The chapter describes the ravages of the 1988 Spitak earthquake in northern Armenia and the geopolitical problems in the Caucasus region, leading to a war between Armenia and Azerbaijan. The widespread destruction, lack of essential materials due to blockade by the neighboring countries, the Soviet Union’s political turmoil and eventual collapse, and poor economy were significant factors that delayed recovery from the earthquake. The chapter also describes the existing mental health system in Soviet Armenia, the role of the clergy, and the inception of the Psychiatric Outreach Program (POP) by volunteer therapists from the diaspora shortly after the earthquake. The initial objective of POP was to provide care to the survivors for six months. Because of the pervasiveness of the psychological problems, the POP expanded its mission to include a teaching and training program for local professionals and paraprofessionals. These newly trained therapists worked alongside the consultants from the diaspora. Subsequently, two clinics were built in the earthquake zone, and the POP therapists serviced the population of Gumri, Spitak, and the adjacent villages for the next two decades. During those years, important trauma-related studies were conducted to determine the progression of stress reactions and the effectiveness of trauma-grief-focused psychotherapy.