Sick of It: Medicine, Margins, & the Struggle to Be Understood
Well, yes! Another zine! For me, theyâve been a constant source of fascination since my middle school emo days, when I first read The Perks of Being a Wallflower. It felt like finding a secret language â a way to express myself outside the mainstream. Back then (and still now), I was obsessed with The Rocky Horror Picture Show and alternative music, and discovering that zines could blend both worlds was mind-blowing. Zines make complex, emotional, and nuanced topics easier to digest â especially in spaces like medicine, where the language can feel cold and clinical, and the stakes are deeply personal.
So why this topic, and why now? Well, the western world doesnât usually think of medicine as a space for ambiguity, emotion, or cultural critiqueâbut I believe we should. As someone going into the medical field, Iâve been grappling with how often care gets reduced to checklists, diagnoses, and prescriptions â especially when it comes to mental health. This topic is personal, too: as a queer person, Iâve seen how systems like the DSM have historically pathologized queerness and continue to enforce narrow ideas of whatâs ânormal.â Why are we so quick to label everyday human struggles as disorders? How did we end up treating things like loneliness, grief, or shyness with medication? And what happens when we bring in philosophy, queer theory, and other humanities to rethink what âhealthâ even means?
By unpacking the history of the DSM, the medicalization of life, and our cultural discomfort with uncertainty, I aim to describe a future where medicine is less about control and more about careâwhere doctors are allowed to sit with the unknown, and where being human doesnât have to mean being sick. This project is an homage to the queer and alternative voices that came before meâbut itâs also for everyone. Everyone should have the right to timely, effective, and personal medical care.
Mental illnesses are real, valid, and can be incredibly debilitatingâtrust me, I know. This zine is in no way intended to delegitimize the reality of mental health struggles or the life-changing benefits that therapy, medication, and diagnosis can offer. For many people, these tools are essential, even lifesaving. This work is not a rejection of medicine, but a critique of how modern (and not-so-distant past) medical systems have sometimes failed to account for nuance, culture, and the full complexity of being human. My hope is to open up space for conversation, reflection, and alternative ways of thinking about care â not to close the door on any particular path to healing.
The American Psychiatric Association's DSM has been thought to be the science-informed, authoritative guide to diagnosing mental illness in the United States (and only in the United States) for decades. Yet its history is about more than simply an expanding knowledge base concerning mental health â it is about deeply ingrained cultural concerns about normativity, identity, and control. [x] From a queer theoretical perspective, the DSM is not merely a clinical instrument, but is equally an apparatus of regulation marking the limits of normative subjectivity.
Presented for the first time in 1952, the DSM has been revised six times, ever more pathologizing increasingly wide swaths of human behavior. With the DSM-III (1980), widely regarded as a revolution in psychiatry, there was an effort made to standardize diagnoses by moving toward its biomedical and symptom-focused model. This shift was couched as scientific advancement, but it reaffrimed the authority of psychiatry at the moment it was losing its legitimacy in culture [DSM: A history of psychiatryâs Bible].
This move may be understood as part of a larger biopolitics â a type of power which governs and specifies life through medicalizing so-called deviancy. Historically, queerness has itself been medicalized within the DSM: homosexuality was categorized as a disorder until 1973, and gender nonconformity is still couched in medical discourse through the diagnoses of "gender dysphoria.â [x] Despite the rewriting of language, the power relations remain. The DSM's categorizations do not merely categorize mental states â they create and impose norms about what sorts of lives are understandable, healthy, and valuable.
The DSM's trajectory from its initial editions to the current DSM-5-TR illustrates a trend toward expanding diagnostic categories. This expansion has been both appreciated for increasing recognition of mental health issues and critiqued for potentially over-pathologizing normal variations in human behavior.
This broadening of diagnoses has significant implications. On one hand, it can lead to greater access to care for individuals experiencing distress. On the other, it risks labeling individuals unnecessarily, leading to stigma and the potential for overmedication. The DSM's influence extends beyond clinical settings, affecting insurance coverage, educational accommodations, and legal decisions, ultimately embedding its classifications deeply into societal structures.
Oddly enough, where there is queer theory, there is Marxistâtheory. The way the DSM deals with capitalist institutions â especially the pharmaceuticalâindustry â has been the central target of such criticism (go figure!). The proliferation of diagnostic categories strongly correlates with the commercial development of many new drugs, leaving one toâwonder about the motives of some of the inclusions in the manual. Critics say such aârelationship can foster the medicalization of normality, in which natural experiences are recast as disorders that must be addressed with drugs.
I think Peter Conrad puts it very well: âThe impact of medicine and medical concepts has expanded enormously in the past ďŹfty years... the jurisdiction of medicine has grown to include new problems that previously were not deemed to fall within the medical sphere.â [The Medicalization of Society...] The money thatâpharmaceutical companies make off these substances is genuinely disgusting. Discoveringânew disorders open markets for medications, and the sanction of the DSM confers legitimacy on these conditions. Itâs this dynamic that has led to favoring medication over other types of therapy, such as psychotherapy or community-based interventions, which may be more beneficial for some people (but don't make the big companies as much money).
The DSM has come under fire forâconflicts of interest in the creation of diagnostic criteria and selection of disorders for inclusion. Research from Cosgroveâet al. informs that a majority ofâmembers of DSM panels had money links to drug firms. [x] This is cause for serious concern about the role of profit motives in determining what gets designated as a mentalâillnessâespecially given that new diagnoses typically spur demand for new medications.
Think about the medicalization of the everyday: shyness as social anxiety disorder, bereavement as major depressive disorder, moodiness in adolescents as intermittent explosive disorderâand all these changes result in a new wave of prescriptions for SSRIs and other psychotropics. The financial incentives to pathologize behavior not only shape the approaches to treatment but also the definitions of illness itself.
This expanding scope of medical prerogative has redefined the limits of what was once thought to be âtreatable," reinforcing the notion that all types of distress or deviation must be remedied through therapeutic channels. As was mentioned earlier, the DSM defined homosexuality as a mental illnessâwhat gets pathologized usually mirrors not scientific agreement but social bias. Although that designation was rescinded more than 50 years ago, the taint of pathologization often still clings to non-normative identity in more insidious forms.
The DSM becomes a site in which capitalist and clinical interests intersect, producing âtreatableâ subjects and driving the commercialization of mental illness. According to Horwitz, diagnoses have not only evolved to serve as tools for treatment but also as tools for the construction of identity, access to treatment, and institutionalization [DSM: A history of psychiatryâs Bible]. For a few, diagnosis offers language for suffering and a path to support. However, queer theorists warn against the comfortable allure of legibility in a system that has historically pathologized and erased non-normative being. Thus, while diagnosis might provide solace in the form of legitimation, communality, and access, it also exacts a frame that threatens to reduce multifaceted lives to lists. For queer and raced communities, this might be a lifeline and a straitjacketâa means of being noticed but only within a frame that has exerted efforts to eliminate them.
So, here in a world in which queer lives tend to get misunderstood or overlooked, diagnosis of mental illness can provide a kind of epistemic acknowledgment. Epi-what-now?! In simple terms, epistemology is a branch of philosophy that deals with the nature, origin, boundaries, and value of knowledge. It deals with the core questions: What does it mean to understand something? How do we separate belief and truth? In medical and psychiatric fields, epistemology assists us in analyzing how a certain type of knowledgeâsuch as diagnostic criteria or clinician expertiseâis made, validated, and used, sometimes laying bare the cultural, political, and institutional power structures that determine what we think of as "capital âTâ truth" about the human body and mind.
Being diagnosed can authenticate that a real process is occurringâwhen the cause of distress is structural in nature, e.g., homophobia, racism, family rejection. In cyberspace in particular, communities tend to congregate in respect to diagnosisâADHD, BPD, autism, CPTSD. For queer people in some cases, these conditions may grant more cultural visibility than queerness does on its own, providing a legible cultural model through which to explain their difference.
In his journal, Michel Foucaultâs asserts that "medical language does not merely describe realityâit aids in the construction of reality."
Diagnoses do not merely name disorder; instead, they aid in the formation of the way individuals perceive themselves and are perceived by others. Neurodivergent conceptualizations appeal to many queer individuals because they upend normative timelines, ways of expressing themselves, and modes of relationship. In this sense, requesting a diagnosis isn't always a matter of fixing the self but rather a matter of resisting assimilation into cishetero-normative and neurotypical forms. It is a survival and articulation tactic in a hostile world. This holds particularly for the diagnosis of gender dysphoria, which itâs possible to reclaim as a means of negotiating healthcare systems while resisting their normative enforcement.
At the same time, we need to make space for paradox. Medical gaslightingâwhere women, queer individuals, and people of color have their symptoms disregardedâis an ongoing and damaging practice that exists. [x] But so does the pathologization of marginalized identity. A queer patient may be invalidated when complaining about pain but also rapidly diagnosed with a psychiatric condition that locates their distress within personal pathology instead of as a reaction to structural violence.
In The Epistemology of the Closet, Eve Kosofsky Sedgwick critiques the rigid binaries that dominate Western thoughtâhealthy or sick, treatable or untreatable, known or unknownâand reveals how those dichotomies oversimplify the richness of human experience. Her metaphor of âthe closetâ is not limited to sexuality; it serves as an epistemological structure that organizes what is speakable and unspeakable, what is acknowledged and what is disavowed. Sedgwick observes that âthe relations of the closetâthe relations of the known and the unknown, the explicit and the inexplicit⌠have the potential for being peculiarly revealing, even paradigmatic, for the understanding of other kinds of epistemological structures.â This insight resonates deeply within psychiatry, a field where uncertainty is often met not with curiosity but with suspicionâand all too often, with diagnosis [The Epistemology of the Closet]. The DSM's relentless push to label and classify emotional distress speaks volumes about a larger cultural tendency to sidestep the discomfort of the unknown. Increasingly, medical practitionersâespecially physiciansâare expected to respond not only to physical illness but also to deeper, less tangible forms of suffering: loneliness, grief, disconnection, and the weight of systemic harm. When care becomes a process of regulationâwhen every ache must be labeled, coded, and treatedâwe risk erasing the profoundly human potential that lies within what medicine canât yet name.
This call for a more humane approach echoes in modern critiques of clinical practice. Hilty et al. argues for a reimagining of medical educationâone grounded in interdisciplinary learning and human-focused care. [x] Similarly, Amsterlaw et al. point out a troubling gap between reality and expectation: while patients often crave certainty and doctors strive to deliver it, certainty rarely captures the messy, fluid truth of human health. [x] That mismatchâbetween lived experience and rigid diagnostic structuresâcan lead to overmedication, fractured trust, and a sense of alienation that no prescription can fix.
So, in short, the DSM is not a neutral document. It is shaped by political, cultural, and economic forcesâwhich, in turn, shapes us. So I offer this: what if naming is not always liberating? What if diagnosis sometimes deepens the exclusions it aims to heal?
Moving Toward a New Philosophy of Care
So, what can be done? It is not just practiceâbut also philosophy that must change in medicine. Weâneed systems that reward relationships, not solely diagnosis: longer visits, integrative teams, community-based care. Physicians shouldâbe taught to hear stories, not just checklists. The humanities in general, and queer theory in particular, supply critical tools: We challenge the binaries, derive worth from theâinarticulate, and practice compassion for what canât be cured.
What if practitioners were trained to say,ââI donât know â but Iâm here with youâ? What if healing wasâabout more than just an absence of symptoms? This isnât naiveâitâs a demand for structural andâcultural change. The medicine of the future is one that isâpermeated with slowness, multiplicity and uncertainty; not because these are failings, but because they are constitutive of caring itself.
Rethinking caring is not just a matter of philosophyâit is aâmatter of action. Areâthe reform efforts centered on access? Without the line to the doctor, the person who isâlistening and the shoulder to lean on, the vision stays silhouetted. Broad-case providers â PAs, NPs,âDOs, MDs â are lifelines in low-access areas. But they are frequently overwhelmed, underpaid and asked to not onlyâheal illness, but also grief, poverty and alienation. This is where reform needs toâstart. Increase access through mobileâclinics, multilingual care and community-centered services. Invest in primary care as the foundation of health â not just as a gateway to specialists, butâas a milieu for relational healing as well. Include humanities and critical theory in medicalâeducation. Dismantleâsilos between fields. Fund time, not efficiency. And restructureâour pharmaceutical systems to prioritize ethics over profit (Iâm so done with these drug ads!).
Finally, itâsânot only a matter of fixing whatâs broken. Itâs about redefining what we mean by healthâand who gets to define it.