In the days following Robert Spitzer’s untimely death last month, aged 83, the focus turned naturally to reviewing the many accomplishments of his long and influential career. Colleagues working on subsequent editions of the DSM, such as PT blogger Allen Frances, spoke warmly of his charm and charisma (very much in evidence to me that afternoon in February 2006), as well as his achievement in removing homosexuality from the DSM in 1973. As Frances reminded, Spitzer reached this difficult outcome in an altogether different climate, under hostile opposition from conservative colleagues who denounced him for heeding the objections of lesbians and gays themselves, much less for accepting that their concerns had any bearing on psychiatry itself.
Recent comparisons have also been made between DSM-III and its precursor, DSM-II, the edition from 1968 that, Spitzer admitted to me, had been edited by just one person, Sir Aubrey Lewis at the Maudsley Institute of Psychiatry in London. But such comparisons almost certainly put the bar too low, making everything else shine in comparison. According to Spitzer, it was Lewis who, without consultation and at a stroke of his pen, redefined multiple psychiatric conditions simply by striking the word “reaction” from them. “Schizophrenic reaction,” with its implied allusion to context, intensity, and frequency, suddenly became “Schizophrenia,” with suggested permanency and seemingly limitless recurrence. In turn, it was Spitzer who led the effort to add the word “disorder” to a large number of related conditions, effectively turning them into semi-permanent, even life-long biological states with an almost inevitable relation to pharmaceuticals.