Wayne R. Dynes
Can Therapy Change
Reproduced here with the permission of the
case of psychiatrist Robert Spitzer, who turned 80 on May 22, 2012.
He spent most of his career at Columbia University, where he was on the
research faculty of the Columbia University Center for Psychoanalytic Training
and Research. Early on he became concerned about the imprecision of the
classification (nosology) of psychiatric disorders. To address this issue
he chaired the task force of the third edition of the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III)
which was released in 1980. Despite criticisms, in its successive editions
the DSM has become widely accepted, and is frequently cited in support of
Appearing in the 2007 BBC TV series "The Trap," Spitzer
acknowledged that the DSM, by operationalizing the definitions of mental
disorders while paying little attention to the context in which the symptoms
occur, may have medicalized the normal human experiences of a significant
number of people. The controversy continues, even as a new edition of the
DSM is being readied for publication.
In 1973, responding to urgent appeals by gay activists. Spitzer spearheaded the
APA's 1973 decision to remove homosexuality from its list of mental
disorders. In charge of the revision of the Diagnostic and Statistical
Manual, he pondered whether homosexuality should be included in the manual.
He decided against inclusion of the category as such, since mental disorders
would be identified by the distress an individual felt or an impairment of
functioning. Yet he stipulated that a listing of "ego-dystonic
homosexuality" be included; that is, homosexuality that seemingly
causes distress to the individual. Significantly, there was no category of
“ego-dystonic heterosexuality,” a sense reported by some feminist women.
In 2001 Spitzer delivered a controversial paper, "Can Some Gay Men and
Lesbians Change Their Sexual Orientation?" at the annual APA
meeting. Spitzer maintained that it is possible that some highly
motivated individuals could successfully change their sexual orientation from
homosexual to heterosexual. A 2001 Washington Post article indicates
that Spitzer held 45-minute telephonic interviews with 200 people who claimed
that their respective sexual orientations had changed from homosexual to
heterosexual. Spitzer said he "began his study as a skeptic," but
the study revealed that "66 percent of the men and 44 percent of the women
had arrived at what [Spitzer] called good heterosexual functioning,"
defined as "being in a sustained, loving heterosexual relationship
within the past year, getting enough satisfaction from the emotional
relationship with their partner to rate at least seven on a 10-point scale,
having satisfying heterosexual sex at least monthly and never or rarely
thinking of somebody of the same sex during heterosexual sex." Spitzer
also found that "89 percent of men and 95 percent of women said they were
bothered only slightly, or not at all, by unwanted homosexual feelings,"
but that "only 11 percent of the men and 37 percent of the women
reported a complete absence of homosexual indicators, including same-sex
attraction." The Post reported that "[s]ome 43 percent of
the individuals in the sample had been referred to Spitzer by 'ex-gay
ministries,'" while "an additional 23 percent were referred by
the National Association for Research and Therapy of Homosexuality."
NARTH is well known for its opposition to homosexuality.
Two years later the paper was peer reviewed and published in the Archives of
Sexual Behavior. Two-thirds of the reviews were critical targeting its
sampling methods and criteria for success.
Finally, in a 2012 interview, Spitzer said he asked to retract the study,
stating that he agreed with its critics:
"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.
In a letter to Kenneth J. 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.”
I admire Dr. Spitzer for his honesty and integrity in making this
avowal. He could have kept silent, but he did not. This is a salutary