When Dr. Matthew Friedman began his career working with veterans nearly 40 years ago, not a single person had been diagnosed with Posttraumatic Stress Disorder, or PTSD. In fact, the term had yet to be invented.
Today, as the executive director for the National Center for PTSD at the Department of Veterans Affairs (VA), Friedman is widely known as a pioneer in the field of traumatic studies. His career has been devoted to identifying the causes of and treatments for PTSD and advocating for those whose psychological well-being has been harmed by stresses of war and other jarring experiences.
“He was there from the very beginning and the extent of his impact is great,” said Dr. Robert J. Ursano, the chairman of the Department of Psychiatry and Neuroscience at the Uniformed Services University of the Health Sciences. “He is a leader in all capital letters.”
After years of distinguished work in the field, Friedman was named as the first executive director of the National Center for PTSD in 1989, and carried out his vision of creating a consortium of seven centers located at VA medical centers connected with strong university programs devoted to research and education on the prevention, understanding and treatment of traumatic disorders.
In the process, Friedman overcame skeptics both inside and outside of the VA. He built partnerships, created a loyal following in the government, academia and Congress, and steadily established a premier institution that has produced authoritative medical standards and educational materials used for the diagnosis and treatment of PTSD.
“The national center is widely regarded not only in the U.S., but internationally, as the mother ship for research, training and clinical care on PTSD,” said Dean Kilpatrick, professor of clinical psychology at the Medical University of South Carolina.
PTSD is a severe anxiety disorder that can occur after a traumatic event such as combat or military exposure, a terrorist attack, a sexual or physical assault, a serious accident or a natural disaster. Symptoms can include anger, fear, nightmares, hopelessness, shame and despair.
Approximately, 6.8 percent of Americans will experience PTSD at some point in their lives, but it is more common in “at-risk” groups such as those serving in combat. About 30 percent of those who served in Vietnam experienced PTSD. Estimates for the Gulf War are as high as 10 percent, while between six to 11 percent of those who have served in Afghanistan and 12 to 20 percent who served in Iraq have been impacted by the disorder.
While PTSD is now recognized as a serious affliction, Friedman had to take on his share of doubters in the early days of his work. “He had to convince the world that veterans had this disorder, and even convince veterans it was okay to say they had this disorder,” said Ursano.
Years before the national center was established, Friedman was among the first VA clinicians to recognize the depth of the traumatic stress faced by returning Vietnam veterans, and in 1973 set up one of the early groups specifically designed to provide the former soldiers with mental health assistance.
At the time, the symptoms that Friedman later helped identify as PTSD were lumped into one non-clinical term—Post-Vietnam Syndrome—and there was little understanding of what these veterans were actually experiencing, or why many of them turned to drinking and drug use, and were unable to hold jobs.
In 1979, Friedman helped found the nation’s first community-based Vet Center in Vermont for Vietnam Veterans with readjustment problems, while also leading and encouraging new research to more fully understand traumatic stress disorders.
Five years later, Congress appointed Friedman to chair a special panel that conducted an unprecedented survey of 450,000 veterans’ outpatient mental health visits. The study identified enormous differences in the way that hospitals treated veterans, and uncovered a bias against diagnosing and treating mental health disorders. His recommendations led to 172 hospitals implementing special clinical programs for PTSD.
After the Sept. 11, 2001 terrorist attacks and Hurricane Katrina in 2005, Friedman and others provided a “psychological first aid manual” to authorities so they could help the victims of these tragedies. He has worked with the Justice Department to help victims of violence; the Department of Transportation to assist families who have lost loved ones in plane crashes; the Pentagon to plan guidance for current service members; and provided assistance to counterparts around the world.
At age 71, Friedman shows no signs of slowing down. He still heads the national center where greater emphasis now is being placed on prevention of PTSD. He also serves as a professor at Dartmouth Medical School, treats patients, and frequently publishes articles and books.
“There is something so compelling and worthwhile and so important about trying to help people whose lives have been changed by their willingness to make a sacrifice,” said Friedman of his primary work with veterans. “Some have suffered greatly because of this willingness and are no longer the same person that they were. I just wanted to help them pick up the pieces.”