Same-Sex Marriage & Mental Health

Same-Sex Marriage & Mental Health

Why Same-Sex Marriage is Also a Mental Health Issue
From Psychiatry Advisor Robert M. Kertzner, MD February 18, 2015

With the impending U.S. Supreme Court review of same-sex marriage this year, mental health arguments will figure prominently into at least some of the justices’ thoughts.

These arguments, centered around the well-being of children being raised by same-sex parents and the psychological harm caused by the denial of civil marriage to lesbians and gay men, have influenced recent decisions in state and federal courts that have struck down bans prohibiting same-sex civil marriage.

Most notably, when Justice Anthony Kennedy ruled against part of the Defense of Marriage Act in 2013 — which lead to same-sex marriages becoming legal in many more states — he argued that same-sex couples were demeaned and their children humiliated by barring federal recognition of same-sex marriages.

Kennedy’s argument is familiar to many mental health clinicians aware of psychological harm caused by stigmatization and discrimination based on sexual orientation. Increasingly, several lines of mental health research support this view. First, multiple studies have found that psychosocial stress associated with having a lesbian, gay, bisexual, or transgender identity is implicated in the increased rate of mental health disorders found in LGBT persons. This stress comprises discrimination, concealment of sexual identity, and internalized negative attitudes about sexual or gender identity.

Other studies more specific to marriage bans report that lesbians and gay men living in states where such bans were implemented had increased rates of mood and anxiety disorders, compared with lesbians and gay men living in states without constitutional amendments.

But what are the mental health effects of including lesbians, gay men, and their children in the institution of civil marriage? In the early years of same-sex civil marriage (when couples traveled to Europe, Canada, or the few states in the U.S. that allowed same-sex marriage), clinicians heard patients — some in decades-long relationships — describe their surprise at how civil marriage conferred a sense of legitimacy to their partnerships.

Standing before assembled family members and friends, their unions recognized by the State, many lesbians and gay men felt that they had stepped out of the shadow of second class citizenry implied by the lesser status of civil unions.

Civil marriage among same-sex couples hasn’t existed long enough to permit longitudinal research studying the effects of marriage on mental health, but it seems likely that benefits described in the general population will accrue to same-sex couples and their children. Marriage dividends include a multitude of tangible and intangible benefits including financial advantages, legal protections, and psychosocial gains such as increased support during times of crises.

Pioneering research on same-sex marriage has identified comparable effects of these benefits, with several cross sectional studies of lesbians and gay adults finding distinct mental health advantages associated with marriage (in comparison with the status of being in a committed relationship or single), such as decreased psychological distress and an enhanced sense of meaning in life.

It also seems reasonable to assume that the legal recognition of both partners’ parental status conferred by civil marriage will lessen stigma experienced by the children of same-sex parents and impart additional stability and security to family life. Over 70 studies have found no difference in the psychological health and adjustment of children of gays and lesbians compared with heterosexual parents, but full legal recognition of both parents’ rights and responsibilities would further support children’s well-being during times of unplanned life events such as medical crises and relationship dissolution.

For these reasons, organizations such as the American Psychiatric Association, the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association have issued policy statements supporting civil marriage for same-sex couples. While some have argued that medical and scientific associations should not take a position on what is perceived as a social policy issue, it is difficult to ignore the environmental impact of marital enfranchisement on mental health in lesbians, gay men, and their children — a potent intervention that clinicians and researchers have already noted.

Our courts increasingly concur, with Justice Kennedy noting that states allowing same-sex marriage exercise a role and power that enhance the recognition, dignity, and protection of lesbians and gay men.  Matters of heart and mind will thus loom large when the U.S. Supreme Court returns to visit the question of same-sex marriage in the current term. Mental health professionals and many of their patients will be listening closely.

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