Renouncing “reparative therapy”: A giant in the field admits his humanity

Renouncing “reparative therapy”: A giant in the field admits his humanity

Robert Spitzer, MD, one of the most influential voices in modern psychiatry, readily admits that he has always been drawn to controversy. He definitely has been at the heart of the controversy about sexual orientation and identity since the 1970s. It was during that time that Dr. Spitzer was instrumental in getting homosexuality removed from the DSM-III thereby declassifying it as a “mental illness.” However, the biggest controversy he may have been a part of was his more recent work on so-called “reparative therapies.” And now his recantation of that work may be one the last (he’s 80 years old now) and possibly one of the most important contributions Dr. Spitzer will make. In an inspiring act of courage and scientific integrity, Dr. Spitzer has written a letter to be published in the Archives of Sexual Behavior in which he states, ““I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy.”

The study that Spitzer is referring to is the highly influential 2003 study he conducted and that was published in the Archives of Sexual Behavior (published, it should be noted, without going through the standard peer-review process) in which he concluded that the majority of participants in his study, who were self-selected as being highly distressed about their sexual orientation, reported having changed their sexual orientation from homosexual to heterosexual. The result was a study that has been widely misused for political purposes to state that homosexuality can (and should) be “cured.” While Spitzer has, reportedly, always disagreed with this interpretation of his study, he has now publically denounced the study as being based on flawed science. All of the findings in the study were based exclusively on self-report from a “highly motivated” sample. In addition, this was not a study of the effectiveness of any type of particular therapy–nearly ½ of the participants never even engaged in any therapy at all. Basically, his study, which has been cited for nearly 10 years as “scientific proof” that sexual orientation/identity can be changed, consisted of interviewing people who reported that they had, in the past, been highly distressed about identifying as homosexual and now felt that they were more strongly identified as heterosexual.

Dr. Spitzer is certainly not alone in his criticism of reparative therapies. In fact he is a bit late in his critique. In 1997, the American Psychological Association came out with a resolution specifically stating that there is no scientific merit to claims of therapies being able to change sexual orientation and condemning the practice of such therapies. In 200, the American Psychiatric Association followed suit and published a resolution challenging the “validity, efficacy, and ethics of clinical attempts to change an individual’s sexual orientation.” Just last week the World Health Organization came out with a report stating that these type of therapies are “a serious threat to the health and well-being — even the lives — of affected people.”

The problem with science is that it is conducted by humans, and we humans have our own preconceptions, egos, and agendas that can get in the way of our science. What is heartening is that someone like Spitzer, a giant in the field, can finally take a stand and correct what he has called his “only professional regret.”

PTSD Without Trauma? A Scientific American article examines some controversies about diagnostic criteria for PTSD

PTSD Without Trauma? A Scientific American article examines some controversies about diagnostic criteria for PTSD

When I was delving into the trauma literature for my dissertation several years ago, I noticed a study that—while not particularly relevant to my needs at the time – offered an intriguing finding. Bodkin, Pope, Detke, and Hudson (2007) found equivalent rates of PTSD symptoms between individuals who did (78%) and did not (78%) report a history of trauma. That is, a significant portion of their sample (who had major depression) similarly exhibited symptoms for PTSD, regardless of whether they had had been exposed to a trauma or not.

This was the first time I became aware of an ongoing controversy relating to how PTSD is diagnosed. In our current nosology (as defined in the DSM-IV), a PTSD diagnosis requires a person to have experienced a traumatic event–Criterion A, defined as threat of injury or death to self or others. However, some data seem to indicate that people can can experience PTSD-like symptoms even in the absence of an identifiable Criterion A trauma (as defined by the DSM-IV).  There is a large group of proponents who think this reveals a deep flaw in our diagnostic critera for PTSD.

For a brief summary of this controversy, check out, Rosen, Spitzer, & McHugh (2008; click on this link for the full pdf). As I’ve written about in a previous post, the current task force is considering tightening up the criterion A definition of what is considered a traumatic event.

I bring all this up now because the controversy has reached the popular press. In an April issue of Scientific American (reprinted online in May), Scott Lilienfeld and Hal Arkowitz provide a brief, readable summary of these concerns in their article, “Does Post-Traumatic Stress Disorder Require Trauma?

This is an issue that can be easily misinterpreted by the public. Critics of diagnostic criteria of DSM are not suggesting that PTSD does not exist; rather, the concern is that our understanding of PTSD and the criteria we use to diagnose it are seriously flawed.

I look forward to watching how this debate plays out in the revision process for the DSM-V.

In the meantime, check out the Scientific American article, and follow it up with Rosen et al. (2008).

Defending behavioral science

Defending behavioral science

A couple weeks ago, the New York Times posted an opinion piece which presented a very pessimistic and narrow view of the behavioral sciences. While I agreed with some of the points of the author, particularly the need for more randomized controlled trials of psychosocial interventions, I also think he “threw the baby out with the bathwater.” While we haven’t solved all the problems of humanity through behavioral science research, we have managed to discover a range of interventions that have been shown to work. 

In response to the NY Times article, a local colleague and friend at Oregon Research Institute, Tony Biglan, wrote an excellent response. In his post, he outlines some of the research-based intervention that have been shown to work.

In a time of decreasing funding for research and particulary for behavioral research, it’s important that we advocate for the importance of science-based psychotherapy and related psychosocial interventions. If you like this piece, consider passing it on, blogging about it, or tweeting it. There are buttons right at the bottom of this page that make it easy to pass along.

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