Biological ancestry is an important part of genetic counseling. Sometimes we call it race or ethnicity, or ask “What countries are your ancestors from?” I am not quite sure what the difference is between race and ethnicity, though in the workaday world of genetic counseling, I over-simplify it for myself by thinking of race, or more precisely, biological ancestry as relevant to genetic disease issues whereas ethnicity reflects sociocultural issues that are relevant to the counseling end of things.
There is much debate about the ethics, meaning, and utility of the terms “race” and “ethnicity.” The arguments for and against these concepts are intricate and complicated; just thinking about them gives me a headache. While the debate is important to genetic counseling, I want to put those arguments aside for a moment. Instead I want to look at the ways that patients respond to the question about their ancestry, and what those responses tell us about social issues, family relationships, stereotyping, and prejudice.
We have all heard many responses when we pose the question of biological ancestry to patients. The puzzled look, followed by “White.” The consumer-society influenced “Heinz 57.” The patriotic “American.” The historical “My family has been here since the Mayflower” (given the number of times I’ve heard that one, the Mayflower must have held more passengers than Royal Caribbean’s Oasis of the Seas). Of course, many patients are proud of their ancestry.
Responses sometimes reflect social issues. In 1983 when I first started as a genetic counselor, my patients rarely answered that they were Native American. Over time, a certain amount of cachet has become attached to being at least partially Native American, that it somehow makes you exotic or cool if you have some “Indian blood.” Now a surprising number of my patients claim to have Native American ancestry. Yet when carefully questioned as to who in their lineage was Native American, the answer is often along the lines of “Well, my great-great-grandfather lived next door to someone who knew a Cherokee.” In many cases, if they had a nosebleed, they would lose their “Indian blood.” It is an interesting example of how, over time, intense hatred can evolve into a distorted sense of pride toward a population group, an attitude shift which no doubt many Native Americans find questionable.
A patient’s answer may provide some insight into family dynamics. For example, the patient may say they are Swedish. When asked if they are full Swedish, the response can be “Well, we’re also German and Polish on my mother’s side, but my father was full Swedish and we were closer to his family, so we always say we are Swedish.”
Sometimes, prejudice and stereotype rear their ugly heads. I have particularly noticed this when I ask if the patient is Ashkenazi Jewish. More than once, I have gotten a harsh response along the lines of “I ain’t no Jew” accompanied by a derisive facial expression. More subtle stereotyping is evident when patients remark “Well I don’t think I am Jewish but I have a big nose” or “Maybe. I am very good with money.” Then they look nervously at me. Many patients think that I am Jewish, as do many of my colleagues. As much as we don’t like to admit it, we all engage in some level of stereotyping and apparently I fit a common Jewish stereotype – educated, from the East Coast, healthcare professional, a physical appearance that roughly conforms to an idea of “Jewish.” In fact, I am a (ex)Catholic whose grandparents were born in Italy and Poland. Either verbally or with expressions, patients indicate that they are unsure if I am Jewish and worry that their remark offended me. In some weird way I feel like a “victim” of prejudice toward a group that I am not even a member of. The remarks are slightly offensive, but not in the same way they would be to a counselor who is Jewish. Rarely do I hear a patient claim to be Jewish when they are not. Apparently, Native American is much higher on the Racial Coolness Hierarchy Scale than Jewish.
These peculiarities about biological ancestry also play out in the world of genetic ancestry testing. Just what value is that information for one’s sense of self? Is it merely an innocent curiosity, or is there a darker underlying truth about how people conceptualize race or ethnicity? Do people think DNA variants and country of origin are somehow biologically tied to behavior and temperament? If you discover that one of your haplogroups is common in Ireland, will you start drinking excessive amounts of alcohol, have large dysfunctional families, develop a new interest in Lords of the Dance, and write great literature (or whatever your stereotype of how an Irishman behaves) simply because of some DNA polymorphisms? Remember, too, that ultimately we are all out of Africa, wherever our ancestors paused or whoever they bred with along the way.
I would like to hear your experiences and thoughts about asking patients about their ancestry. Please leave comments; they are what make blogs interesting.