Mixed Views on Legacy of Controversial Psychiatrist

In the wake of the recent death of psychiatrist Dr. Robert L. Spitzer, gay and lesbian psychiatrists have renewed the debate of his legacy.

Spitzer, 83, died December 25 in Seattle. His wife told media outlets the cause was complications of heart disease.

Spitzer was an outspoken and controversial member of the American Psychiatric Association, whose textbooks and manuals had long described homosexuality as a mental illness.

But in the early 1970s, when Spitzer joined an APA committee charged with reconsidering that policy, the association began to gradually shifts its policies, although not quickly or far enough for many.

The APA removed homosexuality from its Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1973.

Later, Spitzer ignited a firestorm in 2001 when he presented a paper advocating reparative therapy for gays and lesbians who wanted to become heterosexual. Such so-called conversion therapy has been widely discredited as stigmatizing and ineffective.

In 2012, Spitzer disavowed the paper, an apology that was too little and too late for some.

The controversy flared up again following his death when many obituaries praised Spitzer's role as a gay supporter. The New York Times obituary took it a step further, when it included a quote from gay psychoanalyst Dr. Jack Drescher, who said, "The fact that gay marriage is allowed today is in part owed to Bob Spitzer." Drescher confirmed that quote, which was picked up by media outlets around the world, in an interview with the Bay Area Reporter.

"I have a very different perspective," said San Francisco psychiatrist Dr. Nanette Gartrell, a lesbian who's a former clinical professor at UCSF and the author of over 70 peer reviewed research papers.

Rather than seeing Spitzer as the primary force behind removal of homosexuality from the manual, "I credit the many scientific researchers whose scholarship demonstrated that psychological adjustment is unrelated to sexual orientation, and I credit the LGBT psychiatrists and psychologists who educated the APA about these findings," Gartrell said.

Others agreed.

Dr. Elizabeth Harrison, a lesbian who's a psychiatrist in Sacramento and a past president of the Gay and Lesbian Medical Association, credited gay activists - including psychiatrists - who "stepped up and risked their careers to come out and fight the APA."

To credit Spitzer, "is just wrong," she said.

And gay San Francisco psychiatrist Dr. Robert Cabaj, a past president of the Association of Gay and Lesbian Psychiatrists, called praise of Spitzer "revisionist history."

"Dr. Spitzer was more of a block" in the road in the decades-long fight to remove centuries old prejudicial views about gays and lesbians, said Cabaj.

But other local LGBT psychiatrists took a more sanguine view.

Gay retired UCSF clinical professor of psychiatry Dr. David Kessler believes Spitzer should be given credit for "opening the door" that let LGBT therapists "put their foot into the room" to begin the dialogue that led to change.

After he conducted and recorded an hourlong interview with Spitzer in 1993, Kessler concluded that "by far" the good (in Spitzer) outweighed the bad.

In terms of Spitzer's controversial stance on the usefulness of reparative therapy to help homosexuals change, Kessler said, "My interview with him was long before that so I really never understood how and why that came about. But he apologized and I forgive him. Nobody's perfect, even Bob Spitzer."

Dr. James Krajeski, a gay retired Corte Madera psychiatrist and a former chair of the committee on homosexuality at the APA, said Spitzer's life "must be seen in perspective."

"I don't think Bob Spitzer did any of this to enhance his career. Had some of his suggestions been rejected by the APA, I think he would've looked very bad. All in all, I believe he will be remembered positively," he said.

Different Take

But Gartrell has a very different take on those who defend Spitzer's strategy of trying to implement change slowly.

"One of the things I find so frustrating is that most people believe that homosexuality was removed from the DSM in 1973 and the story ended there," she said.

"In fact, as numerous historical documents and prior editions of the APA manual state, a variation on the concept of homosexuality as a mental illness - known as ego-dystonic homosexuality - was retained as a DSM diagnosis into the mid-1980s, despite a complete lack of scientific evidence to support such a diagnosis," Gartrell explained.

To those who criticized Spitzer for recommending that the APA retain the diagnosis of ego-dystonic homosexuality, rather than eliminate it altogether, Krajeski said, "Bob Spitzer deserves a great deal of credit for helping the APA make some major changes, altering years of tradition."

Drescher shed some additional light on the controversy.

Spitzer, he said, "was an academician, not a clinician, and did not see patients."

Like the other psychiatrists interviewed, Drescher said he also "had issues" with Spitzer's views on reparative therapy.

"Bob was a contrarian," he explained, "and was also very stubborn so it took him a while to admit he was wrong" and apologize.

"I think the gay community owes a tremendous debt to Dr. Spitzer," Drescher said. "He wasn't perfect and, as you know, all our heroes have feet of clay. He had an original mind and he changed the world."

It was in 2001 that Spitzer presented the paper supporting conversion therapy, which Gartrell noted has been "shown to be both ineffective and damaging."

"Despite decades of research demonstrating that LGBT people led healthy, happy, successful, fulfilling, and productive lives, Dr. Spitzer only retracted it in 2012," she said.

None of Spitzer's actions surprised Gartrell, who first published her views on him in a book, Lesbians in Academia: Degrees of Freedom, edited by Beth Mintz and Esther D. Rothblum.

In the book, and in an interview with the B.A.R. , Gartrell said that in 1974 - the year after homosexuality had been removed as a mental illness from the APA manual - she was a medical student at UC Davis and was applying to psychiatric residency programs. She applied to Columbia University, where she was interviewed by a number of faculty, including Spitzer. After reading over her list of publications, he asked Gartrell if she was a lesbian.

When she said yes, he then asked her if she wanted to be a man. "I said I did not," she recalled.

"When he asked me if I was the butch or the femme in my relationship, I said that I didn't see the relevance of such questions to my application for residency.

"I also told him that I objected to the American Psychiatric Association's continuing inclusion of the concept of ego-dystonic homosexuality" in the APA manuals, "without including a parallel diagnosis of ego-dystonic heterosexuality," Gartrell said.

When Spitzer questioned the usefulness of such a concept, "I said that I had come across many radical feminists who were dissatisfied with their relations with men and wished they could become lesbians," she said.

"It was very obvious to me," said Gartrell, that in the interview, Spitzer "saw me through a stereotypic lens that bore no resemblance to the reality of my life."

When Gartrell's residency application was subsequently rejected, her medical school mentor called the chair of the Columbia psychiatry training program.

"My mentor was told that the admissions committee had decided that my comfort with my lesbianism - in not considering it a problem - had rendered me incompatible" with Columbia's training program.

"Did my career suffer?" asked Gartrell. "Well, no, not at all because I had already been accepted at Harvard" for psychiatric residency.

"But I feared for the countless LGBT people whose lives would continue to be damaged by the attitudes of psychiatrists like Bob Spitzer," she said.