The simple fact was that he had done something wrong, and at the end of a long and revolutionary career it didn\u2019t matter how often he\u2019d been right, how powerful he once was, or what it would mean for his legacy.<\/p>\n
Dr. Robert L. Spitzer, considered by some to be the father of modern psychiatry, lay awake at 4 o\u2019clock on a recent morning knowing he had to do the one thing that comes least naturally to him.<\/p>\n
He pushed himself up and staggered into the dark. His desk seemed impossibly far away; Dr. Spitzer, who turns 80 next week, suffers from Parkinson\u2019s disease<\/a> and has trouble walking, sitting, even holding his head upright.<\/p>\n The word he sometimes uses to describe these limitations \u2014 pathetic \u2014 is the same one that for decades he wielded like an ax to strike down dumb ideas, empty theorizing and junk studies.<\/p>\n Now here he was at his computer, ready to recant a study he had done himself, a poorly conceived 2003 investigation that supported the use of so-called reparative therapy to \u201ccure\u201d homosexuality for people strongly motivated to change.<\/p>\n What to say? The issue of gay marriage was rocking national politics yet again. The California State Legislature was debating a bill to ban the therapy outright as being dangerous. A magazine writer who had been through the therapy as a teenager recently visited his house, to explain how miserably disorienting the experience was.<\/p>\n And he would later learn that a World Health Organization report<\/a>, released on Thursday, calls the therapy \u201ca serious threat to the health and well-being \u2014 even the lives \u2014 of affected people.\u201d<\/p>\n Dr. Spitzer\u2019s fingers jerked over the keys, unreliably, as if choking on the words. And then it was done: a short letter to be published this month, in the same journal where the original study appeared.<\/p>\n \u201cI believe,\u201d it concludes, \u201cI owe the gay community an apology.\u201d<\/p>\n Disturber of the Peace<\/strong><\/p>\n The idea to study reparative therapy at all was pure Spitzer, say those who know him, an effort to stick a finger in the eye of an orthodoxy that he himself had helped establish.<\/p>\n In the late 1990s as today, the psychiatric establishment considered the therapy to be a nonstarter. Few therapists thought of homosexuality as a disorder.<\/p>\n It was not always so. Up into the 1970s, the field\u2019s diagnostic manual classified homosexuality as an illness, calling it a \u201csociopathic personality<\/a> disturbance.\u201d Many therapists offered treatment, including Freudian analysts who dominated the field at the time.<\/p>\n Advocates for gay people objected furiously, and in 1970, one year after the landmark Stonewall protests to stop police raids at a New York bar, a team of gay rights protesters heckled a meeting of behavioral therapists in New York to discuss the topic. The meeting broke up, but not before a young Columbia University professor sat down with the protesters to hear their case.<\/p>\n \u201cI\u2019ve always been drawn to controversy, and what I was hearing made sense,\u201d said Dr. Spitzer, in an interview at his Princeton home last week. \u201cAnd I began to think, well, if it is a mental disorder, then what makes it one?\u201d<\/p>\n He compared homosexuality with other conditions defined as disorders, like depression<\/a> and alcohol dependence<\/a>, and saw immediately that the latter caused marked distress or impairment, while homosexuality often did not.<\/p>\n He also saw an opportunity to do something about it. Dr. Spitzer was then a junior member of on an American Psychiatric Association committee helping to rewrite the field\u2019s diagnostic manual, and he promptly organized a symposium to discuss the place of homosexuality.<\/p>\n That kicked off a series of bitter debates, pitting Dr. Spitzer against a pair of influential senior psychiatrists who would not budge. In the end, the psychiatric association in 1973 sided with Dr. Spitzer, deciding to drop homosexuality from its manual and replace it with his alternative, \u201csexual orientation disturbance,\u201d to identify people whose sexual orientation, gay or straight, caused them distress.<\/p>\n The arcane language notwithstanding, homosexuality was no longer a \u201cdisorder.\u201d Dr. Spitzer achieved a civil rights breakthrough in record time.<\/p>\n \u201cI wouldn\u2019t say that Robert Spitzer became a household name among the broader gay movement, but the declassification of homosexuality was widely celebrated as a victory,\u201d said Ronald Bayer of the Center for the History and Ethics of Public Health at Columbia. \u201c\u00a0\u2018Sick No More\u2019 was a headline in some gay newspapers.\u201d<\/p>\n Partly as a result, Dr. Spitzer took charge of the task of updating the diagnostic manual. Together with a colleague, Dr. Janet Williams, now his wife, he set to work. To an extent that is still not widely appreciated, his thinking about this one issue \u2014 homosexuality \u2014 drove a broader reconsideration of what mental illness is, of where to draw the line between normal and not.<\/p>\n The new manual, a 567-page doorstop released in 1980, became an unlikely best seller, here and abroad. It instantly set the standard for future psychiatry manuals, and elevated its principal architect, then nearing 50, to the pinnacle of his field.<\/p>\n He was the keeper of the book, part headmaster, part ambassador, and part ornery cleric, growling over the phone at scientists, journalists, or policy makers he thought were out of order. He took to the role as if born to it, colleagues say, helping to bring order to a historically chaotic corner of science.<\/p>\n But power was its own kind of confinement. Dr. Spitzer could still disturb the peace, all right, but no longer from the flanks, as a rebel. Now he was the establishment. And in the late 1990s, friends say, he remained restless as ever, eager to challenge common assumptions.<\/p>\n That\u2019s when he ran into another group of protesters, at the psychiatric association\u2019s annual meeting in 1999: self-described ex-gays. Like the homosexual protesters in 1973, they too were outraged that psychiatry was denying their experience \u2014 and any therapy that might help.<\/p>\n Reparative Therapy<\/strong><\/p>\n Reparative therapy, sometimes called \u201csexual reorientation\u201d or \u201cconversion\u201d therapy, is rooted in Freud\u2019s idea that people are born bisexual and can move along a continuum from one end to the other. Some therapists never let go of the theory, and one of Dr. Spitzer\u2019s main rivals in the 1973 debate, Dr. Charles W. Socarides, founded an organization called the National Association for Research and Therapy of Homosexuality<\/a>, or Narth, in Southern California, to promote it.<\/p>\n By 1998, Narth had formed alliances with socially conservative advocacy groups and together they began an aggressive campaign, taking out full-page ads in major newspaper trumpeting success stories.<\/p>\n \u201cPeople with a shared worldview basically came together and created their own set of experts to offer alternative policy views,\u201d said Dr. Jack Drescher, a psychiatrist in New York and co-editor of \u201cEx-Gay Research: Analyzing the Spitzer Study and Its Relation to Science, Religion, Politics, and Culture.\u201d<\/p>\n To Dr. Spitzer, the scientific question was at least worth asking: What was the effect of the therapy, if any? Previous studies had been biased and inconclusive. \u201cPeople at the time did say to me, \u2018Bob, you\u2019re messing with your career, don\u2019t do it,\u2019\u00a0\u201d Dr. Spitzer said. \u201cBut I just didn\u2019t feel vulnerable.\u201d<\/p>\n He recruited 200 men and women, from the centers that were performing the therapy, including Exodus International, based in Florida, and Narth. He interviewed each in depth over the phone, asking about their sexual urges, feelings and behaviors before and after having the therapy, rating the answers on a scale.<\/p>\n He then compared the scores on this questionnaire, before and after therapy. \u201cThe 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,\u201d his paper concluded.<\/p>\n The study \u2014 presented at a psychiatry meeting in 2001, before publication \u2014 immediately created a sensation, and ex-gay groups seized on it as solid evidence for their case. This was Dr. Spitzer, after all, the man who single-handedly removed homosexuality from the manual of mental disorders. No one could accuse him of bias.<\/p>\n But gay leaders accused him of betrayal, and they had their reasons.<\/p>\n The study had serious problems. It was based on what people remembered feeling years before \u2014 an often fuzzy record. It included some ex-gay advocates, who were politically active. And it did not test any particular therapy; only half of the participants engaged with a therapist at all, while the others worked with pastoral counselors, or in independent Bible study.<\/p>\n Several colleagues tried to stop the study in its tracks, and urged him not to publish it, Dr. Spitzer said.<\/p>\n Yet, heavily invested after all the work, he turned to a friend and former collaborator, Dr. Kenneth J. Zucker, psychologist in chief at the Center for Addiction and Mental Health in Toronto and editor of the Archives of Sexual Behavior, another influential journal.<\/p>\n \u201cI knew Bob and the quality of his work, and I agreed to publish it,\u201d Dr. Zucker said in an interview last week. The paper did not go through the usual peer-review process, in which unnamed experts critique a manuscript before publication. \u201cBut I told him I would do it only if I also published commentaries\u201d of response from other scientists to accompany the study, Dr. Zucker said.<\/p>\n Those commentaries, with a few exceptions, were merciless. One cited the Nuremberg Code of ethics to denounce the study as not only flawed but morally wrong. \u201cWe fear the repercussions of this study, including an increase in suffering, prejudice, and discrimination,\u201d concluded a group of 15 researchers at the New York State Psychiatric Institute<\/a>, where Dr. Spitzer was affiliated.<\/p>\n Dr. Spitzer in no way implied in the study that being gay was a choice, or that it was possible for anyone who wanted to change to do so in therapy. But that didn\u2019t stop socially conservative groups from citing the paper in support of just those points, according to Wayne Besen, executive director of Truth Wins Out<\/a>, a nonprofit group that fights antigay bias.<\/p>\n On one occasion, a politician in Finland held up the study in Parliament to argue against civil unions, according to Dr. Drescher.<\/p>\n \u201cIt needs to be said that when this study was misused for political purposes to say that gays should be cured \u2014 as it was, many times \u2014 Bob responded immediately, to correct misperceptions,\u201d said Dr. Drescher, who is gay.<\/p>\n But Dr. Spitzer could not control how his study was interpreted by everyone, and he could not erase the biggest scientific flaw of them all, roundly attacked in many of the commentaries: Simply asking people whether they have changed is no evidence at all of real change. People lie, to themselves and others. They continually change their stories, to suit their needs and moods.<\/p>\n By almost any measure, in short, the study failed the test of scientific rigor that Dr. Spitzer himself was so instrumental in enforcing for so many years.<\/p>\n \u201cAs I read these commentaries, I knew this was a problem, a big problem, and one I couldn\u2019t answer,\u201d Dr. Spitzer said. \u201cHow do you know someone has really changed?\u201d<\/p>\n Letting Go<\/strong><\/p>\n It took 11 years for him to admit it publicly.<\/p>\n At first he clung to the idea that the study was exploratory, an attempt to prompt scientists to think twice about dismissing the therapy outright. Then he took refuge in the position that the study was focused less on the effectiveness of the therapy and more on how people engaging in it described changes in sexual orientation.<\/p>\n \u201cNot a very interesting question,\u201d he said. \u201cBut for a long time I thought maybe I wouldn\u2019t have to face the bigger problem, about measuring change.\u201d<\/p>\n After retiring in 2003, he remained active on many fronts, but the reparative study remained a staple of the culture wars and a personal regret that wouldn\u2019t leave him be. The Parkinson\u2019s symptoms have worsened in the past year, exhausting him mentally as well as physically, making it still harder to fight back pangs of remorse.<\/p>\n And one day in March, Dr. Spitzer entertained a visitor. Gabriel Arana, a journalist at the magazine The American Prospect, interviewed Dr. Spitzer about the reparative therapy study. This was not just any interview; Mr. Arana went through reparative therapy himself as a teenager, and his therapist had recruited the young man for Dr. Spitzer\u2019s study (Mr. Arana did not participate).<\/p>\n \u201cI asked him about all his critics, and he just came out and said, \u2018I think they\u2019re largely correct,\u2019\u00a0\u201d said Mr. Arana, who wrote about his own experience<\/a> last month. Mr. Arana said that reparative therapy ultimately delayed his self-acceptance as a gay man and induced thoughts of suicide. \u201cBut at the time I was recruited for the Spitzer study, I was referred as a success story. I would have said I was making progress.\u201d<\/p>\n That did it. The study that seemed at the time a mere footnote to a large life was growing into a chapter. And it needed a proper ending \u2014 a strong correction, directly from its author, not a journalist or colleague.<\/p>\n