In Memoriam Alexander Friedmann, M.D.

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Marco Scarpinati Rosso - June, 2010

The bio-sketch below was prepared for publication in the Nov, 2009 issue of the WPA-TPS Newletter. The text has been edited for the purpose of this tribute to the memory of Marco Scarpinati Rosso, who died Sep 1, 2011, after a brief illness and surgery.

An In Memoriam Tribute to
Marco Scarpinati Rosso, M.D.

When Ron asked me to contribute some short biographical notes to this website my first inclination was to decline. As a pretext, I could use the lack of time because of my clinical duties and my research project but, basically, the fact is that I do not like to talk about myself.

However, driven by curiosity, I decided to take a look at the TPS Newsletter and to read some stories written by colleagues and friends. I was really impressed by the generosity and sincerity they introduced in their own narrations dealing with very personal issues. Moreover, I felt that I share feelings and experiences with a lot of them. So, overcoming my shyness, I decided to write something, even if short.

I was born and raised in Rome. My father, a gynecologist, came from a family of doctors and my mother, of French background, from a family with a long heritage of military officers. Her father was in the diplomatic service, so they travelled a lot. I am still convinced that the fact that she could speak French and Arabic played a big role in my current professional interests. I attended the Classic Lyceum - secondary school with a lot of Latin, ancient Greek and philosophy courses – and then medical school at the La Sapienza University in Rome.

I must confess that I did almost anything to avoid becoming a psychiatrist, even though I was really attracted by this discipline from the begin¬ning of medical school. I thought it was very difficult clinical work, with poor treatment outcomes and a high degree of stigma associated with the field. So, to make my life easier, I specialized in neurosurgery; and then I joined the army, becoming a professional medical officer. In this way I was able to make an effective synthesis of my family’s traditions in both medi¬cine and military service.

But as so often happens, it is not you who chooses psychiatry, but rather it is psychiatry that chooses you, and nothing can prevent it when you receive the call. In my case, I became a psychiatrist – and at the same time, a cultural psychiatrist – because of a very concrete cause: war.

Although my primary post was the military hospital in Rome, I have been deployed sev¬eral times abroad, in different conflict areas in peace-keeping and peace-enforcement operations. During these missions, trauma was a constant aspect of my daily clinical work with the military personnel and with the civilian population that we protected and cared for. Dur¬ing the Kosovo crisis, I was deployed as an observer for the OSCE (Organization for Security and Cooperation in Europe) in the capital, Pristina. Before the NATO bombing of Serbia, our unit moved to Macedonia to organize and monitor the refugee camps near the borders. During this mission I confronted the complex and grave burden of the direct efects of war on the population, and the impact that violent ethnic discrimination, displacement and loss have on peoples’ mental health.

This experience has influenced me in several ways. From the clinical point of view, I felt a need to approach the complex phenomenon of trauma from a different and more global perspective, scrutinizing the tight paradigm of PTSD as we use it today. From a broader perspective, I understood that the current models of intervention in relief activities are not effective. Moreover, I thought about the major challenge societies and health services face as a consequence of globalization and the need for a cultural perspective in psychiatry.

Thus, I decided to become a cultural psychiatrist and to increase my knowledge and skills through research. Accordingly, I undertook my specialty training in psychiatry in Rome – thereby changing my clinical perspective from neurotraumatology to psychotraumatology. I resigned from the army and I decided to move to whereever I could realize my clinical and research objectives as a cultural psychiatrist.

My research interests are in cross-cultural psy¬chopathology, psychotraumatology and the interactions between the cultural mind-sets of patients on one hand, and the health services system on the other.

After all these years of clinical practice, I must admit that I still do not believe that cultural psychiatry is radically different from general psychiatry. The needs of the patients are almost the same; to be understood and respected.

But what is really important and unique is that cross-cultural psychiatry can contribute to the reflections on psychiatry itself, about its asymmetrical power relationships between patients and their families, and the health services personnel who provide treatment for them; as well as how to avoid the stereotyping of people as patients. These perspectives are greatly needed in all aspects of contemporary psychiatric practice.

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In Memoriam tribute to Marco Scarpinati Rosso
Henrik Wahlberg and Antti Pakaslahti

Marco was exceptional. We are all special, but Marco was exceptional.

Marco was gifted, refined and deeply humane. His family combined generations of doctors, commissioned officers and diplomats. He completed a classical education with emphasis on Latin, Greek and philosophy. He graduated in medicine from La Sapienza University in Rome and then completed post-graduate training in neurosurgery. After specialization in neurosurgery he became a medical officer in the Italian army He participated several times in peacekeeping missions and also served a tour of duty in the Antarctic.

Marco was confronted with ethnic persecution, displacement and atrocities and their complex and grave burden on people and their mental health, particularly when he participated in the OSCE peace- monitoring mission during the Balkan wars in the mid-1990s. Efforts to ameliorate the traumatic impacts of inter-ethnic conflicts in the Balkan region taught him new aspects of posttraumatic treatment.

Marco’s experiences revealed the importance of psychology and psychiatry, and of mental health in general. Marco said about his specialization in psychiatry: “it is not you who choos¬es psychiatry, but rather it is psychiatry that chooses you, and nothing can prevent it when you receive the call”.

He worked as a chief physician in Uppsala, Sweden, from 2003-06 and learned to speak Swedish within a few years. He worked from 2007-09 in Stockholm, where he was simultaneously a PhD candidate at the Karolinska Institute. During this year he was nearing completion of his thesis in transcultural psychiatry.

Marco was appointed as head of the Department of Emergency and Consultation Psychiatry at the Akademiska Hospital in Uppsala and returned to live there in 2010. He was full of energy and enthusiasm. He was determined to develop and improve the quality and cultural sensitivity of psychiatric care in that department.

In his professional work Marco stressed:
1.    The need for patients to be understood and respected as persons.
2.    The importance of avoiding the stereotyping of people as patients.
He tried to implement these principles in the daily clinical activities of the emergency unit, and he combined them with high quality and efficiency of clinical care.

He impressed us all with his astounding capacities for humane and sound clinical intuition. Marco’s humane nature guided him in everything he did. He worked closely with the recipients of treatment and with their families. He managed to give hope and dignity to those people. He included a representative of the recipients of care in the managing board of his department.

Marco was an enthusiastic member of CPPN, the Nordic Network of Cultural Psychology and Psychiatry. He contributed to the network and actively participated in CPPN meetings in the Nordic countries. He was also an active member of the WPA-Transcultural Psychiatry Section and participated in many WPA-TPS conferences, usually accompanied by his wife, Piera.

He had friends all around the world.

Marco liked Uppsala very much. Uppsala is a small university city, where Carl von Linnaeus made his discoveries. After working in different countries and travelling widely throughout his professional career, Uppsala became his home.

Marco’s legacy at the psychiatric hospital in Uppsala, and to psychiatry in general, is to treat patients as friends and treat them
with professionalism and kindness!

Marco’s unexpected passing came as a shock to his friends in Sweden and around the world. His generous spirit lives on in our hearts and in our memories.

Henrik Wahlberg
WPA Board member
Coordinator of CPPN, Sweden

Antti Pakaslahti
Adjunct Professor of Transcultural Psychiatry
School of Health Sciences, University of Tampere, Finland

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Memoriam tribute to Marco Scarpinati Rosso
Solvig Ekblad, PhD

I met Marco for the first time several years ago, when he worked with refugee children as a clinical psychiatrist. My first memory was Marco’s distinctive professional clinical eye and a wish to know more about cultural formulation in Sweden. During his work as a consultant psychiatrist at the Transcultural Centre, Stockholm, he invited me several times to lecture in courses for clinical staff encountering patients with refugee backgrounds. His research interests in cross-cultural psychopathology, psycho-traumatology and the interactions between the cultural mind-sets of patients on one hand and the health services system on the other, resulted in Marco becoming a PhD student at the Karolinska Institutet, Stockholm. Last year he passed his half-way control seminar and was nearing the end of his PhD studies. His thesis of great potential importance will now not be finalised, but I do hope that his supervisors will publish his data as a tribute to his memory.

I also encountered Marco in two international contexts; in the Nordic network in transcultural psychiatry and psychology, and when he participated in the post-graduate course on Global Mental Health: Trauma and Recovery, comprising both on-site learning and web-based learning 2009/2010.

In his motivation to participate in the Global Mental Health course Marco wrote the following: “I applied to this course for two main reasons. From the clinical point of view, I felt a need to approach the complex phenomenon of trauma from a different and more global perspective, scrutinizing the narrow paradigm of PTSD as we use it today. Further, due to my previous experience in the field, I strongly believe that the current models of intervention in mental health relief activities are not effective. I am looking forward to meeting the faculty and colleagues in order to share knowledge narrations, experiences and - why not, -dreams” (p. 7).

During the last course 2010/201,1 was invited to be a resource person in the international team of facilitators, which I have been in since the inception of this course five years ago.

Marco shared with me some of his knowledge narrations when we met at dinners with other colleagues in central Stockholm or in Italy. The same week when Marco passed away I tried to contact him to arrange a time for a dinner after the summer holidays.
Unfortunately, it was too late. What we did not know was how serious his health problems were. He had a strong integrity, something that deserves our respect.

He passed away too young, but his knowledge narrations in transcultural psychiatry must continue; not only in Uppsala, Stockholm, and the rest of Sweden, but also in the Nordic countries and other countries around the world.

All of us who knew him and liked him have a responsibility to help Marco’s dreams become reality.

I send my condolences to his family in Rome.

Solvig Ekblad, PhD
Senior researcher and Associate professor in transcultural psychology at Karolinska Institutet, Stockholm, Sweden
Member of the Nordic network in Transcultural psychiatry and psychology

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In Memoriam tribute to Marco Scarpinati Rosso
Richard F. Mollica MD MAR

I had the good fortune to meet Marco as a trainee in my Global Mental Health Course in Italy just over 2 years ago. He was in my small group weekly discussions, along with other international medical providers for over five months. Almost immediately I noticed his wonderful intelligence and wit. He had that Italian skepticism of all sacred cows that I loved. Because of his brilliance and insight, I invited him to help start our Global Mental Health Alumni Association.. He dived right in and has done a great job.

On two occassions I met him in Sweden at the Karolinska Institutet ( KI ) where he was studying with my close colleague Professor Solvig Ekblad. At KI he was greatly respected and had a promising academic future.

All of us at the Harvard Program in Refugee Trauma ( HPRT ) and the international faculty of the Global Mental Health Program are shocked and saddened to hear of his death. He was clearly a brilliant and passionate doctor and human being who cared deeply about his patients and his friends.

Marco confided in me about his long journey from being a neurosurgeon in the Italian Army, working in conflict zones, to his cultural psychiatry thesis at KI, to his main clinical preoccupations as a clinical director of a large psychiatry program in Sweden.

He was a man of extraordinary courage on insight.
It is heartbreaking for all of us to hear of his death at such a young age.

In fond remembrance;

Richard F. Mollica MD MAR
Professor of Psychiatry
Harvard Medical School
Director
Harvard Program in Refugee Trauma
Massachusetts General Hospital

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In Memoriam Tribute to Marco Scarpinati Rosso
WOLFGANG RUTZ

Marco Scarpinati Rosso, an Italian – Swedish psychiatrist, a dear colleague and beloved friend of many of us, has left us suddenly and unexpectedly in a time full of activities, future plans and shared projects.
At the time for his death, he was one of the leading chief psychiatrists at the academic university hospital in Uppsala, heading the emergency unit as well as the center for psychiatric stress research.

Marco was Italian, a Roman citizen, humanistically educated, with a strong foundation in ancient philosophy and languages, and consistently striving to give this humanism a modern , relevant meaning in Sweden, his other homeland, in modern Swedish psychiatry. He felt close to humanistic sciences – striving to integrate positivistic knowledge of neuro-psychiatry and neurology, with,psychosocial dimensions of human ecology and mental environment, into the human condition of being body and mind, acknowledging psychiatry’s closeness to and overlap with anthropology, cultural sciences, philosophy and literature.

Marco was educated in Italy, he studied in Rome, completed a PhD there and became specialized in both psychiatry and neurosurgery. At the time of his death he was working on his second PhD dissertation at the Karolinska Institute in Stockholm.
His focus was international and transcultural. He had worked in several countries, including the Balkan countries, helping people in the posttraumatic throes of internal warfare and conflicts, with a strong dedication to individuals and on a societal level, and with a focus on crisis reactions and posttraumatic stress.

When I met him after coming back to Uppsala following seven years in the World Health Organization, we joined in a common network of friends and psychiatrists, elaborating on psychiatry’s psychosocial, biological and even existential dimensions, working both with treatment and pathology but even with salutogenesis and health promotion - fully aware of an holistic “Conditio humana”, in need of being applied in integrative, psychiatric and psychosocial person-oriented clinical work.

Marco later left Uppsala, to work in transcultural psychiatry in Stockholm. One of his main focuses was on refugees and their apathetic children who had become a major political issue at that time in the Swedish political and even professional discussion. Here he focused on clinical work and publications on the psychosocial and existential causalities behind these conditions and even argued intelligently and sharply in discussions and symposia about the fate of “paperless” (undocumented) refugees in Sweden, who at that time had no reasonable access to most basic human rights, such as education and medical treatment. That the situation since then has changed somewhat for the better is due in some part to Marco’s efforts and commitment.

When he came back to Uppsala about a year ago (unfortunately, after my retirement), he soon became again a central figure in a group of dedicated psychiatrists, working toward the goal of re-humanizing psychiatry, including human beings’ humane aspects and – above necessary guidelines and protocols – treating and supporting patients in a personalized, individual and narrative approach, meeting them at the level of equals, inter-subjectivistic and empathic, as persons, not merely diagnoses and syndromes.

To exemplify this, his last project was to present Uppsala’s psychiatry in the context of the city’s “Cultural night”, connecting psychiatric clients to persons from world literature, thus showing the commonality and generalizability, as well as the philosophical and existential interconnection of mental and psychiatric suffering.

Marco was a humanistic, ethically sensitive, gifted and hardworking professional, striving from an holistic point of view to put psychiatry in perspective and give it an outstanding place among the most complex medical specialties, within the context of an academic hospital environment. However, he was clearly aware that psychiatry – like other medical disciplines – had to be seen and treated in the psychosocial and existential context of human life, and that here, psychiatry hopefully was in the forefront of the development of other medical disciplines and specialties.

As a colleague and friend, Marco was consistent, demanding and generous, warmhearted and spiritually stimulating, knowledgeable and innovative, not fearing to be authentic and even controversial when fighting for the ideas he considered important – and he was loved, respected and sometimes greatly admired by his patients.

He was a fighter in the struggle to re-humanize psychiatry, to counteract tendencies to reduce psychiatry to merely a neuropsychiatric medical specialty and efforts to instrumentalize both the psychiatric profession and its clients in a more and more market- and profit-oriented health care system.

He was to us a model of a psychiatric professionalism that has profound humanism and philanthropy at its foundation, as a “conditio sine qua non” and as a final goal.
We will miss him. It will be difficult to fill the role that he has left open in the development of a modern people-oriented Swedish and international psychiatry.

Stockholm / Coburg, September 2011
Wolfgang Rutz, MD, PhD
Professor of Social Psychiatry
f. WHO Regional Advisor for Mental Health in Europe, 1998 – 2005
f. Vice President, Swedish Psychiatric Association

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In Memoriam Tribute to Marco Scarpinati Rosso
Marianne Kastrup

I had the pleasure to meet Marco Rosso when he was working at the Transkulturellt Centrum in Stockholm. He was the core person behind the Swedish adaptation of the DSM-IV Cultural Formulation and we at the Danish Centre of Transcultural Psychiatry in Copenhagen were fortunate in that Marco agreed to come to Copenhagen and lecture about his research and clinical experiences with the Cultural Formulation. This led to the development of a Danish adaptation - inspired greatly by the Swedish version –and we are grateful to Marco for his constructive feedback.

But Marco’s unique style also made this symposium particularly memorable. Sitting there in a cold, not very charming auditorium, the entire audience was charmed by his Italian sense of humor when he was talking about his encounter with Scandinavian psychiatry assessing patients to be depressive – when in fact they were “just Swedish”.

Later, I was fortunate enough to participate in a transcultural congress in Norcia with Marco and his wife, and I still remember how that scientific program was spiced with wonderful encounters with Italian cuisine and further developing our friendship

This is how I recall Marco. He was able to combine scientific rigor with a humanistic approach, and able to flavor it with a particular charm.

He shall be greatly missed.

Marianne Kastrup
Centre for Transcultural Psychiatry, Denmark

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Contribution to In Memoriam tribute to Marco Scarpinati Rosso

Ronald Wintrob MD
Chair, WPA-Transcultural psychiatry Section

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It comes as a shock to realize that even in such a comparatively young field as the contemporary field of cultural psychiatry is, we must confront the illness and death of colleagues and friends who have been important contributors to our discipline.

On March 30th, our good friend and colleague, Alexander Friedmann, died suddenly and unexpectedly, in Vienna.

Alex played a central part in the Vienna Organizing Committee for the highly successful WPA-TPS conference held in Vienna, at the Vienna University Medical School and Hospital, in April, 2006. He was also a key member of the Organizing Committee of the 1st International Conference on Transcultural Psychiatry in the German-speaking Countries, co-sponsored by WPA-TPS and held in Witten Germany, in September 2007.

Before his untimely death, Alex was very actively involved in the planning for the 2nd International Conference on Transcultural Psychiatry in the German-speaking Countries, to be held in Vienna in September 2008.

His enthusiasm, commitment, open-mindedness and good humor will be very much missed by all who knew him and worked with him.

Alex Friedmann was only 59 years old when he died. In addition to many, many friends and colleagues who mourn his loss, he leaves Kitty, twin sons, age 14, and a daughter, age 10.

In January, I worked with Alex on the editing of his bio-sketch, It is included in this memorial tribute to him.

I had heard about Alex; that he was a lively, congenial man and a unique one too. I heard that he had been instrumental in helping the Jewish immigrants to Austria from the former Soviet Union adapt themselves to living in Vienna and other places in Austria.

I first met Alex at the WPA-TPS conference in Vienna, in Apr 2006. It was the first TPS conference I had helped organize since becoming chair of the Section in Sep 2005. I was more than a little anxious about how the conference would go: would the facilities be adequate, would there be enough participants, would the atmosphere and ambience of the conference be what I had hoped for?

I needn't have been so concerned. All those details had been very well organized by Thomas Stompe and the Vienna organizing Committee…that included Alex.

Pauline and I like to attend as many presentations as we can at TPS conferences. Many of the presenters are our friends, and we like to hear them discuss their work. In Vienna, we were eager to hear Alex's presentation on the cultural integration of Jews from the former Soviet Union, especially those from its Asian regions, 'Sephardic' Jews whose cultural traditions were very different from those of the 'Ashkenzi' Jews; the group that both my parents had come from, during the centuries that their families had lived in Russia and Poland before they migrated to Canada in the early 20th century.

Alex's presentation was intensely moving for me and Pauline. I started to tell him that, after his presentation, when I introduced myself. But I couldn't express it, because I almost immediately became choked up with emotion; not something that usually happens to me in response to a colleague's presentation. I felt very awkward at becoming so overcome. Alex was warm, sympathetic and generous in his response.

We became close friends from the time of that interchange. We talked a lot during the conference. I learned more about Alex's contributions to helping rebuild the Vienna and Austrian Jewish communities, and the recognition he was accorded for those efforts by the governments of Vienna and of Austria. I also learned about his own family background, and about his wife and children. He talked about how he had developed his commitments to the Jewish community's welfare; in Vienna, in Austria, in Israel, in the world.

We kept up our contacts by correspondence. We communicated about plans for the launching of a professional group of German-speaking psychiatrists and other mental health clinicians interested in cultural psychiatry. I was invited, and very honored to participate, at the 1st international conference of transcultural psychiatry in the German-speaking world, held in Witten, Germany, in Sep 2007. Alex played a major role in the conference organizing committee. We had a number of opportunities to spend time together in Witten.

We started making plans to spend time together again in Sep 2008; first at the WPA Congress in Prague, then at the 2nd international conference of transcultural psychiatry in the German-speaking world, to be held in Vienna. Alex would again be playing a major part in the Vienna conference organizing committee.

At the Prague Congress, Alex had agreed to give a presentation on his efforts to help rebuild the Jewish community in Vienna since the 1970s, including his visionary work with the Sephardic Jewish immigrants, at a symposium the Section was sponsoring on the impact of Jewish culture on psychiatry.

Such unique men as Alex come amongst us only rarely. He loved people, he loved what he did as a doctor and as a psychiatrist. He had commitments that were deeply felt for his background, for the Jewish community, for Vienna, for Austria. He loved his family. He loved his friends too. And they returned the affection.

He did things to help other people; his patients, their families, and he did things for students and colleagues who came under his influence. People liked working with Alex because of his warmth, commitment and professional wisdom.

For all that, we thank Alex, and we count ourselves very fortunate to have been with him when he was amongst us.

We will miss him…but we will not forget what he has given to enrich our lives for having known him.

All of a sudden, it is too late to confer with Alexander Friedman. His unexpected death on March 30th has made another meeting I had intended to have with him impossible. .

I had met him for an interview in Witten, Germany in September, 2007, during the first international congress of transcultural psychiatry in the German-speaking countries.

Dr Friedmann was one of the organizers of that conference. At the time, I had said to myself, this conference is ending, but the theme of the conference is still in the early stages of development - there is therefore no need to hurry to complete the interview with Alex in Witten- we could meet again in Vienna.

The man who had opened my eyes to a new field of expertise had to leave the congress early to get a plane. His presence however, was noticeable right to the end.

Now, in the middle of ongoing preparations for the second international congress of transcultural psychiatry in the German-speaking countries, to be held in Vienna in Sep 2008, and for which he was principally involved in the planning, he has left us forever.

His friends, family and colleagues are only now able to grasp the fact that he has not merely just temporarily left the room, but that he will not be coming back. Although telephone calls and emails do refer to the tragic event, his loss remains "un-graspable" to us. This sentiment will undoubtedly be reflected in many other obituaries and leave a lasting patina on our memories of him.

It is possible for a full life to be reduced to mere landmarks, if set forth in a table: A-levels at the Lycée Français of Vienna in 1967, award of doctorate in1977 and the qualification of medical specialist in psychiatry in 1984, assistant professor and initiator of a social-psychiatric centre in 1990, instructor in psychiatry, lecturing tutor of the Special Outpatient Clinic for Cross-cultural Psychiatry and Migration-related Psychological Disorders, and initiator of the ESRA association 1994, initiator of a vocational education centre combined with a training workshop in 1998. In 1995 and 2000, he was awarded the Decoration of Merit 1st Class of the Republic of Austria and the State of Vienna.

I am able to retrieve a sign of the living Alexander Friedmann in a reflection he wrote on 21 January 2008 for the website of the World Psychiatric Association (http://www.wpa-tps.org/Friedmann-A.htm). Here I can find answers to questions I was tragically denied the opportunity to ask myself.

Friedmann reports that his parents grew up as Austrian citizens in Czernowitz, the prospering capital of the Bucovina District. The local Jewish community was comprised of Orthodox Hassidic Jews, as well as of highly emancipated and assimilated Jews. In terms of religious tolerance, the Jews of Austria were accepted and treated on an equal footing with other Austrian citizens since 1882, and the Jews were loyal citizens of Austria-Hungary. The Empire collapsed with its capitulation at the end WWI. Alex's parents became Romanian citizens. They married in1942 in Bucharest. Within a short period of time, they fell victim to persecution by the Romanian fascist regime. His mother, prosecuted as a communist and discriminated against as a Jew, was deported to a concentration camp. She was able to survive due to the help of her husband, who went into hiding and supplied forged documents for victims of Nazi persecution.

Their only child, Alexander, was born in Bucharest in 1948. Both parents had somehow survived the Holocaust. They now dreaded Stalinist Romania and fled to Palestine- a saga of its own- to join their Zionist relatives who had been living in Palestine for many years. The mother and the ailing child however, are not able to find peace and gain strength in the newly-founded State of Israel. Alex and his parents re-immigrated to Vienna in 1952. For Alexander, school represented a confluence of French, German and Austrian cultures.

At home he was simply a Jew, with a migration background, while at school he learned to speak six languages. In Austria, as Friedmann recalled the post-WW2 years, the 1950s were no bed of roses for Jews. Anti-Semitism continued to flourish - Austria's self-surrender to Hitler's German Reich is denied to the extent of accepting the historical lie that Austria was the Nazis' first victim.

At age 16, Alexander was arrested as a participant in a rally opposing Neo-Nazis, in 1964:"It was incomprehensible to me, how it could be possible that young Austrians were in denial of the historical reality of WW2 and could maintain the conviction that the Holocaust had never taken place". In retrospect, Friedmann is convinced that the cornerstone for the decision for a course of study that would enable him to understand people and their psychological roots was embedded that very day.

The final decisive influences upon his career choice are the tensions in the forefront of the Six-Day War, in 1967. The very same week, directly after having successfully concluded the entrance examination for medical studies at Vienna University, he departs for Israel. For the following 10 years he will devote his semester breaks to Israel, working as a farm hand, and at the end of this term, provide medical aid to Bedouin nomads by his ambulance service in the Negev desert. He then concentrates on his medical specialist training in Vienna, the emphasis of which is directed to the fields of social and cultural psychiatry.

Cross-cultural psychiatry is so closely tied in with his own life, his family's and his Jewish people's history and experiences, that he never just approaches this field of expertise on an academic discipline. As an assistant professor, he succeeds in establishing an outpatient clinic at the University Hospital, in which people originating from various countries and cultures can find help. According to Friedmann: "Today, many years later, I am convinced that people, even though they may acculturate and lose some of their culturally characteristic features, are very similar when seen from a psychological perspective. They react to and suffer from the same type of illness and the same distressful experiences of life, but they express their anguish using different languages, customs and bodily symptoms.

Friedman also perceives the Jewish Community of Vienna in the light of a changing history. The first Jew mentioned is a medieval era coin maker, who is murdered in the end. In the course of 9 centuries, there is constant change between tolerance and appreciation on one hand, and persecution and casting out on the other. Before the "Anschluss" to Hitler's Reich, there were 200.000 Jews living in Austria, amongst them acclaimed authors such as Schnitzler and Zweig, physician-psychiatrists such as Freud and Adler, musicians such as Mahler and Schönberg.

Whoever was still alive after 1945 and had come back to Austria, finds his former property plundered and "Aryanized". Several thousand victims, who had survived the death camps, are now categorised as "displaced persons", are traumatised, ill, robbed of their roots as well as of their property, and depressed.

In 1970, 85% of all Jews living in Vienna were born outside of Austria. 92 % of all Jews born after 1945 had foreign-born parents, many of whom were refugees from the conflicts in Hungary in 1956, Poland in 1967,and Czechoslovakia in 1968; too exhausted to reach their primary destinations of Israel or USA.

As of 1972, a new wave of immigrants follows, coming from the Asian Soviet Republics - Tajics, Uzbeks, Jews from the Caucasus. They do not speak German, their traditional occupations are not needed or wanted in Austria.

Friedmann experiences how these mostly Sephardic people do not receive a warm welcome by many of the Austrian Ashkenazi Jews: "Initially, the Jewish Community had isolated and rejected these new immigrants". They imitated the xenophobic behaviour of the majority of the Austrian population. "However, several years later, there was a general surprise about the delinquency of a significant number of young immigrant Jews who belonged to this group of Asian immigrants and had declined into drug consumption and criminality". The Viennese Jewish community decided to help.

Dr. Friedmann also encounters such ftroubled youth in his clinical practise. Most of them had neither money nor health insurance coverage. The young doctor founds a union of Jewish fellow doctors, whom he persuades to also work free of charge. "This initiative led to my integration into the social organizations of the Jewish Community, which, up to this point of time, I had only perceived as a representative and religious organisation".

Obviously, being just as creative as helpful, the "mensch" Friedman is elected to leading roles within the Jewish community. He regards it as his task to primarily establish the position of the immigrant Sephardic Jews from Asia within the Viennese Jewish community and subsequently in Austrian society. In the Vienna Jewish Community, opportunities for them to learn German are developed, followed up by vocational integration,and the organisation of housing. Friedmann reports of "their having their first experiences of democracy", referring to cases in which the local authorities could also be convinced to concede democratic (voting) rights to the newcomers in the Jewish community. 1982 sees the beginning of the construction of a synagogue built according to Sephardic tradition. A school soon follows. Within his own periphery, Friedmann shortly later initiates the interdisciplinary outpatient clinic ESRA for immigrants and traumatised survivors of the Holocaust. "This clinic now treats 1400 patients annually", the founder sums up and reports of the vocational training school, which has already had a total of 2500 graduates within 9 years. Young people are now better prepared to meet the demands of school and to deal with social turbulence and unemployment.

Friedmann's summary: "In the year 2007, the Jewish Community has grown to 7500 members. It currently operates three schools, the Vocational Training Centre, two sports clubs and four social facilities for the former Asian Soviet immigrants, who themselves have also established a school of the arts".

Not without pride, he mentions his own distinctions awarded by the state and adds: "My own standard is based on the fact that there is practically no unemployment and no criminality amongst the members of our community and that psychological barriers (of intra-communal prejudice) have been brought under control".

It is consequently no surprise that the assistant professor has also directed his attention to other conflict areas in the last few years. Asylum seekers from the former Yugoslavia, the former Soviet Union, the troubled and war-ravaged areas of the Middle East require specialists for psycho-traumatology. With the Association for Cross-cultural Psychiatry in German-speaking countries, Friedmann intended to advance the constructive debate regarding posttraumatic disorders on a trans-European basis. This now remains the task of those he has inspired and motivated.