The Psychotropic Self/Imaginary: Subjectivity and Psychopharmaceutical Use Among Heroin Users with Co-Occurring Mental Illness

Many people diagnosed with mental illnesses struggle with illicit drug addiction. These individuals are often treated with psychiatric medications, yet little is known about how they experience this treatment. Research on the subjective experience of psychiatric medication use highlights the complex, contradictory, and ambiguous feelings often associated with this treatment. However, for those with mental illness and addiction, this experience is complicated by the need to manage both psychiatric medication and illicit drug use. Using ethnographic data from a study of heroin use in Northeast Ohio, we explore this experience by expanding the pharmaceutical self/imaginary (Jenkins, Pharmaceutical Self: The Global Shaping of Experience in an Age of Psychopharmacology, School for Advanced Research Press, Santa Fe, NM, 2010b) to include psychopharmaceuticals and illicit drugs, what we call the psychotropic self/imaginary. Through this lens we explore the ways participants interpret and manage their psychotropic drug use in relation to sociocultural, institutional, and political–economic contexts. This analysis reveals how participants seek desired effects of legally prescribed and illicit drugs to treat mental illness, manage heroin addiction, and maintain a perceived “normal” self. Participants manage their drug use using active strategies, such as selective use of psychiatric medications, in the context of structural constraints, such as restricted access to mental health care, and cultural contexts that blur distinctions between “good” medicines and “bad” drugs.     

Social Defeat or Social Resistance? Reaction to Fear of Crime and Violence Among People with Severe Mental Illness Living in Urban ‘Recovery Communities’

This article is propelled by recent theory positing that ‘social defeat’ is a common experience for people with severe mental illness, potentially affecting course and outcome. The primary objective is to investigate how far fear of crime and violence contributes toward ‘social defeat’ among people with mental illness. This is done through examining 6 years of ethnographic data collected from a sample of urban-dwelling people with severe mental illness, all securely-housed in apartments located in small scale “recovery communities.” Findings suggest that many participants living in the highest crime neighborhoods report that they deliberately restrict their temporal and spatial movement as a consequence of such crime. This hinders aspects of their recovery. Nevertheless, participants actively confront the nefarious affects of neighborhood crime by engaging in various empowering strategies of resistance. These include confronting disruptive people, fortifying homes, moving around the neighborhood in small groups and carrying objects such as umbrellas and canes that can be used in self-defense. Some reported that fear of crime directly contributed to the development of a rich and gratifying domestic life, centered on hospitality and religion. I conclude that participants partake in valiant and durable “social resistance,” and may better be perceived as imaginative and resourceful resistors, rather than passive victims of “social defeat.” An influential factor fostering such resistance is the “recovery community’ itself, which creates secure and reliable housing within a micro-community in which participants could thrive.     

Negotiating A Path To Efficacy At A Clinic Of Traditional Chinese Medicine

Chinese medicine emphasizes the underlying connection of the bodily, emotional, social, and environmental dimensions in illness experience and healing. The therapeutic process, characterized as tiao (attuning, balancing), targets the patient’s overall illness condition and experience including both physical and nonphysical aspects of suffering. This study, incorporating techniques of microanalysis as an ethnographic tool and using an actual recorded clinical interaction as data, analyzes how the path to effective healing is negotiated among multiple clinical realities at a clinic of Chinese medicine in Beijing. A close examination of interactive features of actual face-to-face communication between a doctor and a patient in a specific case of “stagnation of emotions” reveals that, for an illness recognized in Chinese medicine as originating from disordered emotions, adjustment of the patient’s perceptions of reality and social relations is particularly salient in the “attuning” process. Efficacy then should be understood as more than physiological changes produced by herbs, but also as emergent through an interactive event of clinical encounters. This study demonstrates empirically how the clinical process of Chinese medicine works to define and transform the patient’s emotions and experience.     

Inheritance of resistance to Plum pox virus in apricot (Prunus armeniaca L.)

The inheritance of resistance to Plum pox virus (PPV) has been studied in 1,178 apricot hybrids. Seven hundred and eighteen F1 hybrids, obtained from controlled crosses between the susceptible Greek cultivar “Bebecou” and the resistant PPV cultivars of American origin (“Stark Early Orange,” ‘NJA2,” ‘Veecot,” “Sunglo,” “Harlayne,” and “Orangered”) were evaluated for resistance to the PPV-M (Marcus) strain, 8 years after artificial inoculation. The inheritance of resistance to PPV has been additionally studied for the first time in a BC₁ population of 95 apricot hybrids for four vegetative periods. Reaction of each hybrid to PPV-M was scored through visual symptoms, indexing onto GF-305 and double-antibody sandwich enzyme-linked immunosorbent assay tests. Segregation within the hybrids, determined by Chi-squared analysis, fits a 1:1 ratio (P ≤ 0.05) of the resistant vs susceptible, indicating that resistance to PPV is controlled by a single dominant gene locus and that the above six resistant cultivars are heterozygous for the trait. Plants carrying this gene may initially develop disease symptoms on leaves but eventually recover and no virus can be detected in leaves. Susceptible plants show similar symptoms initially but remain symptomatic. Inheritance of resistance to PPV also has been studied in 365 F1 hybrids by crossing the resistant cultivar “Stella” with the susceptible “Bebecou” and the resistant cultivars “Sunglo” and “NJA2,” for 8 years after inoculation. The segregation ratio was 1:0 (resistant/susceptible) suggesting that “Stella” is homozygous for the resistance trait. The purpose of this work was the enhancement of the knowledge of inheritance of resistance to PPV for the selection of new cultivars.     

Traumatic Amputation: A Case of Laotian Indignation and Injustice

Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they relieve patient distress by allowing the patient to create meaning for symptoms. Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation (“Kwam khem keuang”) as an explanatory model for his ailment. He was diagnosed with post-traumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of the health care system and the specific context in which symptoms and their possible origins are recounted and explored. It also clarified to the treating clinicians some categories of experience and causal explanations that did not fit easily with western biomedical and psychiatric understanding. The case study illustrates how a cultural approach to illness from the patient’s perspective offers a reflexive stance on the clinician–patient interaction that allows for better patient care.     

Microheological properties of different erythrocyte populations in persons with elevated arterial pressure and in physically active persons

Microrheological properties (aggregation and deformability) of erythrocytes separated by centrifugation at 30000×g density gradient into “young” and “old” (the upper and lower fractions, respectively) were studied. The erythrocytes were taken from physically active persons (PAP) and from those with elevated arterial pressure (EAP). A significant difference in microrheological properties of the “young” and “old” erythrocytes was found. The aggregation degree of “old” cells was nearly twice that of “young” cells. The deformability of the erythrocyte subpopulations was significantly different, though the difference was not so pronounced as in the case of aggregation. The aggregation of “young” and “old” erythrocytes in the PAP group was the least (28% lower than in the control). Note, that “old” erythrocytes in the PAP group had better microrheological properties than in the other groups. All erythrocyte populations in the EAP group were characterized by higher aggregation, decreased deformability, and decreased capacity for oxygen transport.     

Source-sink landscape theory and its ecological significance

Exploring the relationships between landscape pattern and ecological processes is the key topic of landscape ecology, for which, a large number of indices as well as landscape pattern analysis model were developed. However, one problem faced by landscape ecologists is that it is hard to link the landscape indices with a specific ecological process. Linking landscape pattern and ecological processes has become a challenge for landscape ecologists. “Source” and “sink” are common concepts used in air pollution research, by which the movement direction and pattern of different pollutants in air can be clearly identified. In fact, for any ecological process, the research can be considered as a balance between the source and the sink in space. Thus, the concepts of “source” and “sink” could be implemented to the research of landscape pattern and ecological processes. In this paper, a theory of sourcesink landscape was proposed, which include: (1) In the research of landscape pattern and ecological process, all landscape types can be divided into two groups, “source” landscape and “sink” landscape. “Source” landscape contributes positively to the ecological process, while “sink” landscape is unhelpful to the ecological process. (2) Both landscapes are recognized with regard to the specific ecological process. “Source” landscape in a target ecological process may change into a “sink” landscape as in another ecological process. Therefore, the ecological process should be determined before “source” or “sink” landscape were defined. (3) The key point to distinguish “source” landscape from “sink” landscape is to quantify the effect of landscape on ecological process. The positive effect is made by “source” landscape, and the negative effect by “sink” landscape. (4) For the same ecological process, the contribution of “source” landscapes may vary, and it is the same to the “sink” landscapes. It is required to determine the weight of each landscape type on ecological processes. (5) The sourcesink principle can be applied to non-point source pollution control, biologic diversity protection, urban heat island effect mitigation, etc. However, the landscape evaluation models need to be calibrated respectively, because different ecological processes correspond with different source-sink landscapes and evaluation models for the different study areas. This theory is helpful to further study landscape pattern and ecological process, and offers a basis for new landscape index design. __________ Translated from Acta Ecologica Sinica, 2006, 26(5): 1444–1449 [译自: 生态学报]     

Chain processes and their biophysical applications: Part I. General theory

A mathematical theory applicable to the biological effects of radiations as chain processes is developed. The theory may be interpreted substantially as a “hit theory” involving the concepts of “sensitive volume” or “target area”. The variability of the sensitivity of the organism to the radiation and its capacity of recovery between single hits is taken into account. It is shown that in a continuous irradiation of a biological aggregate in which the effect of each single hit cannot be observed, recovery and variation of sensitivity are formally equivalent to each other so that a discrimination between these two phenomena is possible only by discontinuous irradiation or by using different radiation intensities. Methods for the calculation of the “number of hits” and for the determination of the kinetics of the processes from “survival curves” or similar experimental data are given. The relation between the recovery and the Bunsen-Roscoe law is discussed. The case in which the injury of the organism is dependent on the destruction of more than one “sensitive volume” is also considered.     

Increasing Knowledge of HIV Infection Status through Opt-Out Testing

The diagnosis of HIV infection is the point of entry for treatment and prevention services, yet many infected persons in both developed and developing countries remain undiagnosed. To reduce the number of undiagnosed infections, a variety of expanded testing policies have been recommended, including opt-out testing. This testing model assumes that in populations of increased HIV prevalence, voluntary testing should be offered to all patients seen in healthcare settings and performed unless patients specifically decline. While this approach raises ethical issues concerning “voluntariness”, access to care, and stigma, the potential benefits of opt-out testing far outweigh its potential adverse effects.     

Correlations between the psychological peculiarities of an individual and the efficacy of a single neurofeedback session (by the EEG characteristics)

Modifications of different EEG rhythms induced by a single neurofeedback session (by the EEG characteristics) directed toward an increase in the ratio of the spectral powers (SPs) of the α vs θ oscillations were compared with the psychological characteristics of the tested subjects (the group included 30 persons). A generally accepted neurofeedback technique was used; the intensity of acoustic white noise served as the feedback signal. EEG potentials were recorded from the C3 and C4 leads. Psychological testing was carried out using Eysenck’s (EPQ), Rusalov’s (OST), and (16 PF) questionnaires. The directions of changes in the SPs of EEG frequency components were found to significantly correlate with some individuality-related peculiarities of the tested subjects. The SP of the δ rhythm correlated with the EPQ scale “neuroticism,” OST scale “social plasticity,” and 16 PF factors H (“parmia”), I (“premsia”), and Q₃ (“self-control of behavior”). The SP of the θ component demonstrated correlations with the OST scales “ergisity,” “plasticity,” and “social temp” and with 16 PF factors M (“autia”), Q₄ (“frustration”), and Q1 (“exvia”). The SP of the α rhythm correlated with 16 PF factors Q₃ (“self-control of behavior”), G (“strength of superEgo”), O (“hypothymia”), L (“protension”), and N (“shrewdness”). The SP of the β rhythm correlated with the OST scale “emotionality,” while that of the γ rhythm showed correlations with the 16 PF indices L (“protension”) and M (“autia”). Changes in the ratio of the α vs θ SPs correlated with the EPQ scale “neuroticism.” Thus, our data confirm the statement that a high individual variability of the results of a single (first in the series) neurofeedback session is to a great extent related to peculiarities of the individual psychological pattern of the subject. Neirofiziologiya/Neurophysiology, Vol. 38, No. 3, pp. 239–247, May–June, 2006.     

Narrating Kidney Disease: The Significance Of Sensation And Time In The Emplotment Of Patient Experience

Drawing on research conducted among patients in Ireland, this article examines the narrative constructions of chronic kidney failure and explores the ways in which patient narratives cross-cut and subvert modernist medical constructions of transplantation as a therapeutic outcome, an endgame, a “gift of life.” In experience, patients dismantle this construction structure by emplotting their stories around the painful lack of an ending, ardently brought to bear by the lived realities of immunosuppressant drug therapy, the silent fears of graft rejection, and the isolation of recipiency. They articulate, instead, stories that disclose a multi-directional flow between past and future therapeutic interventions, between the altering nature of the renal body and personal experience. These storied dimensions are phenomenologically embedded in the sensory and temporal aspects of this condition as essential elements of chronic illness and as organizational properties of patient narratives.     

Transforming Our Thinking about Transitional Forms

A common misconception of evolutionary biology is that it involves a search for “missing links” in the history of life. Relying on this misconception, antievolutionists present the supposed absence of transitional forms from the fossil record as evidence against evolution. Students of biology need to understand that evolution is a branching process, paleontologists do not expect to find “missing links,” and evolutionary research uses independent lines of evidence to test hypotheses and make conclusions about the history of life. Teachers can facilitate such learning by incorporating cladistics and tree-thinking into the curriculum and using evograms to focus on important evolutionary transitions.     

Rare and infrequent southern African grasses: assessing their conservation status and understanding their biology

The taxonomic treatment for the grasses of southern Africa was one of the first to be based on computerised data and the DELTA system. These data, based on over 70,000 herbarium records, are amenable for analysis of species parameters including abundance, frequency and distribution. This information is suitable for the allocation of species into the seven categories of rarity proposed by Rabinowitz using a combination of habitat specificity (“Narrow” or “Broad”), population structure (“Sparse” or “Abundant”) and distribution (“Restricted” or “Widespread”). We compare the species lists obtained for each combination of these three aspects to published Red Data Lists (RDLs) for southern and South Africa. Ninety-three species are placed in the most sensitive or potentially threatened category (Narrow habitat, Sparse populations and Restricted distributions; RSN). This is substantially more than the number of species listed in current RDLs for the region. Chi-square tests indicate a statistically significant bias in taxa from the Fynbos Biome for three of the categories (RSN, RAN and WSN), from the Savanna Biome for the WAN category and from the arid Succulent Karoo and Desert Biomes for the RAB category. Analyses of habitat requirements indicate that many grasses listed (especially those associated with a “Narrow” habitat) are found in some form of wetlands (ephemeral or permanent), especially those at higher altitudes (montane). Despite concerns about the subjective nature in determining the boundaries between the categories, this method is shown to provide a meaningful and valuable list of taxa that require prioritisation for more detailed assessment according to the IUCN criteria.     

pH-Induced Molten Globule State of <Emphasis Type="Italic">Rhizopus niveus</Emphasis> Lipase is More Resistant Against Thermal and Chemical Denaturation Than Its Native State

Here, we have characterized four pH-dependent states: alkaline state, “B” (pH 9.0), native state, “N” (pH 7.4), acid-induced state, “A” (pH 2.2) and molten globule state, “MG” (pH 1.8) of Rhizopus niveus lipase (RNL) by CD, tryptophanyl fluorescence, ANS binding, DLS, and enzyme activity assay. This “MG” state lacks catalytic activity and tertiary structure but it has native-like significant secondary structure. The “R _h” of all the four states of RNL obtained from DLS study suggests that the molecular compactness of the protein increases as the pH of solution decreases. Kinetic analysis of RNL shows that it has maximum catalytic efficiency at state “B” which is 15-fold higher than state “N.” The CD and tryptophanyl fluorescence studies of RNL on GuHCl and temperature-induced unfolding reveal that the “MG” state is more stable than the other states. The DSC endotherms of RNL obtained at pH 9.0, 7.4, and 2.2 were with two transitions, while at pH 1.8 it showed only a single transition.     

The effects of external potassium and magnesium concentrations on the magnesium and potassium inflow rates and growth of micropropagated cherry rootstocks, “F.12/1” (Prunus avium L.) and “Colt” (Prunus avium L.) × Prunus pseudocerasus L.)

The effects (and interaction) of two solution concentrations of Mg (50, 500, μM) and two of K (250, 4250 μM) on the growth of micropropagated plants of “F. 12/1” and “Colt” were investigated using a flowing solution culture system. Magnesium inflow and growth of “Colt” and “F. 12/1” were inhibited to a similar extent by an increased concentration of K in the nutrient solution. However, the consequences of this inhibition were different. Reduced inflow of Mg in “F. 12/1” caused Mg deficiency symptoms at high and low concentrations of K, whereas this only occurred with a combination of high K concentration and low Mg concentration in “Colt”. The distribution of dry matter within the plant was significant in determining susceptibility to Mg deficiency. Since “F. 12/1” has a smaller root:shoot ratio than Colt it is unable to sustain the same concentration of Mg in leaves as “Colt” irrespective of external K concentration. The molar ratio of K:Mg in soil solutions should remain <8.5:1 in order to ensure maximum growth of “F. 12/1” and “Colt”. This revised version was published online in June 2006 with corrections to the Cover Date.     

“Maybe I Made Up the Whole Thing”: Placebos and Patients’ Experiences in a Randomized Controlled Trial

Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo—e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment—provides an inadequate model to explain its salubrious benefits. T.K., E.J., L.C., C.K., J.K. and A.L. initiated the RCT and obtained funding. E.J., T.K., C.K. and L.C. designed the qualitative study. Interviews were performed by E.J., and L.C., T.K., J.S., E.J., L.C., C.K., T.C., A.L. and J.K. performed the initial analysis and interpretation. J.S. devised the coding framework in consultation with all authors. T.K., E.J. and J.S. wrote the first draft. All authors commented on subsequent drafts. T.K. is the guarantor and accepts full responsibility for the conduct of the study and the contents of the paper.     

Mating system and stigmatic behaviour during flowering of Alpinia kwangsiensis (Zingiberaceae)

 Little is known about the breeding systems of tropical perennial ginger species. In this paper, we provide information about the breeding system of Alpinia kwangsiensis in Yunnan, Southwest China, specifically self-compatibility, mechanisms promoting outcrossing, and the visitation characteristics of pollinators. Populations of A. kwangsiensis have two specific phenotypes that differ in flowering behaviour: 1) “cataflexistyle” individuals in which the stigma is held erect above the dehiscent anther when anthesis begins in the morning and becomes decurved under the anther at noon and 2) “anaflexistyle” individuals in which the receptive stigma is decurved under the indehiscent anther first and moves into a reflexed superior position above the anther as it begins to shed pollen at mid-day. The stigmatic movements in the two floral phenotypes, which occur in a ratio of 1:1 in natural populations, are synchronous and correlate with the foraging behaviour of floral visitors; pollination is effected only between floral forms. Field experiments indicate that A. kwangsiensis is self-compatible and dependent upon insects for fertilization. This newly reported floral mechanism, which we have named “flexistyly,” adds to the repertoire of devices that have evolved in flowering plants to insure outcrossing. Received November 29, 2001 Accepted January 8, 2002