December 27, 2015

"Dr. Spitzer’s remaking of psychiatry began with an early interest in one of the least glamorous and, historically, most ignored corners of the field: measurement."

"In the early 1960s, the field was fighting to sustain its credibility, in large part because diagnoses varied widely from doctor to doctor. For instance, a patient told he was depressed by one doctor might be called anxious or neurotic by another. The field’s diagnostic manual, at the time a pamphlet-like document rooted in Freudian ideas, left wide latitude for the therapist’s judgment. Dr. Spitzer, a rising star at Columbia University, was himself looking for direction, increasingly frustrated with Freudian analysis. A chance meeting with a colleague working on a new edition of the manual — the Diagnostic and Statistical Manual of Mental Disorders, or the D.S.M. for short — led to a job taking notes for the committee debating revisions. There, he became fascinated with reliable means for measuring symptoms and behavior — i.e., assessment.... One of the first behaviors he scrutinized was homosexuality, which at the time was listed in the manual as a mental disorder. Dr. Spitzer, after meeting with gay advocates, began re-examining homosexuality based on whether it caused any measurable distress. The issue was extremely contentious, but in 1973, Dr. Spitzer engineered a deal by which the diagnosis was replaced by 'sexual orientation disturbance,' to describe people whose sexual orientation, gay or straight, caused them distress."

Dr. Robert L. Spitzer died last Friday at the age of 83.


Curious George said...

I thought we already had "gay measurement." Like "totally gay. "Kevin Spacey gay."

Fernandinande said...

re-examining homosexuality based on whether it caused any measurable distress.

By that logic, psychopathy could also be removed since psychopaths aren't bothered by their condition.

"From an evolutionary perspective, we will argue, some of the disorders recognized in standard manuals like DSM-IV may turn out not to be disorders at all. The people who have these conditions don’t have problems; they just cause problems!"

JCC said...

So a condition become a mental disorder dependent upon society's treatment of the outward manifestation (of the condition), and the individual's tolerance for (and reaction to) that treatment?


I mean, that's crazy.

JCC said...

BTW, although tis may not be all that uncommon, we used to sit around the office, browsing through the latest DSM, and fitting the described symptoms to our co-workers and bosses. This was at a police department.

It wasn't all that difficult.

Darrell said...

If the real sciences operated this way, we'd be back to living in huts and caves.

Sammy Finkelman said...

The DSM produced criteria that were reliable (that is, tended to be consistent from evaluator to evaluator, at least over the short run, not necessarily pver a period of decades or between people in different countries) but not valid.

In fact, the criteria for the diffewrent categories or labels were kind of ridicululous for a disease or an assessment of internal functioning. You can't depend on how other people react. That's basically circular reasoning.

In science and statistics, validity is the extent to which a concept,[1] conclusion or measurement is well-founded and corresponds accurately to the real world.

William said...

Who was the first cleric who promulgated the doctrine that burning heretics at the stake was not the fulfillment of God's will?.........You can point to many cases where organized religion got it wrong, and this is supposedly an argument for the utter failure of organized religion. If you point to to the many mistakes of psychiatry, however, and use those mistakes to doubt the validity of Freud's teachings, then you are a know nothing, an ignoramus, and probable climate change denier.

Sebastian said...

"'sexual orientation disturbance,' to describe people whose sexual orientation, gay or straight, caused them distress" Did suffering a disproportionate number of sexually transmitted diseases, some fatal or nearly so, count as "distress"?

Michael K said...

The problem of Psychiatry in the 60s was Freud who was a (sorry) fraud. The measurement stage of Psychiatry was ended by the analysts who took over in the 40s. Nonsense ruled until the modern era of neurochemistry which is figuring out how drugs work.

Homosexuality was not a real psychiatric condition and it was an artifact of the pseudo morality that Freud brought. It allowed all sorts of things to be labeled "abnormal." In 1964 a Psychiatric society journal did a poll on whether Barry Goldwater was mentally fit to be president.

Overall, 1960's psychiatry (and psychology) was not known for seeing positive health in its clients (with some notable exceptions such as Carl Rogers). It therefore would have been interesting to see how this same group of psychiatrists might have depicted President Johnson at that time.

In addition, Mr. Roper pointed out, the question asked, "Do you believe Barry Goldwater is psychologically fit to serve as President of the United States?" and was followed by two boxes for respondents to select. Usually, these would be ordered "Yes....No," but in the poll, they were ordered "No....Yes," perhaps drawing for a "No" (unfit) answer.

Perhaps the most damaging issue about the questionnaire, from the juror's standpoint (and from those who read Fact magazine) was that the polling question had been accompanied by a letter from Fact to each psychiatrist informing them that Mr. Goldwater had suffered nervous breakdowns, and asking the psychiatrists such leading questions to consider as, "Does he seem prone to aggressive behavior and destructiveness?"

Psychiatry at work in the 1960s.

SGT Ted said...

The issue was extremely contentious, but in 1973, Dr. Spitzer engineered a deal by which the diagnosis was replaced by 'sexual orientation disturbance,' to describe people whose sexual orientation, gay or straight, caused them distress."

California made it illegal to treat this diagnosis at the behest of queer activists, but only if the patient has same sex or transgender issues.

Chuck said...

Spitzer features prominently in one of the early episodes of the public radio program "This American Life." It was a story reported by Alix Speigel, whose own father and grandfather each served a term as President of the APA, and her grandfather came out as gay when he was in his seventies. The story was entitled "81 Words," signifying the number of words that were changed in the DSM when the APA essentially de-pathologized homosexuality.

It's a remarkable story; and the podcast is easily accessed at the program's website:

Keeping with the politics of public radio and This American Life, the story was intended to intelligently point out the APA's "progress" on homosexuality.

But I came away with the exact opposite impression; for years, some of the best minds in the APA did their best in treating homosexuality and they did so humanely, carefully, and with understanding. The change of the DSM wording in 1973 came as the result of what seems to have been an essentially political change. The program didn't offer any real psychological science, and I'm not sure any exists.

Peter said...

The DSM may be no more scientific than Freudianism, as it represents little other than the consensus of well-connected practitioners. But, at least it's consistent.

Which makes it essential to the business of psychiatry, as consistency is essential if one wishes to get paid by third parties.