The Legacy of Robert Spitzer, Psychiatrist Who De-Pathologized Homosexuality

Dr. Robert Spritzer, the physician responsible for the 1973 declassification of homosexuality as a mental illness, died on Friday, December 25, 2015. Until 1973, the American Psychiatric Association (APA) had considered homosexuality pathological. Their Diagnostic & Statistical Manual of Mental Disorders (DSM), originally published in 1952, is the widely respected diagnostic tool for mental health providers in the United States. It was in the DSM that several normal human qualities, including homosexuality, were portrayed as disorders and ailments rather than normal, natural human behavior.

When the DSM dropped homosexuality as a disorder in 1973, it sent a powerful message to mental health professionals and the American public. On December 16 of that year, the New York Times wrote, "[The APA], altering position it has held for nearly 100 years, on Dec 15 declares that homosexuality is not a mental disorder." In place of "disorder" came the term "sexual orientation disturbance," defined in the Times as a "category for 'individuals whose sexual interests are directed toward people of their own sex and who are either disturbed by, in conflict with or wish to change their sexual orientation'."

Dr. Ronald Bayer is a professor of Sociomedical Sciences at Columbia University. "If [you were] homosexual and [felt] deeply distressed about it, that was a psychiatric diagnosis that was treatable by psychiatry," he said in an interview Broadly, adding that this thinking also eventually evolved. "[Spitzer] was deeply involved in [asking], 'What are the criteria used to define a mental illness? Is it simply subjective distress?' If a person felt distressed about being black, we wouldn't say, 'Well, maybe we can turn them into a white person… The African American Civil Rights Movement played a significant role shaping the discourse at that time," Dr. Bayer explained.

According to Bayer, there were two components of the DSM change that were particularly significant. "What were the internal forces within psychiatry that made this change possible, and how are those shaped by what was going on in the broader political community?" Dr. Bayard said that Dr. Spitzer was the insider who instigated the DSM alteration, but his efforts were in conjunction with the work of gay rights organizations that developed in the wake of the 1969 riots at the Stonewall Inn in Greenwich Village. For a few years, these social justice organizations operated together under the moniker Gay Liberation Front (GLF).

The 1973 changes were possible in part thanks to the long history of gay activist protests. On May 15, 1970, the New York Times reported that members of the Gay Liberation Front members "attempt[ed] to take over American Psychiatric Association session on sex problems." The GLF gathering was in protest of a psychiatric paper that discussed treating gay people with electric shock treatment. Activists, the Times wrote, "contend it is barbaric, sadistic and torture." There was a mounting resistance to the oppression of gay people.

"[This] style of confrontation was very much the style of the late 60s, early 70s," Dr. Bayard said. "People [came] into meetings, disrupted them, [and] raised questions." He recalled one meeting at the APA where a psychiatrist wore a mask and introduced himself as "Dr. Anonymous" to the crowd. "He said, 'I have to be anonymous because if I were out as a gay man, I couldn't practice psychiatry.'"

At that point in American history, many states had anti-sodomy laws in place. Though the psychiatric establishment's treatment of LGBT people is harshly criticized today, Dr. Bayard said that the psychiatrists who were treating queer people in the 60s and 70s saw themselves as helping them avoid the hand of the law. "The psychiatrists have sometimes been framed as bad guys," Dr. Bayard noted. "But at that moment they were stunned to find the people they thought they were helping turn on them and see them as contributing to the very oppression that they were trying to overturn."

According to Dr. Bayard, Dr. Spitzer wasn't motivated by a political movement. "What Spitzer was concerned about was creating a psychiatric diagnostic framework that was liberated from psychoanalytic thought, to redefine the framework of psychiatry." He wanted standard measurements to determine mental wellness, and believed that the Freudian structure the field was built upon was flawed.

Spitzer's advocacy culminated with the release of the new diagnostic manual, DSM III. Not only was homosexuality declassified, but neurosis itself was removed, which challenged the status quo of mid-twentieth century mental health medicine. "[It] was a huge watermark. Finally, in DSM III, they actually eliminated the concept of neurosis as a conceptual framework for psychiatric disorders, which was a central contribution of psychoanalytic thought," said Dr. Bayard, noting that this constituted a remarkable rupture in dominant thinking a the time. "Psychoanalysis was the dominant paradigm in psychiatry through the 1950s and 60s. Every major school that taught psychology was chaired by people with psychoanalytic training."

In 1973, the New York Times wrote, "Dr [Robert] Spitzer says [the APA] is not saying homosexuality is either 'normal' or 'abnormal'." According to the Times, Dr. Spitzer believed the decision to declassify homosexuality as a mental disorder would lead more gay people to receive psychiatric help for problems "other than homosexuality," because the physician will no longer try to "cure," or convert, gay patients. This change supported the gay liberation movement, backing advocacy for the civil rights of homosexual citizens who were, at that time, not only pathologized for their humanity, but criminalized. As of 1973, the Times reported, there were laws criminalizing homosexuality in 42 states, as well as the District of Columbia.

Dr. Spitzer saw psychiatry as a science and wanted diagnoses to be free from subjective, cultural bias. When the concept of "normal" is redefined, Dr. Bayard argued, the behaviors we pathologize change. "People like Spitzer saw the problem as the intrusion of social values into psychiatry." There were other, more extreme radical psychiatrists, like Thomas Szaz, whose book The Myth of Mental Illness argued that mental illness, a vague and misguided notion, replaced the role that religion and witchcraft once played in civilization. But physicians like Spitzer put faith in the field, believing that if we question the definition of normal, we'll gain a keener understanding of the human mind.