Right now the Australian Government has decided that everyone who can vote will be sent a letter asking whether they approve of ‘marriage equality’. This means that we have tick a box, either ‘Yes’ or ‘No’, on whether we think people who are in same sex relationships should, by law, be allowed to marry one another, thus enjoying the same legal rights as heterosexual couples who choose to marry. It has been challenged in the High Court, but alas, the vote is continuing. The debate that has emerged is bitterly divisive and distracts from real issues such as the government’s ability to govern,climate change and, in generally the going on being of the world.

Two colleagues from the Psychoanalytic Psychotherapy Association in Australia have drawn up a statement which was released by the Association today – 19 September 2017.

                                             The right to marry is a basic human right.

Psychoanalytic Psychotherapists support marriage equality 2017

Members of the Psychoanalytic Psychotherapy Association of Australasia (the PPAA) are in a unique position to observe the impact of discrimination, in all its forms, and the contribution of such discrimination to a variety of mental health disorders, including anxiety, depression, substance abuse and suicidality. The PPAA respect the rights of allpeople— regardless of sexual orientation, religious belief, age, gender, ability, lifestylechoice, cultural background or economic circumstances – to live with dignity and safety,and to enjoy healthy relationships in all their diversity. This position is, of course, consistent with The Universal Declaration of Human Rights: http://hrlibrary.umn.edu/edumat/hreduseries/hereandnow/Part-5/8_udhrabbr.htm Therefore, we support marriage equality as a step toward the reduction of discrimination based on sexual orientation in Australia. PPAA Position The Council of the PPAA:  supports initiatives to remove legislative discrimination against people based on their sex, sexuality or gender identity  supports the right to marry as a basic human right  recognises the right of all LGBTIQ clients, employees, volunteers, families and communities to be free of prejudice and discrimination and to have the same rights under Australian law  believes that social inclusion is an integral aspect of a healthy society, while exclusion and discrimination contribute to increased mental health problems and unnecessary suffering  recognises that enshrining human rights in law and addressing discrimination and prejudice are essential to promoting positive mental health for all Australians
On this basis, the Council of the PPAA, on behalf of its members, supports marriage equality – the right of all Australians to access marriage with their partner of choice, irrespective of gender or sexual orientation.

Background

It has long been known, both in Australia and elsewhere, that risk of serious anxiety, depression, substance abuse and suicidality is significantly increased for the LGBTIQ communities. In part, this is related to the frequently reported experience of explicit discrimination from being part of a minority group. However, both research and clinical observations indicate that the impact of institutional discrimination, wherein LGBTIQ people are excluded from participation in mainstream groups, activities and customs, plays a significant and damaging role. PPAA support marriage equality as a step toward redressing the institutional discrimination implicit in the historical exclusion from access to marriage of LGBTIQ people.

The Importance of Recognition

The PPAA recognises that discrimination in all its forms is damaging. Members of our associations in all states and New Zealand encounter the impact of discrimination against LGBTIQ individuals and communities in their daily work with patients. While it is our view that it will take generations to completely redress this deeply embedded, and often unconscious discrimination, we support any actions to remove institutional discrimination based on sexual orientation. It has long been recognised that members of LGBTIQ communities suffer an increased risk of anxiety, depression, substance abuse and suicide. (1,2,3) Stonewall, a UK organisation which promotes equality for people of diverse sexual orientations, reports that “lesbian, gay and bisexual people are more likely to have experienced depression or anxiety, attempted suicide or had suicidal thoughts, and self-harmed than men and women in general” (4). For example, gay and bisexual men report moderate to severe levels of depression and anxiety at double the rate of men in general, with even higher rates of reported depression (49%) among lesbian and bisexual girls. They further report (5) that in 2012, 3% of gay men had attempted to take their own life, compared to 0.4% per cent of all men during the same period. Research from Australia (6) and elsewhere in the western world (7) is consistent with these findings. Unsurprisingly, experiences of bullying are disturbingly common in the lives of LGBTIQ members of our communities. Stonewall reported (8) that 55% of lesbian, gay and bisexual young people experience homophobic bullying in Britain’s schools. Of significance, they report a noteworthy proportion (35%) of gay young people who are not bullied still suffer high levels of depression, compared to 5% of young people generally. There is a growing body of research and clinical experience which suggests that a significant contribution to the adverse mental health impact of belonging to the LGBTIQ communities occurs via exclusion and alienation. In the research literature, this has been referred to as “minority stress” (9) a model which postulates that members of sexual and other minorities are at greater risk for health problems,
because they face greater exposure to social stress related to prejudice and stigma (10,11). Stigma-related experiences can include verbal and physical assault, social and employment discrimination, and the expectation of discrimination regardless of actual discriminatory circumstances (12,13,14). In Australia, the existence of institutional discrimination contributes to this alienation and minority stress, and we would argue, as our colleagues have done elsewhere in the world (15,16,17), that the removal of discrimination in relation to access to marriage is a crucial step to reducing the adverse impact of institutional discrimination. Implications and effects of the voluntary non-binding postal poll and the associated campaign on LGBTIQ people and their families.
We hold serious concerns about how this issue of marriage equality has been raised via a public campaign and a non-binding postal vote which unnecessarily exposes already vulnerable people to divisiveness, derision of their personal and intimate relationships with consequent emotional stress, where the deleterious effects on the mental health of many such individuals is well known.

We cannot presume to speak on behalf of all our members, but we can say that our members are concerned with the hostility, negative publicity and misleading advertising material which has arisen around the issue of marriage equality. We understand this to be damaging to people who identify as LGBTQI and their families, leaving them more vulnerable to further denigration, invalidation and ‘othering’ that they are already exposed to. With this in mind we can also say that our members are concerned to protect and nurture the well-being of children and couples of same sex unions.

Psychoanalytic Psychotherapy Association of Australasia (the PPAA) PO Box 4098, Homebush South, NSW 2140 theppaa.com

The PPAA is a federated body member associations in most Australian States and New Zealand. Its members come primarily from professional backgrounds in psychology, medicine, psychiatry and social work

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The Member Associations of the PPAA are a resource for mental health support for those suffering discrimination:

New South Wales Institute of Psychoanalytic Psychotherapy: nswipp.org Victorian Association of Psychoanalytic Psychotherapists: vapp.asn.au Association for Psychoanalytic Psychotherapy of Western Australia: appwa.org.au Queensland Psychoanalytic Psychotherapy Association: qppa.com.au

New Zealand Institute of Psychoanalytic Psychotherapy: psychotherapy.co.nz

References

1. Rosenstreich, G. (2013) LGBTI People Mental Health and Suicide. Revised 2nd Edition. National LGBTI Health Alliance. Sydney

2. Mereish EH, O’Cleirigh C, Bradford JB. Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities. Psychol Health Med. 2014;19:1–13.

3. Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91, 1869 – 1876.

4. Stonewall Health Briefing: Mental Heath (2012) http://www.stonewall.org.uk/sites/default/files/Mental_Health_Stonewall_Health_Briefing__2012_.pdf

5. Stonewall Gay and Bisexual Men’s Health Survey (2013) http://www.stonewall.org.uk/sites/default/files/Gay_and_Bisexual_Men_s_Health_Survey__2013_.pdf

6. Rosenstreich, G. (2013) LGBTI People Mental Health and Suicide. Revised 2nd Edition. National LGBTI Health Alliance. Sydney.

7. Branstrom, R, (2017) Minority stress factors as mediators of sexual orientation disparities in mental health treatment: a longitudinal population-based study. J.Epidemiol. Community Health. (Published Online 2 January 2017)

8. Stonewall School Report: The experiences of gay young people in Britain’s schools in 2012. (2012). http://www.stonewall.org.uk/sites/default/files/The_School_Report 2012_.pdf

9. Meyer IH. (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psych Bull. 2003; 129: 674–697.

10. Sattler FA, Wagner U, Christiansen H. (2016) Effects of minority stress, group-level coping, and social support on mental health of German gay men. PLoS ONE 11.

11. Branstrom, R, (2017) Minority stress factors as mediators of sexual orientation disparities in mental health treatment: a longitudinal population-based study. J.Epidemiol. Community Health. (Published Online 2 January 2017)

12. Akhtar, S. (2014): The mental pain of minorities, British Journal of Psychoanalysis 30:2, 136-153 14. Domenici, T., and Lesser, R. C.,

13. Domenici, T., and Lesser, R. C., 1995. Disorienting Sexuality: Psychoanalytic Reappraisals of Sexual Identities. New York: Routledge.

14. Hatzenbuehler ML, McLaughlin KA, Keyes KM, Hasin DS. (2010) The impact of institutional discrimination on psychiatric disorders in lesbian, gay, abisexual populations: A prospective study.” Am J Public Health. 100: 452– 459.

15. Buffie W C. (2011) Public Health Implications of Same-Sex Marriage. Am J Public Health.101: 986– 990.

16. Perone AK (2015) Health implications of the Supreme Court’s Obergefell vs. Hodges marriage equality decision. Lesbian, Gay, Bisexual, and Transgender Health 2, 196–199.

17. Meyer, I. (2016), The Elusive Promise of LGBT Equality. Am J Public Health. Vol 106, No. 8 Beyond Blue, 2013. LGBT People: Mental Health & Suicide. Available from: https://www.beyondblue.org.au/docs/default-source/defaultdocument-library/bw0258-lgbti-mental-health-andsuicide-2013-2ndedition.pdf?sfvrsn=2

Australian Federal Parliament, 2004. Marriage Legislation Amendment Bill 2004. Available from: https://www.aph.gov.au/binaries/library/pubs/bd/2003-04/04bd155.pdf

Relationships Australia, https://www.relationships.org.au/national/submissions…/marriage-equality-statement