PAC 230 Module 7 Family History and Beliefs About Destiny Example

"It Runs in the Family": Fatalism, Genetic Essentialism and Talking About Inherited Risk Without Taking Away Hope

Student Name

Psychology and Addiction Studies Program, Aspen University

PAC 230: Families and Health Psychology

Instructor Name

Month Day, Year

"It Runs in the Family": Fatalism, Genetic Essentialism and Talking About Inherited Risk Without Taking Away Hope

Over one month, in three separate appointments at the family's clinic, three Dawsons said versions of the same thing. Walt, seventy-four, recovering from a heart attack, told his cardiologist, "Dawson men don't see seventy. My father went at sixty-two, his father at fifty-eight. I'm living on borrowed time." Carla, forty-nine, told the health coach that her prediabetes did not surprise her: "My mother had diabetes, her sisters had it. It's just a matter of time." And Mike, twenty-six and in recovery from opioid use, told his counselor that addiction is in his blood: "My great-grandfather drank himself to death. I never had a chance." Each statement contains truth, and each carries a risk: that believing an outcome is inherited will make it feel inevitable. This paper examines those beliefs. The Dawsons are composites built for this course and the clinic is fictional, while the research is real.

How People Judge Family Risk

Walter et al. (2004) synthesized qualitative studies of how ordinary people make sense of a family history of the common chronic illnesses that cluster in families. People did not calculate risk the way clinicians do. Instead, they built a sense of vulnerability from their own experience of the family. The number of affected relatives mattered, as did how emotionally close those relatives were, how young they were when they became ill or died and how much the person resembled them, in looks, personality or habits. Witnessing a relative's illness up close often made the risk feel vivid and personal. Some people responded by feeling that their fate was sealed; others felt prompted to take action, such as screening or lifestyle change. Many held both views at different times, sometimes in the same conversation.

The Dawsons' beliefs follow this pattern closely. Walt saw his father and grandfather die young, and people tell him he looks just like his father. Carla nursed her mother through diabetes complications. Mike grew up hearing about his great-grandfather and sees himself as the one who inherited the family weakness.

Genetic Essentialism

Dar-Nimrod and Heine (2011) described genetic essentialism, a set of beliefs that people often hold about genes. Genes are seen as immutable, unchangeable and therefore fixing outcomes; as specific causes, so that a gene for a condition determines it; as defining natural, discrete groups of people; and as the natural essence of a person. The authors reviewed research showing that when people encounter genetic explanations for conditions, they tend to see outcomes as more fixed and less controllable. In health, genetic essentialism can produce fatalism: if a condition is in my genes, my behavior does not matter. The authors noted that this view misunderstands genetics, since most conditions involve many genes interacting with environment and behavior, and genetic risk changes probabilities rather than fixing outcomes.

Does Knowing Genetic Risk Change Behavior?

One might expect that telling people their genetic risk would motivate change, or, if essentialism holds, that it would discourage it. Hollands et al. (2016) pooled randomized trials in which people received estimates of their genetic risk for diseases, based on DNA analysis, and their behavior was measured afterward. Communicating genetic risk had little or no effect on smoking cessation, diet or physical activity. Importantly, the review also found no evidence that receiving genetic risk information reduced motivation or caused people to give up. The findings suggest that risk information alone, whether alarming or reassuring, rarely changes behavior; what people do depends on other things, such as their confidence, supports and plans.

Reframing the Beliefs

Guidance for Conversations

Several practices follow from the research. First, ask what family history means to the person before giving information, since their sense of risk comes from lived experience that statistics alone will not change. Second, acknowledge the risk honestly; denying it would undermine trust. Third, separate what was inherited from what was shared: Walt's father and grandfather shared his genes but also smoked heavily and had no access to modern cardiac care. Fourth, emphasize changeable factors and the actions the person is already taking. Fifth, use family examples of change. In the Dawson family, Walt quit smoking after forty years, Mike is in recovery and Carla has begun walking. These are the strongest evidence that the family's story is not fixed, and they carry more weight with the Dawsons than any statistic because they come from people the family knows and trusts.

When Fatalism Protects

Fatalistic statements sometimes serve a purpose. Walt's "borrowed time" may be a way of managing fear, and Mike's "I never had a chance" may express shame about his addiction. Helpers should listen for these feelings rather than only correcting the belief. A counselor might say to Mike, "It sounds like you've carried a lot of shame about this," before turning to the evidence about heritability and recovery.

Conclusion

The Dawsons' beliefs about their inheritance feel true because they come from relatives they loved and watched suffer. Walter and colleagues explain how people form these judgments, Dar-Nimrod and Heine explain why genetic explanations can feel like fate and Hollands and colleagues show that risk information alone rarely changes behavior. Conversations that acknowledge risk, separate inheritance from circumstance and point to relatives who changed can help the Dawsons see family history as a reason to act, not a sentence.

References

Dar-Nimrod, I., & Heine, S. J. (2011). Genetic essentialism: On the deceptive determinism of DNA. Psychological Bulletin, 137(5), 800-818. https://doi.org/10.1037/a0021860

Hollands, G. J., French, D. P., Griffin, S. J., Prevost, A. T., Sutton, S., King, S., & Marteau, T. M. (2016). The impact of communicating genetic risks of disease on risk-reducing health behaviour: Systematic review with meta-analysis. BMJ, 352, i1102. https://doi.org/10.1136/bmj.i1102

Walter, F. M., Emery, J., Braithwaite, D., & Marteau, T. M. (2004). Lay understanding of familial risk of common chronic diseases: A systematic review and synthesis of qualitative research. Annals of Family Medicine, 2(6), 583-594. https://doi.org/10.1370/afm.242