In another scenario of marriage disinclination that will be familiar to couples therapists, the ambivalence inherent in human relationships may now be uncloaked in same-sex couples that can, at last, get married. With legal recognition bestowed by civil marriage, same-sex relationships no longer need to have an “as if” quality and this may prompt one to re-evaluate if a partnership is one for the ages. The possible revocation by some employers of domestic partner health benefits, now that marriage is possible for all, may similarly push partners in same-sex relationships toward marriage, ready or not.

Many lesbians and gay men, single or in relationships, have created a network of nonbiological and nonmatrimonial kin, in response to family rejection or geographic separation, childlessness or limited intergenerational ties, or the previous unavailability of legal and financial safeguards associated with marriage. Arguably, this characteristic may lessen some of the mental health differences by marriage observed in the general population in which those who are currently married have better psychological health than the never-married.

This is a question we can now more fully consider with greater numbers of married same-sex couples to observe, but it seems improbable that future generations of nonmarried lesbians and gay men will find themselves “condemned to loneliness,” a phrase Justice Anthony Kennedy, who wrote the majority opinion in the Obergefell case, invoked to highlight the punitive effect of excluding lesbians and gay men from the institution of marriage.


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Much has been written about other aspects of law and social and public policy that remain problematic for the mental health of lesbians and gay men, such as the absence of national and state-wide measures to protect LGBT people from discrimination in employment and housing, and the ongoing need for interventions to decrease bullying of gender-nonconforming youth. But these needs do not detract from the profound message of Obergefell vs Hodges: that the most intimate aspirations of lesbians and gay men to love are nothing to be ashamed of.

The task before mental health professionals is to witness how lesbians and gay men reap the psychosocial benefits of this acknowledgment, reckon with universal questions about relationships in a new context, and adapt what was most precious in an earlier era to a greatly changed world of possibility.

Robert M. Kertzner, MD, is an associate clinical professor of psychiatry at Columbia University and an investigator at the Columbia LGBT Health Initiative, Division of Gender, Sexuality, and Health at the New York State Psychiatric Institute. He is also in private practice in New York City.