Global, Permanent War?

On approaching the Big 75, I cannot say it is something I achieved. It happens. Because I have lived my life as a citizen of the United States, I know how fortunate I have been. I am lucky never to have been detained, questioned, arrested or tried anywhere outside of this country. Growing up as a U.S. career military officer's daughter, I was a privileged child. Granted, family life in the military is never simple, nor free from pitfalls. All else aside, even in harm's way, I was part of a peculiarly consistent, if regimented, life.

I was raised to be absolutely loyal to my Country, have always been proud of my Country. Once Russia launched Sputnik; the National Defense Education Act was signed into law. A Foreign Language major, I was eligible to compete for educational funding through the Act. Once again my country gave me an invaluable gift.  In what seemed months, rather than years, however, I was teaching high school students, who went off to war. The death toll prompted me to join in the protest movement early. The televised horrors of war crept into our homes and lives relentlessly. In our minds it was a vile, dirty, business. A family of  right wing Texans, moved in next door, the family cadillac, plastered with American flags and stickers. Put off by the flag-waving neighbors, I had only begun to recognize the implications of turning a blind eye to injustice at home and abroad.

Today I watched in renewed horror, as we played  a documentary film, "Dirty Wars." I am a year late in viewing the film, and in reading the book by Jeremy Scahill, which preceded the documentary. Both are extremely revealing,  even if you believe you have been reasonably well informed. First images of a Yemeni family and friends, slaughtered, right down to pregnant women and infants, assault the senses. Next is the realization that we are not at war with Yemen. We massacred 46 civilian family and friends for gathering to celebrate a wedding. If all this were not enough, we see a Yemeni journalist detained upon the direct orders of President Obama. (This, rather than permit him to disclose the details of the botched operation in his country.) It gets worse.

http://dirtywars.org/the-film

Something horrifying has emerged in the US permanent war: death and assassinations for which there is no due process nor accountability, and all too often no "within the margin of error" justification except that the government and military are able to get away with their actions. There are no public checks and balances. Whistleblowers are prosecuted and jailed at a faster rate under the Obama administrations than under the George W. Bush administrations. ~Mark Karlin, "Truthout"

What have we been telling ourselves to justify unbridled presidential powers and the emergence of JSOC, the Joint Special Operations Command? The implications of JSOC's powers and its actions, combined with those of President Obama and the CIA, are staggering. The War on Terror is global and ongoing. The U. S. is engaging in covert operations whenever and wherever. Whether you believe it or not, we have entered an era of zero accountability to the People of the United States, and it is not merely driven by the ownership of the government by the wealthy. 

http://www.theguardian.com/commentisfree/2013/mar/31/dirty-wars-terrorism-victims

Forgiveness and Reconciliation

Siblings!

Long ago I read "The Five Wishes" booklet, cover to cover. I'd read the critics' remarks, but not the booklet. For anyone who does not know, it is a booklet intended to provide a living will for people who would like to use it, and who live in one of forty-two states in the U.S. that accept it as a legal instrument. For many people, it is a helpful guide, particularly, for end-of-life issues. One of the questions it touches upon is forgiveness, but I don't believe the author(s) were addressing forgiveness in the context of religion. Rather it was in the context of reconciliation. You be the judge:

http://www.fivewishes.org. 

It seems to me there is generally a spiritual component to death, even sudden death, and dying. Regardless ... there are choices to be made.

Reconciliation with family members (and of family members) brings peace to many people facing death. For the living forgiveness is an everyday challenge, one we handle with varying degrees of success. Let's be clear. We are daily confronted with evil, with acts we do not consider worthy of forgiveness. What is your personal threshold for forgiving? Is it divorced from condemning certain behaviors, from forgetting?

Knowing can be a curse on a person's life. I'd traded in a pack of lies for a pack of truth, and I didn't know which one was heavier. Which one took the most strength to carry around? It was a ridiculous question, though, because once you know the truth, you can't ever go back and pick up your suitcase of lies. Heavier or not, the truth is yours now.  -Sue Monk Kidd, The Secret Life of Bees 


Withholding forgiveness can also be a curse on a person's life; it so often goes hand in hand with selective memory. As a parent my adult children's grudge matches overwhelm me with sorrow and a sense of helplessness. One thing I know, however, just as self-care comes before caregiving, forgiving oneself is key to forgiving another. 

With no siblings, living the military life, I knew how to adapt to nearly any environment, as well as how to handle bullies. One thing about moving constantly; it obviates the need to forgive classmates, friends or mean neighbor kids. For me, that left family, to provide role models. That was not to happen. Family did not speak to family. In speaking of other family members, there was plenty of judgment, but people tended not to reconcile.  If Christ's admonition of forgiving one's brother seven times seven hundred, does not speak to us, we can, at least, heal ourselves. "I forgive myself, not to say I am unaware of my faults, nor of misjudgments and consequent errors. Nor must I forget what I have learned from others."

Clinically depressed, I began mindful meditation in mid-life, as a single parent. Nothing else had helped, including crisis intervention and three years of psychoanalysis. Part of my meditation practice was to forgive, starting with myself. It proved to be a game changer, albeit subtle and gradual. I had been estranged from my mother for several years, when she died of a massive stroke. I had married two dysfunctional men, staying in the second marriage overlong. In the same timeframe I relinquished my profession. To say I was "on the ropes," would have been to understate. Part of my journey has been rebuilding, again and again, from ashes.

We have, in the life of Nelson Mandela, a model for forgiveness and reconciliation. His autobiography, Long Walk To Freedom, is a journey worth taking. It speaks to evil and to forgiving what seems unforgivable. Now, when I err, the first question is what to take away, along with whom and what to leave behind. Meanwhile I work on forgiving constantly; it is not a sometime practice.

U Is For Underestimated

A little Medication With That?

"Underestimated, under-identified, under-diagnosed and under-treated" are the terms the National Council on Alcoholism and Drug Dependence (NCADD) has used to describe the substance abuse epidemic among older Americans. An estimated 4 out of 5 elders currently being treated for the abuse of prescription drugs have been identified as alcohol dependent. The same agency estimates nearly half the residents of nursing homes are alcoholics. Of these, four in five abuse other substances. The agency projects opioid abuse will double to 3.5 million by 2020. As they reach retirement age, Baby Boomers are expected to represent a tsunami of substance abusers, due in part, to more permissive attitudes toward substance use.   

     "Overprescribed," by the way, was not among the terms NCADD used, nor did the Centers For Medicare And Medicaid Services (CMS.) The agency refers to prescription drug "over-utilization," and has proposed new protocols: "to protect Medicare beneficiaries and the Medicare Trust fund from the harm and damaging effects associated with prescription drug abuse." I would go much farther, and say, "use." 

What fascinates me about addiction and obsessive behavior is that people would choose an altered state of consciousness that's toxic and ostensibly destroys most aspects of your normal life, because for a brief moment you feel okay. -Moby

     In any case CMS wants Part D beneficiaries with "potential opioid or acetaminophen overuse, identified (presumably by medical providers.) Next would be to implement "appropriate controls" on these drugs for identified beneficiaries." -This seems to me punishing patients for using medications their physicians are eager to prescribe. It utterly circumvents the question of responsibility in marketing pharmaceuticals, both to medical professionals and the public. 
     The agency says it will employ data analysis to identify prescribers and pharmacies that may be engaged in fraudulent or abusive activities. Hmmmm, this would be a monumental task, considering how widespread the exploitive tactics are. CMS wants to use its data to guide its anti-fraud efforts, share results with Part D plan sponsors, law enforcement agencies, pharmacy and physician licensing boards, alluding to joint efforts to combat fraud and abuse.A key provision of the proposed rules would require Part D prescribers to enroll in Medicare. CMS believes this will ensure Part D drugs are prescribed only by qualified individuals ... fine, in theory. Additionally CMS seeks authority to revoke a physician's or eligible professional's Medicare enrollment if:

• The agency determines he or she has a pattern of prescribing Part D drugs that is abusive (i.e., it represents a threat to the health and safety of Medicare beneficiaries or otherwise fails to meet Medicare requirements.) 
• The DEA has revoked or suspended a physician's DEA Certificate of Registration.
• The licensing or administrative body for any state has curtailed a physician's or professional practice's ability to prescribe drugs.

Yet another proposed rule would provide CMS, its antifraud contractors, and other oversight agencies the ability to request and collect information directly from pharmacy benefit managers, pharmacies, and other downstream entities that contract or subcontract with Part D sponsors to administer the Medicare prescription drug benefit. The provision is designed to improve the investigative process, according to CMS.
Approximately a year ago CMS implemented the OMS (Overutilization Monitoring System) to combat Part D fraud and abuse. The agency reports a substantial reduction in the number of acetaminophen and opioid overutilizers in Medicare Part D."  We're waiting, but breathing all the while, for outcomes. Patient-oriented solutions ... that's another topic altogether. 

There is some hope that less expensive rehabilitation is becoming available. A drug in the form of a patch shows promise -- it is a Naltrexone patch. Naltrexone is already in use to treat alcohol addiction. In pill or injectable form, and under a number of brand names, it acts to prevent recidivism. It is also, interestingly, an opiate receptor antagonist, in other words, an individual who uses opiates will not become euphoric. It helps people addicted to opiates rapidly detoxify.

Be mindful my friend, of accountability, as it relates to choice. Preventing a problem is so much better than solving a problem through the backdoor.