Robert Spitzer

The American psychiatrist Robert Spitzer (1932–2015) is best known for leading the effort to end the classification of homosexuality as a mental disorder within the American psychiatric profession. That effort was part of a broader process, led by Spitzer, to establish clear scientific definitions of mental illnesses; he named or popularized the names of several common illnesses that frequently appear in today's mental health landscape, including bipolar disorder and post-traumatic stress disorder (PTSD).

Robert Leopold Spitzer was born in White Plains, New York, on May 22, 1932, the son of Eastern European Jewish immigrants. Spitzer's father, Benjamin, was a dental equipment engineer; his mother, Esther, was a classical pianist who was emotionally troubled by the death of Spitzer's older sister from meningitis. Spitzer grew up in New York and attended the private Walden School. After gaining an awareness of the field known as psychotherapy, he was convinced that it could solve his problems: as a high-school student he skipped class in favor of weekly therapy sessions that cost him five dollars apiece and also earned him parental disapproval. Attending summer camp, Spitzer took a scientific approach to sorting out budding romances: he posted graphs on the wall of his room that charted the ups and downs of his feelings about the girls at the camp toward whom he was attracted.

Modified Belief in Science with Skepticism

One part of Spitzer's psychiatric regimen made him feel skeptical, however. His therapist was a follower of psychoanalyst Wilhelm Reich (1897–1957), who believed that a form of cosmic radiation called orgone energy could lead to, among other things, sexual liberation. Although Spitzer was told to sit in an iron box called an orgone accumulator, he soon began to doubt the value of the therapy. Enrolling at Cornell University, he wrote a paper debunking the theories of Reich, who by that time was under investigation on fraud charges (unfairly, some believed). On the basis of his work, the undergraduate Spitzer was called as an expert witness by attorneys for the U.S. Food & Drug Administration.

Spitzer graduated from Cornell in 1953 and went on to medical school at New York University, receiving his M.D. in 1957. During his residencies at Columbia University and the New York State Psychiatric Institute, he studied computers (a rare field at the time for nonspecialists) and later wrote software to be used by psychiatrists in making mental health diagnoses. Spitzer finished his studies at Columbia's Center for Psychoanalytic Training in 1966 and joined the university's psychiatry department as an instructor. He remained on Columbia's faculty for the rest of his career, retiring in 2003.

Spitzer's career took a new direction in 1966, thanks to a chance meeting in a Columbia University dining room. Over a meal, one of his colleagues told him that he was working on the second edition of psychiatry's Diagnostic and Statistical Manual of Mental Disorders, known as DSM-II, and asked Spitzer whether he was interested in joining him in this work. Published by the American Psychiatric Association (APA), the DSM was first published in 1952 as an attempty to codify the practice of psychiatry into a group of scientifically supported procedures. For many doctors, however, psychiatry was still an intuitive practice based on the insights of Sigmund Freud and the discipline's other early Austrian pioneers.

Spitzer had a small role in the production of DSM-II, which was published in 1968 and went through six printings by 1974. As he became more deeply involved in the shaping of the book, he began to understand the field's cutting-edge issues more deeply. One of those issues was homosexuality, which at the time was classified as a mental illness that could be cured by psychotherapy or other, more extreme, treatments such as electric shock therapy. At the time, Spitzer supported that classification, but he was also aware that gay therapists and others, motivated by a wave of gay activism that began in the late 1960s, were attending APA conferences and demanding that the profession's view of homosexuality be changed.

The turning point for Spitzer came during an informal meeting with a group of gay psychiatrists at a tiki bar at the 1973 APA conference held in Honolulu, Hawai'i. These psychiatrists convinced him that they were not unhappy about their orientation in itself, but only about the discrimination they faced in society. If homosexuality itself did not cause distress, Spitzer reasoned, how could it be considered an illness? Realizing that controversy lay ahead, he had already organized panels representing each side of the question for the conference. He now adopted the view that the mental-illness classification given to homosexuality should be removed.

Changed the Label Describing Gay Behavior

A motion to enact this change was vigorously resisted by older members of the APA, including some of the most respected names in the profession. Spitzer, however, kept pointing to his main argument: if gays were not made unhappy by their condition, they could not be said to be ill. Finally he engineered a compromise: the designation of homosexuality as a mental illness would be removed from the association's positions and replaced by what he described as ego-dystonic homosexuality, characterizing gays and lesbians who were indeed unhappy about their situation. Gay-oriented publications hailed the decision and the ripple effects within in wider American society were profound.

The conference's decision involved changing the way homosexuality was treated in the upcoming DSM, which was scheduled for publication in 1973. In part because of his handling of the homosexuality controversy, Spitzer was chosen to chair the task force responsible for overseeing the revision. He used his position to engineer a wholesale revision of the DSM, insisting on clear definitions of mental illnesses and psychological disturbances that could be scientifically evaluated. Vague words like “neurosis” that were relied upon by Freudian analysts were banished from the manual and replaced by terms that have since become common in public thinking about psychiatry: these include bipolar disorder, attention deficit disorder, post-traumatic stress disorder, and panic disorder. The conditions Spitzer and his colleagues described had always existed, but for the first time they had precise names.

DSM-III, which appeared in 1980, contained 494 pages (compared with 134 pages for DMS-II) and had wide ramifications in U.S. society. The book sold more than one million copies in its first two editions and was discussed on popular television program such as Oprah and reviewed in major magazines. Drug companies, given a large range of new conditions for which they could develop treatments, were also enthusiastic. DSM-III had its critics as well, with some psychiatrists contending that it tended to reduce an intuitive human science to a set of formulas and discount the value of insightful interviewing in psychiatry. Indeed, in later life Spitzer would question whether his revised DSM had gone too far in treating ordinary human behaviors as symptoms of illness.

Spitzer wrote large amounts of the DSM-III himself and dominated the process of its production, but for DSM-IV, APA members chose Michael B. First as editor. Spitzer maintained important consulting roles for DSM-IV (1994) and DSM-V (2013), the latter which featured input from a wider variety of professionals. He continued to advocate for the development of new ideas through debate and discussion. “Maybe it was a New York thing, growing up here, I don't know,” he later admitted to a writer for the New York Times. “I was just always like that, contrary and confident.”

Tested Efficacy of Reparative Therapy

Spitzer's confidence reasserted itself in the later part of his career as he revisited the issue of homosexuality in the early 2000s. The changes he originally favored to psychiatry's dominant view of homosexuality had left open the possibility that ego-dystonic homosexuals might be able to change their orientation, and in the late 1990s he proposed to test the idea that sexual orientation could be changed by therapy. After 200 interviews with male and female homosexuals who had sought out what was then known as reparative therapy, he found that 66 percent of the men and 44 percent of the women were able to function well as heterosexuals.

Spitzer was married three times. A brief marriage entered into during college ended in divorce, as did his second marriage, to fellow physician Judith Berg. That marriage produced two children, Laura and Daniel Spitzer, before crumbling under the stress of his work on DSM-III. Spitzer had three more children, Noah, Ezra, and Gideon Spitzer-Williams, by his third wife, Janet Williams, who outlived him. He was the author of 14 books, many of them with co-authors and most serving as supplements to various editions of the DSM. He received the Thomas W. Salmon Award for contributions to psychiatric research in 2000. Suffering from Parkinson's disease in the last years of his life, Spitzer moved to Seattle, Washington, in the summer of 2015 and died there months later, on December 25, 2015.

Books

Lieberman, Jeffrey A., Shrinks: The Untold Story of Psychiatry, Little, Brown, 2015.

Periodicals

Christianity Today, April 2005, p. 94.

Daily Telegraph (London, England), January 14, 2016, p. 25.

Gay & Lesbian Review Worldwide, July–August 2012, p. 8.

Herald (Glasgow, Scotland), January 5, 2016, p. 23.

New York Times, May 19, 2012, p. A1; December 28, 2015, p. B6.

Times (London, England), February 24, 2016, p. 43.

Washington Post, December 26, 2015.

Online

Washington Post online, http://washingtonpost.com (December 1, 2016), “Robert Spitzer: Psychiatrist of Transformative Influence.”❑

(MLA 8th Edition)