An individual’s ability to choose an identity is constrained by social structure, context, and power relations. Structural constraints on identity formation cannot be ignored, as people do not exist as free floating entities but instead are influenced and constrained in various ways by their socioeconomic and geographical environment . As such, an identity is not just claimed by an individual but is also recognized and validated by an audience, resulting in a dialectical relationship between an individual and the surrounding social structures . Similarly, a ‘new’ perspective on ethnic identity specifically has emphasized the fluidity and contextually-dependent nature of ethnicity, minimizing notions about ethnicity as a cultural possession or birthright and instead emphasizing ethnicity as a socially, historically, and politically located struggle over meaning and identity . Ethnicity or ethnic identity is not some immutable sense of one’s identity but rather something produced through the performance of socially and culturally determined boundaries . Hence, individuals are not passive recipients of acquired cultures but instead active agents who constantly construct and negotiate their ethnic identities within given social structural conditions . In spite of these sociological contributions, which have enriched our understanding of identity generally and ethnicity specifically, the alcohol and drugs fields have not adequately integrated these perspectives, thwarting our ability to understand the relationships between ethnicity and substance use. As such,how to dry cannabis the field is ripe with correlations between ethnic group categories and substance use problems, resulting in solutions to problems that focus on reifying questionable social group categorizations and revealing little about how drugs are connected to identities and shaped by broader social and cultural structures.
It is important to note that we do not intend to argue that existing categories of ethnicity be disregarded in the alcohol and drugs fields. As Krieger and colleagues have noted in another context , surveillance data documenting health disparities, in our case in substance use, are exceedingly important in terms of identifying potential inequities in health. However, without understanding the complexity of ethnic identity and its relationship to substance use, these surveillance data may perpetuate stereotypes and the victimization of specific socially-delineated ethnic groupings, obfuscate the root causes of substance use and elated problems, and reify politicized categories of ethnicity which may have little meaning for the people populating those categories. While acknowledging that socially-deliented ethnic categories are important for documenting social injustices, we must also be vigilant about questioning the appropriateness of those categories . Conceptually this type of critical approach is important for considering how substance use is related to negotiations of ethnicity over time and place and bounded by structure. Maintaining a static and homogenous approach towards ethnic categorizations in the alcohol and drugs fields presents at least two problems. First, it risks overlooking how drugs and alcohol play into a person’s negotiation of identity, particularly ethnic identity, thus revealing little about the pathways that lead to substance use. Cultural researchers have long emphasized the importance of commodity consumption in the construction of identities and lifestyles , particularly within youth cultures , and how it can be an important factor in demarcating and constituting social group boundaries .
A limited body of research in the alcohol and drugs field has emphasized the role of substance use in constructing and performing identities , particularly ethnic identities , uncovering how subgroups within traditionally-defined ethnic minority categories use drugs and alcohol to distinguish themselves from ethnically similar others. For example, in a qualitative study of Asian American youth in the San Francisco Bay area in the US, narratives illustrated how youths’ drug use and drug using practices were a way of constructing an identity which differentiated them from “other Asian” youth groups, specifically allowing them to construct an alternative ethnic identity that set them apart from the “model minority” stereotype . Thus taste cultures and consumption-oriented distinctions highlight the continuing salience of and interconnections not just between substance use and changing notions of ethnicity but also between substance use, class and ethnicity. Ethnic identity gets translated into social captial which in turn has ramifications for one’s economic and social standing . Second, failing to critically appraise our use of fixed and homogenous ethnicity categories in the alcohol and drugs fields jeopardizes our ability to identify the broader social and structural determinants of alcohol and drug use and related problems—like poverty, social exclusion, and discrimination—which are crucial issues for addressing social injustices. So often studies revealing correlations between ethnic categories and substance use related problems result in discussions about the importance of developing culturally-appropriate prevention and treatment interventions, overlooking the structural conditions that adversely affect socially-defined ethnic groupings and may result in some form of engagement with alcohol and/or drugs.
For example, research on street cultures, where ethnic identifications and drugs play a central part, illustrates how some ethnic minority youth use and/or sell drugs to actively construct counter-images or ethnically-infused street cultures of resistance within their neighborhoods, which some researchers have called “neighborhood nationalism” , as a way of resisting or transcending “inferior images” ascribed to them by the wider society . These street cultures provide alternative definitions of self-identity, especially for young men, who live in communities marked by poverty and marginalization and who have little access to masculine status in the formal economy . Such cases clearly show how drug use and sales is not the fault of the individual or a deficiency resulting from one’s ethnicity, but instead from a deficiency in society. Ethnic categorizations saturate our society, are imbued with a shared meaning, and in many cases, influence those assigned to specific categories regardless of whether or not they identify with the categorization. But these studies also emphasize how ethnicity is fluid and in constant negotiation, depending upon context and bounded by powerful structures. It is this element of ethnicity that is currently neglected in the alcohol and drugs fields yet also has important implications for understanding patterns of alcohol and drugs use and identifying the roots causes of inequities among those most oppressed. We call on researchers in the alcohol and drugs research fields to critically appraise their use of ethnic categorizations, querying how to best measure ethnicity within their own studies in ways that are justified beyond simplified of explanations of social convention and that ”do no harm” in terms of perpetuating racism as well as obscuring the root causes of social and health problems related to alcohol and drugs. A substantial number of studies using diffusion tensor imaging techniques have shown white matter abnormalities in schizophrenia and in first-episode psychosis , which include widespread decreased fractional anisotropy in WM tracts.These findings have been replicated in samples of high-risk for psychosis subjects and never-medicated FEP.However, some of these results have been reported in regions that do not coincide between studies using different clinical samples, such as naive vs medicated subjects, and first-episode vs established schizophrenia.Moreover, potential confounding factors such as age,gender,and cannabis use have been reported in the interpretation of FA betweengroup differences. To better understand the biological role of WM abnormalities in schizophrenia, the literature emphasizes the need for additional studies using a longitudinal approach, the use of homogeneous samples, and more accurate and reproducible measurements.In this line, Pasternak et al published the results of an analysis using a bi-tensor model that allows an accurate estimation of the DTI tensor while mitigating partial volume effects, such as voxels containing WM tracts and water from cerebrospinal fluid or edema surrounding the tracts. Following this method, the tensor is calculated without averaging the compartments,best way to dry cannabis which could otherwise induce a biased estimation of the diffusion parameters.This method provides a novel measure of the presence of extracellular free-water in brain tissue, which can be measured in both WM and gray matter . Elevated FW may suggest edema or neuroinflammation, as these processes involve an increased release of water to the extracellular space. However, other processes may also result in FW increases including edema or proximity to CSF, and FW imaging does not disambiguate these causes. Using this methodology, an initial small sample study in subjects with first-episode schizophrenia showed a significant increase in FW in both WM and GM), and, in contrast, a fairly limited number of regions with decrease in fractional anisotropy corrected by FW FAt.Further studies using this technique in patients with chronic schizophrenia found limited increases in FW and significant, albeit quite localized, decreases in FAt compared to controls.
These findings were more localized than those reported in the literature measuring FA without FW correction.In summary, cross-sectional studies in different phases of psychosis suggest the presence of elevated FW with limited decreases in FAt in the early phases, while findings in more established illness include a more modest elevation of FW and a heightened decrease in FAt. The present study uses a longitudinal approach in subjects at the early phase of the illness to directly address the time course of changes in these measures during the early course of psychotic illness. Moreover, FW increases in WM have been linked to symptoms such as delusions in chronic schizophrenia and, counter intuitively, to better cognitive functioning. However, it remains unclear how FW increase is related to negative symptoms, illness severity, illness progression, or clinical outcomes, which could be better elucidated using longitudinal studies. Furthermore, the biological underpinnings of these findings are not yet fully understood. Previous findings converge to suggest the evidence of a neuroimmune process in schizophrenia: Elevated pro-inflammatory markers have been reported in the serum of schizophrenia patients; GM volume reductions in schizophrenia have been related to elevated neutrophil cell count; and evidence of anti-inflammatory properties of antipsychotics has also been reported.In this regard, the excessive extracellular water in first-episode subjects has been hypothesized to rely on inflammatory processes,and, in this line, a recent study has shown an inverse correlation between increased FW in GM and glutathione measured by magnetic resonance spectroscopy in first-episode schizophrenia subjects.Notwithstanding the relation between FW and inflammation is not fully understood, and no studies have tested the correlation between FW elevation and other peripheral inflammatory markers such as neutrophil cell count. In this sense, previous to the search for a corresponding acute or chronic immune mechanism, it is crucial to determine the changes over time of FW and FAt abnormalities in psychosis. Surprisingly, no longitudinal studies have been published testing an FW change over time. The goal of the present longitudinal multi-center study was to utilize the extracellular FW elimination model to determine the presence of WM and GM alterations in FEP, along with any changes in these measures that may occur during the first 2 years of the illness. Based upon the available literature, we hypothesize that patients with FEP will show increased FW in both GM and WM that may decrease across time , as well as decreased FAt in WM along with the evidence of possible anti-inflammatory effects of antipsychotic treatment. All of our participants were engaged in coordinated specialty care for early psychosis during the follow-up period, and most were treated with therapeutic doses of antipsychotics during this time. Additionally, we aimed to investigate the clinical significance of FW abnormalities by examining their relationship with symptomatology and neutrophil cell count.In the present study, as predicted, we found elevated FW in GM and WM in FEP with schizophrenia spectrum disorders compared to controls. In contrast, non-SSD-FEP showed higher FW in GM, but not in WM. Both groups of FEP, SSD and non-SSD, showed FA and , although less so in the central GM surface.Electrical injury is responsible for approximately 1000 deaths and 3–5% of all burn admissions per year in the US. EI victims are not only hospitalized for burns, but also for skeletal muscle tetany, respiratory muscle paralysis, or ventricular fibrillation. However, these statistics do not include the victims that mainly suffer from the neuropsychological, neurological, and psychiatric sequelae associated with EI. While the past literature shows that EI sequelae is typically associated with burns due to the current’s thermal load and the body’s tissue resistance, the literature also shows that remote psychiatric effects are indicative of and distinct to EI. White matter abnormalities after EI have also been found on magnetic resonance imaging scans, particularly hyperintensities in the cerebral corticospinal tract.One morning in the spring of 2009, the 37-year-old patient was walking his dog in a densely populated city, when his dog stepped in a puddle of melted snow and suddenly jumped upwards, yelped, and started convulsing and defecating himself.