Robert L. Custer, 63, Psychiatrist Who Led Treatment of Gamblers
Dr. Custer was widely recognized as a pioneer in helping compulsive gamblers. At a time when out-of-control gambling was widely considered to be merely aberrant behavior, he came to regard it as a disease that should be treated as such.
''We're dealing with a behavior disorder,'' Dr. Custer said not long after the 1974 opening of his clinic, which he set up at a Veterans Administration hospital in Brecksville, Ohio. ''The key to the problem is psychological addiction. It's what I call the pain-avoidance mechanism.'' Gambling to Escape Pain
Dr. Custer rejected the Freudian theory held by many psychoanalysts that people gambled compulsively as a substitute for sex. Addicts gamble excessively, he believed, not for pleasure or self-punishment, but to escape pain.
When recreational bettors go to the race track, he said, including himself in that category, they go to enjoy themselves. ''It's a social thing,.'' he said. ''But the compulsive gambler usually goes alone. He's isolated. He's doing it to relieve some kind of psychic pain. Whether he wins or loses, just being in action relieves the pain.''
In 1980, largely through Dr. Custer's efforts, the American Psychiatric Association classified compulsive gambling as a psychological disorder. Since this recognition, awareness has spread among mental health professionals concerning the course and treatment of the disease.
In its Diagnostic Statistical Manual III, the American Psychiatric Association notes that pathological gambling and alcoholism usually begin in adolescence.