August 2006, Vol. XXIII, No. 9
As conservative groups push for a constitutional amendment that defines marriage as a union between a man and woman1 and lesbians and gay men initiate lawsuits to overturn state bans against same-sex marriages,2 several psychiatrists are researching and discussing how denial of same-sex marriage impacts mental health.
At the American Psychiatric Association (APA) meeting in Toronto, Gene Nakajima, MD, staff psychiatrist with San Francisco’s Center for Special Problems, and Mary E. Read, MD, assistant clinical professor in the department of psychiatry at Harbor-UCLA Medical Center, co-chaired a symposium on same-sex civil marriage.
One presenter was Ellen Haller, MD, adjunct professor of psychiatry at the University of California at San Francisco, who described her own experience. When same-sex marriages became legal in San Francisco in 2004, Haller and her partner of 18 years, together with 2 gay men who had been a couple for 20 years, quickly arranged for a civil ceremony at city hall. Together, the couples were co-parenting their 7-year-old son, Danny. For the ceremony, the couples were going to take turns saying their vows in front of close family and friends. Danny was going to recite a poem he had written about love and play a song on the violin. Afterward, a dinner reception was planned.
Although Haller and her partner had already registered as domestic partners with the state, they wanted to get married for several reasons.
“One [reason] was to bring visibility to the lack of equal civil rights historically for gay and lesbian couples, another was to publicly affirm our love and commitment for each other in front of friends and family, and a third was to take part in an exciting and wondrous time in San Francisco,” Haller told Psychiatric Times.
But their marriage was not to be. On March 11, 2004, 4 days before the planned marriage, the California Supreme Court ruled that San Francisco had to cease and desist the granting of same-sex marriage licenses. So instead of a marriage ceremony, the couples found themselves participating in a protest march. Danny, who chose to participate in the march, confided to a television reporter that he was angry at a government that wouldn’t allow his moms and dads to get married and that he didn’t understand why.
Asked about the mental health effects of the ban, Haller said, “Being treated as a second-class citizen conveys the message that one is less worthy than others. Lack of equal civil rights can degrade people’s self-esteem and can ultimately lead to a sense of negative self-worth, and possibly depression and substance abuse.”
A strong link exists between discrimination and psychological distress, according to Robert Kertzner, MD, and Gilbert Herdt, MD, who recently published an article on the topic in the journal Sexuality Research & Social Policy.3 Their research, supported by the Evelyn and Walter Haas Jr. Fund, was an analysis of 150 studies and articles published during the past 30 years on marriage, discrimination, and denial of marriage to same-sex couples.
Kertzner, associate clinical professor of psychiatry at the University of California at San Francisco and adjunct associate research scientist in the department of psychiatry at Columbia University in New York, also spoke at the APA symposium.
Many researchers, he said, have studied the effects of discrimination on mental health, both in the general population and among lesbians and gay men.4,5
“These studies have shown that the experience of discrimination is associated with increased psychological distress and increased rates of psychiatric morbidity, such as increased rates of depression and anxiety,” Kertzner told Psychiatric Times.
One study by Mays and Cochran4 looked at a nationally representative sample of adults aged 25 to 74 years and self-identifed as homosexual or bisexual (n = 73) or heterosexual (n = 2844). The researchers concluded that higher levels of discrimination may underlie recent observations of greater risk of psychiatric morbidity among lesbian, gay, and bisexual individuals.
Both the American Psychological Association6 and the APA,7 Kertzner said, have issued statements in favor of marriage equality for lesbians and gay men, citing the harmful effects of discrimination on mental health.
Because nearly all states deny the right to civil marriage, with the exception of Massachusetts, the APA said, “Same-sex couples are currently denied the important legal benefits, rights, and responsibilities of civil marriage. Same-sex couples therefore experience several kinds of state-sanctioned discrimination that can adversely affect the stability of their relationships and their mental health.”
Kertzner said that stigmatization of homosexuality is perpetuated by discrimination in marriage denial and that, in turn, perpetuates a vicious circle. Because they are not being allowed to marry, same-sex couples often experience commitment ambiguity marked by uncertainty about the extent of mutual obligations in the relationship ; uncertainty about the recognition of the partnership by family, friends, and others; and uncertainty about when the relationship is over. That ambiguity serves to support stereotypes that lesbians and gay men are incapable of staying together and are therefore unworthy of being married and should be denied marriage.
Marriage denial to same-sex couples in the United States has been based, in part, on assumptions about the immorality and sexual promiscuity of gay men and lesbians.8
Yet Herdt and Kertzner,3 in their article, cite numerous studies that show that a significant number of lesbians and gay men form committed long-term relationships that provide stability, support, increased life satisfaction, and an enhanced sense of personal meaning over the lifespan.
