Psychiatry and Legal Recognition Of Same-Sex Civil Marriage

I have been asked by a number of concerned APA members why psychiatry should enter into the current debate on the legalization of same-sex marriage. A few have resigned, on the grounds that as a scientific and medical professional society, APA should not be commenting on this issue. To quote one disgruntled member, “I feel that APA has truly lost sight of its mission as a MEDICAL organization, led by PHYSICIANS, whose principles should be guided only by SCIENCE and what is in the best interest of those with mental illness.”

The topic of same-sex marriage hits a sensitive nerve for many in our society. The easy response to such sensitivity is to withdraw. But what the Assembly concluded, and the Board of Trustees agreed, is that the psychiatric profession should not stand back simply because an area is controversial. Rather, we serve society by providing our expert understanding of the science involved and also our judgment on its implications for civil rights.

Homosexuality was part of our diagnostic nomenclature until 1973, when the Board of Trustees removed it from the DSM. This change was supported by the membership when a referendum to overturn the Board's decision was defeated in 1974. Since then, research on the nature of homosexuality has uncovered its strong links to genetics and biology. As the science has advanced, so have APA's actions. In 2000 APA endorsed the concept of same-sex civil unions. This year, by action of the Assembly in May and the Board in July, we endorsed legal recognition of same-sex civil marriage (Psychiatric News, June 17, August 19).

APA's action to support legal recognition of same-sex civil marriage is based fundamentally on the research evidence. Many studies have now established that marriage is associated with clear benefits, including better mental and physical health. It is a stabilizing force in our society that enables individuals to make public their commitment to each other and receive acceptance and support from others. Further, research indicates that same-sex partners have the same capacity to form long-term relationships as do heterosexual individuals. To deny this recognition increases the stigma and related distress often experienced by gay and lesbian individuals in other facets of community life.

Against such compelling evidence, opponents of gay marriage cite religious faith and an ideological belief that the institution of marriage is threatened when same-sex partners can participate. In our civil society, which respects freedom of speech, all views should be heard; however, one strain of religious thought (among many) is an inappropriate basis for the official position of APA. APA's position deals with same-sex civil marriage only. And APA has concluded that fears about the future of society have no basis in evidence.

Clarifying the science is just one task of APA. Another is to be true to its implications. The biological basis of sexuality has important implications for civil rights. Gays, lesbians, bisexuals, and transgendered individuals are citizens who deserve the rights and benefits of full participation in society.

Their children deserve fair treatment as well. Measures to improve the mental health of parents have a definite, positive impact on the children in the family. It stands to reason that these children would feel more accepted in the community knowing that their parents are legally married. Marriage also offers more legal options in the case of divorce, such as joint custody and visitation. APA's endorsement of same-sex marriage is a recognition that science can forge a path toward a more decent society.

Although APA is the first medical society to endorse the legalization of same-sex civil marriage, we have been preceded by the American Psychoanalytic Association, American Psychological Association, and National Association of Social Workers.

Gaining legal status for same-sex civil marriage is an uphill battle. At the state level, debate over whether same-sex marriage should be legalized has created great heat, loss of civility, and controversy. Thirty-seven states have enacted so-called Defense of Marriage Acts, which ban same-sex marriage, and other states have similar legislation pending. Only one state, Massachusetts, explicitly allows same-sex marriage and only for residents of that state.

The international scene is more promising. Recently Canada and Spain legalized same-sex civil marriage, and Belgium and the Netherlands have similar provisions.

Marriage by gay and lesbian partners arouses irrational prejudice and fear, but as psychiatrists, we must take a stand on issues that have a clear impact on the mental health of our patients and of persons in the community at large. As an organization, we seek also to promote human rights and freedom from discrimination. Psychiatry leads the way for the rest of medicine on this important issue.

The APA position statement “Support of Legal Recognition of Same-Sex Civil Marriage” is posted on APA's Web site at<www.psych.org/edu/other_res/lib_archives/archives/200502.pdf>.▪