A Shrink Walks into a Gay Tiki Bar…

When Robert Spitzer, the Columbia psychiatrist who revolutionized modern psychiatric diagnostics, died on Christmas Day 2015 at age eighty-three, history had already redeemed him. Six months earlier, on June 26, the US Supreme Court ruled 5-4 in Obergefell v Hodges that bans on same-sex marriage violated the Due Process and Equal Protection clauses of the Fourteenth Amendment. Spitzer had been in the thick of psychiatry’s long debate over homosexuality and he had taken hits from all sides. Now he could rest. 

Forty-two years separated Obergefell from the deed that made Spitzer famous. It was Spitzer who, in 1973, helped persuade the American Psychiatric Association (APA) to remove “homosexuality” from the list of mental pathologies in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the APA’s clinical handbook. First published in 1952, the DSM had attained sacred-text status, and Spitzer’s act lifted the medical stigma that had harmed gay people for decades. Scholars draw a line from Spitzer to Obergefell and beyond. 

“I could not have had a career without Bob Spitzer,” says Jack Drescher, a professor of clinical psychiatry at Columbia and former editor of the Journal of Gay and Lesbian Psychotherapy (now the Journal of LGBTQ+ Mental Health), for which he interviewed Spitzer in 2003. Drescher calls Spitzer “unique,” “brilliant,” and “a force of nature.” Columbia psychiatry professor Jeffrey Lieberman calls him “a true contrarian” and “a truth seeker.” Allen Frances ’63CC, who is chairman emeritus of the psychiatry department at Duke, wrote in The Lancet that Spitzer “shaped psychiatry far more than anyone else in the past half century. Rarely have so many owed so much to just one individual.” Frances studied under Spitzer at the Columbia University Center for Psychoanalytic Training and Research (CPTR), and defined his impact as “wide, deep, pervasive, and enduring, guiding the work of millions of mental health practitioners and improving the lives of hundreds of millions of patients all over the world.”  

The story begins in 1952, when Spitzer was an undergrad at Cornell, and the APA introduced the DSM, a 130-page coil-bound pamphlet designed to standardize psychiatric conditions. The DSM covered 106 diagnoses, among which was “homosexuality,” classified as a “sociopathic personality disturbance” alongside pedophilia and sadism. 

To the psychiatric establishment, this was progressive: Non-procreative sex, or sodomy, was unlawful in every state, and here was the DSM, casting gay people not as criminals but as victims of mental illness who needed treatment. But to those who had this “illness,” the DSM was catastrophic: Society already saw gays as morally and legally at fault; now the psychiatric field, through the DSM, had pathologized them. 

The central debate — was homosexuality a mental disorder, or was it a normal variant of human sexuality? — seemed to have been settled. And while studies like Sexual Behavior in the Human Male (1948) and Sexual Behavior in the Human Female (1953), by sexologists Alfred Kinsey, Wardell Pomeroy ’54GSAS, and Clyde E. Martin (known as the Kinsey Reports), and psychologist Evelyn Hooker’s 1957 paper “The adjustment of the male overt homosexual,” suggested that sexuality exists on a spectrum, most psychiatrists disagreed. To them, homosexuality was a sickness.  

Spitzer graduated college in 1953, at the height of the Cold War, when demagogues like Senator Joseph McCarthy, exploiting anticommunist paranoia, linked sexual nonconformity to political subversion. That year, President Dwight D. Eisenhower ’47HON, pressured by the McCarthyite wing of the Republican Party, signed Executive Order 10450, which barred anyone engaging in “sexual perversion” from the federal workforce. Thousands of employees were fired for being gay or suspected of being gay. Everyone knows the Red Scare, but the Lavender Scare took an even greater human toll, spreading fear, ruining lives, and driving many to self-destruction. 

It’s doubtful that Spitzer, straight, studious, and busy pursuing his medical and psychoanalytic training into the 1960s, was fully cognizant of this persecution. Born in 1932 to immigrant parents from Eastern Europe, he grew up in Manhattan with an engineer father and a mother he described as a “chronic outpatient in psychoanalysis.” As a child he was socially awkward, so his parents sent him to a neo-Freudian analyst whose specialty was orgone therapy, a body-centered psychotherapy focused on unblocking the body’s cosmic energy flow, or “orgone,” purported to heal everything from anxiety to cancer. But it had no effect on Spitzer, and this sharpened his skepticism toward a branch of medicine not immune to pseudoscience and charlatanism. 

Still, Spitzer did not dismiss the validity of psychoanalysis. In 1966 he earned his certificate from the CPTR and began his residency at the New York State Psychiatric Institute at Columbia. 

The institute had a lunch room where staff and residents could mingle with senior researchers. One day, while eating at one of the room’s linen-covered tables, Spitzer got to talking with Ernest Gruenberg, a psychiatric epidemiologist. Gruenberg was chairing a committee on developing a second edition of the DSM, and he asked Spitzer if he could help edit it. Though the work was unpaid, Spitzer said yes. He was named as a consultant, responsible, with Morton Kramer and Bernard C. Glueck ’34CC, for signing off on the final manuscript.  

The DSM-II, like its predecessor, included a diagnosis of homosexuality. That might not have raised many eyebrows in 1952, but it was 1968 now. McCarthy was dead, and the Civil Rights and antiwar movements had blazed a path for gay liberation. In 1967, Columbia recognized the Student Homophilia League, founded by Robert Martin ’69CC (later known as Stephen Donaldson) — the first authorized gay student organization in the US. Then, on June 28, 1969, around 1:20 a.m., New York City police raided a gay bar in Greenwich Village called the Stonewall Inn. Such raids were common, but on this occasion the patrons, some two hundred of them, resisted orders to line up and show identification. The confrontation erupted into the Stonewall Riots — the catalyst of the modern gay-rights movement. 

After the publication of the DSM-II, Spitzer joined the APA’s Task Force on Nomenclature, the committee in charge of developing and updating the DSM. Against the rising tide of gay activism, the psychiatric establishment continued to maintain that homosexuality was an acquired disorder originating in childhood, often the result of an overbearing mother and distant father. As Spitzer told Drescher, most everyone in the field, himself included, “took it for granted that homosexuality was not only an illness, but a very severe illness. It was considered not just an illness of sexual functioning, but really a widespread personality disturbance.”

This was certainly the case at Columbia: Spitzer’s colleague Lionel Ovesey, who invented the term “pseudohomosexuality” (the condition of the heterosexual male who, having been dominated or emasculated by another male, fears he might be gay), told the New York Times in 1970, “Homosexuality is a psychiatric or emotional illness. I think it’s a good thing if someone can be cured of it because it’s so difficult for a homosexual to find happiness in our society. It’s possible that this [gay-rights] movement could consolidate the illness in some people, especially among young people who are still teetering on the brink.”

Another Columbia faculty member, Charles Socarides ’52PH, author of the self-published Homosexuality: A Freedom Too Far (1995), treated patients for homosexuality until his retirement in 1996, and was a vocal opponent of gay rights up until his death in 2005. 

But Spitzer, unlike some of his colleagues, was open to counterarguments. He was also becoming interested in behavior therapy, a form of psychotherapy that focuses on identifying and changing negative habits. In 1972, at the Association for the Advancement of Behavior Therapy convention in New York, Spitzer, expanding his inquiry, organized a symposium on the treatment of homosexuality. 

The event did not last long. Minutes into the talk, a group of gay activists stood and began shouting, accusing psychiatry of hurting gay people. The chair of the symposium asked them to stop, without success, and the meeting ended. Spitzer was outraged. He was all for debate, but he deplored disruption. He went up to one of the protesters and told him so. 

That protester was Ron Gold, a Brooklyn-born entertainment journalist. After a moment, Gold and Spitzer began conversing, and it came out that Spitzer was on the nomenclature committee of the DSM. Gold lit up: This was exactly the psychiatrist he needed. 

Gold proposed that he and his associates meet face to face with the nomenclature group. Spitzer, who had never met an openly gay person, was intrigued. He consulted with Henry Brill, the chair of the task force. Brill agreed to a meeting. 

The two groups convened, and Gold and two other activists gave their presentation. In it, they argued that much of the discrimination, repression, and abuse that gay people suffered was a direct result of psychiatry’s claim that they were sick. 

There was no real escaping the point. Recalled Spitzer: “When they left, Brill turned to me and he said, ‘Okay Bob, you’ve gotten us into this mess. Now what do we do?’”

Spitzer, ever the problem solver, came up with a plan. The APA annual meeting in May 1973 was to be held in Honolulu, Hawaii, and Spitzer decided to reprise the talk with Gold: a debate between the two sides. Only this time it would unfold before the entire psychiatric field. 

In the months leading up to Honolulu, Spitzer got to know Gold and his associates. Remarkably to him, they seemed secure in their skins and, as far as he could tell, psychologically healthy. Spending time with them, Spitzer began questioning certain long-held ideas. 

The debate was held at the Sheraton-Waikiki Hotel. On Gold’s side stood psychiatrist Judd Marmor ’30CC, ’33VPS, who had been arguing since the 1960s that homosexuality was not a mental disorder. Opposing them were Charles Socarides and the psychoanalyst Irving Bieber, who expressed shock that homosexuals were voicing hostility toward psychiatry’s efforts to ease their suffering. Two other panelists, psychiatrists Robert Stoller and Richard Green, occupied the center, arguing that homosexuality, though abnormal, fell short of being a mental illness. 

But for all the big names in the room, the brightest star was Gold. His address, titled “Stop It, You’re Making Me Sick,” became an instant classic of gay history. As Gold stated in a 2003 episode of This American Life, reported by Alix Spiegel, “Essentially, I said that the diagnosis of the illness of homosexuality is the greatest tool of oppression imaginable. And that they’ve got to take us out of the nomenclature in order to prevent this from being the kind of sick that you get when people are repressing you.”

In Spiegel’s report, Gold reveals that Socarides was a great help, making repeated blunders and torpedoing his own argument: “One of the things he said in that panel was that there are no homosexuals in kibbutzes in Israel. And I had just come back from Israel and had had a thing with somebody who was raised in a kibbutz. And I said so in their panel, and they all laughed hysterically. But it made him seem to be a perfect jackass, which, of course, he was.”

After the talk, someone pulled Gold aside and whispered that a secret group of gay members of the APA — they called themselves the GAYPA— would be gathering at a nearby tiki bar for their annual bash. Gold was not to breathe a word of it: The APA did not recognize gay psychiatrists, and these gay-only parties were always clandestine affairs. 

Gold understood this. But he also saw an irresistible opportunity: Spitzer had claimed that he didn’t know any gay psychiatrists and doubted there were any, and Gold could not think of a better way to disabuse the doctor of this notion than to bring him to the bar. 

So, defying the GAYPA, Gold invited Spitzer along, cautioning him to be discreet. According to Spiegel, Spitzer “was instructed not to speak, or stare, or indicate in any way that he was anything other than a closeted gay man.”

When they arrived at the tiki bar, Spitzer was astonished. Amid the bamboo and fake palms and paper-umbrella Mai Tais were faces Spitzer recognized: psychiatrists, some of them prominent. Despite his best efforts to be inconspicuous, Spitzer struck a dissonant chord, and his presence sent a ripple of panic through the bar. The head of the GAYPA told Gold to get rid of Spitzer. But Gold refused, saying that Spitzer was there to help. 

Then, as if from nowhere, a man in a military uniform appeared. 

As Spitzer looked on, the man went up to Gold, embraced him, and, weeping, thanked him for his speech. He said he was an army psychiatrist stationed in Hawaii, and that Gold’s words had inspired him to visit a gay bar for the first time. And here he was. 

“It was a very moving event,” Gold recounted. “I mean, this man was awash in tears. And I believe that that was what decided Spitzer right then and there.” 

That night, Spitzer and Gold went back to the hotel and wrote the first draft of the resolution to remove the diagnosis of homosexuality from the DSM.

 “My own view started to change in terms of basic assumptions,” Spitzer told Drescher years later. “Now, how much of that was a result of true scientific logic? I would like to think that part of it was that. But certainly, a large part of it was just feeling that they were right! That if they were going to be successful in overcoming discrimination, this clearly was something that had to change.”

Spitzer had no illusions about the battle. The APA was not going to strike homosexuality from the DSM-II entirely. That meant Spitzer would have to reconcile two contradictory viewpoints: the traditional psychoanalytic notion of homosexuality as a treatable illness, and the Kinsey-Hooker concept of a natural, nonpathological variance. 

Reflecting on this, Spitzer realized that psychiatry had never actually defined “mental disorder.” What did it mean, exactly? If you were going to label homosexuality a mental disorder, Spitzer thought, you ought to have a definition.

So Spitzer decided to create one. He scoured the DSM-II to find a common thread that ran through the hundreds of different disorders. Seeking a unifying meaning that would somehow exclude homosexuality, Spitzer reasoned that a mental disorder usually involves distress or functional impairment. Psychiatry, of course, assumed that gay people were distressed by their sexuality, and yet the activists Spitzer knew were not distressed by being gay. They were distressed by how others reacted to their being gay.

Spitzer was aware that his logic — that a mental disorder must be associated with either distress or general impairment, and that many gay people were neither distressed nor impaired, and therefore not sick — would not satisfy the hardliners. Even Spitzer believed that there still ought to be a diagnostic label for someone who didn’t want to be gay. And so, playing semantics, he invented the diagnosis of “sexual orientation disturbance.” 

“This was Bob’s Solomonic decision,” says Drescher. “Cut the baby in half. You take out homosexuality, but not completely. You could still treat some people, if they needed treatment.”

In December 1973, the APA voted to replace “homosexuality” with “sexual orientation disturbance” for the 1974 revision of the DSM-II. With that crucial edit, millions of people were relieved of the indignity and injustice of being viewed by the psychiatric profession as sick. 

The DSM has always been a work in progress — and a lightning rod for criticism. The big complaints in the 1970s were that it relied more on theory than evidence, and that it lacked specific criteria for its diagnoses. Such shortcomings had knocked psychiatry from its postwar pedestal, and the field faced a crisis of credibility. The DSM needed a major overhaul. And so in 1974 the APA called on Spitzer, fresh from his DSM-II triumph, to oversee the development of the DSM-III. 

Spitzer threw himself into the project, devising a new methodology that relied on empirical diagnostic criteria, rendered in a common language understood by practitioners everywhere. When the DSM-III was published in 1980, mental-health professionals hailed it as a giant leap forward. “For all practical purposes,” says Jeffrey Lieberman, “Spitzer saved psychiatry.”

Still, the APA’s progress on the DSM did not sit well with organized psychoanalysis. “After the APA decision in 1973,” notes Drescher, “all the other mental health professions began gradually integrating their gay and lesbian members and bisexual members into their communities. But not the psychoanalysts. They circled the wagons.” 

When Drescher applied for psychoanalytic training in 1988, he skipped over Columbia’s program, which at the time did not accept openly gay people. It wasn’t until 1991 that another Columbia affiliated psychiatrist, Richard Isay, who had come out as gay, threatened to sue the American Psychoanalytic Association (APsA) for discrimination. APsA backed down and agreed to accept openly gay trainees, and then, the following year, to accept openly gay faculty. 

It was a long time coming, but the tide of change that Spitzer had engineered back in 1973 had even reached the shores of American psychoanalysis.  

The twists and turns in Spitzer’s evolution are a good illustration of the maxim, attributed to Heraclitus, that character is destiny. Spitzer was incapable of not questioning his own beliefs, of not challenging orthodoxy. He simply had to turn a thing inside out. 

In 1998, at the annual APA meeting, held that year in Toronto, the APA honored the twenty-fifth anniversary of the 1973 decision. There was a panel, but Spitzer wasn’t asked to be on it. That upset him greatly, says Drescher, but he went anyway. Upon arriving he noticed, outside the convention center, a group of protesters. But these were not the sort of activists he’d become acquainted with in the ’70s. No: These activists were claiming to be ex-gays who had been cured of their homosexuality. And they wanted the APA to re-pathologize homosexuality. 

Spitzer was curious. Were these people genuine? Had they really been cured? Was “conversion” possible? Could a gay person, if highly motivated, truly change? 

True to his contrarian impulses, Spitzer decided to investigate. He embarked on his own study, and in March 2000, he called Jack Drescher. 

“Bob said he wanted to have a debate at the APA between people who believe you can change and people who believe you can’t change,” Drescher recalls. “He invited me to be on the panel. I said, ‘I don’t want to be on that panel, I’m not interested in giving those people a forum.’ And he yelled at me, saying I had no right to refuse him. But I did refuse him. And I remember hanging up and thinking, ‘Oh, no, Dr. Spitzer is mad at me.’” 

The next month, ABC News ran a segment on Spitzer’s research, and revealed that Spitzer would be the moderator of his own proposed debate. That apparent conflict of interest caused the debate’s two countering psychiatrists to pull out, and the APA was obliged to call the whole thing off. In response, the conservative Christian group Focus on the Family ran a full-page ad in USA Today, condemning the APA for cancelling. “What Bob didn’t understand,” says Drescher, “is that he was being manipulated by the religious right.”

The following year, at the APA annual convention, held in New Orleans, Spitzer presented his controversial study. He had spoken with two hundred men and women who had gone through reparative therapy, also known as conversion therapy. And he found that most of them had been able to change their sexual attraction. 

Antigay groups were jubilant: The famous psychiatrist who removed the diagnosis of homosexuality from the DSM seemed to have undergone a conversion of his own. At a time of public debate over gay civil unions, the antigay movement seized on Spitzer’s paper. 

But the study was not sound: in a textbook instance of “bias sampling,” Spitzer had recruited his subjects from ex-gay advocacy groups and the National Association for Research and Therapy of Homosexuality, or NARTH, cofounded by Charles Socarides. 

“The subjects in the study were not people Bob had interviewed before and after treatment,” says Drescher. “These were people who called him on the phone for a forty-five-minute interview.” 

Reputable journals rejected the paper and barraged Spitzer with criticism. Undeterred, Spitzer eventually found a publisher: the Archives of Sexual Behavior, a journal edited by a psychologist who treated children with “gender dysphoria,” a term describing a person’s desire to be a different gender. Fans of such therapies cheered Spitzer’s study, which had not been peer reviewed. Mainstream psychiatry considered it junk. 

Back in New York, Spitzer and Drescher were scheduled to appear together on a local news broadcast to discuss the topic. “We were in the green room together,” Drescher says, “and Bob looked like the loneliest person in the whole world. Everybody was mad at him. He had waded into the culture wars, not fully knowing what he was getting himself into.”

Drescher worried, too, that if Spitzer discredited himself in the eyes of gay-rights supporters, it would undermine all the good he’d done. But what could anyone say? Spitzer had to reach his own conclusions. As Drescher knew, the only person who could really challenge Spitzer was Spitzer. 

And Spitzer began to see it. Antigay activists were weaponizing his study to attack gay civil unions. Spitzer supported civil unions. Angered, he wrote letters to newspapers blasting the misuse of his research. At the same time, he defended his study on the grounds that science must not bend to people’s emotions. Speaking to Drescher in 2003, he acknowledged the ethical conundrum — that in the pursuit of truth, there may be casualties. 

But Spitzer was not done revising himself. He knew he had done harm, and it pained him. In 2012, suffering from Parkinson’s disease, he gathered his strength to compose a letter to the Archives of Sexual Behavior.

Published on May 24, 2012, two days after his eightieth birthday, the letter was brief and pointed. In it, Spitzer stated that the critics of his study were right. His research, he wrote, was “fatally flawed:” It was impossible, he admitted, to verify his subjects’ assertions that they had changed their sexual orientation. 

“I believe I owe the gay community an apology,” Spitzer wrote, “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.”

Such disavowals of published work are rare, and apologies are even rarer. That the apology came from the man known as the father of modern psychiatry made it momentous. 

Spitzer had considered the issue from both sides of the wire, and by 2015 he had come full circle. He lived to see same-sex marriage sanctioned nationwide that June, and by the time of his death that Christmas, the civil-rights victory that he helped hasten was being celebrated with weddings in every state. 

“Bob opened the door that led forty years later to Supreme Court decisions that legalized gay marriage and criminalized discrimination against homosexual people,” wrote Allen Frances in his tribute. “Without Bob, homosexuality might still be viewed as a mental disorder and society might not be granting full marital status and child custody rights.” For all his faults and missteps, Spitzer remained, for Frances, “a confident and undaunted innovator pulling a reluctant field forward.”

The Honolulu tiki bar where Spitzer watched a military man weep with joy for his liberation was never landmarked. Its name appears to have been lost to history. But in June 2016, six months after Spitzer’s death, President Barack Obama ’83CC, Hawaiian-born, came to New York, to Christopher Street, where he dedicated another bar, the Stonewall Inn, as the first national monument to LGBTQ rights. Robert Spitzer would have raised his glass.