The U.S. mental-health system can do better. Just about every expert I’ve ever interviewed agrees psychiatric care isn’t as accessible as it should be, with provider shortages, high fees, and a homogenous workforce preventing some people from getting the care they want.

But recently, I stumbled across a social-media thread from psychiatrist Dr. Paul Minot, who argues the system’s problems go way beyond access. In Minot’s words, mainstream psychiatry is an “intellectual scam” that diagnoses and treats people without solid science to back up those decisions, and thus isn't nearly as effective as it should be.

That’s a strong statement. But after diving into the data and speaking with numerous experts and patients, I think it’s fair to say his assessment contains elements of truth. Psychiatry lacks the objective data of most other medical specialties, and patients are paying the price.