Psychosocial Rehabilitation of Karabakh Armenians: The Womanly Face of Trauma

Over the past thirty years, the residents of Artsakh (Nagorno-Karabakh) have witnessed all stages of state-building: “liberation movements,” war, democratic forms of the direct expression of the people’s will (referenda), creation of state institutions, transfer of power, reforms, etc. During these three decades, they experienced all the positive and negative developments that led to the socio-political transformation of Nagorno Karabakh.

The Karabakh movement began with great enthusiasm and faith in the omnipotence and fairness of the Soviet Politburo [1]. However, it was followed by pogroms, arrests and forced displacement of hundreds of thousands of people, the First Karabakh War and a nearly two-year blockade, along with starvation, lack of communication and thousands of dead or missing, both military and civilian. The situation was further aggravated by social problems — homes destroyed by shelling, housing shortages as well as physical and moral injuries.

Decades of Trauma

It seemed that the year 1994 would mark a new era of peace, reconstruction, social development and creation. However, everything was overshadowed by the unresolved status of NagornoKarabakh, the constant threat of a new war and incessant casualties (both military and civilian) along the line of contact. This was followed by wars and escalations in 2016, 2020 and 2023. Each war was scarier than the previous one. Each time, the population of Nagorno-Karabakh had to relive the tragic events anew.

Nevertheless, if in the 1990s things turned out well for Armenians in Nagorno-Karabakh, which instilled in them a winner's complex for many years, the subsequent hostilities, particularly the 2020 war, had tragic consequences for the Armenian side — thousands of new victims, each family mourning the loss of a loved one. In 2023, after a ten-month blockade of Nagorno-Karabakh and another escalation, the region was handed over to Azerbaijan, which was accompanied by forced displacement.  

Any professional psychologist would argue that the residents of Nagorno-Karabakh are valuable research subjects in need of in-depth psychological support, psychotherapy, treatment and rehabilitation. After all, for more than three decades, these people have been under constant stress, with traumatic experiences accumulating over time.

The specific nature of this conflict was that due to the small territory, all settlements of Nagorno-Karabakh, willingly or unwillingly, were engaged in hostilities. Inevitably, women, children and the elderly became direct victims of the conflict. Therefore, the mental health of those, who lived in the conflict zone, should be examined as a whole rather than divided into social categories.

The Impact of Trauma and Stigma

After the First Nagorno-Karabakh War, the notion of psychological support was not popular. There were several reasons for this: Soviet education still persisted, there was no Internet, and society remained closed, partly because the only communication with the outside world was through Armenia. After the war all efforts were focused on solving economic problems. However, the stories I will cite below show that people living in conflict zones have a whole bunch of psychological traumas.

Karine [2], a 66-year-old pensioner, recalls that

“women were responsible for everything that happened on the home front. They were not allowed to cry or show weakness either during the war or in the postwar years. If men were at war, women took over all the duties on the home front: surviving in the basement with their children and elderly parents, providing with water and food, washing and dressing them, doing other household chores under constant bombardment, making sure that the children were safe and at the same time clearing away rubble after bombing raids, caring for the wounded and taking charge of funerals. In addition, women waited and worried, carefully hiding their anxieties, fears and thoughts from their children and parents. This is the hardest part.”

According to Karine, she:

“worried about her brother and father during the First Karabakh War, then about her sons and husband during the subsequent wars. ” She doesn’t want to talk about her health and admits that she doesn’t go to the doctor. She self-medicates for pain. She relieves stress with “hard work or quarrels with her neighbors.”

Marianna (45 years old) was born and raised in Baku. According to her, she experienced stress many times, but didn’t pay much attention to it because, as she puts it: “In those days, nobody had a clue about psychology or psychotherapy.”

Marianna recalls that she experienced her first shock at a young age, during the pogroms against the Armenian population in Baku.

 “My father hid my mother and me in a safe nook. He himself assumed a defensive position to protect us in case the Azeris attacked. He said he would not let us be captured and instructed my mother to kill me in case of his death, so that I wouldn’t fall into the hands of Azeri men. I heard all this and saw sheer terror in my mother’ s eyes. The Soviet military found us before the Azeris did. So we were saved, but the fear stayed with me for a long time.”

Then Marianna recounts in detail how they settled in Stepanakert, how they survived the First Karabakh War and the first blockade (1990-1992) amidst hunger, lack of electricity and gas, without communication with the outside world, how they endured the new war and blockade, how they were forced to flee to Armenia and live without safe and stable housing.

“If I am asked how I lived my life, I’ll definitely answer — a life of constant anxiety. Even when I got married and had children, I felt nothing but anxiety. I did everything that society demanded of me. Now I suffer from constant anxiety. Sometimes I have suicidal thoughts because I am afraid that I won’t be able to cope with the problems displaced people face in Armenia — no roof over your head, no job and stable income and at risk of becoming homeless.”

Gayane (58 years old) who was widowed during the First Karabakh War, raised her children alone. She admits that it was hard work, both physically and mentally.

“In addition to social problems, I had to face the cruelty of postwar society — indecent proposals from well-to-do men and unfair and critical treatment from well-to-do women. It was very hurtful to be treated so unfairly. After all, my children and I sacrificed the most precious thing for peace — the father of the family. As soon as I found myself without protection and with small children, I was stigmatized by society. I cried at night. I didn’t want to go to work or leave the house at all. That’s how I lived for many, many years. I calmed down a bit when my sons grew up but the fear of being unfairly treated still remains. ”

Maya (48 years old) says that she got married after the First Karabakh War, in 1995. She had two miscarriages. Her doctors said they were caused by the blockade. Many young women who survived the blockade in basements under bombardment, could not carry a baby to term.

“At the time, such a diagnosis surprised me. But then I found myself in a ward with several young women with the same diagnosis. I don’t know anyone who carried out her first pregnancy to term and gave birth.”

Anush (48 years old) recounts that in May 1992, when Shushi came under the control of Armenian forces and transport links with Armenia were reopened, her mother sent her to Yerevan and told their relatives to marry her off immediately. She had just turned 16. Their relatives followed her mother’s order without delay. At 17, she gave birth to her first child.

“My mother later told me that she was trying to help me settle down as her eldest daughter, so that it would be easier for her to take care of the younger ones. As a result, I had no childhood or adolescence. There was only early childhood, then the war and adulthood. I did my best to make sure that my children weren’t deprived of the simple joys of life. But, unfortunately, this is hard to do when you live in a conflict zone.”

Gender and Intersectoral Aspects of Trauma

All the heroes of the stories cited above are women. This is not surprising as women are the backbone of society. Pensioners, people with disabilities and ex-combatants constitute another group that also needs special treatment. Most of them are lonely, and it is unclear how they deal with life’s challenges. They are entitled to state pensions and care provided by social workers. However, those in need of social care outnumber social workers. Places in nursing homes are limited.

Mher (50 years old) was drafted into the army at the height of the First Karabakh War. He immediately participated in military actions. After the war, he began to drink alcohol to relieve stress.

“I tried to quit drinking many times: when I got married and when my children were born. I managed to stay sober for two or three months. Then the nightmares came back and I started drinking again to dull my pain. One day my wife couldn’t stand it anymore. She took the kids and left me for good. I started drinking even more. I got all kinds of diseases. I was admitted to a psychiatric hospital several times. There I was treated only with injections. They’d give me a shot that would knock me out for a few hours. Isolated, I go from one hospital to another, without hope and faith in the future.”

Tsovinar (55 years old) says that she and seven other girls from her class did not marry; after the war there was a deficit of boys, as many had died. All her life she helped her brothers’ families raise their children.

“Now I am left alone as my nephews have grown up. Each of them is busy with his own family. I have many health issues. I have undergone several surgeries. I have little desire to live, I don't want to be a burden to my relatives because of my illness. I feel ashamed, especially now, in Armenia, where we are refugees and everyone has their own problems.”

Arsen (53 years old), a disabled veteran of the Karabakh War, says that he is lucky to have strong parents and a loving wife.

“After I was wounded, I lost the ability to move. I am still alive because my wife and my parents were there for me, supporting me and helping me to get well soon. My pension and the rehabilitation center in Stepanaker, where I was treated twice a year, were a great help. But as soon as I left the center, physical and psychological problems began. First of all, there are no facilities for people with disabilities — buildings and public transportation are not accessible. Most people think that we should stay at home all the time. Getting a job is a problem. I couldn’t have made it through without the support of my life and my parents. ”

Asya, an 87-year-old widow, lost her husband during the First Karabakh War. Her daughter-in-law moved to Russia with her children, leaving her alone. During the bombardment of  her village, she was wounded by shrapnel and incapacitated.

“My husband died long before the war. But when my son was killed, I thought I was going to die, I wanted it very much. But God didn’t take me away. I continued to live, neighbors helped me. And now that I am a refugee, other generous people offer their help. In Artsakh, I spent most of my time visiting my son’s grave, talking to him, crying and hugging his tombstone. During the deportation I thought I would die on our way to Armenia. I don’t know how my heart endures all this. I don’t understand why I live.”

During our conversation, she suddenly lost her temper. She said that she was tired of questions: “Everyone knows everything, why bother asking too many questions?”

Tigran (23 years old) participated in the 44-Day War. He says that after he was discharged from the army and returned home, he began to recover from the horrors of war with the help of his relatives and tried to lead a ‘normal’ life.

“All of us who went through the war suffer from stress and burnout. We were told: “Be glad that you made it back home alive, so keep going.” And I tried to keep going. I didn’t complain. Many of my friends became disabled, and many died.”

None of my interlocutors admits to needing or seeking psychological support to talk through their feelings and cope with traumas. People just live their lives, resigned to their fate. Everyone seems content. They don’t make a fuss. They comfort themselves with a phrase that has become a trend among the Karabakh Armenians: “If only there weren’t a war.”

Growing Awareness Amid Constant Rejection and Prejudice

After the 2020 war, the need for psychological support was recognized at the state level. Discussions about psychological rehabilitation of combatants as well as wounded and disabled servicemen did not cause any confusion. As soon as this plan was examined more carefully and put into effect, it became obvious that one should also create a stable environment for military servicemen and combatants. The Government of Artsakh, specifically ministries responsible for health and social affairs, concluded that rehabilitation involved restoring personal development skills of each citizen.

Psychologists began serving in educational and medical institutions in Stepanakert and in the district centers of Nagorno-Karabakh. Psychosocial support centers and public psychoeducational organizations emerged. They mainly worked with groups. In rare cases, specialists conducted individual sessions. Psychology became more recognized and people took the work of a psychotherapist or psychologist more seriously.

Before her forced displacement from Nagorno-Karabakh, Zarine (30 years old) worked in one of the psychosocial support centers in the Martuni region. According to her, the center’s specialists had to visit families, establish communication with them and explain why psychological rehabilitation was so importants and how much damage cumulative trauma could cause.

“People rarely agreed to visit the center. There are many reasons for this but mostly it was due to misunderstanding and mistrust. People also made weak excuses about having no time. On rare occasions, having attended one session of psychotherapy, people wanted to undergo every session in the center. In any case, everyone needs to communicate. Regardless of the depth of trauma, everyone wants to express themselves and evoke the interlocutor’s empathy and sympathy.”

After the forced displacement, Zarine continued her work in Armenia with the support of the Armenian Association of Social Workers.

“Needless to say, after all the tragic events we have experienced, everyone needs a psychologist and psychotherapist. Once again we come to understand how important it is to seek solutions to social problems in a stable state of mind. Once again we are faced with the fact that people don’t find time for psychological rehabilitation, thinking it will not help them to survive or adapt.”

The reluctance to find time to see a psychologist remains a serious problem. It is difficult to say whether this attitude is the result of a pervasive bias towards psychology or a total unawareness of the problem.

Lack of “Time and Energy” to Cope with Trauma 

In Armenia, the aid package for displaced people also includes psychological rehabilitation. However, this package is available only for those who are financially secure, have no housing problems and live in urban areas. Not many people meet these criteria. Although people began to realize that psychological disorders require treatment, they are either reluctant to go to a psychologist, or do not find time for this.

To illustrate this, I will cite a couple of examples from my conversations with displaced people from Nagorno-Karabakh who now have refugee status in Armenia. It means that new layers of stress, anxiety and burnout have been added to their traumas experienced in the 1990s and after 2020.

Armine (33 years old) had four sons. They lived in a border village. During the escalation in September 2023, two of her sons, aged 10 and 8, died. In Armenia, she has recently been diagnosed with high blood pressure, deteriorating eyesight, endocrine and psychological disorders and diseases of the female reproductive system. Armine refuses to be treated or see a psychologist.

“Yes, I need someone who will listen to me, understand my grief and help me deal with tantrums and aggression. But I don't have time for that. I have a husband and two sons. I want to take care of them every minute and not let them out of my sight.”

Tatevik (28 years old) says that during the blockade, due to food shortages, many young women had to terminate their pregnancies. They still suffer agonies of guilt as they believe that they committed infanticide. Tatevik thinks that these women also need psychological support.

The parents of 53-year-old Misha have been hospitalized for four months now.

“My elderly parents had a hard time enduring the painful three-day passage through the Lachin corridor. When we arrived in Armenia, we had to take them to the hospital. High blood sugar, blindness, gangrene, heart and stomach conditions, high blood pressure. The sad thing is that they don’t want to be treated. They say they are ashamed to be alive while so many young people have died. My wife and I thought of inviting a psychologist to visit them but we are afraid that they will not be happy about it. ”

Georgi (53 years old) says that he and his family have settled in an Armenian village. Their next-door neighbors are old pensioners who lost their sons in the 2020 and 2023 wars.

“You see grief in their eyes. They are silent all the time, they don’t talk to anyone. Every time I go to them to talk and offer my help, they don’t say anything. They serve me tea and see me off in silence. They have become withdrawn. I recall what my mother went through after losing my father. She was as heartbroken as they are now.  The doctors said her stress would pass and she would be back on her feet. But she died in the end. Now my heart aches when I think of my elderly neighbors. I realize that they are in need of psychological rehabilitation. But how can I advise them to do that if they don’t even see a doctor?”

Thus, we can conclude that the Karabakh Armenians exemplify a typical closed community with its socio-cultural codes and stereotypes. This is especially evident in women’s everyday lives which directly affects the upbringing of their children. Anxieties over survival in a new place — housing, work, good education, skepticism about durable peace in the region — are so numerous that there is neither energy nor time left for mental health.

In addition, these people’s health condition is so neglected that it has become chronic. It is necessary to examine the psychosocial problems of  displaced Karabakh Armenians, focusing on social factors. Otherwise, left without housing, jobs, social benefits and health, they will never agree to psychological support. They will not agree to waste time for “useless conversations,” as they put it, if it can be spent on earning their daily bread. As it happens, these people try to overcome all stages of grief (denial, anger, bargaining, depression and acceptance) on their own.

[1] Highest political body of the Central Committee of the Communist Party of the Soviet Union.

[2] All names in the text have been changed.