On This Day … 22 May

People (Births)

  • 1932 – Robert Spitzer, American psychiatrist and academic (d. 2015).

Robert Spitzer

Robert Leopold Spitzer (22 May 1932 to 25 December 2015) was a psychiatrist and professor of psychiatry at Columbia University in New York City. He was a major force in the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Education

He received his bachelor’s degree in psychology from Cornell University in 1953 and his M.D. from New York University School of Medicine in 1957. He completed his psychiatric residency at New York State Psychiatric Institute in 1961 and graduated from Columbia University Centre for Psychoanalytic Training and Research in 1966.

Spitzer wrote an article on Wilhelm Reich’s theories in 1953 which the American Journal of Psychiatry declined to publish.

Career

Spitzer spent most of his career at Columbia University in New York City as a Professor of Psychiatry until he retired in 2003. He was on the research faculty of the Columbia University Centre for Psychoanalytic Training and Research where he retired after 49 years in December 2010. He has been called one of the most influential psychiatrists of the 20th century. The Lancet’s obituary described him as “Stubborn, sometimes abrasive, and always eager, Spitzer’s work was guided by a strong sense of ethical fairness”. A colleague at Columbia has described him as an “iconoclast” who “looked for injustice”.

Screening and Diagnostic Tools

Spitzer was a major architect of the modern classification of mental disorders. In 1968, he co-developed a computer program, Diagno I, based on a logical decision tree, that could derive a diagnosis from the scores on a Psychiatric Status Schedule which he co-published in 1970 and that the United States Steering Committee for the United States-United Kingdom Diagnostic Project used to check the consistency of its results.

Spitzer was a member on the four-person United States Steering Committee for the United States-United Kingdom Diagnostic Project, which published their results in 1972. They found the most important difference between countries was that the concept of schizophrenia used in New York was much broader than the one used in London, and included patients who would have been termed manic-depressive or bipolar.

He developed psychiatric methods that focused on asking specific interview questions to get at a diagnosis as opposed to the open-ended questioning of psychoanalysis, which was the predominant technique of mental health. He codeveloped the Mood Disorder Questionnaire (MDQ), a screening technique used for diagnosing bipolar disorder. He also co-developed the Patient Health Questionnaire (PRIME-MD) which can be self-administered to find out if one has a mental illness. The portions of PRIME-MD directed at depression (PHQ2 and PHQ9) have since become accepted in primary care medicine for screening and diagnosis of major depression as well as for monitoring response to treatment.

Position on the Diagnostic and Statistical Manual of Mental Disorders

In 1974, Spitzer became the chair of the American Psychiatric Association’s task force of the third edition of the Diagnostic and Statistical Manual of Mental Disorders the so-called, DSM-III which was released in 1980. Spitzer is a major architect of the modern classification of mental disorders which involves classifying mental disorders in discrete categories with specified diagnostic criteria but later criticised what he saw as errors and excesses in the DSM’s later versions, although he maintained his position that the DSM is still better than the alternatives.

In 2003, Spitzer co-authored a position paper with DSM-IV editor Michael First, stating that the “DSM is generally viewed as clinically useful” based on surveys from practicing professionals and feedback from medical students and residents, but that primary care physicians find the DSM too complicated for their use. The authors emphasized that given then-current limitations in understanding psychiatric disorders, a multitude of DSM codes/diagnoses might apply to some patients, but that it would be a “total speculation” to assign a single diagnosis to a patient. The authors rejected calls to adopt the ICD-9 because it lacked diagnostic criteria and would “[set] psychiatry back 30 years,” while the ICD-10, closely resembled the DSM-III-R classification.[14] In 2013, a definitive autobiography of Spitzer, The Making of DSM-III®: A Diagnostic Manual’s Conquest of American Psychiatry, was published by author and historian Hannah S. Decker.

Spitzer was briefly featured in the 2007 BBC TV series The Trap, in which he stated that the DSM, by operationalising the definitions of mental disorders while paying little attention to the context in which the symptoms occur, may have medicalised the normal human experiences of a significant number of people.

In 2008, Spitzer had criticised the revision process of the DSM-5 for lacking transparency. He has also criticised specific proposals, like the proposed introduction of the psychosis risk syndrome for people who have mild symptoms found in psychotic disorders.

On Homosexuality

Spitzer led a successful effort, in 1973, to stop treating homosexuality as a mental illness.

It was partly due to Spitzer’s efforts that homosexuality was “removed” (i.e. renamed as Sexual Orientation Disturbance) in 1974 DSM-II: “By withdrawing it from the manual, homosexuality was legitimized as a normal difference rather than a psychiatric behavior. This early powerful statement by institutional psychiatry that this is normal sped up the confidence of people in the movement.”

In 2001, Spitzer delivered a controversial paper, “Can Some Gay Men and Lesbians Change Their Sexual Orientation?” at the 2001 annual APA meeting; he argued that it is possible that some highly motivated individuals could successfully change their sexual orientation from homosexual to heterosexual.

Awards

Spitzer received the Thomas William Salmon Medal from the New York Academy of Medicine for his contributions to psychiatry.

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