Position Statements

Support of Legal Recognition of Same-Sex Civil Marriage
POSITION STATEMENT
Approved by the Assembly, May 2005
Approved by the Board of Trustees, July 2005

"Policy documents are approved by the APA Assembly and Board of Trustees…These are … position statements that define APA official policy on specific subjects…" -- APA Operations Manual.

As physicians who frequently evaluate the impact of social and family relationships on child development, and the ability of adults and children to cope with stress and mental illness, psychiatrists note the invariably positive influence of a stable, adult partnership on the health of all family members. Sustained and committed marital and family relationships are cornerstones of our social support network as we face life’s challenges, including illness and loss. There is ample evidence that long-term spousal and family support enhances physical and mental health at all stages of development.

This position statement is about the legal recognition of same-sex civil marriage, not religious marriage, and it does not pertain to any organized religion’s view of same-sex marriage.

Heterosexual relationships have a legal framework for their existence through civil marriage, which provides a stabilizing force. In the United States, with the exception of Massachusetts, same-sex couples are currently denied the important legal benefits, rights and responsibilities of civil marriage. Same-sex couples therefore experience several kinds of state-sanctioned discrimination that can adversely affect the stability of their relationships and their mental health.

The children of unmarried gay and lesbian parents do not have the same protection that civil marriage affords the children of heterosexual couples. Adoptive and divorced lesbian and gay parents face additional obstacles. An adoptive parent who is lesbian or gay is often prejudicially presumed as unfit in many U.S. jurisdictions. Furthermore, when unmarried couples do adopt, usually one parent is granted legal rights, while the other parent may have no legal standing. These obstacles occur even though no research has shown that the children raised by lesbians and gay men are less well adjusted than those reared within heterosexual relationships.

As the population ages, the denial of legal recognition of civil marriage has consequences for increasing numbers of older adults in same-sex relationships who face age-related health and financial concerns. Excluding these adults from civil marriage protections of survivorship and inheritance rights, financial benefits, and legal recognition as a couple in health care settings increases the psychological burden associated with aging.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination in matters that have an impact on mental health. APA has also supported same-sex civil unions and the right of same-sex couples to adopt and co-parent children. This is because APA has a longstanding interest in civil rights and legal issues that affect mental health as well as a code of ethics that supports and respects human dignity. Educating the public about lesbian and gay relationships and supporting efforts to establish legal recognition of samesex civil marriage is consistent with the Association’s advocacy for minority groups.

Civil marriage is associated with a unique set of benefits that provide legal and economic protections to adults in committed relationships and to their children. Equal access to the institution of civil marriage is consistent with the APA’s opposition to discrimination based on sexual orientation. Therefore be it resolved that:

"In the interest of maintaining and promoting mental health, the American Psychiatric Association supports the legal recognition of same-sex civil marriage with all rights, benefits, and responsibilities conferred by civil marriage, and opposes restrictions to those same rights, benefits, and responsibilities.” Supporting Documents:

American Psychiatric Association (1973), Position statement on homosexuality and civil rights. American J. Psychiatry, 1974, 131:497.

www.psych.org/edu/other_res/lib_archives/archives/730010.pdf

American Psychiatric Association (1990), Position statement on homosexuality and the armed services. www.psych.org/edu/other_res/ lib_archives/archives/900013.pdf

American Psychiatric Association (1991), Position statement:

Homosexuality and the Immigration and Naturalization Service. American J. Psychiatry, 148:1625.

American Psychiatric Association Committee on Gay, Lesbian, and Bisexual Issues (1993), Position statement on homosexuality. American J. Psychiatry, 150:686. www.psych.org/edu/other_res/ lib_archives/archives/ 730010.pdf

Resource Document on Controversies in Child Custody: Gay and Lesbian Parenting; Transracial Adoptions; Joint v. Sole Custody and Custody Gender Issues: Approved by Board of Trustees, December 1997.

Resource Document on Same Sex Marriage: Approved by the Board of Trustees, December 1998.

American Psychiatric Association (1998), Position statement on psychiatric treatment and sexual orientation. American J. Psychiatry, 1999; 156:1131. www.psych.org/edu/other_res/ lib_archives/archives/ 980020.pdf

American Psychiatric Association (2000), Commission on Psychotherapy by Psychiatrists (COPP): Position statement on therapies focused on attempts to change sexual orientation (Reparative or conversion therapies). American J. Psychiatry, 157:1719-1721. www.psych.org/edu/other_res/ lib_archives/archives/200001.pdf

American Psychiatric Association (2000), Position statement on same sex civil unions. December 2000American Psychiatric Association (2002),

Position Statement on Adoption and Co-Parenting of Children by Same Sex Couples. November 2002.

Brief for Amici Curiae in the case of Lawrence and Garner v. Texas (signed by American Psychiatric Association), January 2003. www.psych.org/edu/other_res/lib_archives/archives/amicus/02-102.pdf

American Psychological Association (2004), Resolution on Sexual Orientation and Marriage. http://www.apa.org/pi/lgbc/policy/marriage.pdf

Amended APA Resource Document on Same Sex Marriage;

Approved by the Board of Trustees, December 2004.

American Psychiatric Association: Position statement on same sex civil unions (revised); Approved by Board of Trustees, December 2004.

Position paper of the Massachusetts Psychiatric Society on Gay Marriage, November 2004

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Position Statement on Same Sex Unions
Approved December 2000 by the APA Board of Trustees

The APA expresses a valid interest in the well being of heterosexual married couples in such areas as children's mental health and other aspects of family life. Heterosexual relationships have a legal framework for their existence, which provides a stabilizing force.

In the United States, with the recent exception of Vermont, same sex partners are currently denied the important benefits and responsibilities of legal marriage. Same sex couples therefore experience several kinds of state-sanctioned discrimination that affect the stability of their relationships.

The children of gay and lesbian parents do not have the same protection that legal marriage affords the children of heterosexual couples. Adoptive and divorced lesbian and gay parents face additional obstacles. An adoptive parent who is lesbian or gay is presumed unfit in many U.S. jurisdictions. Furthermore, when couples do adopt, usually one parent is granted legal rights, while the other parent may have no legal standing. These obstacles occur even though research has shown that the children raised by lesbian and gay men are as well adjusted as those reared within heterosexual relationships.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination regarding legal issues affecting mental health. Educating the public about lesbian and gay relationships and supporting efforts to establish same sex legal unions is consistent with the Association's advocacy for other disadvantaged minority groups.

"The American Psychiatric Association supports the legal recognition of same sex unions and their associated legal rights, benefits, and responsibilities".


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"Reparative" Therapy
 
Committee on Psychotherapy by Psychiatrists (COPP) Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies)

Approved by the Board of Trustees March 2000

Approved by the Assembly May 2000

Preamble

In December of 1998, the Board of Trustees issued a position statement that the American Psychiatric Association opposes any psychiatric treatment, such as "reparative" or conversion therapy, which is based upon the assumption that homosexuality per se is a mental disorder or based upon the a priori assumption that a patient should change his/her sexual homosexual orientation (Appendix 1). In doing so, the APA joined many other professional organizations that either oppose or are critical of "reparative" therapies, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, The American Counseling Association, and the National Association of Social Workers (1). The following Position Statement expands and elaborates upon the statement issued by the Board of Trustees in order to further address public and professional concerns about therapies designed to change a patient's sexual orientation or sexual identity. It augments rather than replaces the 1998 statement.

Position Statement
In the past, defining homosexuality as an illness buttressed society's moral opprobrium of same-sex relationships (2). In the current social climate, claiming homosexuality is a mental disorder stems from efforts to discredit the growing social acceptance of homosexuality as a normal variant of human sexuality. Consequently, the issue of changing sexual orientation has become highly politicized. The integration of gays and lesbians into the mainstream of American society is opposed by those who fear that such integration is morally wrong and harmful to the social fabric. The political and moral debates surrounding this issue have obscured the scientific data by calling into question the motives and even the character of individuals on both sides of the issue. This document attempts to shed some light on this heated issue.

The validity, efficacy and ethics of clinical attempts to change an individual's sexual orientation have been challenged (3,4,5,6). To date, there are no scientifically rigorous outcome studies to determine either the actual efficacy or harm of "reparative" treatments. There is sparse scientific data about selection criteria, risks versus benefits of the treatment, and long-term outcomes of "reparative" therapies. The literature consists of anecdotal reports of individuals who have claimed to change, people who claim that attempts to change were harmful to them, and others who claimed to have changed and then later recanted those claims (7,8,9).

Although there is little scientific data about the patients who have undergone these treatments, it is still possible to evaluate the theories, which rationalize the conduct of "reparative" and conversion therapies. Firstly, they are at odds with the scientific position of the American Psychiatric Association which has maintained, since 1973, that homosexuality per se, is not a mental disorder. The theories of "reparative" therapists define homosexuality as either a developmental arrest, a severe form of psychopathology, or some combination of both (10-15). In recent years, noted practitioners of "reparative" therapy have openly integrated older psychoanalytic theories that pathologies homosexuality with traditional religious beliefs condemning homosexuality (16,17,18).

The earliest scientific criticisms of the early theories and religious beliefs informing "reparative" or conversion therapies came primarily from sexology researchers (19-27). Later, criticisms emerged from psychoanalytic sources as well (28-39). There has also been an increasing body of religious thought arguing against traditional, biblical interpretations that condemn homosexuality and which underlie religious types of "reparative" therapy (40-46).

Recommendations:
1. APA affirms its 1973 position that homosexuality per se is not a diagnosable mental disorder. Recent publicized efforts to repathologize homosexuality by claiming that it can be cured are often guided not by rigorous scientific or psychiatric research, but sometimes by religious and political forces opposed to full civil rights for gay men and lesbians. APA recommends that the APA respond quickly and appropriately as a scientific organization when claims that homosexuality is a curable illness are made by political or religious groups.

2. As a general principle, a therapist should not determine the goal of treatment either coercively or through subtle influence. Psychotherapeutic modalities to convert or "repair" homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm. In the last four decades, "reparative" therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to first, do no harm.

3. The "reparative" therapy literature uses theories that make it difficult to formulate scientific selection criteria for their treatment modality. This literature not only ignores the impact of social stigma in motivating efforts to cure homosexuality; it is a literature that actively stigmatizes homosexuality as well. "Reparative" therapy literature also tends to overstate the treatment's accomplishments while neglecting any potential risks to patients. APA encourages and supports research in the NIMH and the academic research community to further determines "reparative" therapy's risks versus its benefits.

References

(1) National Association for Research and Treatment of Homosexuality, (1999), American Counseling Association Passes Resolution to Oppose Reparative Therapy. NARTH Website (http://www.narth.com/docs/acaresolution.html).

(2) Bayer, R. (1981), Homosexuality and American Psychiatry; The Politics of Diagnosis. New York: Basic Books.

(3) Haldeman, D. (1991), Sexual orientation conversion therapy for gay men and lesbians: A scientific examination. In Homosexuality: Research Implications for Public Policy, ed. J. C. Gonsiorek & J. D. Weinrich. Newbury Park, CA: Sage Publications, pp. 149-161.

(4) Haldeman, D. (1994), The practice and ethics of sexual orientation conversion therapy. J. of Consulting and Clin. Psychol., 62(2):221-227.

(5) Brown, L. S. (1996), Ethical concerns with sexual minority patients. In: Textbook of Homosexuality and Mental Health. ed. R. Cabaj & T. Stein. Washington, D.C.: American Psychiatric Press, pp.897-916.

(6) Drescher, J. (1997), What needs changing? Some questions raised by reparative therapy practices. New York State Psychiatric Society Bulletin, 40(1):8-10.

(7) Duberman, M. (1991), Cures: A Gay Man€s Odyssey. New York: Dutton.

(8) White, M. (1994), Stranger at the Gate: To be Gay and Christian in America. New York: Simon & Schuster.

(9) Isay, R. (1996), Becoming Gay: The Journey to Self-Acceptance. New York: Pantheon.

(10) Freud, S. (1905), Three essays on the theory of sexuality. Standard Edition, 7:123-246. London: Hogarth Press, 1953.

(11) Rado, S. (1940), A critical examination of the concept of bisexuality. Psychosomatic Medicine, 2:459-467. Reprinted in Sexual Inversion: The Multiple Roots of Homosexuality, ed. J. Marmor. New York: Basic Books, 1965, pp. 175-189.

(12) Bieber, I., Dain, H., Dince, P., Drellich, M., Grand, H., Gundlach, R., Kremer, M., Rifkin, A., Wilbur, C., & Bieber T. (1962), Homosexuality: A Psychoanalytic Study. New York: Basic Books.

(13) Socarides, C. (1968), The Overt Homosexual. New York: Grune & Stratton.

(14) Ovesey, L. (1969), Homosexuality and Pseudohomosexuality. New York: Science House.

(15) Hatterer, L. (1970), Changing Homosexuality in the Male. New York: McGraw Hill.

(16) Moberly, E. (1983), Homosexuality: A New Christian Ethic. Cambridge, UK: James Clarke & Co.

(17) Harvey, J. (1987), The Homosexual Person: New Thinking in Pastoral Care. San Francisco, CA: Ignatius.

(18) Nicolosi, J. (1991), Reparative Therapy of Male Homosexuality: A New Clinical Approach. Northvale, NJ: Aronson.

(19) Kinsey, A., Pomeroy, W., & Martin, C. (1948), Sexual Behavior in the Human Male. Philadelphia, PA: Saunders.

(20) Kinsey, A., Pomeroy, W., & Martin, C. and Gebhard, P. (1953), Sexual Behavior in the Human Female. Philadelphia, PA: Saunders.

(21) Ford, C. & Beach, F. (1951), Patterns of Sexual Behavior. New York: Harper.

(22) Hooker, E. (1957), The adjustment of the male overt homosexual. J Proj Tech, 21:18-31.

(23) Bell, A .& Weinberg, M. (1978), Homosexualities: A Study of Diversity Among Men and Women. New York: Simon and Schuster.

(24) Bell, A., Weinberg, M. & Hammersmith S. (1981), Sexual Preference: Its Development in Men and Women. Bloomington, IN: Indiana University Press.

(25) LeVay, S. (1991), A difference in hypothalamic structure between heterosexual and homosexual men. Science, 253:1034-1037.

(26) Hamer, D., Hu, S., Magnuson, V., Hu, N. & Pattatucci, A. (1993), A linkage between DNA markers on the X-chromosome and male sexual orientation. Science, 261:321-327.

(27) Bem, D. (1996), Exotic becomes erotic: A developmental theory of sexual orientation. Psychol. Review, 103(2):320-335.

28) Marmor, J., ed. (1965), Sexual Inversion: The Multiple Roots of Homosexuality. New York: Basic Books.

(29) Mitchell, S. (1978), Psychodynamics, homosexuality, and the question of pathology. Psychiatry, 41:254-263.

(30) Marmor, J., ed. (1980), Homosexual Behavior: A Modern Reappraisal. New York: Basic Books.

(31) Mitchell, S. (1981), The psychoanalytic treatment of homosexuality: Some technical considerations. Int. Rev. Psycho-Anal., 8:63-80.

(32) Morgenthaler, F. (1984), Homosexuality Heterosexuality Perversion, trans. A. Aebi. Hillsdale, NJ: The Analytic Press, 1988.

(33) Lewes, K. (1988), The Psychoanalytic Theory of Male Homosexuality. New York: Simon and Schuster. Reissued as Psychoanalysis and Male Homosexuality (1995), Northvale, NJ: Aronson.

(34) Friedman, R.C. (1988), Male Homosexuality: A Contemporary Psychoanalytic Perspective. New Haven, CT: Yale University Press.

(35) Isay, R. (1989), Being Homosexual: Gay Men and Their Development. New York: Farrar, Straus and Giroux.

(36) O'Connor, N. & Ryan, J. (1993), Wild Desires and Mistaken Identities: Lesbianism & Psychoanalysis. New York: Columbia University.

(37) Domenici, T. & Lesser, R., eds. (1995) Disorienting Sexuality: Psychoanalytic Reappraisals of Sexual Identities. New York: Routledge.

(38) Magee, M. & Miller, D. (1997), Lesbian Lives: Psychoanalytic Narratives Old and New. Hillsdale, NJ: The Analytic Press.

(39) Drescher, J. (1998) Psychoanalytic Therapy and The Gay Man. Hillsdale, NJ: The Analytic Press.

(40) Boswell, J. (1980), Christianity, Social Tolerance and Homosexuality. Chicago, IL: University of Chicago Press.

(41) McNeil, J. (1993), The Church and the Homosexual, Fourth Edition. Boston, MA: Beacon.

(42) Pronk, P. (1993), Against Nature: Types of Moral Argumentation Regarding Homosexuality. Grand Rapids, MI: William B. Eerdmans.

(43) Boswell, J. (1994), Same-Sex Unions in Premodern Europe. New York: Villard Books.

(44) Helminiak, D. (1994), What the Bible Really Says About Homosexuality. San Francisco, CA: Alamo Press.

(45) Gomes, P. J. (1996). The Good Book: Reading the Bible with Mind and Heart. New York: Avon.

(46) Carrol, W. (1997), On being gay and an American Baptist minister. The InSpiriter, Spring, pp. 6-7,11._Appendix 1

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Adoption and Co-parenting of Children by Same-sex Couples
POSITION STATEMENT
Approved by the Board of Trustees, November 2002
Approved by the Assembly, November 2002

"Policy documents are approved by the APA Assembly and Board of Trustees…
These are position statements that define APA official policy on specific subjects…" -- APA Operations Manual.

Numerous studies over the last three decades consistently demonstrate that children raised by gay or lesbian parents exhibit the same level of emotional, cognitive, social, and sexual functioning as children raised by heterosexual parents. This research indicates that optimal development for children is based not on the sexual orientation of the parents, but on stable attachments to committed and nurturing adults. The research also shows that children who have two parents, regardless of the parents’ sexual orientations, do better than children with only one parent.

While some states have approved legislation sanctioning second parent adoption, other court judgments and legislation have prohibited lesbian women and gay men from adopting or co-parenting. Therefore, in most of the United States, only one partner in a committed gay or lesbian couple may have a legal parental relationship to a child they are raising together. Adoption by a second parent, however, would not only formalize a child’s existing relationships with both parents in a same-sex couple, it would also provide vital security for the child. Children could avail themselves of both parents’ health insurance benefits, access to medical care, death benefits, inheritance rights, and child support from both parents in the event of separation. Adoption protects both parents’ rights to custody and/or visitation if the couple separates or if one parent dies.

The American Psychiatric Association has historically supported equity, parity, and non-discrimination regarding legal issues affecting mental health. In 2000, APA supported the legal recognition of same sex unions and their associated legal rights, benefits, and responsibilities. APA has also supported efforts to educate the public about homosexuality and the mental health needs of lesbian women, gay men, and their families. Removing legal barriers that adversely affect the emotional and physical health of children raised by lesbian and gay parents is consistent with the goals of the APA.

The American Psychiatric Association supports initiatives which allow same-sex couples to adopt and co-parent children and supports all the associated legal rights, benefits, and responsibilities which arise from such initiatives.

This position statement was drafted and proposed by the Committee on Gay, Lesbian, and Bisexual Issues and was supported by the Council on Minority Mental Health and Health Disparities.

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Parenting Rights for Same-Sex Couples Advanced

On June 15, the American Medical Association became the latest organization to call for equal parenting rights for same-sex couples. Learn more about supportive policy statements of the following organizations:

[ http://www.hrcactioncenter.org/ct/mpzcUY115BTt/ ]American Academy of Child and Adolescent Psychiatry
[ http://www.hrcactioncenter.org/ct/mdzcUY115BTv/ ]American Academy of Family Physicians
[ http://www.hrcactioncenter.org/ct/EdzcUY115BTb/ ]American Academy of Pediatrics
[ http://www.hrcactioncenter.org/ct/m7zcUY115BT5/ ]American Anthropological Association
[ http://www.hrcactioncenter.org/ct/j7zcUY115BT4/ ]American Bar Association
[ http://www.hrcactioncenter.org/ct/E1zcUY115BTg/ ]American Medical Association
[ http://www.hrcactioncenter.org/ct/E7zcUY115BT6/ ]American Psychiatric Association
[ http://www.hrcactioncenter.org/ct/EpzcUY115BTO/ ]American Psychoanalytic Association
[ http://www.hrcactioncenter.org/ct/U1zcUY115BTW/ ]American Psychological Association
[ http://www.hrcactioncenter.org/ct/UdzcUY115BTI/ ]Child Welfare League of America
[ http://www.hrcactioncenter.org/ct/m1zcUY115BTf/ ]National Association of Social Workers
[ http://www.hrcactioncenter.org/ct/jpzcUY115BTr/ ]North American Council on Adoptable Children


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