03/04/2013 06:22 pm ET Updated Feb 02, 2016

Marriage Equality in the Hearts and Minds of LGBT People

Marriage equality is not just about civil rights, it's about mental health. The denial of civil marriage to lesbians and gay men is a striking example of discrimination that contributes to well documented mental health disparities between heterosexual and sexual minority persons. As the U.S. Supreme Court reviews the constitutionality of California's Proposition 8 and the federal Defense of Marriage Act, it should recall an earlier ruling almost sixty years ago based, in no small measure, on the pernicious psychological effects of discrimination experienced by minority persons.

When the landmark case of Brown v. Board of Education is discussed, the legal doctrine that is most often recalled is that "separate is inherently unequal." This certainly has relevance for the debate today over whether "civil unions" are enough to provide marriage equality for LGBT people. But when I think about Brown, a different quotation is the one that stays with me: that segregation of children "may affect their hearts and minds in a way unlikely ever to be undone."

As a psychiatrist, I hear in these words an evocation of lengthy psychotherapies with lesbians and gay men who feel that their committed relationships are still "less than" the marriages of heterosexual siblings in the eyes of families (not to mention their communities and the law). This sense of inferiority sometimes results in a form of "relationship ambiguity," in which some same-sex couples don't take their partnerships seriously enough to acknowledge anniversaries or expect joint invitations to family events.

The negative effects of dismissing same-sex partnerships are not limited to those in relationships. Lesbians and gay men living in States that introduced laws or promoted initiatives to ban same-sex marriage, for example, have increased rates of anxiety and depression, as demonstrated in a widely publicized study led by Mark Hatzenbuehler, a colleague of mine with the new LGBT Health Initiative at Columbia University.

So, what then happens to lesbians and gay men when marriage discrimination is lifted? Hearts and minds get better. Research supports this assertion. Gay men's medical and mental health care visits, for example, declined in the year after same-sex marriage became legal in Massachusetts; this was true regardless of whether or not men were partnered. And having a legally recognized same-sex spouse confers extra protection against depressive symptoms in the face of sexual orientation stigmatization and stress associated with aging such as worries about health or finances.

There's another story I've been hearing in recent years. In my work with lesbians and gay men who wed their partners, I am struck by the common exclamation of being surprised by the transformative effect of legally marrying a partner, even after a couple has been together for many years. Sometimes this has to do with the joint acknowledgement by both partners' kin that they have created a new family and, by extension, that those marrying must now be seen as "fully adult."

For other lesbians and gay men, the deeply embedded social, cultural, spiritual, and legal meanings of civil marriage imbue their love with a sense of legitimacy that had eluded them previously. Full marriage equality becomes a pardon from the purgatory of having a relationship that is eternally deemed either pre-marital or extra-marital. And it also connotes no longer being relegated to second-class citizenship.

Whereas Brown addressed the harmful effects of educational inequality, the current marriage cases before the Supreme Court speak to a government-mandated devaluation of love between two people. This has profound effects on the hearts and minds of lesbians and gay men, as it denigrates the feelings of love that tell us with whom to be intimate, whom to care for and what to care about, and how to give meaning to our brief lives as mortal beings. To quote Barack Obama's second inaugural address, "if we are truly created equal, then surely the love we commit to one another must be equal as well" -- and be as essential to the well-being of lesbians and gay men as it is to heterosexual men and women.

Robert Kertzner, M.D., is a psychiatrist and investigator at the LGBT Health Initiative at the Columbia University Medical Center.