Clinical Impact Statement: This manuscript provides mental health professionals with tools for addressing individuals’ suffering following traumatic events using one organization’s method to mitigating the emotional and physical impacts of trauma across the globe. Humanitarian relief work in Armenia is used as an example. Specific interventions focus on processing negative emotions, connecting with a sense of forgiveness, creating meaning after disorienting traumatic situations, and physical release through breath and meditation.
The landscape of the world is becoming increasingly connected and globalized. It is difficult to exist, even in the United States (U.S.), without hearing about the events happening across the globe: hurricane in Puerto Rico, earthquake in Haiti, war in Syria, mudslides in Sierra Leone, to name a few. Many of us living and practicing in the U.S. are also immigrants ourselves, with connections, emotional or practical, to our countries of origin. Many of us have and hear stories of fleeing, escaping trauma, and survival. We also have a deep desire to contribute to the well-being of those who remain in disaster areas and dire circumstances.
The purpose of this article is to share the work of one such mental health humanitarian relief organization, the Association for Trauma Outreach & Prevention (ATOP), Meaningfulworld. This organization was founded by Dr. Ani Kalayjian and provides an example of humanitarian action applied to a community affected by trauma. Established in 1990 and affiliated with the United Nations (UN) Department of Public Information, Meaningfulworld has been committed to the service of humanity, fostering healing, instilling peace and justice, and transforming generational pain and suffering. Meaningfulworld’s Humanitarian Outreach Programs have worked in over 46 countries around the globe in seven regions: Africa, Asia, North and South Americas, Caribbean, Europe, The Middle East, and the Caucuses, transforming the lives of over a million people. This article will focus on the work in Armenia, a country that has suffered from both a sizeable natural disaster and continuous human-made conflict with neighboring countries.
Armenia is a small landlocked country in the Southern Caucasus region of Eurasia that has withstood several devastations (e.g., Ottoman Turkish Genocide of Armenians, 1988 earthquake, independence from the Soviet Union in 1991, and border ongoing conflict with Azerbaijan) and is currently experiencing aftermaths from the wars in nearby Syria and Iraq that continue to negatively impact to its residents. Exposure to traumatic events is well documented to negatively impact one’s psychological wellbeing (Kendall-Tackett, 2009; Perry, 2008; Wu, Schairer, Dellor, & Grella, 2010). Some level of post-traumatic stress is common following a traumatic event, with individuals presenting with disruptions in sense-making systems, loss of faith, and feelings of anger (Carver, 1999; Frankl, 1962; Park & Ali, 2006). These can develop into syndromes such as depression, anxiety, acute stress disorder, horizontal violence, and post-traumatic stress disorder (Deschenie, 2006; Kalayjian & Eugene, 2010a,b; Kessler, Sonnega, Bromet, & Hughes, 1995).
During the last decade, the conflict between Armenia and Azerbaijan over the Artsakh territory has led to more than 20,000 casualties, large numbers of refugees moving away from both Armenia and Azerbaijan, and expulsions of ethnic Armenians and Azeris from both sides (Geneva Academy of International Humanitarian Law and Human Rights, 2012). Starting in 2001, Armenia saw an increase in Iraqi refugees and then after 2010, Syrian refugees, as affected people began to relocate to Armenia as a result of the U.S. invasion of Iraq and civil war Syria. The settling of refugees in this contested territory is likely to lead to future political clashes, as well as increases in horizontal violence from one community to a neighboring one. Since the collapse of the Soviet Union, the economic status of Armenia has been unstable, with many groups of native as well as refugee communities competing for limited resources. Often when a country experiences an economic crisis, the population’s psychological wellbeing decreases as people face feelings of anger, desperation, uncertainty, anxiety, depression, and suicidal ideation (Hong, Knapp, & McGuire, 2013; Lee et al., 2010).
Additionally, although the Armenian Constitution states that men and women are equal and Armenia has historically treated women as equals (for example, granting women voting rights long before women were granted such rights in the U.S.) mechanisms to ensure equality in the daily life of Armenian society are now nonexistent. Women face domestic violence and poverty, and are often solely responsible for children and elderly parents. They are typically employed in all professions, while their average monthly wages represent only 64% of men’s, giving Armenia one of the largest gender pay gaps in all of Eastern Europe and Central Asia (Barsoumian, 2016).
Central to healing from trauma is the ability to find meaning in the traumatic event and cultivate a sense of meaning and purpose in one’s life (Frankl, 1962; Kalayjian & Eugene, 2010a,b). Meaning-making can be defined as the forming of mental representations for the relationships between things and events and what connects representations to each other (Baumeister, 1991). Meaning-making has been linked to better adjustment following stressful life events (Collie & Long, 2005; Skaggs & Baron, 2006) and lower severity of post-traumatic stress symptoms (Kalayjian, Shigemoto, & Patel, 2010). Those who are able to process and make personal sense of often incomprehensible and atrocious events are able to experience healing following a traumatic event. A less well-understood variable is forgiveness. Forgiveness has been identified as a way of coping with the effects of perpetrated, human-made trauma (Chapman, 2007; Kalayjian, 2010; Schaefer, Blazer, & Koenig, 2008; Staub, Pearlman, Gubin, & Hagengimana, 2005; Worthington, 2006), including in post-conflict societies (Swart, Turner, Hewstone, & Voci, 2011). Forgiveness is described as shifting from the automatic ego reaction of hitting back (revenge, hurting back) to a conscious empathic response considering that the perpetrator is also human and perhaps not acting mindfully (Kalayjian, 2010), thereby increasing one’s sense of peace and decreasing incidents of anger, retaliation, and depression. Researchers have shown that forgiveness leads to lower levels of post-traumatic stress (Friedberg, Adonis, von Bergen, & Suchday, 2005; Peddle, 2007; Stein et al., 2008; Toussaint, Kalayjian, & Diakonova-Curtis, 2017), while failure to forgive one’s perpetrators exacerbates psychological suffering (Worthington, 2006).
Humanitarian Outreach in Armenia
With great excitement, the Meaningfulworld humanitarian team arrived in Yerevan, the capital of Armenia, in April 2017 to begin the vital work. From the moment we arrived we were privileged to observe many of the traditions and customs of the rich Armenian culture, one that reflects Armenia’s long history and carries with it great meaning into the present. These traditions give the Armenian culture its unique character and essence. We experienced it through kneading dough and observing the baking of flatbread in a Lavash bread factory, as well as lighting candles at the oldest Cathedral in the world, the impressive Echmiadzine Cathedral. We were blessed with banquets of traditional Armenian food prepared by our gracious hosts, with many ingredients grown and harvested in their own garden. Cultural foods included homemade organic yogurt, a variety of fragrant greens, cheese, apricot jam, sour cherry juice, sausages, and eggs hatched by the chickens in the back yard. Driving through the streets of Yerevan brought to view the stark contrast of the rich history of Armenia with a modern business and shopping center, and a bustling subway system. There is also a palpable energy brought by a growing number of young Armenians determined to return to their roots while tending to new creative growth.
During our meetings and consultations with people from a variety of organizations and some in high-level positions, we learned that while most governmental funding for education throughout the world is at a 20% level, only 3% of the governmental budget in Armenia is allocated for education. The majority of the budget is allocated for defence to secure the borders blockaded by Turkey and Azerbaijan. We also learned that people in Armenia struggle with the challenges of unemployment at 30%, and in some towns as high as 50%. This level of poverty has resulted in the exodus of many Armenian men to Russia and other European countries to find employment, with the women left alone to care for children and the elderly. This devastating reality made us feel the heavy weight of responsibility for the work that we came here to do.
The goals of our mission to Armenia included promoting emotional healing and wellbeing, working towards the transformation of the generational trauma of genocide, transforming horizontal violence, and training professionals in the 7-Step Integrative Healing Model which incorporates and promotes self-care, self-healing, mindfulness, emotional intelligence, empathy, forgiveness, and meaning-making. In addition to these goals was the team’s commitment to follow up on the initiative that Meaningfulworld started during our 2014 mission, which was to help create a suicide prevention lifeline. The need for a suicide prevention lifeline was clearly evidenced in the steady increase in frequency of death from suicide and attempted suicide for adolescents and adults, fuelled by the challenging socioeconomic climate and the presence of generational trauma, horizontal violence, and other daily stressors faced by the Armenian people. We worked with 12 organizations, children in orphanages, Syrian Armenians dealing with the challenges of resettlement while struggling to survive in a country dealing with severe economic hardship, professionals who are working with them, and university students suffering from drafts to the army where death tolls continue to rise along the border with Azerbaijan. We conducted workshops on empowering young girls and boys, teaching the UN Declaration for Human Rights, the UN Sustainable Development Goals, discussing mindfulness techniques, assertiveness, meaning-making, and forgiveness.
The Ottoman Turkish Genocide of Armenians Remains a Difficult Conversation
Furthermore, our team had the privilege of being in Yerevan on April 24, 2017, during the centennial commemoration of the 1.5 million of Armenians who were slaughtered during the Genocide by the Ottoman Turks. On this day every year people in Armenia and the Armenian diaspora around the world celebrate Genocide Remembrance Day. In Yerevan, thousands of people gather at the Genocide Memorial complex to climb the hill upon which the Memorial sits, lay flowers, and mourn the millions of ancestors who perished during the Genocide. The path up the hill symbolizes the road travelled by Armenians who were brutally forced into their death march along the Syrian Desert. The Armenian people were persecuted for their ethnicity and religion, being Christian in a largely Muslim Ottoman Empire. Men, women, and children were beaten, raped, starved, hung, burned, and abandoned in the desert. In addition to the millions of people killed during the genocide, Armenia lost much of its territory during the conquest, including 12 provinces now in present-day Turkey. Only 29 countries have acknowledged the Ottoman Turkish Genocide of Armenians, including: Brazil, Canada, France, Germany, Italy, and Russia. However, local governments have called on other nations to officially recognize the Genocide; the U.S., and, most notably, the government of Turkey, have not officially recognized the Genocide. This contributes to the continued trauma felt by generations of Armenian people across the diaspora, as many still struggle to move toward healing from the atrocious events perpetuated against their ancestors.
Two events stand out as evidence for this continued trauma. First, during a workshop with university educators in Yerevan, our team presented evidence that forgiveness, even in circumstances where no apology was issued for a wrongdoing, helps one release anger and find healing after a human-made traumatic event. This idea was met by vehement rejection and disagreement from the audience of Armenians. Participants entered into a heated discussion and refused to entertain the idea of forgiveness until the Genocide is, at the least, officially recognized by the Turkish government and the global community. The anger, hurt, sadness, and self-destruction that still exist 102 years later are evidence for the level of generational trauma and need for reparations and healing. In fact, any time Dr. Kalayjian presented the idea of forgiveness in Armenia, she received angry reactions, threats, and personal attacks, even though she is an in-group member with parents who were survivors of the Genocide. We realized that much work remains to be done to mitigate the negative emotions connected to the Genocide in order to move toward a meaningful and productive conversation on the matter.
On the other side, back in New York, our team encountered opposition for an open discussion and recognition of the Genocide. From October 23-27, 2017, we had organized a photography exhibit, entitled “Transforming Suffering into Resilience,” in honor of UN’s founding. Photos from our humanitarian missions in six countries, including Armenia, were to be displayed inside the UN. However, after the photos were approved and hung, we received a call urging us take every photo from Armenia down, as our sponsor, the Haitian Mission to the UN, received threats and pressure from the Turkish Mission to the UN, forcing them to withdraw their sponsorship on the grounds that the Armenian photos were offensive to the Turkish people. This response by the Turkish Ambassadors, and the UN’s subsequent long delay to our organization’s urges to resolve this incident, were extremely disappointing and characteristic of the reason for continued feelings of anger, hurt, and shame around the issue of the Genocide.
As psychotherapists and mental health professionals, we are in a unique position to help communities find peace and healing after traumatic events, due to our understanding of the emotional processes involved in surviving trauma. We are trained to assess and mitigate negative emotions, and teach the tools for reducing their effect. We are familiar with the roles that forgiveness and meaning-making play in decreasing the influence of external wrongdoings. We can apply this knowledge at the individual level, when working with people living in or fleeing adversity, at the community level, by presenting information, research findings, and workshops, as well as at the policy level, by educating governments on these issues affecting people in disaster areas and urging them to move toward reconciliation and peace-building.
Cite This Article
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