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The Marrying Mind Health, Happiness and the Right to Wed 06.23.08 By Sarah Paris 
UCSF's John Lewis, left, and Stuart Gaffney reacting to the May 15 California Supreme Court court’s decision in San Francisco. Photo: Bob Bobster On June 16, the day of the first legal marriage between a same-sex couple in California, UCSF held its annual award presentation for Gay, Lesbian, Bisexual, and/or Transgender Leadership. The serendipity of this coincidence wasn't lost on the crowd, who delivered standing ovations to the honorees, or on Chancellor Bishop, who remarked on the historic occasion in his introduction. Lowell Tong, MD, who was given the faculty award for GLBT leadership, summed up his feelings by describing himself as an "accidental leader," noting that just to be out professionally and in society is a political statement -- even in San Francisco; and certainly getting married to a same-sex partner is a big political statement. With considerable emotion, and eliciting heartfelt applause, Tong emphasized"I look forward to the day when same-sex couples getting married will just be about marriage." Tong, a faculty member in the department of psychiatry, was the chair of the American Psychiatric Association's GLBT Committee when he organized a symposium in 1998 on the 25th anniversary of the removal of homosexuality as a diagnosis from the Diagnostic and Statistical Manual (DSM). The event was widely covered in the press and contributed to public awareness about the changes in how psychiatry has viewed homosexuality over the decades. Less in the public awareness and insufficiently studied are the mental and physical health effects of marriage discrimination – the inability to marry the person of one's choice. In a chapter he wrote in a book edited by UCSF Associate Clinical Professor Robert Cabaj (see sidebar), Tong compares the arguments against gay marriage to arguments raised four decades ago before the US Supreme Court knocked down all state laws banning mixed-race marriages. "The objections to mixed-race marriage in those days are virtually identical to today's opposition against same-sex marriage."  GLBT Leadership award winners Lowell Tong, Lisabeth Castro-Smyth, and Amanda Yeaton-Massey (r), with Chancellor Bishop  Discrimination and Stress But Tong points out one difference which can make the experience more complex – and arguably more stressful– for LGBT populations: "Because many LGBT people can 'pass,' it is more common for them to be in the presence of discriminatory talk or behavior not necessarily targeted towards them. Added then to the stress of discrimination is the stress of deciding whether to expose one's identity in these circumstances." Even subtle bias can bring up questions straight people rarely have to face. Tong cites as an example a recent airplane conversation, where a fellow traveler, possibly noticing Tong's wedding band, asked about "your wife." "This was a friendly question, which did not express discrimination, only heterosexual bias. But each such instance requires some decision on how to respond. The cumulative effect over many times, just about every single day, takes its toll." From his clinical practice, it is also evident to Tong that a prevailing societal view of same-sex couples as "dating" -- even if they are in a long-term, committed relationship -- can have subtle or not-so-subtle effects on someone's concept of what kind of relationship they are capable of – or are thought to be capable of. A 2006 article in Psychiatric Times describes the experience of another UCSF faculty member, Ellen Haller, MD, adjunct professor of psychiatry and co-director of the Lesbian Health and Research Center. Her planned marriage in 2004 was cancelled when the California Supreme Court ruled that San Francisco had to cease and desist the granting of same-sex marriage licenses. "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," Haller said. Robert Kertzner, MD, UCSF associate clinical professor of psychiatry, did an analysis of 150 studies and articles published during the past 30 years on marriage, discrimination and denial of marriage to same-sex couples (see sidebar). "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 was quoted in Psychiatric Times. The American Psychiatric Association, the American Psychological Association, the American Psychoanalytic Association and other professional health organizations have issued statements in favor of marriage equality for lesbians and gay men, citing the harmful effects of discrimination on mental health (see sidebar). Marriage Discrimination and Physical Health It is unclear what effect marriage discrimination may have on physical health, and whether the state of marriage itself confers health benefits. Some research indicates that heterosexual people who are married or in long-term relationships tend to be healthier, although this effect appears greater for men than women. These results have been attributed to more resilience to stress, greater resources, better social support and integration, and modification of risky behavior. Whether or not this applies to same-sex couples is unclear. In a 2006 article in the Journal of Epidemiology (see sidebar), the authors suggest: "The social respectability conferred by state sanction of same-sex relationships combined with the financial benefits of such unions and the necessary commitment to a shared future may have positive health effects." LGBT health experts caution, however, that such a conclusion may be premature. Says UCSF LGBT Resources Director Shane Snowdon, "at this point, a very high percentage of the same-sex couples who are marrying have been in long-term relationships, so we would not necessarily expect a strong 'marriage effect' on them. In addition, there is research showing that some aspects of physical health, especially for women, decline in long-term relationships. Also, as we look at same-sex relationships, we'll want to think carefully about what we mean by 'health,' since same-sex couples may view 'health' a little differently from their straight counterparts." |
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