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. A Washington Post article indicated that Spitzer held 45-minute telephone interviews with 200 people who claimed that their respective sexual orientations had changed from homosexual to heterosexual. Spitzer said he "began his study as a skeptic," but the study revealed that "66 percent of the men and 44 percent of the women had arrived at what [Spitzer] called good heterosexual functioning," defined as "being in a sustained, loving heterosexual relationship within the past year, getting enough satisfaction from the emotional relationship with their partner to rate at least seven on a 10-point scale, having satisfying heterosexual sex at least monthly and never or rarely thinking of somebody of the same sex during heterosexual sex." Spitzer also found that "89 percent of men and 95 percent of women said they were bothered only slightly, or not at all, by unwanted homosexual feelings" but that "only 11 percent of the men and 37 percent of the women reported a complete absence of homosexual indicators, including same-sex attraction.[...] Some 43 percent of the sample had been referred to Spitzer by 'ex-gay ministries.[...] An additional 23 percent were referred by the National Association for Research and Therapy of Homosexuality." Spitzer has stated that his research "shows some people can change from gay to straight, and we ought to acknowledge that." Considering how difficult it had been to find 200 participants, and that they were considered the best cases of conversion therapy, Spitzer concluded that although change could occur, it was probably very rare. The APA issued an official disavowal of Spitzer's paper, noting that it had not been peer reviewed and stating, "There is no published scientific evidence supporting the efficacy of reparative therapy as a treatment to change one's sexual orientation." Two years later, Spitzer's paper was