Dr. Robert Spitzer, considered by some to be the father of modern psychiatry, in Princeton, N.J., May 11, 2012. Spitzer recanted a study he did in 2003 that supported the use of so-called reparative therapy to "cure" homosexuality, and said that he owes the gay community an apology.
Alex di Suvero, New York Times
Psychiatrist apologizes for gay 'cure' study
- Article by: BENEDICT CAREY
- New York Times
- May 18, 2012 - 9:25 PM
PRINCETON, N.J. - The simple fact was that he had done something wrong, and at the end of a long and revolutionary career it didn't matter how often he'd been right, how powerful he once was, or what it would mean for his legacy.
Dr. Robert L. Spitzer, considered by some to be the father of modern psychiatry, who turns 80 next week, lay awake at 4 a.m. knowing he had to do the one thing that comes least naturally to him.
He staggered into the dark. His desk seemed impossibly far away; Spitzer suffers from Parkinson's disease and has trouble walking, sitting, even holding his head upright. The word he sometimes uses to describe these limitations -- pathetic -- is the same one that for decades he wielded to strike down dumb ideas, empty theorizing and junk studies.
Now, he was ready to recant a study he had done, a poorly conceived 2003 investigation that supported the use of so-called reparative therapy to "cure" homosexuality for people highly motivated to change.
What to say? The issue of gay marriage was rocking national politics again. The California Legislature was debating a bill to ban the therapy. A writer who had been through the therapy as a teenager recently visited his house, to explain how miserably disorienting the experience was.
And he would learn that a World Health Organization report, released Thursday, calls the therapy "a serious threat to the health and well-being -- even the lives -- of affected people."
Spitzer's fingers jerked over the keys, unreliably, as if choking on the words. And then it was done: a letter to be published this month in the Archives of Sexual Behavior, the same journal where the original study appeared. "I believe," it concludes, "I owe the gay community an apology."
'Drawn to controversy'
In the late 1990s as today, the psychiatric establishment considered the therapy to be a nonstarter. Few therapists thought of homosexuality as a disorder.
It wasn't always so. Up into the 1970s, the field's diagnostic manual classified homosexuality as an illness, calling it a "sociopathic personality disturbance." Gay advocates objected furiously and in 1970, protesters heckled a meeting of behavioral therapists. The meeting broke up, but not before a young Columbia University professor sat down with the protesters to hear their case.
"I've always been drawn to controversy, and what I was hearing made sense," Spitzer said. "And I began to think, well, if it is a mental disorder, then what makes it one?"
He compared homosexuality with other conditions, like depression and alcohol dependence, and saw immediately that the latter caused marked distress or impairment, while homosexuality often did not.
He also saw an opportunity to do something about it. Spitzer was then a junior member of an American Psychiatric Association committee helping to rewrite the field's diagnostic manual, and he promptly organized a symposium to discuss the place of homosexuality.
That kicked off a series of bitter debates, pitting Spitzer against a pair of influential senior psychiatrists who would not budge. In the end, the psychiatric association in 1973 sided with Spitzer, deciding to drop homosexuality from its manual. Spitzer achieved a civil rights breakthrough in record time.
"The declassification of homosexuality was widely celebrated," said Ronald Bayer of the Center for the History and Ethics of Public Health at Columbia. "'Sick No More' was a headline in some gay newspapers."
Partly as a result, Spitzer took charge of updating the diagnostic manual. Together with a colleague, Dr. Janet Williams, now his wife, he set to work. To an extent that is still not widely appreciated, his thinking about this one issue -- homosexuality -- drove a broader reconsideration of what mental illness is, of where to draw the line between normal and not. The new manual, a 567-page doorstop released in 1980, became an unlikely best-seller. It instantly set the standard, and elevated him to the pinnacle of his field.
'It's the only regret I have'
Reparative therapy, sometimes called "conversion" therapy, is rooted in Freud's idea that people are born bisexual and can move along a continuum from one end to the other. To Spitzer, the question was at least worth asking: What was the effect of the therapy, if any?
His study of 200 men and women who had had the therapy created a sensation even before it was published. It concluded: "The majority of participants gave reports of change from a predominantly or exclusively homosexual orientation before therapy to a predominantly or exclusively heterosexual orientation in the past year."
Ex-gay groups seized on it as evidence for their case. But gay leaders accused him of betrayal. The study had serious problems. It was based on what people remembered feeling years before and included some ex-gay advocates, who were politically active. And it didn't test any particular therapy; only half of the participants engaged with a therapist at all.
By almost any measure, the study failed the test of scientific rigor that Spitzer himself was so instrumental in enforcing. "As I read these commentaries [that accompanied his published study], I knew this was a problem, a big problem," Spitzer said. "How do you know someone has really changed?"
It took 11 years for him to admit it publicly. At first he clung to the idea that the study was exploratory. But after he retired in 2003, the reparative study remained a staple of the culture wars and a personal regret that wouldn't leave him be. The Parkinson's symptoms have worsened in the past year, exhausting him and making it still harder to fight back pangs of remorse.
"You know, it's the only regret I have; the only professional one," he said. "And I think, in the history of psychiatry, I don't know that I've ever seen a scientist write a letter saying that the data were all there but were totally misinterpreted. Who admitted that and who apologized to his readers."
He looked away and back again, his big eyes blurring with emotion. "That's something, don't you think?"
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