Robert L. Spitzer (born May 22, 1932) was a major architect of the modern classification of mental disorders. He is a retired professor of psychiatry at Columbia University in New York City, United States and was on the research faculty of the Columbia University Center for Psychoanalytic Training and Research. He retired after 49 years[1] in December 2010.[2] He is called arguably the most influential psychiatrist of the 20th century.[3]
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Born to a Jewish family[4] in White Plains, New York in 1932, Spitzer received his bachelor's degree in psychology from Cornell University and his M.D. from New York University School of Medicine in 1957.[5][6] Spitzer wrote an article on Wilhelm Reich's theories in 1953 which the American Journal of Psychiatry declined to publish.[7]
Spitzer served on the four-person United States Steering Committee for the United States–United Kingdom Diagnostic Project, who published their results in 1972. (The most important difference between countries they found was that the concept of schizophrenia used in New York was much broader than the one used in London and included patients who would have been termed manic-depressive or bipolar.)[8] Spitzer co-developed a computer program, Diagno I, in 1968, based on a logical decision tree, that could derive a diagnosis from the scores on a Psychiatric Status Schedule (which he co-published in 1970) and that the Project used to check the consistency of its results.[9]
Spitzer codeveloped the Mood Disorder Questionnaire (MDQ), a screening technique used for diagnosing bipolar disorder. He also codeveloped the Patient Health Questionnaire (PRIME-MD) which can be self-administered to find out if one has a mental illness.[10]
Spitzer was chair of the task force of the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) which was released in 1980. Spitzer was a major architect of the modern classification of mental disorders which involves classifying mental disorders in discrete categories with specified diagnostic criteria, but later criticized what he saw as errors and excesses in the Manual's later versions; however, Spitzer maintained his position that the DSM is still better than the alternatives.
Spitzer was briefly featured in the 2007 BBC TV series The Trap, in which he stated that the DSM, by operationalizing the definitions of mental disorders while paying little attention to the context in which the symptoms occur, may have medicalized the normal human experiences of a significant number of people.[11]
Despite acknowledging the shortcomings of the DSM, Spitzer co-authored a position paper in 2003 with DSM-IV editor Michael First stating that the "DSM is generally viewed as clinically useful." The position paper based this observation on data such as surveys from practicing professionals and feedback from medical students and residents. The authors added that primary care physicians find the DSM too complicated for their use. While agreeing that DSM is far from perfect, they reject the call for it to be abandoned. The authors emphasizes that given then-current limitations in understanding psychiatric disorders, a multitude of DSM codes/dignoses might indeed apply to some patients, but that it would be a "total speculation" to assign a single diagnosis to a patient. The authors also acknowledged that the criteria for certain disorders are known to be poor, but argue that this is one of the reasons why the Manual must undergo periodic revisions. Further, the authors rejected calls to adopt the ICD-9 because it lacks diagnostic criteria and would "[set] psychiatry back 30 years", while the ICD-10, they argue, closely resembles the DSM-III-R classification.[12]
Spitzer has criticized the revision process of the DSM-5 for lacking transparency.[13] He has also criticized specific proposals, like the proposed introduction of the psychosis risk syndrome for people who have mild symptoms found in psychotic disorders.[14]
Spitzer "spearheaded the APA's 1973 decision to remove homosexuality from its list of mental disorders."[15]
Spitzer, in charge of the revision of the Diagnostic and Statistical Manual, was left to decide whether homosexuality should be included in the manual. He decided against inclusion, since mental disorders would be identified by the distress an individual felt or an impairment of functioning. He ruled that homosexuality would be deleted from the list of mental disorders and that a listing of "ego-dystonic homosexuality" be included; that is, homosexuality that causes distress to the individual.... He stated that the revision in the manual could provide the possibility of finding a homosexual to be free of psychiatric disorder.[16]
In 2001, Spitzer delivered a controversial paper, Can Some Gay Men and Lesbians Change Their Sexual Orientation? at the 2001 annual APA meeting; in that paper, Spitzer argued that it is possible that some highly motivated individuals could successfully change their sexual orientation from homosexual to heterosexual. A 2001 Washington Post article indicates that Spitzer held 45-minute telephonic interviews with 200 people who claimed that their respective sexual orientations had changed from homosexual to heterosexual. Spitzer said he “began his study as a skeptic,” but the study revealed that “66 percent of the men and 44 percent of the women had arrived at what [Spitzer] called good heterosexual functioning,” defined as “being in a sustained, loving heterosexual relationship within the past year, getting enough satisfaction from the emotional relationship with their partner to rate at least seven on a 10-point scale, having satisfying heterosexual sex at least monthly and never or rarely thinking of somebody of the same sex during heterosexual sex.” Spitzer also found that “89 percent of men and 95 percent of women said they were bothered only slightly, or not at all, by unwanted homosexual feelings,” but that “only 11 percent of the men and 37 percent of the women reported a complete absence of homosexual indicators, including same-sex attraction.” The Post reported that “[s]ome 43 percent of the sample had been referred to Spitzer by ‘ex-gay ministries,’” while “an additional 23 percent were referred by the National Association for Research and Therapy of Homosexuality.” Spitzer has stated that his research "shows some people can change from gay to straight, and we ought to acknowledge that." [17] Considering how difficult it had been to find 100 participants, and that they were considered the best cases of conversion therapy, Spitzer concluded that although change could occur, it was probably very rare.[18][19]
The APA issued an official disavowal of Spitzer's paper, noting that it had not been peer reviewed and stating that "[t]here is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one's sexual orientation."[20] Two years later, the paper was peer reviewed and published in the Archives of Sexual Behavior.[21] Two-thirds of the reviews were critical, and the publication decision sparked controversy, with one member of the publication's supporting organization resigning in protest.[22] The paper has been criticized for its sampling methods and criteria for success.[23]
In a 2005 interview, Spitzer stated that “[m]any colleagues were outraged” following the publication of the study. Spitzer added that “[w]ithin the gay community, there was initially tremendous anger and feeling that I had betrayed them.” When asked whether he would consider a follow-up study, Spitzer said no, and added that he felt “a little battle fatigue.”[24] While Spitzer has said that he has no way of knowing whether the study participants were being honest,[25] he has also indicated that he believed that the interviewees were being candid with him.[26]
Spitzer received the Thomas William Salmon Medal from the New York Academy of Medicine for his contributions to psychiatry.[10]