Psychiatry Giant Sorry for Backing Gay ‘Cure’
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, lay awake at 4 o’clock on a recent morning knowing he had to
do the one thing that comes least naturally to him.
He pushed himself up and staggered into the dark. His desk seemed
impossibly far away; Dr. Spitzer, who turns 80 next week, 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 like an ax to strike down dumb
ideas, empty theorizing and junk studies.
Now here he was at his computer, ready to recant a study he had done
himself, a poorly conceived 2003 investigation that supported the use of
so-called reparative therapy to “cure” homosexuality for people
strongly motivated to change.
What to say? The issue of gay marriage was rocking national politics yet
again. The California State Legislature was debating a bill to ban the
therapy outright as being dangerous. A magazine 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 later learn that a World Health Organization report,
released on Thursday, calls the therapy “a serious threat to the health
and well-being — even the lives — of affected people.”
Dr. Spitzer’s fingers jerked over the keys, unreliably, as if choking on
the words. And then it was done: a short letter to be published this
month, in the same journal where the original study appeared.
“I believe,” it concludes, “I owe the gay community an apology.”
Disturber of the Peace
The idea to study reparative therapy at all was pure Spitzer, say those
who know him, an effort to stick a finger in the eye of an orthodoxy
that he himself had helped establish.
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 was not always so. Up into the 1970s, the field’s diagnostic manual classified homosexuality as an illness, calling it a “sociopathic personality disturbance.” Many therapists offered treatment, including Freudian analysts who dominated the field at the time.
Advocates for gay people objected furiously, and in 1970, one year after
the landmark Stonewall protests to stop police raids at a New York bar,
a team of gay rights protesters heckled a meeting of behavioral
therapists in New York to discuss the topic. 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,” said Dr. Spitzer, in an interview at his Princeton home last
week. “And I began to think, well, if it is a mental disorder, then what
makes it one?”
He compared homosexuality with other conditions defined as disorders, 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. Dr. Spitzer was
then a junior member of on 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 Dr. Spitzer against a
pair of influential senior psychiatrists who would not budge. In the
end, the psychiatric association in 1973 sided with Dr. Spitzer,
deciding to drop homosexuality from its manual and replace it with his
alternative, “sexual orientation disturbance,” to identify people whose
sexual orientation, gay or straight, caused them distress.
The arcane language notwithstanding, homosexuality was no longer a
“disorder.” Dr. Spitzer achieved a civil rights breakthrough in record
time.
“I wouldn’t say that Robert Spitzer became a household name among the
broader gay movement, but the declassification of homosexuality was
widely celebrated as a victory,” 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, Dr. Spitzer took charge of the task 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, here and abroad. It instantly set the standard for future
psychiatry manuals, and elevated its principal architect, then nearing
50, to the pinnacle of his field.
He was the keeper of the book, part headmaster, part ambassador, and
part ornery cleric, growling over the phone at scientists, journalists,
or policy makers he thought were out of order. He took to the role as if
born to it, colleagues say, helping to bring order to a historically
chaotic corner of science.
But power was its own kind of confinement. Dr. Spitzer could still
disturb the peace, all right, but no longer from the flanks, as a rebel.
Now he was the establishment. And in the late 1990s, friends say, he
remained restless as ever, eager to challenge common assumptions.
That’s when he ran into another group of protesters, at the psychiatric
association’s annual meeting in 1999: self-described ex-gays. Like the
homosexual protesters in 1973, they too were outraged that psychiatry
was denying their experience — and any therapy that might help.
Reparative Therapy
Reparative therapy, sometimes called “sexual reorientation” or
“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. Some
therapists never let go of the theory, and one of Dr. Spitzer’s main
rivals in the 1973 debate, Dr. Charles W. Socarides, founded an
organization called the National Association for Research and Therapy of Homosexuality, or Narth, in Southern California, to promote it.
By 1998, Narth had formed alliances with socially conservative advocacy
groups and together they began an aggressive campaign, taking out
full-page ads in major newspaper trumpeting success stories.
“People with a shared worldview basically came together and created
their own set of experts to offer alternative policy views,” said Dr.
Jack Drescher, a psychiatrist in New York and co-editor of “Ex-Gay
Research: Analyzing the Spitzer Study and Its Relation to Science,
Religion, Politics, and Culture.”
To Dr. Spitzer, the scientific question was at least worth asking: What
was the effect of the therapy, if any? Previous studies had been biased
and inconclusive. “People at the time did say to me, ‘Bob, you’re
messing with your career, don’t do it,’ ” Dr. Spitzer said. “But I just
didn’t feel vulnerable.”
He recruited 200 men and women, from the centers that were performing
the therapy, including Exodus International, based in Florida, and
Narth. He interviewed each in depth over the phone, asking about their
sexual urges, feelings and behaviors before and after having the
therapy, rating the answers on a scale.
He then compared the scores on this questionnaire, before and after
therapy. “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,”
his paper concluded.
The study — presented at a psychiatry meeting in 2001, before
publication — immediately created a sensation, and ex-gay groups seized
on it as solid evidence for their case. This was Dr. Spitzer, after all,
the man who single-handedly removed homosexuality from the manual of
mental disorders. No one could accuse him of bias.
But gay leaders accused him of betrayal, and they had their reasons.
The study had serious problems. It was based on what people remembered
feeling years before — an often fuzzy record. It included some ex-gay
advocates, who were politically active. And it did not test any
particular therapy; only half of the participants engaged with a
therapist at all, while the others worked with pastoral counselors, or
in independent Bible study.
Several colleagues tried to stop the study in its tracks, and urged him not to publish it, Dr. Spitzer said.
Yet, heavily invested after all the work, he turned to a friend and
former collaborator, Dr. Kenneth J. Zucker, psychologist in chief at the
Center for Addiction and Mental Health in Toronto and editor of the
Archives of Sexual Behavior, another influential journal.
“I knew Bob and the quality of his work, and I agreed to publish it,”
Dr. Zucker said in an interview last week. The paper did not go through
the usual peer-review process, in which unnamed experts critique a
manuscript before publication. “But I told him I would do it only if I
also published commentaries” of response from other scientists to
accompany the study, Dr. Zucker said.
Those commentaries, with a few exceptions, were merciless. One cited the
Nuremberg Code of ethics to denounce the study as not only flawed but
morally wrong. “We fear the repercussions of this study, including an
increase in suffering, prejudice, and discrimination,” concluded a group
of 15 researchers at the New York State Psychiatric Institute, where Dr. Spitzer was affiliated.
Dr. Spitzer in no way implied in the study that being gay was a choice,
or that it was possible for anyone who wanted to change to do so in
therapy. But that didn’t stop socially conservative groups from citing
the paper in support of just those points, according to Wayne Besen,
executive director of Truth Wins Out, a nonprofit group that fights antigay bias.
On one occasion, a politician in Finland held up the study in Parliament
to argue against civil unions, according to Dr. Drescher.
“It needs to be said that when this study was misused for political
purposes to say that gays should be cured — as it was, many times — Bob
responded immediately, to correct misperceptions,” said Dr. Drescher,
who is gay.
But Dr. Spitzer could not control how his study was interpreted by
everyone, and he could not erase the biggest scientific flaw of them
all, roundly attacked in many of the commentaries: Simply asking people
whether they have changed is no evidence at all of real change. People
lie, to themselves and others. They continually change their stories, to
suit their needs and moods.
By almost any measure, in short, the study failed the test of scientific
rigor that Dr. Spitzer himself was so instrumental in enforcing for so
many years.
“As I read these commentaries, I knew this was a problem, a big problem,
and one I couldn’t answer,” Dr. Spitzer said. “How do you know someone
has really changed?”
Letting Go
It took 11 years for him to admit it publicly.
At first he clung to the idea that the study was exploratory, an attempt
to prompt scientists to think twice about dismissing the therapy
outright. Then he took refuge in the position that the study was focused
less on the effectiveness of the therapy and more on how people
engaging in it described changes in sexual orientation.
“Not a very interesting question,” he said. “But for a long time I
thought maybe I wouldn’t have to face the bigger problem, about
measuring change.”
After retiring in 2003, he remained active on many fronts, but 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 mentally as well as
physically, making it still harder to fight back pangs of remorse.
And one day in March, Dr. Spitzer entertained a visitor. Gabriel Arana, a
journalist at the magazine The American Prospect, interviewed Dr.
Spitzer about the reparative therapy study. This was not just any
interview; Mr. Arana went through reparative therapy himself as a
teenager, and his therapist had recruited the young man for Dr.
Spitzer’s study (Mr. Arana did not participate).
“I asked him about all his critics, and he just came out and said, ‘I think they’re largely correct,’ ” said Mr. Arana, who wrote about his own experience
last month. Mr. Arana said that reparative therapy ultimately delayed
his self-acceptance as a gay man and induced thoughts of suicide. “But
at the time I was recruited for the Spitzer study, I was referred as a
success story. I would have said I was making progress.”
That did it. The study that seemed at the time a mere footnote to a
large life was growing into a chapter. And it needed a proper ending — a
strong correction, directly from its author, not a journalist or
colleague.
A draft of the letter has already leaked online and has been reported.
“You know, it’s the only regret I have; the only professional one,” Dr.
Spitzer said of the study, near the end of a long interview. “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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