obscure the more common likelihood that they are symptomatic of emo¬ tional disturbances in the parents and are contributing to emotional distur¬ bances in the children. Rather, the point of these observations is similar to that made so well in the accompanying article (see 127): namely, that clinicians need to avoid overgeneralized, preconceived notions if they are to provide adequate care to families in which incest has occurred.

Like other conditions that come to the pediatrician's attention, incest requires careful differential diagnosis and treatment planning, so that clin¬ ical attitudes and actions are tailored to meet the particular patient's needs. Some children who have been involved in incest may require psychotherapy, whereas others may have no need of psychological intervention; some may benefit from being taken out of their home or having their parents sepa-

rate, whereas for others such changes in their family context will have many more detrimental than beneficial ef¬ fects. These and similar considera¬

tions, weighed against an accurate clinical perspective on incest, need to

guide

the

management of these

cases.

IRVING B. WEINER, PHD Case Western Reserve University Cleveland, OH 44106

References 1. Weiner IB: Father-daughter incest: A clinical report. Psychiatr Q 36:607-632, 1962. 2. Weinberg SK: Incest Behavior. New York, Citadel Press, 1955. 3. Masters REL: Patterns of Incest. New York, Julian Press, 1963. 4. Freud S: Totem and Taboo, standard edition. London, Hogarth Press, vol 13, 1955. 5. Adams MS, Neel JV: Children of incest.

Pediatrics 40:55-62, 1967. 6. Cavallin H: Incestuous fathers: A clinical report. Am J Psychiatry 122:1132-1138, 1966. 7. Cormier BM, Kennedy M, Sangowicz J: Psychodynamics of father-daughter incest. Can Psychiatry Assoc J 7:203-217, 1962. 8. Lukianowicz N: Incest. Br J Psychiatry 120:301-313, 1972. 9. Machotka P, Pitman FS, Flomenhaft K:

Incest as a family affair. Fam Proc 6:98-116, 1967. 10. Weiner IB: On incest: A survey. Escerpt Crim 4:137-155, 1964. 11. Yorukoglu A, Kemph JP: Children not severely damaged by incest with a parent. J Am Acad Child Psychiatry 5:111-124, 1966.

Incest: Genetic Considerations Brother-sister and father-daughter incest is far from a rare occurrence and Weitzel et al (see p 127) are correct to emphasize the need for empathetic support for the involved daughters and brother and sisters. However, we must not lose sight of the children who may, or in fact do, result from such unions. The women involved are almost invariably young,1 a fact that adds a well-recognized increase in mortality and morbidity among the resulting children. More importantly, progeny of incestuous unions have an inbreeding intensity four times that of first cousin marriage. Data suggest2 that there is a 4% to 5% greater frequency in death plus major congenital defect in children of first cousins compared

with control children. In the children of a first cousin marriage, the probability that a child will be homozygous for a specific gene present in one of the grandparents is .0625. In the child of incest, the same probability is .250. A simple linear extrapolation from studies of first cousin marriage to the outcome of incestuous union would call for a 16% to 20% increase in death, plus defect. Adams and Neel1 ob¬ served a 28% increase among 18 cases of incest and a comparison group. In addition to the predicted in¬ creased frequency of children homozy¬ gous for rare recessive deleterious genes, there also appears to be an increase in conditions thought to be under polygenic control. Thus, of prospectively ascertained children of

incest who were followed up for more than one year, approximately one half showed significant developmental lag suggesting mental deficiency. All in all this prognosis suggests that physi¬ cians caring for these children be advised of the genetic consequences of incest. MORTON S. ADAMS, MD University of Rochester School of Medicine Rochester, NY 14522

References 1. Adams MS, Neel JV: Children of incest. Pediatrics 40:55-62, 1967. 2. Neel JV, Schull WJ: The effect of inbreeding on mortality and morbidity in two Japanese cities. Proc Nat Acad Sci USA 48:573, 1962.

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Incest: genetic considerations.

obscure the more common likelihood that they are symptomatic of emo¬ tional disturbances in the parents and are contributing to emotional distur¬ banc...
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