The psychiatric epidemiologist at Harvard University holds academic appointments at the Miami VA healthcare system, the University of Miami School of Medicine, and serves on the editorial advisory board of the Journal of Traumatic Stress.
What sparked your interest?
CF: My interest in PTSD was spurred by my clinical experience treating underserved racial minorities (most of whom were homeless) with severe trauma histories. It was then that I began to wonder why some people are more susceptible to developing PTSD when exposed to a traumatic event, and more importantly, if there is a way to prevent PTSD from developing at all.
Is PTSD getting enough attention from the medical community?
CF: Even though scientists have been studying the psychiatric reactions of traumatic events since the 1800s, PTSD was not an official diagnosis until 1980. Since then, there has been an explosion of new knowledge gained about PTSD. So yes, PTSD is getting a lot of attention—I can’t even keep up with the amount of new research published every day, and I do this for a living!
Can you explain some of your thoughts on the epidemiology of PTSD?
CF: Psychiatric epidemiologists who focus on PTSD (like myself) often study the patterns and causes of traumatic stress and PTSD in specified populations. Our goal is to discover optimal approaches to PTSD prevention and treatment in the greatest number of people possible. We conduct scientific studies, some of which consist of data from millions of people across the globe, and rely heavily on statistical modeling to accomplish this goal.
Has there been progress in assessing PTSD and trauma?
CF: Tons! We have several ways to assess PTSD and trauma. There are measurements for children, adults, veterans, civilians, you name it. However, one area that needs improvement is assessing trauma and PTSD across different ethnicities, races, and cultures (in the U.S. and abroad).
What are your thoughts on recreational drugs?
CF: I am in favor of conducting clinical trials to determine whether these drugs [e.g. ecstasy, medical marijuana]are safe, effective, and better than existing PTSD treatments. However, I am against using any type of drugs (without a doctor’s supervision) as a means of self-medicating PTSD symptoms–this will likely do more harm than good. Attacking PTSD from multiple angles, including drugs, talk therapy, and/or a combination of multiple treatments, is typically the most effective approach for treating PTSD..
Are we wrong in thinking that there is not a singular focus on how to treat PTSD or trauma?
CF: There are several types of treatments available, just like there are several types of painkillers to treat a backache. However, similar to most medical specialties, we don’t know who will benefit from which PTSD treatment and under what circumstances. This often becomes disheartening for patients who have to try many types of treatments before finding one that works. Fortunately, scientists from many different medical disciplines (including myself) are now prioritizing research geared toward making PTSD treatments more individualized based on a person’s genetic profile.
What do you think about the “D” in PTSD?
CF: Frankly, I have mixed feelings on this. There has been a long history of controversy regarding whether PTSD is a “normal” reaction to a trauma or not. I agree that the word “disorder” can be stigmatizing and potentially discourage someone from receiving treatment. Decreasing this stigma surrounding PTSD (and all mental illnesses) is crucial, but I’m not convinced that removing the ‘D’ in PTSD will suffice. How do we know that the existing stigma won’t just transfer to whatever the new name is? It is also important to consider that removing the ‘D’ may have several unforeseen consequences, such as insurance companies not paying for mental health treatment for those without an “official diagnosis.”
Does a society’s culture play a role in response to trauma?
CF: There are countless reasons to explain a person’s response to a traumatic event, and cultural background is an important factor to consider. Culture may influence how people react to traumatic events, what types of PTSD symptoms appear, and how treatments need to be tailored, among many other things.
All Wounds Are Not Visible is our motto. Do you think PTSD is an invisible wound?
CF: I absolutely agree that PTSD is an invisible wound. I despise it when I hear someone saying something stigmatizing about PTSD like, “you should just get over it” or “it’s not a real thing.” These attitudes can cause someone to feel alone in their suffering, although this is actually not the case. There are (unfortunately) millions of people across the globe who are currently battling PTSD.
What are the main goals for the field moving forward?
CF: Obliterating PTSD completely.