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The established, institutionalized set of beliefs and practices that define mainstream psychiatry—the often-unexamined assumptions about mental [illness], diagnosis, treatment, and the role of psychiatry in society. Psychiatric orthodoxy includes commitments: that mental disorders are brain disorders, that diagnosis is objective, that DSM categories name real diseases, that medication is often the best treatment, that psychiatric authority is legitimate, that the current psychiatric system is basically sound, that critics are anti-science or anti-treatment. Like all orthodoxies, it provides frameworks for [understanding] and treating mental distress, but it functions as institutional power—determining who gets diagnosed with what, what treatments are covered, who counts as mentally ill, and what alternatives are [marginalized]. Psychiatric orthodoxy shapes not just how we treat mental distress but what we think mental distress is, making particular conceptions of illness seem natural and alternatives (social, [psychological], spiritual) seem insufficient.

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