Robert Spitzer (psychiatrist)
Encyclopedia
Robert L. Spitzer 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 in December 2010. He is called arguably the most influential psychiatrist of the 20th century.
family 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. Spitzer wrote an article on Wilhelm Reich
's theories in 1953 which the American Journal of Psychiatry declined to publish.
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
.) 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.
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.
'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.
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.
Spitzer has criticized the revision process of the DSM-5
for lacking transparency. 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.
http://www.respond.org.uk/support/resources/talks/homosexuality_psychoanalysis.html
from homosexual to heterosexual. Considering how difficult it had been to find 100 participants, and that they were considered the best cases of conversion therapy, Dr. Spitzer concluded that although change could occur, it was probably very rare.
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."
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."
Two years later, the paper was peer reviewed and published in the Archives of Sexual Behavior
. The publication decision sparked controversy, and one sponsoring member resigned in protest. The paper has been criticized for its sampling methods and criteria for success.
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.” While Spitzer has said that he has no way of knowing whether the study participants were being honest, he has also indicated that he believed that the interviewees were being candid with him.
Classification of mental disorders
The classification of mental disorders, also known as psychiatric nosology or taxonomy, is a key aspect of psychiatry and other mental health professions and an important issue for consumers and providers of mental health services...
. He is a retired professor of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
at Columbia University
Columbia University
Columbia University in the City of New York is a private, Ivy League university in Manhattan, New York City. Columbia is the oldest institution of higher learning in the state of New York, the fifth oldest in the United States, and one of the country's nine Colonial Colleges founded before the...
in New York City
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...
, United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
and was on the research faculty of the Columbia University Center for Psychoanalytic Training and Research. He retired after 49 years in December 2010. He is called arguably the most influential psychiatrist of the 20th century.
Education and early years
Born to a JewishAmerican Jews
American Jews, also known as Jewish Americans, are American citizens of the Jewish faith or Jewish ethnicity. The Jewish community in the United States is composed predominantly of Ashkenazi Jews who emigrated from Central and Eastern Europe, and their U.S.-born descendants...
family in White Plains, New York
White Plains, New York
White Plains is a city and the county seat of Westchester County, New York, United States. It is located in south-central Westchester, about east of the Hudson River and northwest of Long Island Sound...
in 1932, Spitzer received his bachelor's degree in psychology from Cornell University
Cornell University
Cornell University is an Ivy League university located in Ithaca, New York, United States. It is a private land-grant university, receiving annual funding from the State of New York for certain educational missions...
and his M.D. from New York University School of Medicine
New York University School of Medicine
The New York University School of Medicine is one of the graduate schools of New York University. Founded in 1841 as the University Medical College, the NYU School of Medicine is one of the foremost medical schools in the United States....
in 1957. Spitzer wrote an article on Wilhelm Reich
Wilhelm Reich
Wilhelm Reich was an Austrian-American psychiatrist and psychoanalyst, known as one of the most radical figures in the history of psychiatry...
's theories in 1953 which the American Journal of Psychiatry declined to publish.
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
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
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
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
.) 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.
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.
Position on the DSM
Spitzer was chair of the task force of the third edition of the American Psychiatric AssociationAmerican Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
's Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification 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
Operational definition
An operational definition defines something in terms of the specific process or set of validation tests used to determine its presence and quantity. That is, one defines something in terms of the operations that count as measuring it. The term was coined by Percy Williams Bridgman and is a part of...
of mental disorders while paying little attention to the context in which the symptoms occur, may have medicalized
Medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat...
the normal human experiences of a significant number of people.
Despite acknowledging the shortcomings of the DSM, Spitzer co-authored a position paper in 2003 with DSM-IV editor Michael First
Michael First
Michael B. First is an American psychiatrist who focuses on diagnostic criteria for mental disorders. He is Professor of Clinical Psychiatry at Columbia University. First was the Editor of the DSM-IV-TR, the Editor of Text and Criteria for the DSM-IV, and the editor of the Structured Clinical...
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
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
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
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
, they argue, closely resembles the DSM-III-R classification.
Spitzer has criticized the revision process of the DSM-5
DSM-5
The next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders , commonly called DSM-5 , is currently in consultation, planning and preparation...
for lacking transparency. 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.
http://www.respond.org.uk/support/resources/talks/homosexuality_psychoanalysis.html
Removal of homosexuality from the DSM
Robert Spitzer "spearheaded the APA's 1973 decision to remove homosexuality from its list of mental disorders."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.
Views on conversion therapy
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 orientationSexual orientation change efforts
Sexual orientation change efforts are methods that aim to eliminate a same-sex sexual orientation. They may include behavioral techniques, cognitive behavioral techniques , psychoanalytic techniques, medical approaches, religious and spiritual approaches.The longstanding consensus of the...
from homosexual to heterosexual. Considering how difficult it had been to find 100 participants, and that they were considered the best cases of conversion therapy, Dr. Spitzer concluded that although change could occur, it was probably very rare.
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."
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
Reparative Therapy
Conversion therapy, sometimes called reparative therapy or reorientation therapy, is one type of sexual orientation change effort that attempts to change the sexual orientation of a person from homosexual or bisexual to heterosexual. These types of therapies have been a source of intense...
as a treatment to change one's sexual orientation."
Two years later, the paper was peer reviewed and published in the Archives of Sexual Behavior
Archives of Sexual Behavior
The Archives of Sexual Behavior is a peer-reviewed academic journal in sexology. It is the official publication of the International Academy of Sex Research.- History :...
. The publication decision sparked controversy, and one sponsoring member resigned in protest. The paper has been criticized for its sampling methods and criteria for success.
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.” While Spitzer has said that he has no way of knowing whether the study participants were being honest, he has also indicated that he believed that the interviewees were being candid with him.
Later career
Spitzer received the Thomas William Salmon Medal from the New York Academy of Medicine for his contributions to psychiatry.Books
- Critical Issues in Psychiatric Diagnosis (with Donald F. Klein), Raven 1978, ISBN 0-89004-213-6
- DSM III Casebook, American Psychiatric Publications 1981, ISBN 0-89042-051-3
- Treatment of Mental Disorders (with James W. Jefferson), Oxford University Press 1982, ISBN 0-19-503107-5
- Psychopathology, a Case Book (with Janet B.W. Williams und Andrew E. Skodol), McGraw-Hill 1983, ISBN 0-07-060350-2
- DSM-111 Case Book: Casebook to 3r.e (Diagnostic), Cambridge University Press, 1985, ISBN 0-521-31530-1
- APA: Desk Reference to DSM III R: Desk Reference to the Diagnostic Criteria of 3r.e (Diagnostic), Cambridge University Press, 1987, ISBN 0-521-34693-2
- An Annotated Bibliography of DSM III, 1987, ISBN 0-88048-257-5
- Scid-P, 1990, ISBN 0-88048-411-X
- Dsm-IV Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, 1994, ISBN 0-88048-675-9
- Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), 1997, ISBN 0-88048-931-6
- International Perspectives on DSM-III, Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association 1998, ISBN 0-88048-017-3
- DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association 2002, ISBN 1-58562-058-0
- Treatment Companion to the DSM-IV-TR Casebook, American Psychiatric Association 2004, ISBN 1-58562-139-0
- DSM-IV-TR Casebook, Volume 2, American Psychiatric Association 2006, ISBN 1-58562-219-2