medical bistory.
Wbat is more, medicalization may even lead to reestablisbing relationsbips among family members," wbo
may become closer to one anotber not only because tbey
share a disease but also because tbey have developed a
new sense of sharing a genetic heritage. In fact, family
and kin become closer not only to tbe living but also to
tbe dead, wbom tbey must recall to account for tbeir
genetic heritage; this may promote a sense of continuity
with the past, even if it is based on adversity.
Tbe family medical history recapitulates their kinship
history for people whose kinship memories may lack
depth. In present-day American society, wbere memory
is sballow, DNA becomes a central repository of human
memory by assuming agency and true ontological status
witb its alleged capacity to "remember" people's ancestors in ways that their living memories may bave forgotten. The medicalization of family and kinship binds
people to the past as well as to the future and propels
them to search for ancestors and anticipate future afflicted descendents. Arguably, human beings are the only
animals that contemplate a past and a future, and our
genetic conceptualizations emphasize that aspect of our
humanity. DNA engenders a dialectic between anticipation of tbe future and remembrance of tbe past. It is
devoid of morality or affect, a ballmark of family and
kinship relations (see Finch and Mason 1993, Witherspoon 1975); it is inherently impersonal and does not
impose, express, or insist on responsibilities, obligations,
or love otber than requiring living relatives to furnish
blood samples in order to establisb genetic markers on
cbromosomes;^" yet it stands in for our past and future
family and kin, our personhood, and our being. The family medical history is mindful that the body remembers.
Connerton (1989:87) observes tbat "ceremonies of tbe
body, such as are exemplified in court etiquette at Versailles, remind performers of a system of honor and hereditary transmission as the organizing principle of social
classification. Blood relations are signs cognitively
known and recalled through the visibly elaborate display
of privileges and avocations which make sense only by
constant reference to tbat principle." In contemporary
times, tbe ceremonies of the body bave been reduced to
blood tests, nucleic acid, and molecules, ignorant of
bonor and social classifications, connecting us witb kin
in tbe past.
What is most intriguing is that at the level of the individual, the medicalization of family and kinship impacts people in profoundly different ways. As we have
seen from the narratives, for healthy women from fam23. Organ transplantation will also promote a strengthening of biological kinship ties among persons who may have been alienated.
In fact, a few of the adoptees I interviewed noted their desire to
find their blood kin for that purpose as well. The relationship between transplantation and the medicalization of kinship requires
exploration.
24. The metaphor "to give one's blood for someone," denoting devotion, is here concretized as the one act a family member may
perform for another.

246 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

ilies with a history of cancer, the concept of genetic inheritance at once created fear of the future and provided
some meaning for their fears and potential suffering,
sometimes even moving them to action to avoid becoming ill. These women tended to believe that, knowing
their predisposition to inheritance of a disorder, they
could do something, if only by avoiding identified risk
factors, to prevent the "inevitable."^^ For the adoptees,
in contrast, the medicalization of family and kin produced fragmentation, internal conflict, and turmoil, creating special dilemmas that do not affect individuals who
have been raised by blood kin. Adoptees were impelled
to search for their birth parents by the very consciousness of genetic inheritance and in large part by the need
for a family medical history, and they came to question
the fiction of living as if they were related by blood to
their adoptive families. The power of the medicalization
of family and kinship, pitted against their experience of
love and solidarity within their adoptive families, had
led them to search for their birth parents, placing them
in profound contradiction. Most of the adoptees I studied
had difficulty reconciling the belief in genetic inheritance with their experience of being a member of an
adopted family, frequently a loving one, with whom they
lacked blood ties and whom they did not resemble physically. What is more, it is significant, if also puzzling,
that the adoptees who had found their birth parents had
taken on new personas, created a past with new ancestors, and become transformed by their newly formed
relationships.
Curiously, in contrast to patients or potential patients,
who sometimes found answers to basic existential questions associated with their affliction, the adoptees tended
not to discover answers for their issues of abandonment
and rejectionthe question "Why was I given away?"
that may have been the deepest reason for searching for
their biological families. Their cultural comprehension
of kinship in biological terms did, however, allow them
to attempt to deal with these issues by reestablishing
contact with their birth parents and creating histories,
if only medical ones. By becoming reunited with their
birth families, the fragmented adoptees, torn hetween
cultural ideologies and lived experience, became, in the
words of many, "whole," arguably masking the fragmentation people may feel more generally in contemporary capitalist society. But at the same time they confronted new issues and confiict that tore them apart.
Bartholet (1993:166) argues that in American society "biological origins are central to our destiny" and that "it
is only genetically linked parents who are truly entitled
to possess their children and to whom children truly
belong" (p. 167). Along with others (e.g., Andersen 1993)
25. of course, the medicalization of family and kinship may also
reassure healthy people that they come from healthy stock. People
may take pride in the fact that their ancestors gave them positive
features such as hlue eyes or lanky bodies. Although these may he
offset hy unfavorable characteristics such as heavy thighs or other
deprecated physical attributes, these attributes do not draw the
individual into the medical domain in the same way as conceptualizations of genetic inheritance of disease.

she observes that the assumption of the search movement is that "adoptees must forever suffer the loss of
their birth parents and the related loss of genetic continuity with the past" and that they are prone to 'genealogical bewilderment' as they struggle to live a life
cut off from their genetic origins" (p. 172). In short, in
this literature adoptees are in pursuit of a genetic inheritance that is taken to be equivalent to their true
family, their "significant same." According to Bartholet,
adoptees suffer when they are cut off from their biological links and generational continuity is destroyed. She
observes that "sperm donors, their offspring, and birth
mothers in surrogacy arrangements increasingly voice
complaints of the pain they suffer from being cut off from
genetic forebears or descendants" (pp. 227-28),^* although she rightly claims that parenting cannot be
equated with procreation. She wisely observes that a
sense of immortality comes not from passing on one's
genes but from the parental relationship and how it
shapes the child. She concludes, "All adoptions require
parents to transcend the conditioning that defines parenthood in terms of procreation and genetic connection"
(p.
^^

Summary and Conclusion

My concern is not with the truth or falsity of the science
of genetic inheritance. There is an extensive literature
that argues that biomedicine and the scientific enterprise
to which it is wedded are socially, culturally, and historically molded. For instance, according to Bowler
(1989:12), "without denying the important factual consequences that have flowed from the development of genetics, the history of the field will show that the new
science was invented to serve human purposesit did
not grow automatically as a consequence of factual observations." Thus "theories are invented rather than discovered" (p. 13). From Bowler's vantage point, genetic
models are constructed to "reflect the values of the social
groups whose interests are best served by the promotion
of these particular models" (p. 17).
Fujimura (1996) is but one of a number of scholars to
26. Dolgin (1997) in fact reports that donor-inseminated offspring
seek their genetic fathers.
27. The majority of adoptees do not search for their birth parents.
According to the head of the support group 1.9 out of 4 adoptees
do so. The remaining adoptees may decline to do so, she suggested,
because of denial of their real feelings, loyalty to their adoptive
parents, lack of interest, or lack of mental energy. In her words,
"You have to have some form of stability to be able to even undergo
the process. Dysfunctional people would certainly find it difficult
to start and finish, because it is an emotional and time-consuming
process. It seems to be people that are comfortablemost of the
people who I see search are comfortable with themselves and they
want their answer to finish formulating their image of themselves
and their past and their background. People who are very unhappy
with themselves normally don't search, from what I see. The argument is that such people are too busy trying to survive the consequences of that. People search at considerable emotional and financial cost. The emotional search is draining, and also there is an
ambivalence of not wishing to hurt the adoptive family's feelings."

The Kin in the Gene \ 247

have shown that scientific knowledge, including hiomedical knowledge, is socially produced. She makes a
compelling case that genetic knowledge is constructed
when she demonstrates that in the late 1980s the view
of cancer changed from a "set of heterogeneous diseases
marked by the common property of uncontrolled cell
growth to a disease of human genes" (p, i). This change
was brought about not by new discoveries or new epistemic advances but by negotiated social processes (Latour 1987), Haraway (1991:184), in a more critical mode,
describes the social constructionist approach best when
she states that "no insider's perspective is privileged,
hecause all drawings of inside-outside boundaries in
knowledge are theorized as power moves, not moves towards truth,"
In keeping with these scholars' perspective, we have
come to acknowledge that biomedicine is a cultural system (Hahn and Kleinman 1983, Finkler 1991, Ingleby
1982, Krieger and Fee 1994, Lock 1980, Lock and Gordon
1988, Martin 1997, Wright and Treacher 1982, Young
i98iP^ and that, like science itself (Brandt 1997, Fujimura 1996, Haraway 1991, Hess 1997, Latour and Woolgar 1979, Martin 1997, Richter 1972, and, on genetics.
Bowler 1989), is an intellectual endeavour that has
emerged at a particular historical moment in the social
formation of Western society. Like all other knowledge
systems, biomedicine is socially and culturally constructed, reflecting the themes of the society and culture
of which it is part while imposing these themes on cultural conceptualizations. For example, biomedicine's
model of the human body as a standardized machine and
illness as the breaking down of its component parts (Berliner 1975, Martin 1987, Osherson and Amara Singham
1981, Turner 1992) mirrors the predominance of technology and machines in modern society while at the
same time imprinting on people's consciousness a mechanistic view of themselves,^' An extensive body of literature shows persuasively how medical concepts are
socially constructed (Finkler 1991; Wright and Treacher
1982; Turner 1987, 1992), reflecting broader cultural
themes including gender differences (Johnson 1987, Martin 1997, Petchesky 1987, Ritenbaugh 1982, Rodin 1992,
Yanagisako and Collier r99o). Current hereditarian concepts are not, however, confined to any one gender (see
Granner 1988, Nelkin 1992, Nelkin and Lindee 1995),
Recognizing the contingent nature of hiomedical conceptualizations, even the most ardent critic of genetic
determinism will acknowledge the incontrovertible evidence that a handful of diseases are inherited (Huhhard

and Wald 1993), We need to ask, however, why family

and kinship have been medicalized as we enter the 21st
century. The medicalization of family and kin is facilitated by American conceptualizations of kinship. In fact,
attrihuting disorders to genetic inheritance not only addresses ultimate causality but also builds on American
cultural understandings of kinship in biogenetic terms,
Schneider (1984:193) remarked that "kinship has heen
defined by European social scientists, and European social scientists use their own folk culture as the source
of many, if not all, of their ways of formulating and understanding the world about them," He recognized that
anthropological studies had imposed their folk knowledge on non-Western kinship, hut he seems to have failed
to discern that scientific claims frequently follow a similar pattern (see Finkler 1991 on physicians' cultural beliefs and biomedical understandings), I suggest that the
emphasis placed on genetic transmission elaborates on
the American folk category of bilateral kinship. Not surprisingly, then, the fact that American kinship builds on
a biogenetic template facilitates the wide popular acceptance of the helief in genetic inheritance and also explains, along with the powerful authority that science
possesses in contemporary society, the lack of resistance
to and even ready acceptance of the medicalization of
family and kinship. Folk notions of family as a biogenetic
entity allow for an effortless embrace of the scientific
and biomedical notion of genetic determinism precisely
because it mimics cultural conceptualizations of the biogenetic foundations of kinship.

The medicalization of family and kinship weaves into

a mantle of science the historical and cultural grasp of
kinship and reaffirms family and kinship cohesion that
has been lost in the lived world. As we have seen, Schneider viewed biological unity as the symbol for relationships of enduring diffuse solidarity, but whatever solidarity may exist rests in genetic unity. The American
family has not disappeared, but, arguably, it lacks unifying forces, a phenomenon that even Tocqueville had
recognized when he stated in the mid-19th century that
"not only does democracy make men forget their ancestors but also it clouds their view of their descendants
and isolates them from their contemporaries"
(i98o[i84o]). People have tended to become separated
from kin, if not from their immediate families, and family and kinship have taken on an amorphous cast. No
single explanation for diminished kinship ties in modern
society suffices. The most obvious cause may be geographic dispersal associated with social and economic
mobility, but the organization of work and the glorifi28, And see Fleck (1979(193 5]:35), who, prior to most contemporary cation of individualism that nourishes the market econscholars, said, "In science, just as in art and in life, only that which omy may also have played a role,
is true to culture is true to nature,"
I suggest that biomedicine defines the family in precise
29, See especially Douglas (1992(1970]) on how our comprehension
terms
hy uniting individuals with their families and kin.
of the hody reflects hroader societal themes,
30, My study dealt with women with family histories of hreast The more social processes tend to distance people from
cancer, hut my argument applies equally to men and women and family and kin, the more biomedicine tends to move
to the numerous diseases currently construed as hereditary, (I has- them closer to consanguinity, creating new forms of inten to add that specific diseases may also have other consequences teraction that may be embedded in the very absence of
not encountered among women with hreast cancer,) The full impact
of the medicalization of family and kinship must continue to he interaction. People are compelled to recognize consanguinity even when in the lived world they define family
an empirical question.

248 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

by a sense of sameness that may be grounded in friendship or sharing of affect and interest rather than in genes.
With the belief in genetic inheritance and the medicalization of kinship, interaction with family and kin may
no longer be required for people to recognize relatedness
and connection.
In the past, people's existence was embedded in family
and kinship relations. A human being was defined as a
social person, inheriting from family status, power,
goods, blood, and honor. Normally, families bequeathed
to their offspring everything that was positive and negative in human existence. At present, family and kinship
relations may be defined more by the inheritance of disorders and pain than by the inheritance of status and
social attributes. People's kinship is sustained by the
DNA that mediates memory of their ancestors by the
relentless transmission from generation to generation of
its encoded material. DNA, as our proxy, records and
remembers our ancestors better than our fragile memories do. It establishes continuity with the dead, a continuity of particles that lack the moral responsibilities
associated with relatedness.
Memories are usually embedded in sounds, smells, affect, and tales of past ancestors and kinship ties. But we
recall our ancestors not for these characteristics or for
their achievements, for their beliefs, for the numerous
dimensions of their being, for their quirks, but for their
physicality.^' Although through DNA we establish continuity with the dead, it is a continuity comprised of
hollow particles that may lack any of the affect that is
normally associated with memories. Even if people wish
to forget their antecedents and reinvent themselves, the
physician will remind them of their "true" biological
ancestors. The family medical history is part of the person's identity and memory. Within the biomedical domain, the medical history and biological antecedents determine personhood, and knowing one's genetic ties is
sometimes raised to a spiritual state, a transcendent experience (Finkler loooa).^'^
Yet, phenomenologically there is a distinction between experiencing oneself as a member of a "significant
same" group that feels a sense of solidarity and relatedness associated with shared experiences from the beginning of life and experiencing oneself as a member of
a family, or group, that shares DNA molecules. Once
adoptees find their birth mothers and medical histories,
they tend to create new fictions for themselves by establishing presumably loving relationships with those
people. And while they may, as most of the people I
interviewed reported, find a new "wholeness," experi3r. However, in the 19th century certain diseases were considered
prestigious; tuberculosis, for example, served as a metaphor for an
artistic personality (see Sontag 1978). Hemophilia may have been
a mark of nobility, and obesity was a mark of wealth. Sickle-cell
anemia is an indicator of race associated with African-American
descent (see Wailoo 1996].
32. In a lecture entitled "Genetics and Faith," Francis Collins
(i999i>), head of the Human Genome Project, has advanced the
notion that there is no conflict between religion and genetics and
that uncovering the genome is a "religious experience."

entially it masks a sense of fragmentation as they continue to exist between two worlds: one rooted in the
fiction of "as if by blood" and the other in shared experience and affective ties.
The notion of shared experience suggests being in the
world and interacting with others, whereas being part of
the same DNA circle requires no social interaction. Bauman (1992:42) points out what Merleau-Ponty knew, that
the only way we can comprehend ourselves and know
that we are alive is by being with others and being anchored in a moral order. Levinas observes that humans
are beings with meaning and that meaning comes out of
our responsibility for others; "being reduced to the 'is'
without the 'ought' equals solitude" (quoted by Bauman
1992:42). As I have argued elsewhere (Finkler 1994), to
be human is to be a moral being, to insist on the "ought"
and the "should" against all odds, and the sense of responsibility to others that arises out of the "ought" is
initially experienced in one's "significant same" group.
To sense that one is part of a family chiefly because one
shares the same genes, requiring no social participation
or sense of responsibility to those who are related except
to provide blood samples for testing purposes, removes
the moral context of family relations and being in the
world. Relations between family and kin, however defined, are governed by a special morality arising out of
the recognition of commonality (Finch and Mason 1993,
Freeman 1968, Witherspoon 1975), whereas relations established on the basis of the new genetics lack moral
imperatives.
Paradoxically, genes are both amoral and moral. On
the one hand, people do not hold their ancestors responsible for transmitting "faulty" genes. On the other hand,
the medicalization of family and kinship gives meaning
to the randomness inherent in geneticsto the "luck of
the draw"^by supplying a reason for suffering and thus
making it more bearable. Belief in genetic inheritance
carries a moral load in that it may even bring people
back to the religious notion of original sin and the sins
of the fathers, embodying the notion of predestination
(see Finkler 2000a). Ironically, the contemporary solitary,
independent, and autonomous individual becomes
united with genetic family and kin by sharing asocial
and amoral DNA. Bauman (1992:198) correctly observes
that "the sociality of the postmodern community does
not require sociability. Its togetherness does not require
interaction. Its unity does not require integration." Thus,
the individual can enjoy traditional kinship and family
relations without moral obligation, responsibility, or sociability. At the same time, medicalization expands the
recognition of family and kin and gives them new importance for the individual that they may have lacked
before. Paradoxically, molecular biology and the genetic
model of family and kinship bridge the essentialism of
modern science with postmodern ideologies and experience. It could even be said that the ideology of genetic
inheritance promises contemporary humans immortality within the flux of the postmodern world. The individual exists in a transient world but is fastened biolog-

The Kin in the Gene | 249

ically to the past and to the future because DNA codes
the past and the future.
Concepts about genetic inheritance do the work for
memories lost. Kinship is not only a relationship of the
present. Kinship relations are repositories of and connections with the past, sustained in the genealogical
memories of one's forebears. The memory represented
by DNA never forgets,- it is embedded in the absence of
experience and feelings. DNA remembers what has long
been forgotten. It does not permit reinvention of the self
or the embellishment of ancestors: it records only the
forerunners' physicality. People cannot invent or appropriate ancestors, because a DNA test will reveal the
truth.
Tocqueville noted that in a democracy "those who
have gone before are easily forgotten" (i98o[i84o]:5O7).
Indeed, in postmodern times, more than ever, memory
may be depthless, but genetic inheritance establishes
depth and continuity with previous generations and unifies people with their past. It reinforces or, arguably, reintroduces the experience of chronology, of time passing.
But, in characteristic postmodern fashion, as time and
space become compressed, memory is reduced to the exquisite simplicity of DNA molecules. While the postmodern individual may chiefiy know the present, the
medicalization of family and kinship reminds people
that there was a past to which they are connected, defining an intergenerational space. In day-to-day experience, aunts, uncles, and even grandparents may not be
recalled, but they must be remembered when one is
asked for a family medical history.
Building on biologism, the medicalization of family
and kinship reinforces contemporary humans' physicality by assigning shared identities to people, past and present, who may have little in common. It adds a new
dimension to memory while distancing people from their
being by erasing the complexity of living, if not of life.
Drawing on phenomenology, I introduce the notion of
"life's lesions," the adversity and the moral contradictions that become inscribed on the body and are expressed in non-life-threatening symptomatologies (see
Finkler 1991, 1994). With the medicalization of kinship,
people's lives and experience become irrelevant to their
disorder, diminishing the work of memory. The chemical
construction of the gene is registered on the body of family and kin, overlooking life's lesions.
The medicalization of family and kinship compels us
to remember the relatives and ancestors who bewitched
us by giving us bad genes. In fact, it engages us in a
profound contradiction. We have lost our right to exercise choice in selecting our relatives. The medicalization
of family and kinship forces us to establish a connectedness with kin in the wake of the weakening of family
ties, whether we choose it or not.
In sum, the medicalization of family and kinship is
but an extension of the ongoing process of the expansion
of the medical gaze to include our most profound relationships, building on the cultural template of bilateral
and biogenetic kinship that forms part of American beliefs and practices. It recasts our dispersed and loose kin-

ship ties as inexorable genetic ones and reestablishes our

continuity with family and kin. Once uprooted, we have
been reunited by the medicalization of family and kinship. Willingly or not, we must recognize our connectedness, albeit by our dysfunction and disorders. DNA
joins the compartmentalized, fragmented postmodern
individual to his or her ancestors.
The medicalization of family and kinship raises numerous research questions. Future studies of the diffusion of biomedicine (cf. Finkler 2ooo>) need to focus on
the phenomenology of the medicalization of family and
kinshiphow biomedical beliefs, especially about genetic inheritance of disease, are interpreted in Western
developed and non-Western societies. Although it is recognized that "very little research has been done on genetic disorders, or the use of genetic services, from a
family perspective" (Richards 1996:250), Richards's work
in England raises various important considerations concerning the intersection between the new genetics and
kinship, as does, for example, the work by Sachs (1996)
on more general notions of the concept of risk. It is also
necessary, however, to turn to Third World societies. For
instance, in Mexico, where the family and not the individual is still the primary unit of existence (Finkler
1991, 1994), the notion that one's family is detrimental
to one's health is disorienting. While there have been a
few clinical studies on how people respond to genetic
counseling in non-Western society (e.g., Dumars and
Chea 1989), it will be especially important for both academic and practical reasons to examine how people in
kinship-oriented societies, such as those in Africa, Melanesia, the Middle East, and India, respond to the medicalization of family and kin.^^ Moreover, while my study
focused on people who, with a few exceptions, are part
of the giant American middle class, we need field studies
of how the medicalization of family and kinship is experienced among the working poor and among the elite.
Because people of all classes in the United States are
exposed in varying degrees to biomedical treatment and
thus to the taking of family medical histories, as well as
to the mass media, I hypothesize that the medicalization
of kinship will be widely accepted in American society
across classes. The degree to which these ideas have penetrated throughout American society and the Western
world remains an empirical question that requires future
investigation. Finally, given the increasing consciousness of genetic inheritance, it will be important to learn
to what degree it affects marriage and procreation
choices.

33. Dumars and Chea (1989:164) describe the genetic diseases

among the Cham (an ethnic group originating in Southeast Asia),
including a high frequency of alpha and heta thalassemia and E
hemoglobin. Here, although medical personnel explained the reasons for the disease that resulted in many newborn deaths, "this
did not alter their reproductive behavior" (p. 165).

25O I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

Comments
JANET DOLGIN

Hofstra Law School, Hempstead, N.Y. risso, U.S.A.

{lawjld@maih.hofstra.edu). 14 xi 00
Many aspects of Finkler's insightful analysis in "The Kin
in the Gene," as well as in her recent hook Experiencing
the New Genetics (2000a), deserve praise and scholarly
notice. This hrief note, however, comments on only one
issue.
Finkler suggests that the new genetics and the attendant ideology of genetic inheritance usher in an unprecedented notion of "patient." She explains that "with the
medicalization of kinship the individual is no longer the
sole patient" and that "genetic counselors are beginning
to ask questions such as 'who is the patientthe individual? The familythe spouse, the sister, the hrother,
or the child?' (Nelkin 1992:180)" and suggests that "the
medicine of the future will he the medicine not of the
individual hut of the family." Some implications of this
insight are evident in a set of legal and institutional responses to the use of genetic information, especially in
familial contexts. The most remarkable of these is a
court case decided by a New Jersey appellate court in
1996. That case. Safer v. Pack/ was initiated hy Donna
Safer, who was diagnosed with a hereditary form of colon
cancer at age 36. Twenty-six years earlier Donna's father,
Rohert Batkin, had died of the same illness.^ Donna sued
Dr. George Pack, who had treated Batkin during his final
illness.^ Donna and her husband, Robert Safer, argued
that Dr. Pack had had a duty to warn those at risk (including Donna) that his patient's condition was hereditary "so that they might have the henefits of early examination, monitoring, detection and treatment."" The
court agreed. Judge Kestin, who wrote the court's decision, defined a hroad duty to warn: "It is appropriate . . .
that the duty he seen as owed not only to the patient
himself hut that it also 'extends heyond the interests of
a patient to members of the immediate family of the
patient who may he adversely affected hy a breach of
that duty.'"'^
1. Safer v. Pack, 677 A.:id 1188 (N.J. Super. Ct. App. Div. 1996).
2. Robert Batkin was diagnosed with adenocarcinoma. A pathology
report prepared in 1956, after Rohert Batkin first underwent surgery
for colon cancer, noted the existence of diffuse intestinal polyposis.
The condition is hereditary. J am grateful to Gary Maher, attorney
for Donna Safer and her hushand, Rohert Safer, for sending the
Safer's complaint to the Hofstra Law Library.
3. Dr. Pack had died in 1969. Thus, the suit was actually commenced against George Pack's estate (677 A.2d at 1190).
4. 677 A.2d at 1190.
5. 677 A.2d at 1992, citing Schroder v. Perkel, 432 A.2d 843 (N.J.
1981). Soon after the decision in Safer, the New Jersey legislature
rejected the opinion's more far-reaching implications. The state
legislature provided that health-care workers are permitted to warn
relatives of patients suffering from genetic disorders only if the
patient has either consented to the revelation or died (Genetic Privacy Act, N.J. Stat. Ann., Sec. 178:30-12 [West 1998]).

The basic message of Safer is reflected as well in a

1998 statement of the American Society of Human Genetics (ASHG),*^ which suggested that health-care workers be allowed to reveal confidential information about
a patient to "at risk relatives" (p. 474).
Both Safer and the ASHG statement suggest a broad
redefinition of family privacy. Both assume a genetic
family, delimited exclusively through reference to shared
DNA. Within that family, each person is presumed to
mirror each other person and the larger whole. The implications are startling. As Finkler suggests, this construction of familyand presumably of other groups
that society identifies through reference to a genomereplaces the notion of autonomous individuality
with a notion of a larger group, defined through the metaphor of the individual but within which each person is
indistinguishahle from each other and from the genetic
group.
This construction of group suhordinates the interests
of the individual to those of a larger social whole. Louis
Dumont described that possihility as resulting from "the
attempt, in a society where individualism is deeply
rooted and predominant, to suhordinate it to the primacy
of the society as a whole" (Dumont 1977:12). That redefinition displaces the autonomous individual with a
group, itself viewed as an undifferentiated, autonomous
whole. Moreover, that redefinitionwhich might affect
ethnic and racial groups as much as familiescould ultimately exclude as "Other" all those defined as genetically different from the so-called human genome.''

SARAH FRANKLIN

Department of Sociology, Lancaster University,

Lancaster LAi 4YL, U.K. {s.franklin@lancaster.ac.uk).
3 XII 00

Finkler's contrihution to the literature on kinship in the

context of the new genetics makes a far-reaching and
original claim ahout the extent to which the gene acts
as an asocial repository of kin ties and indeed helps to
restore them, paradoxically, hecause "the DNA records
and remembers our ancestors better than our fragile
memories do." Moreover, while she notes that negative
effects of geneticization include the "perpetual patient"
situation of a healthy person predisposed to an illnessyet-to-he, she contrasts this aspect of geneticization with
some of its more positive aspects, such as hringing people
closer together through hoth practical aspects of collecting and sharing genetic information and a sense of
solidarity in confronting actual or possible genetic ill6. The Society limited this right to cases in which the patient had
first been encouraged to inform identifiable "at risk relatives" but
had failed to do so, the "harm is likely to occur and is serious and
foreseeahle," and "the harm that may result from failure to disclose" is deemed to "outweigh the harm that may result from disclosure" (ASHG 1998:474).
7. The implications of this brief comment are considered in greater
depth in my article "Personhood, Discrimination, and the New
Genetics" (n.d.).

FiNKLER The Kin in the Gene \ 251

ness. These arguments are used to make a broader set of
claims about the extent to whicb contemporary American society remains kin- and family-based and the extent to which geneticization furthers very strongly established models of blood-based bilateralism and even to
suggest that DNA anchors individuals' relationship to
the past and future differently. This is a very helpful
article botb because it makes some very bold assertions
and because it does so in relation to a very clearly presented interpretation of some of the major sociological
questions about modernity, kinship, and embodiment
raised by the new genetics.
In contrast to recent ethnographers who consider kinship in the context of new reproductive and genetic technologies (Rapp 1999, Edwards 2000), emphasizing the variety, creativity, and constraints in the ways existing
kinsbip knowledges are deployed in relation to the new
genetics, Finkler wants to be able to draw some broad
formal conclusions that extend and contribute to existing models of modernity, medicalization, and kinship.
This leads her to spend quite a bit of time at the outset
reviewing the literature on the way in whicb modernization diminished tbe reliance on kin ties in favour of
market-based individualism, medicalization produced a
new form of modern subject for wbom pathology became
identity, and new blended parenting arrangements gave
us tbe postmodern, flexible family. Because she wants
to add to tbis picture with ber data, using specific cases
of tbe conflicts and resolutions individuals from a range
of backgrounds found in pursuit of more genetic information to illustrate new shifts in tbe story of contemporary American kinship wbere it meets tbe new genetics, she returns to tbese very broad tbemes at tbe end,
arguing tbat, in a sense, tbe new genetics is forcing us
to return to a more traditional definition of family
tiestbat is, consanguinity rather than choice. It is not
so mucb tbat Finkler wants tbe analytical categories sbe
is using to stand still as tbat sbe wants tbem to be reordered in wbat migbt be described as very consistent
patterns. In sum, sbe wants to tell us bow geneticization
fits into or refigures tbe models of modernization and
medicalization we already know, but witb a new twist.
Tbis analytical goal distinguisbes ber work from tbat of
many otber scbolars working in this field and in particular from tbe work on kinsbip by Marilyn Stratbern and
a bost of otber scbolars wbo want to use tbe new tecbnologies as a "defamiliarizing lens," to add new refiexivity to tbe questions tbat are being asked about bow
anthropological knowledge produces its objects and to
point out tbat tbis process cannot be separated from
otber questions we are asking. Tbis is wby mucb of tbe
work on kinsbip in tbe context of new reproductive and
genetic tecbnologies bas overlapped with science studies, cultural studies, and feminist tbeory.
As Dorotby Nelkin and Susan Lindee (1995) bave demonstrated, DNA is not simply a set of physical molecules
but a powerful set of cultural representations. To use
Donna Haraway's pbrase, DNA is a "material semiotic
entity" at tbe dense interface between biology and information, wbicb is doing a great deal of representational

work botb in cbanging scientific and medical accounts

of bodies, bealtb, and illness and in tbe myriad cultural
settings, from advertisements to contemporary art, in
wbicb it bas become an iconic signifier. For me tbis is
one of tbe reasons tbat it is bard to know exactly wbat
Finkler means wben sbe says tbat "DNA remembers tbe
past" and at tbe same time describes it as amoral and
asocial. I read ber as being very literal in tbese claims,
but I find tbem difficult to reconcile witb bow polyliterate "DNA" and "genes" bave become in contemporary society. Attributing memory to DNA seems to me
evidence of tbe way in wbicb DNA is being socialized.
Holding a biological or cbemical definition of DNA as
somebow "objectively" separate from tbe social relations wbicb make DNA visible or active in very particular ways returns to a nature-culture dualism of wbicb
a great deal of recent scholarly work in tbisfieldbas
been explicitly critical.
Finkler's tbesis tbat DNA reties tbe blood tie is undoubtedly true in certain cases and demonstrates tbe
contradictory nature of geneticization. Tbe exercise of
retbinking tbe relationsbip between modernity, medicalization, and kinsbip is also bigbly appropriate in tbe
context of tbe new genetics, wbicb is rapidly resbaping
basic elements of bow bealtb will be defined in tbe future
and mucb else besides. It is unlikely, bowever, tbat tbe
social and cultural dimensions of tbe new genetics will
be analysed in mucb deptb witbout a corresponding degree of tbeoretical innovation tbat moves beyond establisbed binarisms of tbe individual and society, nature and
culture, or ideological and scientific. In fact, DNA is
itself a very good place to look for tbe ways in wbicb
all of these categories are being very explicitly
reprogrammed.

HUGH GUSTERSON

Anthropology Program, MIT, Cambridge, Mass. 02139,

U.S.A. [guster@mit.edu]. 27 xi oo
Evans-Pritcbard (1937) told us tbat illness can provoke
a sense tbat tbe world is out of joint until tbe identity
of tbose causing it bas been divined. For tbe Azande,
tbey were witcbes; for modern Americans tbey are increasingly likely to be ancestors wbo bave passed on "bad
genes."
Tbis is not a bad tbing for tbe medical profession. Finkler sbows tbat tbose wbo believe tbemselves to be genetically predisposed to certain illnesses become "perpetual patients." By analogy witb tbe "permanent war
economy" (Melman 1974) of tbe cold war era, we migbt
say tbat tbis situation offers tbe medical-industrial complex tbe prospect of a "permanent sickness economy"
in wbich "patients" pay for medical belp before, or witbout, getting sick.
Finkler, bowever, is not so interested in tbe political
economy of tbis situation as in tbe ways in wbicb it is
remaking our sense of self. After tbe atropby of tbe family in tbe postindustrial United States, some feel a new,
and discomfiting, sense of connection to tbe parents and

252 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

grandparents who hequeathed them their genes; those

given up for adoption may feel that, without their hiological family's medical history, they are missing a key
part of their identity, and "perpetual patients," suhject
to the new micropanoptical technologies of genetic testing, increasingly see themselves as prisoners of their
genes.
Finkler's compassionate and insightful article is particularly good at dramatizing the ways in which people
are reimagining their life histories and prospects in the
era of genetic testing and the new kinds of pain and
meaning this is generating. We might push the analysis
a little farther by prohing the political functioning and
consequences of the discourse she anatomizes. As this
discourse circulates, the prohahilistic language used hy
experts in academic journals morphs in the minds of
ordinary citizens into a deterministic language of genetic
reductionism. It would be interesting to know how it
thrives when it is at odds with the complex, multicausal
models of our leading hiomedical thinkers (Fox Keller
2000) and to what degree doctors and those sectors of
the medical-industrial complex that will benefit from
genetic testing and gene therapy are implicated in this.
It also hears pointing out that looking for the cause of
our cancer in our mothers' genes rather than in the water
we drink and the air we breathe has political consequences that work to the benefit of powerful institutions
that deposit carcinogens in the environment. Instead of
looking for cancer clusters around industrial plants and
laboratories, we learn to look at our familiesthose who
care for us when we are sickas the source of our ills.
This is a way of seeing (Berger 1995) the world that needs
to be looked into more deeply.
Finkler asks how this geneticized way of seeing will
change the American family. One can imagine that, as
Silver (1998) has suggested, it will do so in part by providing new axes of inequality and stratification. Bourdieu
(1984) bas argued tbat, in tbe industrial era, privileged
families learned to use tbe educational system to convert
one generation's financial capital into the cultural capital of the next, which then converted it hack to economic wealth. We can expect an increasing interchangeability of financial and genetic capital as affluent families
use genetic screening and embryo selection to give their
children the best possible start in life. Tbose who cannot
afford to access these technologies may find themselves
disadvantaged in the job market, the medical insurance
market, and so on. Thus, we may see a return to the
kinds of ideologies about family "breeding" that characterized 18th- and 19th-century Europeexcept that
this "breeding" will now be technologically mediated.
If I have one quibble with Finkler, it is in her use of
the term "medicalization"a word that is not adequate
to convey the novelty and power of the processes she
analyzes. I would suggest that we speak not of the "medicalization" of the family but of its "geneticization." Homosexuality was medicalized wben it ceased to be a sin
and became instead a disease. It became "geneticized"
more recently when Dean Hamer (Hamer and Copeland
1996) claimed to have found a "gay gene" that made it

not a disease but a genetically determined variation in

tbe population. The family was medicalized, as Foucault
and his intellectual heirs have argued, when we learned
to look for tbe origin of our bebavioral problems in our
parents' relationsbips, wben the state hegan to send social workers into the families of the poor, and when a
massive literature emerged on normal and deviant families. What Finkler descrihes goes heyond this as we learn
to reconstrue the family not in terms of social pathologies but in terms of tbe deterministic force of vectors
of gene transmission. She is documenting the emergence
of a new way of seeing that has profound implications
for us all.
NORTIN M. HADLER AND JAMES P. EVANS

Department of Medicine, University of North

Carolina, Chapel Hill, N.C. 27599-7280, U.S.A.
[nmh@med.unc.edu]. 28 x 00
Finkler's conceptualization of the medicalization of kinship is compelling. Of course, the driving force for this
medicalization is the return to prominence of genetic
determinism among medical doctrines. To the extent
that this doctrine is flawed, the medicalization of kinship
is likely to be misguided, if not iatrogenic. Likewise, to
tbe extent that the doctrine is flawed, the recrudescence
of social iatrogenesis is facilitated. It is our intent, in this
hrief commentary, to demonstrate that tbe doctrine is
seriously flawed indeed.
This is not to say that science isflawedor that a "social
constructionist" view of genetics is in any way valid.
However, the relevance of tbe new insights to tbe buman
predicament is far more limited than is widely appreciated and far more circumscribed tban the assertions of
august bodies and leading scientists cited by Finkler. Unbridled promise and enthusiasm is symbiotic witb the
growth of the biotechnology industrial sector. All of this
permeates the hallowed halls of tbe medical academies,
persuades continuing medical education, and bears tbe
promise of profit for many in tbe know. In remonstrating
tbat the science supports Finkler's thesis far more than
the creed of tbe genome, we are iconoclasts.
Genetic determinism offers clinical promise when diseases are consequent to discrete gene defects with high
penetrance. In such circumstances, genotyping is informative. For example, MEN-2 is a rare familial endocrinopathy with regard to which foreknowledge mandates
removal of the precancerous thyroid as early as infancy.
We may hope that, in our lifetime, foreknowledge based
on genotyping will afford palliation if not cure for individuals marked with a high likelihood of developing
hemophilia, sickle cell disease, cystic fibrosis, Fanconi's
anemia, and more. For example, in certain cases, genetic
testing to ascertain risk of colon cancer may allow intensive screening by colonoscopy to be appropriately targeted to high-risk individuals. However, in the case of
the BRCA genes, which predispose to early onset of
breast and ovarian cancer, surveillance is imperfect and
the pharmaceutical and surgical options anything but

The Kin in the Gene | 253

optimal. Until effective and acceptable preventative
measures exist for women at high risk of these cancers,
prognostic genetic testing is fraught with problems.
What likelihood would a particular person consider so
compelling as to call for prophylactic mastectomies and
oophorectomies? For someone such as Eve in Finkler's
paper, disabuse, not genotyping, is in order.
Indeed, for most common diseases, prognostic genetic
testing is seldom more than marginally informative and
presents personal dilemmas for the patient and moral
dilemmas for the clinicians. The choice to pursue even
highly informative genetic testing rests on many individual factors and is rarely an unmixed blessing. The
genetics community was surprised to find that after introduction of a test for Huntington's disease, few at-risk
individuals chose to pursue this option. When properly
informed and educated, individuals are quite capable of
determining whether such information is likely to be of
benefit to them; "patients" will vote with their feet. The
medical establishment must eschew hubris and educate
the public (as well as itself) so that our burgeoning arsenal of genetic tests can be used in an informed and
responsible manner.
The promise of genetic determinism relates to pauciallelic genetic diseases. This promise will be realized and
will be a triumph. However, genotyping is no match for
all that is multifactorial. A genetic influence has been
demonstrated for the susceptibility to and even the
course of many disease states. The crucial word is "influence." For example, it has been possible to demonstrate that a segment of the population is more likely to
develop lupus, but the likelihood in that segment still
leaves lupus a rare disease. Kirsten also needs to be disabused; lupus is not a familial disease in spite of a demonstrable genetic influence on predisposition. This is
also true for most of the highly prevalent diseases, particularly those that are prevalent in the last decades of
life.
In our deterministic fervor, we often forget that
whether one develops any disease has less to do with
"nature or nurture" than with chance. Random stochastic mechanisms are the most important determinant
of disease occurrence and progression. It is a fool's hope
(or perhaps blessing) to believe that we will be able to
sort out the interactions of environment, 100,000 human
genes, and the role of chance to provide a crystal ball
that is anything but murky. Uncertainty prevails. Is it
meaningful that someone is a bit more likely to suffer
dementia and a bit less likely to suffer coronary artery
disease? For the informed clinician, patient, or person,
the question is rhetorical.
What price the medicalization of kinship?

case of the grip that biogenetic models have on the (Anglo-European) grasp of specific social relations, thoughtprovoking in that the material it presents exemplifies
practices that seem specifically North American and
thus invite cross-cultural comparison.
Finkler posits that the medicalization of kin and family relationships at once concurs with an American
model of biogenetic kinship and serves to link people
who might otherwise have no wish (or need) to be connected, thus defying an ideology of individual free
choice. Leaving aside the problematic notion of "American," Finkler's empirical findingthat people hold contradictory values and draw on them variouslymirrors
social realties more generally. Indeed, the contrary would
be exceptional. Of greater interest are the ways in which
such contradictory values are articulated and practiced.
Research among the involuntarily childless in Norway
and their practices of assisted conception (be it through
new reproductive technologies or by transnational adoption) indicates that people hold both cultural and biological models and shift between them according to context. Although this tension between indigenous models
of nature and nurture runs through much of Norwegian
society, there is no doubt that biogenetic models are gaining ground. This is, for instance, reflected in laws pertaining to the rights of adopted children to know their
biological origins and the renewed debates on artiflcial
donor insemination, where there is a movement to repeal
the current law of donor anonymity. In both cases the
arguments are grounded in notions of knowing one's
identity, and identity is unproblematically assumed to
be the same as biogenetic origins. However, laws based
on such "knowledge" do not deter people from adopting
children from abroad. Local ideas of identity are more
complex; origins and belonging are not necessarily perceived as the same thing.
Issues of identity are also immanent in Finkler's discussion of medical histories. Finkler states that "the family medical history is part of the person's identity and
meinory." It is through the need to establish medical
histories that people begin their quest for unknown kin.
This need, moreover, is irrespective of whether one is ill
or not; it is the possibility of becoming ill that is a driving
force. Medical histories, if they can be established, give
one a semblance of control over the future by unraveling
particular facts about the past. Thus they are more than
just a record of individual health cycles; they are a mnemonic device structuring individual perceptions of significant relationships. DNA is the key that unlocks
memory, inscribing ancestry into (or onto) related bodies
in the present and future. DNA is not only a matter of
time; viewed as a fact (devoid of morality), it contradicts
the values people attach to it.
Medical histories surface as documents certifying who
MARIT MELHUUS
one is. Yet, the necessity of possessing one seems to rest
Department of Social Anthropology, University of
on the demands of health insurance companies, and thus
Oslo. P.B. ro9i Blindern, 0317 Oslo, Norway
the family medical history is a type of identity document
[marit.melhuus@sai.uio.no]. 29 xi 00
that not only has personal valuein the sense of giving
Finkler's article is both disturbing and thought-provok- a person a sense of being^but may in fact be crucial in
ingdisturbing in that it presents yet another empirical obtaining medical treatment. In Western democratic-

254 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

type societies, we associate identity papers (and the right
to issue them) with state institutions (e.g., hirth certificates, passports, identity cards) and certain forms of governmentality. They are related to notions of citizenship
as well as to control and power. Not only do we assume
that we have a right to these documents hut we helieve
that they confer on us certain rights (e.g., mohility, the
vote, schooling, and in some countries, health care). In
a recent study from Peru, Lund (2001) shows how heing
indocumentado, without documents (which is the case
for approximately 30% of Peru's population), causes
prohlems not only for individuals (limiting their access
to basic institutions) hut also for the state. In her case
it is, among other things, a prohlem of matching peoples
and territory and establishing houndaries.
Identity documents are powerful and visihle mechanisms of inclusion and exclusion. Although family medical histories appear to he of a different order from identity papers, they seem to work in the same way. Both
documents are invested with certifying authority the absence of which has marked repercussions on people's
lives. Whereas identity papers are official documents regulated by the state, family medical histories work as
insidious gatekeepers, not open to puhlic contestation.
The cultural meanings of biogenetic models can perhaps
be better apprehended by examining the social practices
through which they are enacted. This may enhance our
understandings of the apparent ease with which biogenetics is accepted as configuring realties.

reproductive technology industry. Women willing to undergo difficult and often dehumanizing procedures spend
more than $1 billion annually on infertility services. The
discourse on reproduction is pervaded by images of
banks, deposits, property, products, and possessions. Articles in family magazines have such titles as "Babies to
Order" and "Shopping for Mr. Good Genes." Sperm donor profiles read like personal ads, providing detailed information ahout the donor's favorite colors, ability to
carry a tune, and serious hobbies. Donor eggs from
women with carefully specified education and talents are
advertised on the Internet for as much as $50,000whatever the traffic will bear. Eggs and sperm are consumer
products evaluated according to their genetic worth, and,
like other commodities, they have been subject to theft.
They are part of the commodification of kin.
Commercial enterprises have proliferated to service
the family in the age of genetics. Genetic testing is big
business, and companies are identifying not only criminals but also kin. Highway billboards and New York
City taxicabs carry advertisements: "Call 1-800-DNAType." Unregulated firms provide identity tests by mail.
Dads use their services to avoid child support and moms
to claim their right to child support through paternity
identification. Meanwhile children become "property"
on the hasis of biological criteria, and their ongoing family relationships may he disrupted.
As biological ties assume growing importance, new
business enterprises form. Search firms are in the business of finding biological parents for adoptees seeking
"roots." An international registry affiliated with 450
DOROTHY NELKIN
groups worldwide is available for people looking for relDepartment of Sociology, New York University, New
ativesif, of course, they can pay. Genealogy is also a
York, N.Y. 10003, U.S.A. [dorothy.nelkin@nyu.edu].
growing business, and companies have proliferated to
31 X 00
help people trace their genetic origins so as to avoid "genealogical bewilderment." And disinterment services
Why are genetic explanations so powerful? As Susan Lin- are available for people who want to document, through
dee and I observed in The DNA Mystique (1995), they DNA tests, their genetic connections with a dead relaare particularly appealing in a society reacting with anx- tiveoften to validate inheritance claims.
iety to the ambiguities of "new families." The family
Family anxieties about inherited disease also have
seems to be besieged, threatened by feminism, divorce, commercial implications. Assumptions about the origay rights, the ability of children to sue their parents, gins of disease or behavioral conditions imply preferred
the complex arrangements enabled by new reproduc- treatments. If a condition is defined in social terms, one
tive technologies, and other social changes. Families looks to changes in the family or social environment for
grounded in emotional ties appear to be chronically un- solutions. If a condition is helieved to follow from gestable, fragile, and insecure. Genetics, in contrast, seem netic endowment, the preferred treatment is drugs or
to ground family relationships in a stable and well-de- medication. Genetic explanations have contributed to
fined unitthe geneproviding the individual with in- the sale of psycho-stimulants, antipsychotic agents, antidisputable roots that are more reliable than the depressants, antianxiety agents, and sedatives. The pharephemeral ties of love, friendship, or shared values. Fur- maceutical industry has much to gain from medicalizing
thermore, as Finkler notes, we readily accept this med- the family.
icalization of kinship "hecause it mimics conceptualiMeanwhile, the family defined hy genetic predisposizations of the biogenetic foundation of kinship." In tion may face economic problems. If a woman is "preeffect, medicalization reinforces traditional family disposed" to a genetic disease, her children and siblings
values.
may also be at risk, and they all may be subject to emI would like to add a further reason for the influence ployment or insurance discrimination. Defining the famof genetic explanations. They suit our commercial cul- ily in terms of genetic predisposition may also encourage
ture. They have not only medicalized but commodified family decisions based on a commercial calculus. An odd
kinship. Let me provide some examples. Belief in genetic example was the mother who knew that she was a carrier
determinism has led to the remarkable expansion of the of the Huntington's gene and that her two daughters had

The Kin in the Gene \ 255

needed to suhstantiate the claim that the new molecular
genetics has medicalized understanding of kinship and
family relationships or that genetic inheritance has become the prevailing causal explanation of affiictions and
of human behaviour more generally.
As the four respondents she quotes demonstrate, there
are those for whom family medical histories are particularly salient, and it may well he the case that current
concerns with genetics have increased such salience and
perhaps, for some, provided new narratives for discussion
of family relationships. However, our own interviews
with women at risk from the inherited forms of hreast
cancer (see Richards 1999) show that, in some cases at
least, the knowledge that the disease "runs in the family" long pre-dates molecular genetics. Indeed, some
members of the present generation of such families may
he relieved to discover that their family knowledge is
now accepted by the medical profession and that they
can be given risk information and, for those who want
it, predictive genetic testing.
In a discussion of the medicalization of kinship, it is
surprising that Finkler does not consider the possible
MARTIN RICHARDS
Centre for Family Research, University of Cambridge, consequences of easily available DNA paternity testing
or the use of such techniques in matters such as the
Cambridge CB2 3RF, U.K. {mpmr@cam.ac.uk).
assessment of liability for child support payments. These
21 XI 00
pose new situations for families.
Finkler suggests that kinship no longer plays a signifFinkler's paper is to he welcomed as an addition to the
disappointingly small numbers of studies of family and icant role in our lives. While there have been major
kinship in relation to the new genetic technologies. Fink- changes in families, the evidence suggests that kinship
ler raises important points about the ways in which in- remains important for identity and social position in the
herited disease may colour family histories and remem- U.S.A. (Johnson 2000) and the U.K. (Finch and Mason
hrances and influence family attitudes and relationships. 1993, Edwards 2000). New reproductive technologies
However, she also makes a numher of generalizations may pose new situations for conventional notions of kinship, but they are also used and perceived through conwhich are difficult to sustain.
She suggests that family and kinship are being medi- cepts of kinship. So, for example, extrafamilial providers
calized by the advent of the new genetics. While she of gametes may either be included in families as friends,
summarizes a number of studies which show the med- "aunts," or godparents or have their existence hidden hy
icalization of social and moral conditions, she provides secrecy (Richards 2001). In this context it would be helplittle evidence that medicalization stems from the new ful to explore the parallels between adoption and the use
human genetics. She states that "more than 5,000 med- of new reproductive technologies (see Haimes 1988). For
ical conditions have been attributed to genetic inheri- example, to what extent is there an association between
tance, and with the work of the Human Genome Project, the development of open adoption and openness within
we daily learn of another disorder that is traceable to families ahout the use of donated eggs and sperm? Finkgenetic transmission." While it is true that there are ler provides striking narratives from adopted individuals
some 5,000 Mendelian disorders which have dominant, who have sought to find their hirth parents, but such
recessive, or sex-linked patterns of inheritance, this is searches are probably as old as adoption. What is needed
knowledge that in many cases is a century old and owes to support her thesis is evidence that the narratives of
nothing to the Human Genome Project. These are dis- searches have changed in the era of molecular genetics.
orders which have their characteristic patterns of inherFinkler may not be "concerned with the truth or falsity
itance across generations. What new genetic research has of the science of genetic inheritance" but her arguments
done is to provide tests that can predict which individ- need to he closely informed ahout the metaphors and
uals within the families at risk are likely to develop those images provided for the public by biomedical scientists
diseases which develop in adulthood and who has or is (Nelkin 1997, Fox Keller 1995) and the ways in which
a carrier of the recessively inherited conditions. It is not these are perceived and hy which biomedical technolotrue that the Human Genome Project demonstrates ge- gies may influence families. Her view of the ways in
netic transmission where this has not been previously which notions of genetic science and its technological
recognized. Similarly, the taking of family medical his- practices influence family relations and histories needs
tories is a basic technique in Western medicine which to be developed further because, as she states, genetic
can be traced back to the 19th century, when there was diseases are the concern of families, not individuals. But
much concern ahout inherited disease. More evidence is in doing this we need to distinguish what follows from

a 50% chance of inheriting the gene. She hrought the

girls to a clinic to he tested for the gene because she
could only pay tuition for one child and wanted to decide
which one to send to college.
But technological optimism persists. The new genetics
offer medicalized families a hope of buying solutionseven perfectionthrough gene enhancement.
Emerging technologies offer the possibility of diagnosing
genetic disease in the emhryo and the hope of in vitro
therapy prior to implantation. Gene therapies are leading
to gene manipulationperhaps, in the future, for cosmetic purjjoses. Heredity may yet he overcome.
Relationships in the commodity culture of the United
States are increasingly hased less on moral understandings than on market exchange. Aggressive commercialization is invading nearly every sector of human life. Not
surprisingly, the new genetics is fostering not only the
medicalization but also the commodification of kinship
and family life in contemporary American society.

256 I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

modern developments and wbat is part of a much older

understanding of diseases tbat may run in tbe family
(Richards 1996).
LISBETH SACHS

Department of Communication Studies, Linkoping

University, Linkoping, Sweden [lisbeth.sachs
swipnet.se]. 30 x 00
It is very satisfying to discover tbat tbe study of kinsbip
in anthropology is entering a new era because of research
in genetics and tbe genetic inheritance of disease. Finkler
explores tbe impact of tbis biomedical researcb on today's fragmented, postmodern way of dealing with family and kinship witb great engagement and intelligence.
Her focus is on American society, but ber descriptions
and arguments are valid for the European world as well.
She bas a way of dealing witb ber etbnograpby that is
intriguing and mucb appreciated in tbe Nordic countries.
Some surprising discoveries stand out. Tbe fact tbat
some adopted persons begin searching for their roots and
tbeir families mainly for tbe sake of their medical histories, ratber than for tbe psycbological reasons (e.g., tbe
question "Wby did you leave me to somebody else?")
tbat are so common in earlier descriptions of adoptees'
problems, strikes me as one of tbe major implications of
tbe medicalization of kinsbip.
Being familiar witb Finkler's earlier work, I find it
somewbat surprising tbat sbe is not tempted in tbis article to take up tbe discussion of causality and life experience in relation to beredity in ber interview material.
Surely tbe persons sbe bas been talking to bave tbeir
doubts about genes' being the only cause of disease and
try to explain familial disease and suffering in otber
ways.
It also strikes me tbat tbere is no information here
about bow people bave become aware of their predisposition to or risk of cancer. In our researcb in Sweden
tbere is a big difference between tbe experience of risk
tbat one gets from presymptomatic diagnostic information based on genealogical mapping and tbe information tbat one gets from genetic testing. It is not yet
possible to test for all diseases. Tbe interactive process
in a clinical situation in whicb tbe individual's risk is
calculated either from a medical bistory or from a DNA
test is very important for tbe management of risk over
time. Tbere is also an important difference in tbe kinds
of knowledge generated by tbese two procedures.
Finkler adopts tbe perspective tbat biomedicine is socially and culturally constructed. I wisb she had taken
tbis a step fartber by relating some of tbe biomedical
facts in ber study to tbe ongoing discussion. Tbis would
bave extended tbe earlier work in tbe field of medical
antbropology (e.g.. Good 1994) in tbe direction of a truly
interdisciplinary discussion of knowledge and beliefs related to ber etbnograpbic material. In my vie^ we bave
carried postmodernist social constructivism too far in
discussions of diseases sucb as AIDS and cancer. Tbese
diseases do exist, as does tbe body, and we bave to deal

witb botb in relation to our more culturally created notions and interpretations of medical facts. Social scientists ougbt to be able to discuss etiology and causality
witb a more open mind and relate tbeir researcb based
on fieldwork to biomedical knowledge. Tbis kind of
problematization is among tbe most fruitful aspects of
Finkler's earlier researcb in Mexico. Even thougb sbe is
dealing witb mainstream Americans here, tbe problem
is tbe same.
One last comment is on tbe notion of personal/emotional and molecular memory in Finkler's article. In my
own researcb in clinical situations of presymptomatic
diagnosis, it is obvious tbat memory is related to tbe
importance of remembering. If you are depending on tbe
medical bistory for information about your own risk or
tbat of your children, your memory may be sbarper tban
it is witb regard to distant kin tbat you ougbt to inform
about tbe family's risk. Here tbere is also a difference
between tbose wbo bave a diagnosis based on genealogical mapping and tbose whose diagnosis comes from a
genetic test. But tbe main argument bere is tbat a person's memory is tbe only "material" there is on wbicb
to base a presymptomatic risk diagnosis, and DNA can
only confirm from tbe tests tbat bave been taken
wbetber people carry tbe same mutation on a gene. Tbe
power in genetic researcb is witb the informant, tbe person wbo exposes bis or ber family and kin by mentioning
them as potential carriers of a predisposition. Finkler's
statement tbat DNA remembers wbat bas long been forgotten is of course valid only wben you can cbeck
wbetber people are trying to invent ancestors. Family
members wbo are not visualized by tbe memories of
tbeir kin do not exist even for the memory of DNA.

Reply
KAJA FINKLER

Chapel Hill, N.C., U.S.A. 13 xii 00

Tbe various responses to tbis paper are gratifying in tbat
tbey stimulate so many exciting new ideas and broaden
tbe perspectives for the study of family and kinsbip in
tbe context of beliefs about genetic inberitance. Tbey
also testify to tbe tensions between tbe two tbeoretical
approaches in antbropology tbat tbis paper straddlessocial constructivism, advanced by Franklin, Gusterson, and Nelkin, and positivism, advocated by Hadler
and Evans, Ricbards, and Sacbs. I basten to add that tbese
tensions exist also in otber academic disciplines, including pbilosopby (between nominalism and realism).
I tbank all tbe commentators for tbe time and careful
consideration tbey gave to tbis paper and Dolgin for calling attention to my 2000a book, whicb would probably
answer some of tbe concerns raised by Nelkin, Ricbards,
and Sacbs. In tbis reply, I will first address tbe individual
commentators' observations and tben move on to some

FINKLER The Kin in the Gene \ 257

thoughts on the conflict between tbe two theoretical
perspectives.
Research on family and kinship and the new reproductive technologies has heen greatly advanced by various scbolars, notably Dolgin, Franklin, Stratbern, and
otbers, but tbe examination of tbe ideology of genetic
inheritance in the context of family and kinship is in its
infancy. Unquestionably, reproductive tecbnologies raise
many political, economic, social, and ethical issues, but,
as I have said and as Franklin recognizes, my concern
here is not with these technologies. The new reproductive technologies and the new genetics are closely intertwined, hut they must not be conflated as tbey seem
to be by Ricbards and Nelkin. There is a great deal of
difference between an embryo created by in vitro fertilization and people wbo come from families witb breast
cancer. Wbile tbe ideology of genetic inheritance may
guide both, tbey must not be confused.
Dolgin addresses tbe legal consequences of the medicalization of family and kinship, which call attention
to the "cracks" in what is normally accepted as unproblematic biomedical truth about the inheritance of disease. Safer v. Pack is a superh example of a consequence
that I have not explored, namely, the violation of privacy
(hut see n. 22). Arguahly, privacy is sacred in American
society, and it is being sacrificed with the medicalization
of family and kinship because a group rather than an
individual is the patient. For better or for worse, tbe autonomous individual will no longer stand alone or suffer
in isolation but will also no longer be able to cboose his
or her family, having become subordinate to a biogenetically defined group. Dolgin and Melhuus foresee a disturbing future in which individuals may be excluded and
marked as Otber because tbeir genomes do not conform
to tbe normal profile. At tbe same time, as Gusterson
suggests, some may acquire "genetic capital" and become a separate class witb special privileges.
Nelkin's observations adumbrate issues of tbe commodification of genetics that Gusterson discusses and
Hadler and Evans allude to as well. The business of genetics, including the Human Genome Project (HGP), has
opened new frontiers for the medical and pharmaceutical
industries.
Elsewhere (2000a) I present various theories that attempt to explain the prevalence of the ideology of genetic
inheritance in mid-2oth century. I point out that the
political economy of the medicalization of family and
kinship helps to answer this question only in part. Nevertheless, Nelkin's observations are extremely pertinent,
and sbe provides us with stunning support for my assertion that people desire to establisb connection with
ancestors through DNA testing to the extent that they
seek disinterment services. The mother with the
Huntington's gene who sought a genetic test for her children to help her decide which child merited a college
education is an especially striking instance of Gusterson's idea of parents' attempting to ensure their children's accumulation of botb educational and genetic
capital.
Franklin's work in the field of kinship and reproduc-

tive technologies has been exemplary, and sbe has also

captured heautifuUy the major point of my argument. I
see DNA as a reality to which we give agency and attribute memory every time a genetic counselor and a
physician ask for a family medical history. Franklin is
needlessly puzzled by my use of DNA as a marker of
remembrance. The fact that an amoral and asocial DNA
is represented and molded by our culture underscores
my conviction tbat culture and nature cannot be separated and that DNA is configured as culture. But perhaps
I have not sufficiently emphasized my view that the two
are inextricahly intertwined. DNA is at once a molecule
that leaves traces from generation to generation and a
proxy for memory. It is also, in Melhuus's words, a "mnemonic device structuring individual perceptions of significant relationships." We cannot escape from the reality that can only be known culturally and tbat makes
sense only because human beings give it meanings. A
"material semiotic entity" is still a material reality that
"hites."
Gusterson's comments are thought-provoking in suggesting various ramifications of the medicalization of
family and kinship. I am particularly intrigued by bis
application of Bourdieu's tbeory of capital to genetic capital and by his notion of a permanent-sickness economy
to accommodate perpetual patients. Although I regard
the political-economy approach as powerful, Gusterson
is correct that my focus here is on people's experience
of the medicalization of family and kinship and the advantages, dilemmas, and contradictions it creates for
them in contemporary society. He takes the analysis in
yet another direction wben be raises tbe question of the
degree to which doctors and tbe medical industrial complex contribute to genetic reductionism. I bave elsewhere (2ooofl) discussed his point tbat tbe medicalization of family and kinship relieves the state of the
responsihility to deal with the deposition of carcinogens
in the environment and in foods that may be tbe cbief
cause of cancer. It is easier to blame families and ancestors, wbo lack lobbies in Congress, tban for tbe state to
consider and deal witb the extrasomatic factors that may
produce sickness.
Indeed, Gusterson and Dolgin point out that the medicalization of family and kin could lead to creating a new
Other, deepening inequalities and producing a new social
stratum based on tbe possession of genetic capital. Tbis
issue is of particular concern to etbicists in tbe face of
the new technologies that may encourage attempts to
invent "perfect" emhryos and rests at the intersection
between tbe new reproductive tecbnologies and tbe new
genetics.
I appreciate Gusterson's "quibble" over my use of tbe
notion of medicalization. Actually, as I explain elsewhere (2000a), I prefer to use the concept of the hegemony of the gene instead of geneticization because tbe
Gramscian construct of begemony encompasses tbe concept of tbe power of dominant institutions to impose an
ideology by tbeir very authority, which permeates the
social and cultural fahric of daily life, without the use
of force. I do not find "geneticization" a similarly com-

258 I CURRENT ANTHROPOLOCY Volume 42, Number 2, April 2001

pelling term, although I agree with Gusterson that "medicalization" is a more general and "geneticization" a
more specific term for the phenomenon at hand.
Melhuus too takes the notion of the medicalization of
family and kinship in a new direction, especially in likening the family medical history to an identity document that has the power to include and to exclude. I
consider Melhuus's notion that identity documents are
issued by the state and family medical histories are "insidious gatekeepers" highly original. Indeed, one already
hears predictions that soon we will carry on our bodies
chips encoding our DNA that can be used for multiple
purposes in the public and private domains.
I am indebted to Sachs for noting that my analysis is
applicable to Nordic Europe as well. Along with Melhuus, I hope that studies will be done cross-culturally
to address the extent to which the medicalization of family and kinship takes place in different Western and nonWestern settings. I too was surprised by my findings
about adoptees. Although it would be incorrect to reduce
the reasons for their searches to purely medical ones, all
the adoptees I interviewed but one identified the need
for a family medical record as one major reason for
searching for their biological families.
Sachs notes and Melhuus too has found that people
may have their doubts about the ideology of genetic inheritance. This is clear from narratives of women with
breast cancer (Finkler 2000^2). It is fascinating, however,
that while people contemplate alternative explanations
for their affliction, including exposure to environmental
toxins, most reject them in favor of genetic inheritance
because the ideology of genetic inheritance has become
naturalized.
Sachs calls attention to an important distinction between the ways in which people become conscious of
the ideology of genetic inheritancewhether through
the taking of a medical history or through DNA testing.
However, this distinction fails to account for healthy
adoptees' determination to find their birth mothers, inasmuch as they have not been exposed to genetic counseling. The adoptees have, however, been exposed to biomedicine, to the media, and to the Zeitgeist. Arguably,
there are cultural differences between Europe and the
United States that may also influence the ways in which
people become conscious of beliefs about genetic inheritance. Nelkin and Lindee (1995) show that in the United
States we are constantly bombarded by reports on genetic
inheritance in the print and visual media. Judging by
Melhuus's observations, what Hornblower (1999) has described as "roots mania" has not yet reached Norway.
Aside from the mass media and genetic counseling,
however, another dimension to the medicalization of
family and kinship that influences people's perceptions
of genetic inheritance is the pervasive scientific ethos
that insists on evidence for any claim. A familial medical
history supplies such evidence. People may discount alternative explanations, such as the possibility that the
entire family was exposed to similar toxins that might
have produced the disease or, as in Maya's case, that her
family was bewitched. Moreover, as many adoptees have

pointed out and as we have seen in Kristen's case, physicians depend on a family's medical history to make the
diagnosis that the disease is familial (Richards 1996).
Even so, Sachs's concern about the ways in which people
learn about the belief in genetic inheritance should alert
future investigators of medicalization to address this
question.
Finally, Sachs's point about DNA as memory seems
to suggest that humans beings have a choice about what
they remember. Of course, as Freud recognized long ago,
memory of any kind is selective. However, the medicalization of family and kinship requires people to remember; it makes memory of kin important.
Richards incorrectly asserts that I attribute medicalization to the new genetics. In fact, I recognize that medicalization is not new, and nowhere do I suggest that the
Human Genome Project is responsible for it. The HGP
assumes that identifying the genes will open the door to
the understanding of disease. For example, according to
the web site of the National Human Genome Research
Institute, "Our genes orchestrate the development of a
single-celled egg into a fully formed adult. Genes influence not only what we look like but also what diseases
we may eventually get." The HGP also promises to usher
in an era of "molecular medicine, with precise new approaches to the diagnosis, treatment, and prevention of
disease" (www.0rnl.gov/hgmis/faq/faqs1.html4/20). Furthermore, Francis GoUins (1999), director of the National
Human Genome Research Institute, has hailed the project as the "book of life" that will be opened by the year
2002 and will explain, cure, and predict nearly all human
diseases.
Richards points out that the family medical history
was adopted by biomedicine in the 19th century, at a
time when there was also great concern about inherited
diseases, albeit understood more in Lamarckian than in
Mendelian and Weismannian terms. His remark supports my point that the taking of medical histories is
linked with hereditarian views. His report that knowing
that a disease is familial often relieves the patient of
responsibility for it is a point that emerges from many
narratives (Finkler 20000). We can sense Kristen's relief
that she is sane on learning that Raynaud's disease is
rooted in her heredity. As has Richards, I have found that
knowing that a disease is inherited also gave informants
a sense of control. What is more, I have found that for
some the notion of surviving a familial history of affliction is evidence of the strength of the family rather than
its weakness.
Richards is correct that the new paternity testing for
child support will raise new issues, adding yet another
dimension to the medicalization of family and kinship.
As Daniels (1997) demonstrates, the father's genetic contribution to his offspring's health state is invisible, disease in the child usually being attributed to the gestational mother. With the medicalization of family and
kinship the father's role in his offspring's health will
become more visible and he will need to accept responsibility in many new ways.
Richards may have overlooked my n. 7, in which I cite

The Kin in the Gene \ 259

Finch and Mason's work and indicate that there seems
to he some difference between the U.K., France, and the
United States regarding the role of the postmodern family in people's lives. His assertion that there is a similarity between open adoption and the use of donated eggs
is very interesting, but, as Bartholet (1993) observes, the
two must not be equated. His comment that adoptees'
searching for their hirth parents is probably as old as
adoption is an assertion that he fails to substantiate. As
I note, searches may have existed, but the rise of an
extensive search movement among adoptees corresponds
to the time when the ideology of genetic inheritance
came to the forefront in the 1960s (see Bartholet 1993,
Belkin 1999, Finkler 2000a, Modell 1994).
I concur with Richards that we need to see what is
new and what is not. Indeed, I have traced the history
of the concept of heredity elsewhere (2000^). Introduced
into the English medical literature between i860 and
1870, it no longer was simply a descriptive term that
denoted the transmission of property or physical and
moral qualities but became a "self-sufficient cause" (Lopez-Beltran 1994; see also Rosenberg 1976).
I especially value Hadler and Evans's response because,
as physicians and geneticists, they bring a biomedical
perspective to the analysis. It is rewarding to find one's
conclusions corroborated when one is treading on another's territory. Hadler and Evans stress, as I do, the
incontrovertible evidence that certain diseases are inherited genetically, and they have identified better than
I have which diseases follow a predictably inherited pattern. Yet, they, too, lament the genetic determinism that
is manifested in the medicalization of family and kinship. For example, they call attention to the fiaws of
medical surveillance of ovarian and breast cancer and
the dubiousness of genetic testing. Their observation
that "whether one develops any disease has less to do
with 'nature or nurture' than with chance" is especially
insightful.
But to accept the notion of chance is to be willing to
live with uncertainty to which human beings cannot
easily submit. To be human is to impose order and meaning on the reality of chaos. This has heen the work of
religion (Berger 1969) and now is also the work of biomedicine. As many of the afflicted recognize, humans
reject the notion of randomness, a "roll of the dice." In
fact, one of the reasons that sacred healing attracts so
many people is the quest for certainty (Finkler 1994).
Genetic determinism promotes a sense of certainty, and
with this certitude comes a sense of control. Eve is able
to do something about the "certainty" that she will become affiicted. Paradoxically, people in her situation
may also contemplate the idea of predestination that is
embedded in genetic determinism in the same way as,
as Melhuus points out, people may hold both cultural
and biological models at the same time. One of the
women I interviewed had a prophylactic mastectomy in
an attempt to control the risk of getting cancer owing
to her family medical history and was dismayed and morally indignant when she nevertheless became affiicted
with breast cancer (Finkler 2ooofl).

Hadler and Evans are not social constructivists; it is

precisely because they are scientists that they can see
the fiaws in genetic determinism. The ideology of genetic inheritance bridges positivism with postmodernism, and so, I helieve, does my work. As Sachs intimates,
I have attempted to steer clear of the "culture wars." In
my long experience as an anthropologist, my theoretical
approach has been pragmatic. By this I mean that my
starting point has always been a question about human
life for which I seek answers in ethnographic work and
empirical data. Whatever theoretical approach illuminated that question was the one I would use. A quantitative, more positivistic approach may he useful for
some questions but not for others (see Finkler 1991).
Thus, in much of my work I have comhined positivistic,
social constructivist, and political-economic approaches
without feeling a traitor to any one of these. For example,
as I show in another place (Finkler 2oooi>; also 1991),
biomedicine becomes constructed in United States and
reconstructed in another cultural venue, such as Mexico,
but, I argue, we must nevertheless question what exactly
is being constructed and what remains invariant in diverse cultural settings.
While I do not douht for a moment that kinship reckoning and family structure are social and cultural constructs, can we say the same for genetic inheritance?
Whereas extreme social constructivism may even say
that there is no objective reality, cancer is palpable today
as it was for ancient Egyptians and Greeks, who described it and their understanding of its causes (Finkler
2000a). Breast cancer is no more socially constructed
than tuberculosis or amoebiasis, hut the explanation for
its occurrence, its etiology, and the meaning we give it
are socially constructed. In seeking explanations for their
suffering, human beings the world over have developed
etiological theories of diseasewhether witchcraft, invasion by evil spirits, punishment by a deity, ancestral
ghosts, and an inimical environment or, in Western biomedicine, the failure of body parts, invasion by pathogens, contagion, trauma, stress, aging, and heredity. To
make sense of human beliefs and practices, I have drawn
upon a modified social constructivist perspective that I
believe has always been intrinsic to anthropological discourse by the very nature of its preoccupation with the
concept of culture. I depart from the strict constructivist
view, however, in helieving that there is a reality independent of our cultural productions. Genetic transmission is not purely a social construction, as any victim,
of, say, Huntington's disease will attest. I consider the
presence of a reality, say, of DNA molecules, which, paradoxically, cannot exist without being culturally interpreted. In this manner, we can avoid the dualism that
rightly concerns Franklin and retain the realism that
Sachs insists on. Sachs is correct in saying that postmodernism and social constructivism must be approached with caution, as I have tried to do here. However, in the instance of the ideology of genetic
inheritance, the issue may not be the binarism of nature
vs. culture but, as Hadler and Evans assert, the random-

26o I CURRENT ANTHROPOLOGY Volume 42, Number 2, April 2001

ness of genesunless, of course, one wishes to reduce

the notion of randomness to a social construction.
In the end, whether cultural beliefs and practices are
socially constructed or rooted in an objective reality may
arguably be less significant than how the individual, as
agent, experiences and negotiates them. To assess this,
we cannot simply theorize but must meticulously observe and carefully listen to the culture bearers. This is
why I said that I do not question the truth or falsity of
the ideology of genetic inheritance.
This meditation on the conflict between constructivism and positivism is my attempt to deal with a dilemma
that is difflcult to resolve for oneself, let alone for human
experience. Arguably, this is just one step in that
direction.

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