Shrinks (16 page)

The final and most enduring professional blow that resulted from the antipsychiatry movement was an assault on psychiatry’s near-monopoly of therapeutic treatment. Since the core argument of the antipsychiatry movement was that mental illness was not a medical condition but a social problem, psychiatrists could no longer claim they should be the sole medical overseers of mental health care. Clinical psychologists, social workers, pastoral counselors, new age practitioners, encounter groups, and other lay therapists leveraged the antipsychiatrists’ arguments to strengthen their own legitimacy as providers for the mentally ill, diverting increasing numbers of patients from medically trained psychiatrists. Soon, proliferating numbers of self-styled therapists without any license at all began carving up the mental health care market. The most ominous and aggressive of these non-medical alternative therapies was the Church of Scientology, a quasi-religious system of beliefs created by the science fiction writer L. Ron Hubbard. Scientology holds that people are immortal beings who have forgotten their true nature and past lives. They condemn the use of psychiatric drugs, instead encouraging individuals to undergo a process of “auditing” whereby they consciously re-experience painful or traumatic events from their past in order to free themselves from their harmful effects.

Each of the rival groups espoused its own theories and methods, but all shared a common conviction articulated so emphatically by the antipsychiatrists: Mental disorders were not bona fide medical illnesses and therefore did not need to be treated by physicians. The Conways, who brought their schizophrenic daughter Elena to see me, are an example of those who embrace the arguments of the antipsychiatrists, favoring holistic treatments over medical ones.

By the mid-1970s, American psychiatry was being battered on every front. Academics, lawyers, activists, artists, and even psychiatrists were publicly condemning the profession on a regular basis. The 1975 movie
One Flew Over the Cuckoo’s Nest
, based on Ken Kesey’s 1962 hit novel, came to symbolize the surging sentiment against psychiatry. This Academy Award–winning film was set in an Oregon state mental institution where the main character, a charismatic and mischievous rogue played by Jack Nicholson, was hospitalized for antisocial behavior. Nicholson leads a boisterous patient rebellion against the tyrannical authority of the psychiatric ward, Nurse Ratched, who cruelly reasserts control by forcing McMurphy to undergo electroshock treatment and then having him lobotomized. While the story was intended as a political allegory rather than an antipsychiatry polemic, the film emblazoned the image of a morally and scientifically bankrupt profession upon the public’s mind.

Surveying the situation in the early 1970s, the American Psychiatric Association warned its members, “Our profession has been brought to the edge of extinction.” The Board of Trustees called an emergency conference in February of 1973 to consider how to address the crisis and counter the rampant criticism. Everyone agreed that there was one fundamental problem central to all of psychiatry’s troubles: It still had no reliable,
scientific
method for diagnosing mental illness.

Chapter 4

Destroying the Rembrandts, Goyas, and Van Goghs: Anti-Freudians to the Rescue

Physicians think they do a lot for a patient when they give his disease a name.

—I
MMANUEL
K
ANT

Unfortunately for us all, the
DSM-III
in its present version would seem to have all the earmarks for causing an upheaval in American psychiatry which will not soon be put down.

—B
OYD
L. B
URRIS, PRESIDENT OF THE
B
ALTIMORE
W
ASHINGTON
S
OCIETY FOR
P
SYCHOANALYSIS
, 1979

An Unlikely Hero

There was little in the early life of Robert Leopold Spitzer to suggest he would one day be a psychiatric revolutionary, but it wasn’t hard to find indications of a methodical approach to human behavior. “When I was twelve years old I went to summer camp for two months, and I developed considerable interest in some of the female campers,” Spitzer tells me. “So I made a graph on the wall of my feelings towards five or six girls. I charted my feelings as they went up and down over the course of summer camp. I also recall being bothered by the fact that I was attracted to girls that I didn’t really
like
very much, so maybe my graph helped me make sense of my feelings.”

At age fifteen, Spitzer asked his parents for permission to try therapy with an acolyte of Wilhelm Reich. He thought that it might help him understand girls better. His parents refused—they believed, rather perceptively, that Reich’s orgonomy was a sham. Undeterred, Spitzer snuck out of his apartment and secretly attended sessions, paying five dollars a week to a Reichian therapist in downtown Manhattan. The therapist, a young man, followed Reich’s practice of physically manipulating the body and spent the sessions pushing Spitzer’s limbs around without talking very much. Spitzer does remember one thing the therapist told him. “If I freed myself of my crippling inhibitions, I would experience a physical streaming, a heightened sense of awareness in my body.”

Seeking that sense of “streaming,” Spitzer persuaded a Reichian analyst who possessed an orgone accumulator to allow him to use the device. He spent many hours sitting within the booth’s narrow wooden walls patiently absorbing the invisible orgone energy that he hoped would make him a happier, stronger, smarter person. But after a year of Reichian therapy and treatments, Spitzer grew disillusioned with orgonomy. And, like many zealots who lose their faith, he became determined to unmask and expose his former orthodoxy.

In 1953, during his final year as a Cornell University undergraduate, Spitzer devised eight experiments to test Reich’s claims about the existence of orgone energy. For some trials, he enlisted students to serve as subjects. For other experiments, he served as his own subject. After completing all eight experiments, Spitzer concluded that “careful examination of the data in no way proves or even hints at the existence of orgone energy.”

Most undergraduate research never reaches an audience wider than the student’s own advisor, and Spitzer’s study was no exception; when he submitted his paper debunking orgonomy to the
American Journal of Psychiatry
, the editors promptly rejected it. But a few months later he received an unexpected visitor to his dorm room: an official from the Food and Drug Administration (FDA). The man explained that the FDA was investigating Reich’s claims of curing cancer. They were looking for an expert witness to testify about the effectiveness of Reich’s orgone accumulators—or lack thereof—and they had obtained Spitzer’s name from the American Psychiatric Association, the publisher of the
American Journal of Psychiatry
. Would Spitzer be interested? It was a gratifying response for an aspiring young scientist, though in the end Spitzer’s testimony was not needed. The incident demonstrated that Spitzer was already prepared to challenge psychiatric authority using evidence and reason.

After graduating from the New York University School of Medicine in 1957, Spitzer began his training in psychiatry at Columbia University and psychoanalysis in its Center for Psychoanalytic Training and Research, the most influential psychoanalytic institute in America. But once Spitzer started treating his own patients using psychoanalysis, he soon became disillusioned once again. Despite his ardent efforts to properly apply the nuances and convolutions of psychoanalytical theory, his patients rarely seemed to improve. Spitzer says, “As time went on, I became more aware that I couldn’t be confident I was telling them anything more than what I wanted to believe. I was trying to convince them they could change, but I wasn’t sure that was true.”

Spitzer soldiered on as a young Columbia University clinician, hoping that he would encounter some opportunity to change the course of his career. In 1966, that opportunity arrived in the Columbia University cafeteria. Spitzer shared a lunch table with Ernest Gruenberg, a senior Columbia faculty member and the chair of the Task Force for the
DSM-II
, which was under development. Gruenberg knew Spitzer from around the department and had always liked him, and the two men enjoyed an easy and lively conversation. By the time they finished their sandwiches, Gruenberg made the young man an offer: “We’re almost done with the
DSM-II
, but I still need somebody to take notes and do a little editing. Would you be interested?”

Robert Spitzer, the architect of
DSM-III
. (Courtesy of Eve Vagg, New York State Psychiatric Institute)

Spitzer asked if he would be paid. Gruenberg smiled and shook his head. “Nope,” he replied. Spitzer shrugged and said, “I’ll take the job.”

The
DSM
was still considered useless by the vast majority of psychiatrists, and nobody viewed the bureaucratic cataloging of diagnoses as a stepping-stone toward career advancement. But Spitzer thought he would enjoy the intellectual puzzle of carving apart mental illnesses more than the vague and inconclusive process of psychoanalysis. His enthusiasm and diligence as the
DSM-II
scribe was quickly rewarded by his promotion to an official position as a full-fledged member of the Task Force, making him at age thirty-four the youngest member of the
DSM-II
team.

After the new edition of the
Manual
was completed, Spitzer continued to serve as a member of the APA’s soporifically titled Committee on Nomenclature and Statistics. Under most circumstances, this was a humdrum position with little professional upside, and Spitzer had zero expectation that his involvement would lead anywhere—until controversy abruptly thrust him into the national spotlight: the battle over the
DSM
diagnosis of homosexuality.

Classifying Homosexuality

American psychiatry had long considered homosexuality to represent deviant behavior, and generations of psychiatrists had labeled it a mental disorder.
DSM-I
described homosexuality as a “sociopathic personality disturbance,” while the
DSM-II
gave homosexuality priority of place as the very first example of its “sexual deviations,” described as follows:

This category is for individuals whose sexual interests are directed primarily toward objects other than people of the opposite sex, toward sexual acts not usually associated with coitus, or toward coitus performed under bizarre circumstances. Even though many find their practices distasteful, they remain unable to substitute normal sexual behavior for them.

One leading proponent of the homosexuality diagnosis was psychiatrist Charles Socarides, a prominent member of the Columbia University Center for Psychoanalytic Training and Research. He believed that homosexuality was not a choice, crime, or immoral act—it was a form of neurosis that originated with “smothering mothers and abdicating fathers.” Thus, Socarides argued, homosexuality could be treated like any other neurotic conflict. From the mid-1950s through the mid-1990s, he attempted to “cure” gay men by trying to help them unearth childhood conflicts and thereby convert their sexual orientation to heterosexuality. There’s precious little evidence, however, that anyone was ever “cured” of homosexuality through psychoanalysis (or any other therapy, for that matter).

It often happens that one’s personal theories of mental illness are put to the test when a family member comes down with the illness, such as when R. D. Laing’s theory of schizophrenia as a symbolic journey was challenged after his own daughter became schizophrenic. (Laing ultimately discarded his theory.) Charles Socarides’s son Richard was born the same year that he began treating homosexual patients, and as an adolescent he came out as gay, denouncing his father’s ideas. Richard went on to become the highest-ranking openly gay man to serve in the federal government, as an advisor to President Clinton. Unlike Laing, Socarides remained unwavering in his conviction that homosexuality was an illness until the end of his life.