All in the Gay Family

All in the Gay FamilyLesbian and Gay Families: Past, Present, and FutureShelly Cohen, MD Lorraine Lothringer, MD Daniel Medeiros, MD Littal Melnik, MD Eric Yarbrough, MD Kenn Ashley, MD1

A Legal Overview of Same Sex MarriageShelly Cohen, MD, JD NYU Department of Psychiatry, PGY3

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Civil Marriage:A legal status that automatically confers over a thousand (1,138) federal rights and benefits and hundreds of additional rights and benefits under state law. While some can be obtained (through private legal agreements), most cannot. A social and cultural institution that is understood as a couples commitment and love for one another.

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Same Sex Marriage States:Massachusetts (2004) Connecticut (2008) Iowa (2009) Vermont (2009) New Hampshire (2009) District of Columbia (2010) California (18,000 couples married between June and November 2008)

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Civil UnionA separate legal status that was created to extend rights/responsibilities of marriage to same sex couples. Provides nearly all the rights/responsibilities provided to married persons under state law, but not any of the federal benefits of marriage.Family law: divorce, child custody, alimony, div of property Tort rights: wrongful death and loss of consortium) Health care related rights: durable power of attorney, visitation State joint tax filing status Right to get property of a deceased partner that dies without a will NO federal benefits (social security, immigration, tax benefits)5

Civil UnionsStates Which Allow Civil Unions: New Jersey (since 2006) New Hampshire (since 2007) Illinois (takes effect June 1, 2011) Hawaii (takes effect Jan 1, 2012) Rights/responsibilities only apply as long as the couple remains within that state.

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Domestic PartnershipA legal form of union under which gay (and sometimes non-gay) noncouples in some states or regions can formalize their partnership Like civil unions, limited to recognition by that state and no federal benefits

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Domestic Partnership States:y California y Oregon (2008) y Nevada (2009) y Washington y Wisconsin (2009) y Maine8

Recognition of Out-of-State Out-ofSame Sex MarriageMaryland New Mexico Rhode Island New York California (entered before Nov 5, 2008. Provides domestic partnership recognition if after)9

Federal versus StateU.S. Constitution requires each state to give full faith and credit to the laws of other states Defense of Marriage Act (DOMA), passed by US Congress and signed by Clinton in 1996 (response to Hawaii), deprives married same-sex couples of samefederal marriage recognition. Defines marriage federally as a union between a man and a woman No federal benefits Expressly undercuts full faith and credit.10

Federal v. State: DOMAState DOMA laws Over 40 states enacted DOMA laws. specifically bar same sex marriage in that state. will not recognize same sex marriage from any state that allows it (even in states that provide some form of same sex relationship recognition) On Feb 23, 2011, President Obama declared that his administration would stop defending DOMA in pending lawsuits that challenged the constitutionality of the law. Congress has stated it would defend the law in place of the Dept of Justice.

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Constitutional Amendmentsy Removes the issue from judicial arena y 29 states have amended their constitutions to prohibit same

sexy US Congress attempted to pass amendment to the U.S.

Constitution which would ban same sex marriage nationwidey Unable to obtain 2/3 majority in 2004 & 2006.12

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Legal ArgumentsEqual Protection Clause Part of the 14th Amendment to the U.S. Constitution, provides that "no state shall ... deny to any person within its jurisdiction the equal protection of the laws". Due Process Clause Fifth and Fourteenth prohibit the federal and state governments, respectively, from depriving any person of "life, liberty, or property, without due process of law.

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Equal Protection: Levels of ScrutinyStrict scrutiny: scrutiny: Narrowly tailored and least restrictive means to further a compelling governmental interest Reserved for suspect classes: race, religion, national origin, alienage Intermediate scrutiny: scrutiny: Furthers an important government interest in a way that is substantially related to that interest (Gender) Rational basis review: review: State action be rationally related to a legitimate government interest (Default standard, deferential)15

EP Case law:Where does sexual orientation fall? Romer v Evans (1996): Statute to amend Colorado constitution to nullify anti-discrimination protections for homosexuals and antiprohibited passage of anti-discrimination laws in the future antiviolated the Equal Protection clause of the 14th amendment Court used rational basis review a desire to harm a politically unpopular group cannot constitute a legitimate governmental interest.

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EP Case lawGoodridge v Dept of Public Health (2003): Denying gays/lesbians rights/benefits conferred by civil marriage violated the constitution because it did not further a legitimate government goal. Goals offered by state:1) promoting procreation

2) ensuring a good child rearing environment and 3) preserving state financial resources. Condemning a lifestyle is not a constitutionally adequate reason to prohibit something.17

EP Case lawLawrence v. Texas (2003)Struck down statute prohibiting sodomy based on DP, did not specify level of scrutiny applied. In Justice Sandra Day O'Connor's concurring opinion, she argued that by prohibiting only homosexual sodomy, and not heterosexual sodomy as well, Texas's statute did not meet rationalrational-basis review under the Equal Protection Clause.yArguments based on sex could elevate review to

intermediate scrutiny.

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Due Process ClauseDue Process Clauses of the Fifth and Fourteenth prohibit government from depriving any person of "life, liberty, or property, without due process of law. Substantive due process: demarcates the line between, acts subject to public regulations or legislation, and acts that courts place beyond the reach of any governmental regulation.19

DP: Fundamental RightsMust be a fundamental right to be protected Deeply rooted in American history and traditions. Triggers strict scrutiny, otherwise rational basis default Freedom of association Freedom of movement Right to vote Right to property Freedom of contract Freedom of speech Right to Privacy20

DP: Right to PrivacyThe Right to Privacy: Not explicitly mentioned in the Constitution First discussed in Griswold v. Connecticut (1965), found in the penumbras of various amendments. Prohibiting sale and use of birth control as unconstitutional because it intruded on the right to marital privacy Extended to unmarried persons in Eisenstadt v. Baird (1972)21

Due Process: The Right to PrivacyLochner v New York (1905):Right to freely enter into employment arrangement without state intrusion

Pierce v. Society of Sisters (1925):Right of parents to rear children as they see fit (education)

Roe v. Wade (1973):Right of a woman to decide whether or not to terminate her pregnancy

Cruzan v. Missouri Department of Health (1990):right of competent adults to make advanced directives for the withdrawal of lifelifesustaining measures

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DP: Right to Privacyy Loving v. Virginia: (1967): decision based on EP, however went

on to say marriage itself is a fundamental right.y Lawrence v. Texas (2003): people have a liberty under the Due

process clause that gives them the full right to engage in intimate conduct without intervention of the government.y Deeply rooted in American history and traditions.y 34 states had ended race-based marriage discrimination when the Supreme race-

Court ruled in Loving v. Virginia (1967).

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Looking AheadIn May 2008, the California Supreme Court held in the case In re Marriage Cases that state statutes limiting marriage to opposite-sex applicants violated the California oppositeConstitution (based on EP). Marriage licenses provided starting June 2008. Stopped providing marriage licenses November 5, 2008, due to the passage of Prop 8, an amendment to the California Constitution that limited marriages to those between one man and one woman. On May 26, 2009, the California Supreme Court held, in Strauss v. Horton, that Proposition 8 was a lawful enactment, but that same-sex marriages contracted before sameits passage remained valid.24

Looking AheadPerry v. Schwarzenegger (2010) Federal CaseU.S. District Court judge ruled that Prop 8 violated both DP and EP, and therefore unconstitutional. Ninth Circuit Court of Appeals has ordered the judgment stayed pending appeal. May rise to U.S. Supreme Court where court will be forced to rule on federal recognition of marriage.

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The Psychological Cost of Anti-Gay AntiPolitics: Social Stress TheoryLorraine Lothringer, MD PGYPGY-5 Fellow in Child and Adolescent Psychiatry New York University Child Study Center/Bellevue Hospital Center26

No funding disclosures

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What is Social Stress Theory?Stigma Prejudice DiscriminationStressful social environment minority stress

Brooks, 1981; Meyer, 199528

Are LGBT people at risk?1973 2011 IOM Report on the health of LGBT peoplea call for more research on the health needs of LGBT peopleIf LGBT people are at increased risk for excess mental distress and disorders due to social stress, it is important to understand this risk Only with understanding can psychologists, public health professionals, and public policymakers work toward designing effective prevention and intervention programs. - Meyer, 2003

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A review of the literaturePrejudice, Social Stress, and Mental Health in LGB Populations: Conceptual Issues and Research Evidence (Meyer, 2003) a meta-analysis of 8 epidemiological metastudies comparing LGB individuals to heterosexual individuals LGB individuals found to have:Increased prevalence of substance abuse Increased prevalence of affective disorders Increased prevalence of suicide

Conclusion:LGB people are at increased risk for exposure to discrimination and violence There is an association between victimization and psychological distress, including selfselfblame and self-devaluation self-

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Marriage Amendments and Psychological Distress in LGB Adults (Rostosky, 2009)Increased psychological distress in LGB people living in states that passed marriage amendments after the November 2006 election. Marriage amendments create an environment associated with negative psychological outcomes for LGB people.

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State-Level Policies and Psychiatric Morbidity In StateLesbian, Gay, and Bisexual Populations (Hatzenbuehler, 2009)National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, N = 34,653) States coded for policies extending protections against hate crimes and employment discrimination based on sexual orientation. In states w/o policies: stronger association between LGB status and having a psychiatric disorder in the past 12 months: GAD, PTSD, Dysthymia. State level protective policies modify the effect LGB status has on psychiatric disorders.

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Lesbian, Gay, and Bisexual Individuals Psychological Reactions to Amendments Denying Access to Civil Marriage (Rostosky, 2010)A content analysis of open-ended responses in a survey (N=300) to openexplicate psychological reactions to the November 2006 elections.

7 themes: indignant, distressed, fearful or anxious, feeling alienated, blaming, hopeless or resigned, and hopeful, optimistic, determined.

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I find it very upsetting that so many strangers, whove never met me, hate me and think of me as a second class human because of something I didnt choose. Im sure if I met some of these people, theyd think I was a wonderful person.

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Social Stress Theory and LGB populationsExperience of prejudice Expectations of rejection, vigilance, stigma Hiding, concealing Internalized homophobia Ameliorative coping processes (+/-) (+/Stress: External events or conditions that are taxing to individuals and exceed their capacity to endure, therefore having potential to induce mental or somatic illness. Meyer, 2003; Dohrenwend, 2000.35

Coping, Resilience, +/+/ActivismAlter environmental circumstances Group solidarity/cohesiveness, community Adaptation learned via the coming out process Personal resources, resilience Group resources All can potentially alter mental health outcomes36

Conclusions for PractitionersCarefully consider the social contexts that contribute to psychological distress. Do not underestimate the impact social stigmatization may have on the mental health and well-being of LGBT patients wellAnti-LGBT legislation institutionalizes and legalizes the unequal Antitreatment of LGBT individuals and families and exacerbates stigma (Levitt, 2009) It is important to be aware of and ask questions about the experience of LGBT individuals in treatment, given the current political climate in the US and Internationally37

Research on Lesbian and Gay Families May 2011Daniel M. Medeiros, MD Assistant Professor of Psychiatry, Columbia University College of Physicians and Surgeons Director, Child and Family Institute Chief, Division of Child and Adolescent Psychiatry St. Lukes and Roosevelt Hospitals 1090 Amsterdam Ave, Suite 16F2 New York, NY 10025 [email protected]

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Complexity of the IssueBiblarz, T. and Stacey, J., How Does Gender of Parents Matter?, Journal of Marriage and Family, February 2010, pgs 3-22. 3Few studies examine how gender, as distinct from number of parents, marital status, sexual orientation or biogenetic relationship of parents affects children No research compared planned parenting by couples composed of women only, men only, or heterosexual couples No studies compared single-parent adoptions by women and men singleSingle parent: chosen, accidental, loss of coparent due to death/desertion/divorce, custody contested or granted willingly

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Complexity of the IssueBiblarz, T. and Stacey, J. How Does Gender of Parents Matter?, Journal of Marriage and Family, February 2010, pgs 3-22. 330 studies two parent: lesbian compared to heterosexual 2 studies two parent: gay male compared to lesbian 1 study two parent: gay male compared to heterosexual 48 studies single parent: mom compared to dad (both presumed heterosexual)

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ConclusionBiblarz, T. and Stacey, J. How Does Gender of Parents Matter?, Journal of Marriage and Family, February 2010, pgs 3-22. 3Current claims that children need both a mother and a father are spurious because they attribute to the gender of parents benefits that correlate primarily with the number and marital status of a childs parents since infancy. At this point no research supports the widely held conviction that the gender of parents matter for child well-being. well-

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Conclusion

Biblarz, T. and Stacey, J. How Does Gender of Parents Matter?, Journal of Marriage and Family, February 2010, pgs 3-22. 3Compared to all other family forms, families headed by (at least) two committed, compatible parents are generally best for children. Whether the participation of three or more parents as in cooperative stepfamilies, intergenerational families, and coparenting alliances among lesbians and gay men would be better or worse has not yet been studied.

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US National Longitudinal Lesbian Family Study: Psychological Adjustment of 17-Year-Old 17-YearAdolescentsPediatrics, Volume 126, Number 1, July 2010, pgs 28-36 28-

US Census 2005: 270,313 American children were living in households headed by samesame-sex couples Nearly twice that number of children have a single lesbian or gay parent There has been three decades of research that has consistently shown that the psychological adjustment of children is unrelated to parents sexual orientation. Cross sectional studies. The first generation of children conceived by lesbians through artificial insemination is presently coming of age This study is significant for studying this population longitudinally

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Authors: Nanette Gartrell, MD and Henry Bos, PhD From 1986-1992 recruited 153 prospective lesbian mothers through announcements 1986at lesbian events/flyers in Boston, DC and San Francisco Conceived through artificial insemination 78 offspring, 39 each M/F Parent interviews at pregnancy, when child 2, 5, 10 and 17yo Interviews and questionnaires when the child was 10yo and 17yo CBCLs by mom at both time points 93% retention rate

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Conclusion: Adolescents who have been reared in lesbian-mother families since lesbianbirth demonstrate healthy psychological development Results section: According to their mothers reports, the 17yo children of lesbian mothers were rated significantly higher in social, school/academic, and total competence and significantly lower in social problems, rule-breaking, aggressive ruleand externalizing problem behavior than their age-matched counterparts in ageAchenbachs normative sample of American youth.

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29 children from known donors, 19 from yet unknown, and 31 from permanently unknown donors 31 families were continuously coupled 40 separated mothers 6 single mother families 56% of mothers who were coparents when child was born separated, had been together an average of 12 years, mean age of child when parents separated was 6.97yo. Separated couples: 71.4% custody was shared, 28.6% the birth mother was the primary custodial parent

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US comparison: nearly 50% of first marriages end in divorce, lasting an average of 7-8 years. 65% of mothers retain sole physical and legal custody of their 7children Limitations of the study:Nonrandom sample Youth did not complete YSR

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Myth of the Ideal Family

Approximately 50% of pregnancies are terminated Approximately 50% of live births were unplanned Approximately 50% of first marriages end in divorce

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SummaryNo evidence that it is necessary to have both a mom and a dad to raise a healthy child Two moms, or two dads are comparable to having a mom and dad, but there is more evidence in regards to two moms. Two adults raising children provide advantage likely due to sharing of caretaking responsibilities and increased finances. Lesbian and gay couples likely go through much more planning in order to decide to become parents (due to various barriers and less likelihood of accidents) and may then be more prepared to become parents: these are wanted children Society will need to support diversity of families and shift away from an idealized version (mom and dad) in order to help minimize stigma (such as single parents, adoption, foster parenting, raised by extended family) Gay marriage will likely psychologically strengthen the family unit and will bring protections for the children of LGBT families, and this protection should be supported by society.

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ADOPTION BY LESBIAN, GAY, AND BISEXUAL PARENT FAMILIESLittal Melnik MD PGYIII Beth Israel Medical Center NY, NY

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Growing number of children with same sex parentsIncreasing availability of donor insemination Decreased discrimination against homosexuals in private and public adoption Scientific literature demonstrating that children of gay or lesbian parents fare as well in emotional, cognitive, social, and sexual functional as children of heterosexual parents

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Orientation not relevant to parental abilityParenting and Child Development in Adoptive Families: Does Parental Sexual Orientation Matter? Farr, Forsell, Patterson 2010 27 lesbian, 29 gay, 50 heterosexual couples Parents and Teachers reports that on avg children were developing in typical ways Childrens adjustment, parenting approaches, parenting stress, and couple relationship adjustment not significantly associated with parental sexual orientation

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Orientation not relevant to parental abiltyGrowing body of scientific literature demonstrates that children who grow up with 1 or 2 gay and/or lesbian parents fare as well in emotional cognitive, social, sexual functioning as do children whose parents are heterosexual.- American Academy of Pediatrics, heterosexual.Technical Report: Coparent or Second-Parent Adoption by Same-Sex Parents, 109 Pediatrics 341 (Feb. 2002). SecondSame-

Not a single study has found children of gay or lesbian parents to be disadvantaged in any significant respect relative to children of heterosexual parents. Indeed, the evidence to date suggests that home environments provided by gay and lesbian parents are as likely as those provided by heterosexual parents to support and enable childrens psychosocial growth. American Psychological Association, Lesbian and Gay Parenting:A Resource for Psychologists 8 (1995).

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Orientation should not be a determinative factor of individuals to foster/adopt American Academy of Child and Adolescent Psychiatry (1999) American Academy of Pediatrics (2002) American Bar Association (1999, 2003) American Medical Association (2004) American Psychoanalytic Association (2002) American Psychological Association (2004) Child Welfare League of America (2004) National Adoption Center (1998) National Association of Social Workers (2002) North American Council on Adoptable Children (1998)

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SameSame-sex parenting householdsAs of 2005 there are 270,00 children being raised by samesamesex couples 2020-30% of same-sex couples are raising children same65,500 of the U.S.s adopted children live with a lesbian or gay parent 14,000 children live with a lesbian or gay foster parent

Williams Institute Census snap shot 2007

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Same Sex parent CharacteristicsSame sex # of children under 18 Single wage earner Median household income Home Owner 1.8 32.4% $46,200 Hetero sexual married 1.9 34.8% $59,600

51%

77%

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Foster in the United States500,000 Children living in foster care in the United states (DHHS 2007). 46% Family foster homes of non-relative care givers non24% Family foster homes of family care givers 18% Group homes 8% Preadoptive placements 2% Runaway

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Adoption in the United StatesOutside the child welfare system -international -private domestic With in the child welfare system 114,00 Children waiting to be adopted

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Adoptive same sex parents legal over view

Individual adoptions SecondSecond-parent and joint adoptions Legal protections provided by adoptions

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Individual adoptionsAdoptions in which an individual, unmarried person adopts a child who has been placed for adoption by his or her biological parent or parents, who have agreed to give up all of their parental rights -A state child welfare agency, private state authorized adoption agency, consensual arrangements by private parties -Must be reviewed by a court

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Individual adoptionEvery state permits unmarried individuals to adopt As of 2010 no state categorically prohibits gay and lesbian parents from becoming adoptive parents by statute This is a change in FL No person eligible to adopt under this statute may adopt if that person is a homosexual.

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Individual adoptionUtah prohibits adoptions by "a person who is cohabiting in a relationship that is not legally valid and binding marriage under the laws of the state" Mississippi prohibits "adoption by couples of the same Gender" Arkansas prohibited anyone with an unmarried partner from adopting or becoming a foster parent-unconstitutional in 4/2010 parent-

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Individual adoption

"the best interest of the child" is the primary criterion In re Adoption of Evan, 583 N.Y.S.2d 997 (Sur. Ct. 1992) In re Adoption of Charles B., 552 N.E.2d 884 (Ohio 1990) Pima County Juvenile Action B-10489, 727 P.2d 830 (Ariz. Ct. BApp. 1986).

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Second parent and Joint adoptionsSecond parent adoptions allow same-sex partners to adopt a samepartner's biological or adoptive child without terminating the first legal parent's rights Joint Adoption-both partners in a couple simultaneously adopt a Adoptionchild

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Second parent and Joint adoptionsFosters Child emotional growth and familial bonds Protect the child financially entitling them to inheritance rights, wrongful death/tort damages, social security benefits, and child support. Protect the second parent ensuring they will have a legally recognized reationship if the other parent dies, becomes incapacitated, or is incarcerated

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Second Parent and joint adoptionsMost states allow a married person to adopt their spouses children but do not allow for an unmarried couple to adopt in this way Strict interpretation of adoption codes vs "the best interest of the child"

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Second parent and joint adoptionExplicit laws allowing same-sex second parent adoption sameCA, CO, CT, DC, IL, IN, IA, ME, MA, NV, NH, NJ, NY, OR, PA, VT, WA SecondSecond-parent adoptions granted by trial judges AL, AK, DE, HI, LA, MD, MI, MN, NM, RI, TX. WV SecondSecond-parent adoptions are not permissible by state adoption statute NE, OH, WI, KY

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Legal protectionsSocial security, state worker's compensation, Insurance benefits Continuing contact with parents when the family is no longer intact.

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The Particulars of Gay and Lesbian CouplesEric Yarbrough, M.D. Attending Psychiatrist St. Lukes Roosevelt Hospital New York, NY

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Gay and Lesbian Couples

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Gay CouplesNew social construct as of the late 20th century Can exist in a variety of ways Although some data has been collected, there are limits in research

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Gay CouplesMcWhirter and Mattison (1984) was one of the first systematic and longitudinal studies They looked more and love and commitment than sexuality alone

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Gay Couples

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Gay CouplesAssumption of equality The idea of sexual exclusivity Issues regarding intimacy and bonding

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Gay CouplesStage 1 Bonding (Year 1) Merging Limerence Equalizing of partnership High sexual activity Stage 2 Nesting (Year 2 and 3) Homemaking Finding compatibility Decline of limerence Ambivalence

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Gay CouplesStage 3 Maintaining (Years 4 and 5) Reappearance of individual Risk taking Dealing with conflict Establishing traditions Stage 4 Building (Years 6-10) 6Collaborating Increasing productivity Establishing independence Dependability of partners

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Gay CouplesStage 5 Releasing (Years 11-20) 11Trusting Merging of money and possessions Taking each other for granted Stage 6 Renewing (Beyond 20 Years) Achieving security Shifting perspectives Restoring the partnership Remembering

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Lesbian CouplesLimited research Higher levels of relatedness Higher levels of equality Can be challenged by internal and external influences

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Lesbian CouplesInternal influences can come from the nature of the womans psychological development, unexamined internalized homophobia, and lack of internalized sexsexbased role models Fusion79

Lesbian CouplesExternal Influences

Legal problems Homophobia Economic problems

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Treatment with Gay and Lesbian Couples (Internalized Homophobia)

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Treatment with Gay and Lesbian CouplesThey seek therapy for the same reasons straight couples do Additional specific issues may include employment and competition, coming out as a couple, jealousy and envy, help having a child Gay and lesbian couples struggle with distance and merging respectively83

Treatment with Gay and Lesbian CouplesGay and lesbians lack external support from law, religion, and their families of origin They frequently dont get a chance to practice dating during adolescence The highs and lows straight people experience with adolescence may be felt later on for gays and lesbians when navigating relationships for the first time84

Treatment with Gay and Lesbian CouplesBe careful not to impose your ideas about what makes a relationship onto the patients Relationships can only be defined by those involved in them The therapist shouldnt decide if a couple should stay together or not. Support communication and understanding

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Treatment with Gay and Lesbian Couples (Assessment)First evaluate individuals with a psychiatric evaluation Explore the individual stages of gay and lesbian development Stage the relationship according to the models available Evaluate external issues and influence with the couple86

Questions?

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Documents

All in the Gay Family