humility…

Posted on Wednesday 25 April 2012

In 1973, in the early days of preparing to lead the group that would produce the DSM-III, Dr. Robert Spitzer decided that homosexuality would be removed from the list of psychiatric diagnoses in the coming manual – a contraversial decision that had a major impact on our culture but remained a focus of debate for decades. It pitted the Gay community against the Religious Right and a lot of what followed condensed around the issue of psychotherapy – "Could psychotherapy produce lasting change in sexual orientation? Then, thirty years after championing the depathologizing of homosexuality, there was a a big surprise. Robert Spitzer himself presented a paper at the 2001 APA suggesting that such a change was possible based on interviews, later published in a reputable journal:

Position statements of the major mental health organizations in the United States state that there is no scientific evidence that a homosexual sexual orientation can be changed by psychotherapy, often referred to as “reparative therapy.” This study tested the hypothesis that some individuals whose sexual orientation is predominantly homosexual can, with some form of reparative therapy, become predominantly heterosexual. The participants were 200 self-selected individuals (143 males, 57 females) who reported at least some minimal change from homosexual to heterosexual orientation that lasted at least 5 years. They were interviewed by telephone, using a structured interview that assessed same sex attraction, fantasy, yearning, and overt homosexual behavior. On all measures, the year prior to the therapy was compared to the year before the interview. 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. Reports of complete change were uncommon. Female participants reported significantly more change than did male participants. Either some gay men and lesbians, following reparative therapy, actually change their predominantly homosexual orientation to a predominantly heterosexual orientation or some gay men and women construct elaborate self-deceptive narratives [or even lie] in which they claim to have changed their sexual orientation, or both. For many reasons, it is concluded that the participants’ self-reports were, by-and-large, credible and that few elaborated self-deceptive narratives or lied. Thus, there is evidence that change in sexual orientation following some form of reparative therapy does occur in some gay men and lesbians.
The Ex-Gay Movement ["reparative" therapy] jumped on this article like manna from heaven – legitimizing their claims. When he saw how it was being misused, Spitzer tried to correct that, but wasn’t very effective. Two weeks ago, the American Prospect published a comprehensive article by Gabriel Arana [My So-Called Ex-Gay Life] with his recent interview of Dr. Spitzer, now nearly 80:
This spring, I visited Spitzer at his home in Princeton. He ambled toward the door in a walker. Frail but sharp-witted, Spitzer suffers from Parkinson’s disease. “It’s a bummer,” he said. I told Spitzer that Nicolosi had asked me to participate in the 2001 study and recount my success in therapy, but that I never called him. “I actually had great difficulty finding participants,” Spitzer said. “In all the years of doing ex-gay therapy, you’d think Nicolosi would have been able to provide more success stories. He only sent me nine patients.”

“How’d it turn out for you?” he asked. I said that while I stayed in the closet for a few years more than I might have, I ended up accepting my sexuality. At the end of college, I began to have steady boyfriends, and in February of last year—ten years after my last session with Dr. Nicolosi—I married my partner. Spitzer was drawn to the topic of ex-gay therapy because it was controversial—“I was always attracted to controversy” — but was troubled by how the study was received. He did not want to suggest that gay people should pursue ex-gay therapy. His goal was to determine whether the counterfactual — the claim that no one had ever changed his or her sexual orientation through therapy — was true.

I asked about the criticisms leveled at him. “In retrospect, I have to admit I think the critiques are largely correct,” he said. “The findings can be considered evidence for what those who have undergone ex-gay therapy say about it, but nothing more.” He said he spoke with the editor of the Archives of Sexual Behavior about writing a retraction, but the editor declined [repeated attempts to contact the journal went unanswered].

Spitzer said that he was proud of having been instrumental in removing homosexuality from the list of mental disorders. Now 80 and retired, he was afraid that the 2001 study would tarnish his legacy and perhaps hurt others. He said that failed attempts to rid oneself of homosexual attractions “can be quite harmful.” He has, though, no doubts about the 1973 fight over the classification of homosexuality. “Had there been no Bob Spitzer, homosexuality would still have eventually been removed from the list of psychiatric disorders,” he said. “But it wouldn’t have happened in 1973.”

Spitzer was growing tired and asked how many more questions I had. Nothing, I responded, unless you have something to add. He did. Would I print a retraction of his 2001 study, “so I don’t have to worry about it anymore”?

Today, Truth Wins Out published a letter from Dr. Spitzer to Dr. Ken Zucker, Editor of the Archives of Sexual Behavior:
Several months ago I told you that because of my revised view of my 2001 study of reparative therapy changing sexual orientation, I was considering writing something that would acknowledge that I now judged the major critiques of the study as largely correct. After discussing my revised view of the study with Gabriel Arana, a reporter for American Prospect, and with Malcolm Ritter, an Associated Press science writer, I decided that I had to make public my current thinking about the study. Here it is.

Basic Research Question. From the beginning it was: “can some version of reparative therapy enable individuals to change their sexual orientation from homosexual to heterosexual?” Realizing that the study design made it impossible to answer this question, I suggested that the study could be viewed as answering the question, “how do individuals undergoing reparative therapy describe changes in sexual orientation?” – a not very interesting question.

The Fatal Flaw in the Study – There was no way to judge the credibility of subject reports of change in sexual orientation. I offered several [unconvincing] reasons why it was reasonable to assume that the subject’s reports of change were credible and not self-deception or outright lying. But the simple fact is that there was no way to determine if the subject’s accounts of change were valid.

I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some “highly motivated” individuals.

Robert Spitzer. M.D.
Emeritus Professor of Psychiatry,
Columbia University

While this may seem a symbolic gesture at this point, to my gay friends who’ve lived through these last four decades of such a tumultuous change, it’s a welcome affirmation of their tireless work and part of their gift to the gay kids of the future. I’m particularly happy for a special friend, speaking of tireless work. Great job Ralph! The ex-gay movement has actually been destructive to a lot of people. Just read Gabriel Arana’s narrative in the American Prospect [My So-Called Ex-Gay Life] for an example. It was way more than simply "wasted time and energy" – it was close to fatal, and that was true for far too many.

Along another familiar theme, this whole story points out how important it is to get our diagnostic system right. These labels aren’t intellectual exercises ["Spitzer was drawn to the topic of ex-gay therapy because it was controversial — 'I was always attracted to controversy' — but was troubled by how the study was received. He did not want to suggest that gay people should pursue ex-gay therapy. His goal was to determine whether the counterfactual — the claim that no one had ever changed his or her sexual orientation through therapy — was true."]. They’re labels attached to actual people. Robert Spitzer did something very decent in 1973 and again in 2012, but he slipped up in 2001. I know it wasn’t a diagnosis, but it was close – a possibility that undermined his previous work. At least he could admit that he was wrong. In that sense, both he and Dr. Allen Frances have modeled a humility not prevalent in these circles. We owe them both.

Let’s hope we see a bit of this kind of humility when the DSM-5 Task Force updates us in a couple of weeks…
  1.  
    April 26, 2012 | 12:01 AM
     

    Thanks for sharing this on your blog, Mickey. You’ve put it in good perspective.

  2.  
    Nick Stuart
    April 28, 2012 | 10:49 AM
     

    I follow your stuff avidly though I do not post comments. Just to let you know and to say thanks.

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