Stigma, shame and family secrets as consequences of mental illness in previous generations: A micro-history approach.

In this article we evaluate micro-history as a method for investigating the meaning of stigma, shame and family secrets through generations. We present micro-histories of two Australian soldiers who developed mental illness years after serving in World War 1 and were committed to a psychiatric hospital where they died. Data were drawn from publicly available records and interviews with family members. The contrasting stories held by the families of each man illustrate the transmission of stigma and secrets through families. We explore possible reasons for the differences between the families related to the wider literature on stigma and mental health and show why the family stories people present should be considered social constructions rather than facts. We also address ethical issues that arose during the research, and which have relevance for researchers investigating sensitive or potentially stigmatising topics.

Searching for secrets, searching for self: Childhood adversity, self-concept clarity, and the motivation to uncover family secrets through direct-to-consumer genetic testing.

Direct-to-consumer (DTC) genetic tests have become an attractive product for those hoping to gain insight into their health, ancestry, and biological relatedness. In some cases, test results are unexpected, and lead to the revelation of previously undisclosed family secrets. A subset of individuals may pursue testing explicitly for this purpose; however, the psychosocial processes underlying this motivation remain unexamined. Grounded in the literature on family secrecy, trauma, and the development of self-concept, we tested a hypothesized mediation model to provide insight into this motivation among a sample of 433 individuals in pursuit of DTC genetic testing. In line with the documented association between maladaptive family communication patterns and trauma exposure in childhood, we found that exposure to adverse childhood experiences was associated with the motivation to pursue DTC genetic testing for the purpose of uncovering family secrets. We also found evidence of an indirect effect through reduced self-concept clarity. These findings suggest that impaired identity formation processes may have played a role in transmitting the effect. Furthermore, the findings highlight a novel way in which family histories may contribute to DTC genetic testing motivations. Future examination of these and other psychosocial phenomena that contribute to DTC genetic testing will be crucial to consider as the tests become increasingly accessible, and as the information they can provide becomes increasingly comprehensive. Findings from this line of research could help to identify for whom and under what conditions DTC genetic testing benefits well-being, and the conditions under which the act of testing and receipt of results could have adverse psychosocial effects. These insights will be of interest to genetic counselors working in the field of DTC genetic testing, and those working with individuals and families affected by unexpected test results.

Family secrets: Experiences and outcomes of participating in direct-to-consumer genetic relative-finder services.

In recent decades, genetic genealogy has become popular as a result of direct-to-consumer (DTC) genetic testing. Some DTC genetic testing companies offer genetic relative-finder (GRF) services that compare the DNA of consenting participants to identify genetic relatives among them and provide each participant a list of their relative matches. We surveyed a convenience sample of GRF service participants to understand the prevalence of discoveries and associated experiences. Almost half (46%) of the 23,196 respondents had participated in GRF services only for non-specific reasons that included interest in building family trees and general curiosity. However, most (82%) also learned the identity of at least one genetic relative. Separately, most respondents (61%) reported learning something new about themselves or their relatives, including potentially disruptive information such as that a person they believed to be their biological parent is in fact not or that they have a sibling they had not known about. Respondents generally reported that discovering this new information had a neutral or positive impact on their lives, and most had low regret regarding their decision to participate in GRF services. Yet some reported making life changes as a result of their discoveries. Compared to respondents making other types of discoveries, those who learned that they were donor conceived reported the highest decisional regret and represented the largest proportion reporting net-negative consequences for themselves. Our findings indicate that discoveries from GRF services may be common and that the consequences for individuals, while generally positive, can be far-reaching and complex.

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study.

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.

El propósito de este estudio de un grupo focal fue analizar las experiencias de los terapeutas familiares que trabajan con el secreto familiar. Nuestro estudio destaca que los secretos familiares presentan desafíos importantes y emocionantes para los terapeutas familiares. Además, nuestro estudio revela que parece haber algunas estrategias básicas que usan los terapeutas familiares a la hora de manejar estos desafíos en las sesiones de terapia. Una estrategia básica es que los terapeutas familiares tratan de proteger su postura de ser un terapeuta confiable para cada miembro de la familia evitando atascarse en el secreto familiar. Es más, los terapeutas analizan maneras de guiar a la familia hacia la revelación del secreto a fin de aliviar la toxicidad del misterio. Esto destaca la importancia del modelo sistémico y cuán influyente es esta perspectiva en la práctica de la terapia familiar. Sin embargo, algunos participantes tienen además una segunda estrategia que a veces usan: hablar con la familia acerca del secreto sin pretender que se revele el secreto. En la sección de debate del artículo, reflexionamos sobre la posibilidad de que en las elecciones estratégicas que hacen los terapeutas familiares podrían estar implicados aspectos conceptuales. Por otro lado, subrayamos la importancia de continuar investigando.

Influência do segredo na dinâmica familiar: contribuições da teoria sistêmica / Secrecy and its influence on family dynamics: contributions of the systems theory

Este estudo de caso teve como objetivo ilustrar e compreender a dinâmica de uma família em situação de vulnerabilidade social, considerando os segredos familiares que a permeavam. Relatou-se e discutiu-se um processo de terapia familiar do qual participaram uma senhora, seus dois netos e três bisnetos, atendidos no serviço-escola de uma universidade brasileira. Destacou-se a presença de segredos mantidos com o objetivo de proteção mútua, bem como a aprendizagem de padrões de omissão de informação pelas crianças. Entre as repercussões do segredo, identificaram-se comportamentos sintomáticos que podem ser compreendidos como uma forma de lidar com a ansiedade gerada por esses segredos e uma sensação de insegurança nos relacionamentos. Os segredos mantidos por essa família, que vivia uma situação de vulnerabilidade social, mostraram-se como fatores de risco adicionais a todas as dificuldades já enfrentadas. Os segredos minavam e obscureciam seus recursos familiares, impedindo que contassem com o apoio uns dos outros.(AU)

This case study aimed to illustrate and to comprehend the dynamics of a social vulnerable family, considering their family secrets. Their family therapy process was related and discussed. A woman, her two grandchildren and three great-grandchildren participated in family therapy sessions conducted in a Brazilian university clinic. Secrets aimed to protect other family members were prominent, as also the learning, by the children, of communicative process characterized by concealments. Their family secrets brought as repercussions: symptomatic behaviors comprehended as a mechanism to cope with the anxiety caused by the secrets, and relationship insecurity. The secrets kept by this family, which lived in a social vulnerability situation, acted as additional risk factors to the difficulties already faced by them. The secrets damaged and hided their family resources, preventing their mutual support.(AU)

Children of parents with alcohol problems performing normality: A qualitative interview study about unmet needs for professional support.

BACKGROUND: Children of parents with alcohol problems are at risk for serious long-term health consequences. Knowledge is limited about how to recognize those in need of support and how to offer respectful services. METHOD: From nine interviews with adult children from families with alcohol problems, we explored childhood experiences, emphasizing issues concerning potentially unmet needs for professional support. Smart's perspective on family secrets and Goffman's dramaturgical metaphor on social order of the family focusing on the social drama and the dramaturgy enacted by the children supported our cross-case thematic analysis. FINDINGS: The social interaction in the family was disrupted during childhood because of the parent's drinking problems. An everyday drama characterized by tension and threats, blame and manipulation was the backstage of their everyday life. Dealing with the drama, the children experienced limited parental support. Some children felt betrayed by the other parent who might trivialize the problems and excuse the drinking parent. Family activities and routines were disturbed, and uncertainty and insecurity was created. The children struggled to restore social order within the family and to act as normally as possible outside the family. It was a dilemma for the children to disclose the difficulties of the family. CONCLUSION: Altogether, the children worked hard to perform a normally functioning family, managing a situation characterized by unmet needs for professional support. Adequate support requires recognition of the children's efforts to perform a normally functioning family.

On family secrets and -K.

In this paper I present a novel interpretation of family secrets. Leaning on Bion's concept of -K, the constitution of secrecy is interpreted in terms of family dynamics that actively prevent knowledge formation and mental growth. Family secrets are interpreted as a destructive process that attacks the family's truth-generating-space - the shared semiotic space within which meanings are constituted through family relationships. The paper explores the microstructure interpersonal process of -K through the analysis of Mike Leigh's movie, Secrets and Lies. Two scenes in the movie are used to demonstrate how -K is worked out in the form of a specific intersubjective semiotic endeavor that unconsciously blocks the process of meaning-making.

Will talking about it make it worse? Facilitating family conversations in the context of chronic and life-shortening illness.

This article explores secrecy and openness in the context of chronic and life-shortening illness. Illustrated by clinical work with families at the Center for Families and Health at the Ackerman Institute for the Family, I examine the impact of secrecy on family relationships, including the serious relational price of silence, the danger to physical and emotional well-being, and the formation of triangles. Through the stories of four families, I demonstrate ways to facilitate greater openness when illness pertains. The benefits to families of being able to speak with candor and authenticity are shown. The article concludes with a range of questions to guide the clinician.

Segredos de família: a contratransferência como recurso terapêutico / Family secrets: a therapeutic resource as countertransference / Secretos de familia: la contratransferencia como recurso terapéutico

Neste trabalho são apresentados desenvolvimentos teóricos que fundamentam a premissa de que a contratransferência pode ser utilizada pelo analista como um recurso privilegiado para a compreensão da dinâmica psíquica compartilhada pelos membros de uma família que se veem às voltas com segredos. A discussão é exemplificada por meio de uma vinheta clínica. Conclui-se que aquilo que não pode ser expresso verbalmente pela família é comunicado ao analista, que por sua vez pode entrar em contato com esses aspectos secretos por meio das vivências contratransferenciais.(AU)

In the present work, theoretical developments underlie the conceivable use of countertransference by psychoanalysts as a privileged resource to understand the psychic dynamics shared by family members that deal with secrets. The discussion is illustrated with a fragment of a case report. It is concluded that those things families can't express verbally are communicated to the psychoanalyst. The professional will be able to contact these secret aspects through experiences involving countertransference.(AU)

En el presente trabajo se presentan desarrollos teóricos que fundamentan la premisa de que la contratransferencia puede ser utilizada por el analista como un recurso privilegiado para la comprensión de la dinámica psíquica compartida por los miembros de una familia que se encuentra lidiando con secretos. La discusión se ilustra con una viñeta clínica. Se concluye que aquello que no puede ser expresado verbalmente por la familia es comunicado a el analista, que a su vez podrá entrar en contacto con esos aspectos secretos por medio de las vivencias contratransferenciales.(AU)

Segredos de família: a contratransferência como recurso terapêutico / Family secrets: a therapeutic resource as countertransference / Secretos de familia: la contratransferencia como recurso terapéutico

Neste trabalho são apresentados desenvolvimentos teóricos que fundamentam a premissa de que a contratransferência pode ser utilizada pelo analista como um recurso privilegiado para a compreensão da dinâmica psíquica compartilhada pelos membros de uma família que se veem às voltas com segredos. A discussão é exemplificada por meio de uma vinheta clínica. Conclui-se que aquilo que não pode ser expresso verbalmente pela família é comunicado ao analista, que por sua vez pode entrar em contato com esses aspectos secretos por meio das vivências contratransferenciais...

In the present work, theoretical developments underlie the conceivable use of countertransference by psychoanalysts as a privileged resource to understand the psychic dynamics shared by family members that deal with secrets. The discussion is illustrated with a fragment of a case report. It is concluded that those things families can't express verbally are communicated to the psychoanalyst. The professional will be able to contact these secret aspects through experiences involving countertransference...

En el presente trabajo se presentan desarrollos teóricos que fundamentan la premisa de que la contratransferencia puede ser utilizada por el analista como un recurso privilegiado para la comprensión de la dinámica psíquica compartida por los miembros de una familia que se encuentra lidiando con secretos. La discusión se ilustra con una viñeta clínica. Se concluye que aquello que no puede ser expresado verbalmente por la familia es comunicado a el analista, que a su vez podrá entrar en contacto con esos aspectos secretos por medio de las vivencias contratransferenciales...

Os prejuízos do segredo familiar / The damage of family secrets

Nesse trabalho encontram-se algumas questões suscitadas dentro do campo da clínica psicanalítica. A autora propõe uma articulação do adoecimento somático com a existência de segredos que provocam uma repetição de algo que deveria ser mantido oculto. Esses são da ordem de não-ditos advindos de lutos não elaborados de certos membros da família e que prejudicam a capacidade representacional do portador do segredo.

This article raises some issues abaut the field of psychoanalytic clinical practice. The author proposes an articulation of the somatic illness in regards whit the existence of secrets that cause a repetition of something that should have remained hidden, being such the unspoken unelaborated grieves that affect the representational capacity of the secret holder.

Os prejuízos do segredo familiar / The damage of family secrets

Nesse trabalho encontram-se algumas questões suscitadas dentro do campo da clínica psicanalítica. A autora propõe uma articulação do adoecimento somático com a existência de segredos que provocam uma repetição de algo que deveria ser mantido oculto. Esses são da ordem de não-ditos advindos de lutos não elaborados de certos membros da família e que prejudicam a capacidade representacional do portador do segredo (AU)

This article raises some issues abaut the field of psychoanalytic clinical practice. The author proposes an articulation of the somatic illness in regards whit the existence of secrets that cause a repetition of something that should have remained hidden, being such the unspoken unelaborated grieves that affect the representational capacity of the secret holder (AU)