Why Same-Sex Marriage is Also a Mental Health Issue

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.