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Lessons from the life of Robert Spitzer

January 5, 2016
by H. Steven Moffic
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I'm sure you’ve seen the yearend tributes to the greats in our society who passed away in 2015. Rarely, if ever, does that happen in behavioral health. Whether that is due to stigma, the private nature of our field, or something else, the giants in our field usually die without recognition other than a longer obituary.

Yet, there can be much for us and the public to learn from the lives of our greats. One of them will always be Robert Spitzer, MD, who died on Christmas Day at the age of 83. He was a gift to our field.

The importance of diagnosis

If you've heard of him, it is probably in light of his role in brashly and almost single-handedly leading the major transition in how our Diagnostic and Statistical Manual (DSM) was conceptualized and constructed, starting with DSM III in 1980. Instead of the earlier psychoanalytically-based DSM I and II, Spitzer thought it was time for clear and rigorous diagnostic criteria based on expert consensus.

For example, the term "disorder" replaced "neurosis" as the fulcrum of the classification we are all familiar with now.

This change produced a much more popular and much bigger manual. Insurance companies used it for reimbursement. Perhaps most importantly, its cookbook approach and openness to use beyond psychiatrists included all mental healthcare disciplines as potential clinical diagnosticians.

Spitzer continued to consult and advise for DSM IV and, more recently, our current DSM 5. They were so well received internationally that DSM 5 was basically adapted within the International Classification of Diseases (ICD) for its listing of mental disorders.

Of course, this change in our diagnostic classification was not without its controversies. Nevertheless, every time we make a carefully considered and accurate diagnosis of a patient, we are reflecting the legacy of Spitzer.

The normality of homosexuality

One particular diagnosis came to be most associated with his career: homosexuality. Though at first he believed that homosexuality was indeed an illness, after further study and interviews of highly successful people who happened to be happily homosexual, he changed his mind. Thereafter, he led the thought leadership to consider homosexuality to be a disorder only if it was dysphoric, and then to complete removal from DSM.

Yet, even here, his work was not without controversy. Despite helping to get homosexuality removed as a disorder, he published a study in 2001 that supported so-called conversion therapy that could "cure" someone of homosexuality—in other words to change sexual preference. The backlash led him to retract that study in 2012.

Therefore, not only did Spitzer help to establish the normality of being homosexual which led to gay marriage, but whenever we are able to change our opinion about any mental health issue with new data, we are reflecting his legacy.

The benefits of disruption

If anyone could be thought to be a "disrupter" in our field it is Robert Spitzer. I also believe we need more like him to complement his work in diagnostics. We need similar advances in the conceptualization and criteria for treatment of these diagnoses, for successful treatment is really all that matters essentially.

In the meanwhile, every time you successfully use what we have now as evidence-based guidelines geared toward the diagnosis of a unique patient, you are extending the legacy of Dr. Robert Spitzer.

Keep him in mind.

 

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...