Mental health and an Assembly resolution

The victims of war and civil unrest have more to worry about than the California Assembly, or so one would think. Recently, the Assembly voted to recognize the Nagorno-Karabakh region of Azerbaijan as an independent entity. I’m waiting for those who voted yes on this measure to explain why they are involved in foreign policy, a function exclusive to federal government according to the Constitution. I’d also like to hear what they have to say to the 1,000,000 Azeris and others who became displaced from this region during the war with Armenia in 1992-1994. Unfortunately, no one’s talking.

It’s like this. Picture Iowa populated with 75% ethnic Canadians and 25% Americans, surrounded by the U.S. as we know it. Conflict occurs between the Canadians and Americans resulting in the murder and exodus of over a million Americans from the region. The region remains contentious, with both the Canadians and Americans fighting for recognition as the rightful inhabitants of the region. Then, years later, the British House of Commons decides to weigh in and recognize the Republic of Iowa as an independent nation. Does this make sense? Of course not.

By acknowledging the Nagorno-Karabakh region as in independent nation, the California Assembly has risked worsening the PTSD of displaced people

As a psychiatric nurse practitioner, I have treated refugees and witnessed the suffering of those uprooted from their homelands, amidst the terror of war. I have seen the eyes of a woman flashing back to the murder of her husband and sons, while showing me the angry scar on her shoulder where soldiers attempted to cleave her arm from her body. Now imagine telling her that her homeland is no longer, at least according to California legislators.

As one can imagine, post-traumatic stress disorder (PTSD), anxiety, and depression are common among refugees and internally displaced people. Displaced people are also at higher risk of mental illness due to the loss of a sense of belonging, livelihoods, and social structures (Siriwardhana et al, 2013). Haunted by the symptoms of PTSD, they experience intense fear, hopelessness, and horror. The trauma is persistently re-experienced through intrusive thoughts, dreams, dissociative flashbacks, and intense psychological distress (American Psychiatric Association: DSM-IV-TR, 2000).

One of the exacerbating factors that has shown to prolong PTSD is the lack of redress for those responsible for traumatizing events. According to Basoglu et al (2005), redress in the form of imposing fairness or reparation is essential to achieving meaningful recovery from war. When there is an ongoing threat of victimization due to impunity of the offenders, PTSD can worsen. In addition, an attachment to one’s nation is related to its citizens psychological well-being (Ferenczi & Marshall, 2013), the failure to acknowledge a person’s nation is at most potentially harmful and at worst retraumatizing.

If the California Assembly is bent on being involved in the affairs in other parts of the world, why not focus on providing psychological resources to such regions?

By acknowledging the Nagorno-Karabakh region as in independent nation, the California Assembly has risked worsening the PTSD of displaced people.  This is especially true for the survivors of the February 1992 Khojaly tragedy. Described by the Human Rights Watch as “the worst massacre of the war,” Armenian and Russian forces annihilated the Azerbaijani town of Khojaly, leaving over 600 dead and thousands of survivors wounded and traumatized.

It is known that impunity creates an atmosphere lacking legal justice and results in protection of the perpetrators. This in turn causes an increase in mental health vulnerability as it creates persistent feelings of powerlessness and exclusion from society (Rauchfuss & Schmolze, 2008). The California Assembly has chosen to give impunity to the Armenian aggressors of the Nagorno-Karabakh region.  Recognizing the Armenians as the “rightful” inhabitants of Nagorno-Karabakh, there is a lack of truth finding, legal justice, and conflict memory, all of which contribute to a high risk of retraumatization.How many citizens of California knew that when voting for assembly people, they were also voting on foreign policy and the revictimization of a million displaced people vs the immediate needs of their own state?

If the California Assembly is bent on being involved in the affairs in other parts of the world, why not focus on providing psychological resources to such regions? Uprooting and displacement of a region’s people propagates the loss of physical, social, and psychological resources. Curative factors shown to ameliorate these losses include provision of social support, social recognition, and effective mental health treatment (Ajduvovic, 2013).

I want to believe that the Assembly’s decision-making for this vote was simply uninformed and certainly not intending to do harm. However, lawmakers must remember that making consequential decisions without information can be dangerous. Thus, the only reparative solution is for the California Senate to vote no on Assembly Joint Resolution 32 and instead focus on the physical and mental health of its own citizens.

It’s the only humanitarian right thing to do.
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Ed’s Note: Dr. Mallory Moss is a Board Certified Nurse Practitioner of Psychiatry and a clinical nurse specialist in psychiatric nursing.  Dr. Moss currently serves at Colorado’s prestigious AspenPointe.