Legalized discrimination has real, tangible effects on the life prospects of those who are subject to its restrictions. Fortunately a number of laws have been passed in recent years that have made discrimination based on race, gender, physical impairment or sexual preference much more rare. For more than a decade, state laws outlawing same-sex marriage were the one notable exception to this egalitarian trend. After Congress passed the Defense of Marriage Act in 1996, 31 states ultimately passed referendums that prohibited gay marriage via constitutional amendment, and in many locations these referendums were passed by large margins. The tide of public opinion has finally turned on this issue, however, with recent polls showing support for legalized same-sex marriage running above the 50 percent mark. The attitudes of the judiciary have evolved as well, and court decisions have now struck down the majority of the anti-gay-marriage state amendments. About two-thirds of America\u2019s LGBT citizens reside in the 35 states where same-sex marriage is currently permitted, and this percentage will continue to rise as the latest judicial rulings are put into application. Calculating the True Costs of Institutional Discrimination But there were some dark days for advocates of marriage equality in the early to mid-2000s. Their disappointment was especially acute during the 2004-2005 election cycle, when 16 states rushed to adopt constitutional amendments banning gay marriage. These votes were preceded by nasty pre-election campaigning that fanned the flames of hate and prejudice, causing much hurt, anger, discomfort and disappointment among members of the LGBT community. Using statistics obtained from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), a team of Ivy League researchers set out to investigate the changing mental health of LGBT individuals caught in the crossfire of these sometimes ugly public policy debates. NESARC personnel surveyed a broad range of Americans in two separate phases covering the 2001-2002 and 2004-2005 time periods respectively, gathering extensive information about the mental health issues faced by survey participants. This meant it possessed data collected both before and after the passage of the anti-gay marriage amendments; and since NESARC statistics were also broken down by state and sexual preference, the Ivy League research team had access to everything it needed to chart changes in the mental health of gays, lesbians and bisexuals who had been exposed to the divisive debates that surrounded these initiatives. Painful Consequences of the Gay Marriage Debate In the 16 states where anti-gay marriage constitutional amendments were adopted between 2004 and 2005, evidence suggests the mental health of LGBT constituents was impacted in a statistically significant way by the controversy connected to this process. Between 2002 and 2005, the diagnosis of mood disorders in this group increased by 36.6 percent, alcohol use disorders by 41.9 percent and psychiatric comorbidity (the presence of two or more mental disorders at once) by 36.3 percent. Under the mood disorder category, the most notable spikes were for major depression (24.9 percent increase), panic disorder (60.8 percent increase) and generalized anxiety disorder (rates of diagnosis increased from 2.7 percent of the LGBT population to 9.4 percent, a jump of 248 percent). Conversely, in states that passed no such legislation, the incidence of mood disorders decreased by 23.6 percent among members of the relevant demographic groups. Unexpectedly, the incidence of substance abuse disorders as a whole increased by approximately 25 percent for the LGBT demographic in both sets of states. An expansion of alcohol abuse was the problem in the constitutional amendment states, while a rapid spike in drug abuse explained the jump that occurred in the rest. The latter phenomenon could have been related to distress over the divisive national discussion on the issue, or there could have been an entirely unrelated dynamic at work. But each of these suggestions is simply conjecture. It should also be noted that the heterosexual community in states where the constitutional amendments were passed showed no changes in mental health, so the numbers revealed in the LGBT community were not indicative of a larger societal trend. An earlier study from some of the same researchers supports the thesis that these changes reflected feelings of social alienation and a stress response to perceived hostility from public institutions. In a 2009 edition of the American Journal of Public Health, the Ivy League scientists unveiled a statistical analysis that showed LGBT individuals living in states whose anti-discrimination laws did not protect based on sexual preference or gender identity were being diagnosed with mental health disorders at elevated rates (in comparison to their peers in other states). Banning of Empathy by Constitutional Amendment It has been well established by previous research that stress is one of the most significant triggers for poor mental health. This is especially true for depression, anxiety disorder and substance abuse, all of which are caused or aggravated by feelings of powerlessness and hopelessness and the fear of social rejection. Bans on gay marriage have had real-world consequences for many people, and it is heartening to see public policy and opinion evolving in a more constructive direction on this issue. But beyond the tangible effects, hearts were wounded and psyches damaged by the fractious debate that followed the passage of the Defense of Marriage Act and all of its state-level imitators. Actions hurt but so do words and attitudes, and the pain they can cause often runs much deeper than anyone suspects.