A More Perfect Union: U.S. Supreme Court Decision on Gay Marriage Helps Ease Stigma and Improve Mental Health
While not the first nation to assert the rights of gay couples, last month’s U.S. Supreme Court ruling is especially historic when considered against the backdrop of the 1969 Stonewall riots, considered to be the catalyst for the gay liberation movement, and the removal of “ego-syntonic homosexuality” from the list of disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1973. For American social (and legal) policy, this ruling came at lightning speed – within the Baby Boomer lifetime.
Access to health care coverage is associated with improved health and lower mortality1 – improving both the health of the nation and the financial well-being of the health care system.
So what does this mean for the health of the nation? “First, do no harm.” The stuttering approval for same-sex marriage by individual states has not promoted the apocalyptic decline in heterosexual marriage anticipated by opponents. Furthermore, there are no studies to support social decline, moral deterioration or deleterious effects on children (of straight or gay parent couples) attributable to legal same-sex marriage. With harm out of the way, consider the multiple benefits of this ruling, and the institution it legalizes:
1. Improved access to employer-sponsored insurance
Significantly more Americans will access employer-sponsored insurance through their spouses, with some men and more women now able to drop Medicaid coverage, as seen in New York following enactment of the Marriage Equality Act in 2011. Access to health care coverage is associated with improved health and lower mortality1 – improving both the health of the nation and the financial well-being of the health care system.
2. Recognition that a gay “lifestyle” is not a choice helps to mitigate mental health issues
The ruling validates a “lifestyle” historically considered a choice (and a bad one, at that), now recognizing a lifestyle as more predetermined than chosen. Minority stress, shame, secrecy, fear and stigma have all contributed to increased levels of depression, anxiety, substance use and suicide in gay and lesbian teens and adults. Internalized homophobia by many LGBT individuals has placed a positive value on “passing” in straight society while devaluing their core identity. Add to this the stigma associated with mental health problems, and it is not surprising that poor self-esteem among LGBT individuals has been prevalent. The scourge of HIV/AIDS – and the country’s initial response to it – further magnifies these problems.
3. Marriage promotes overall well-being
There are benefits of marriage itself that promote mental health (e.g., decreased suicide), strengthen relationships, provide financial security, and enhance the overall well-being of children in same-sex parent households. The California Health Interview Survey found that same-sex married couples felt more committed to their relationships, had levels of distress similar to those of married heterosexual couples, and had significantly lower stress levels than single (unmarried) gay, lesbian or bisexual individuals. Dozens of studies of children of gay and lesbian parents have failed to show any psychological difference between them and children of heterosexual parents. Several studies demonstrate that the single most important (parenting) factor in child well-being is one good (i.e., involved and supportive) parent, and two good parents are even better – without any reference to the gender of those parents. Having committed parents who feel dignified by their marriage could only be an added plus.
The ruling validates a “lifestyle” historically considered a choice (and a bad one, at that), now recognizing a lifestyle as more predetermined than chosen.
The overarching point is this: Social stigma, ill-conceived beliefs and policies, and real (sometimes life-threatening) danger, are at the root of mental health issues among LGBT individuals – not homosexuality itself.
While the court cannot mandate tolerance, recognizing and legitimizing same-sex couples as equal citizens under the law goes a long way towards mitigating the negative effects of stigma and ensuing mental health issues.
1 Wilper AJ, Woolhandler S, Lasser K, et al. Health insurance and mortality in US adults. Am J Public Health 2009; 99(12):2289-95.