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When it comes to mental health, diagnosis is a mindfield. The DSM breaks things out using overlapping and often vague symptoms, as though just by describing what seems to go together can define a distinct mental condition, even when the root cause is entirely opaque.
While the DSM has had its uses, and particularly early on it formed a framework that allowed for better understanding of patterns in behavior and mental events that proved the basis for theory and treatment options, it’s also always been subject to political influence, stigmatizing the diagnosed, disagreements over how to conceptualize a disorder, and creating role identities for clients.
The DSM, as a disease-based model for mental states, also fails to account for conditions of cure, leaving clients forever trapped by a label they can never shed.
Well, I don’t think it has to be this way.
Not only has knowledge grown in all sectors of research, but today we also have tools available, even without AI, that would make it possible to build databases of common features in human life and connect them with ease.
For the last several months, I have been puzzling over this problem, and today I’m going to share the way I would approach this problem, would that I ever became a therapist, or psychology science decided to study topics that could be quantified empirically again.
Introducing the Total Mind Diagnostic Model — a better map for real minds
The Total Mind Diagnostic Model (TMDM) is my attempt at creating a new framework to evaluate what we currently call mental illness. It’s not another label system. It’s a way of describing how a person actually functions — biologically, emotionally, mentally, behaviorally, and socially — so clinicians, researchers, and people themselves can see what’s going on and act on it.
Below is a plain-language tour of how it works, why it matters, and what needs to happen next, if this, or a refined version, were to be seriously considered. Wouldn’t that be cool!
How it works — five domains, one profile
TMDM looks at a person through five co-equal lenses. Each lens is scored and described, not stamped with a disease label.
Biology
Medical conditions, medication and supplement effects, genetics and biomarkers (where clinically appropriate). This is the hard-science check: thyroid function, inflammation markers, known neurological conditions, toxins, drug interactions. The point: don’t mistake a treatable medical problem for “just a mental thing.”Emotion Regulation
This covers five practical abilities you can measure and strengthen:Awareness & clarity (does a client notice and name emotions?)
Acceptance vs avoidance (does a client make room for feelings or push them away?)
Impulse control (can the client pause before acting when upset?)
Goal-directedness under distress (can the client keep pursuing goals despite emotion?)
Strategy repertoire (does the client have tools like reappraisal, breathing, grounding?)
These are targets, not judgments. If impulse control is low, DBT skills represent a focused method for improvement; if repertoire is thin, teach new strategies.
Mental Events
Not everyone thinks with an inner dialogue, but everyone has mental events that inform and describe their inner experience. Mental events include words, images, memories, body sensations, urges, daydreams, and even blank states or flow. For each item we record:Modality (words, image, sensation, etc.)
Frequency (common / uncommon / rare)
Function (adaptive / neutral / unadaptive)
This recognizes that an image-based intrusive memory is different from a critical inner monologue — and both need different responses.
Behaviors
Concrete actions: sleep patterns, avoidance, substance use, rituals, exercise, social withdrawal, manipulation. Again: frequency × adaptiveness. Behavior is what is most easily targeted with therapy and can change fastest.Environment
Social and contextual realities: acute abuse, chronic poverty, caregiving strain, divorce, isolation, workplace stress or insecurity, family attachment history. Environment is often the driver. If someone’s hypervigilance is adaptive to a dangerous workplace, the first intervention may be exploring employment alternatives, not therapy skills for how to calm down.
The method: real-time data with EMA (but human-friendly)
To decide what’s common, what’s rare, and what’s actually causing harm will require some data building. To achieve this, we could use existing apps to have clients regularly monitor their mental events, behaviors, and other important factors over short periods using Ecological Momentary Assessment (EMA) — short, frequent check-ins that capture experience in the moment.
People answer tiny prompts on their phones (or tap icons, voice notes, quick photos) several times a day for short bursts (e.g., 14 days).
Prompts are adaptive: they ask about current modality (image? body sensation? inner speech?) and context (who they’re with, what’s happening).
EMA gives us real frequency data instead of “how did you feel last week?” guesses.
Anonymized, over time, this would create a dataset that clarifies what is really common, uncommon, and rare, along with extenuating circumstances that may be having a hidden impact.
Therapeutically, this would also serve to focus client attention on both internal and external factors in the moment.
Visualizing the person — simple, shareable, useful
Clinicians and patients need one-page clarity. TMDM could be visualized in several ways that illustrate areas of concern. For example, you could develop:
A radar chart showing domain scores (Biology, EmotionReg composite, Mental Events, Behaviors, Environment).
A 3×3 grid for Mental Events and for Behaviors (frequency × adaptiveness), populated with examples the person actually reports.
An emotion subscale bar chart for the five emotion-regulation factors.
A biology panel listing flagged tests/meds and an environment heatmap with concrete needs (housing, legal, social work).
Put this on one page and you can tell a meaningful story at a glance: “This is mostly an environmental problem; these are biological flags to check; this is the skill deficit our therapy should target.”
Why this matters
Reduces misdiagnosis. Many “psychiatric” symptoms come from treatable medical conditions or medication side-effects. While some clients are recommended therapy by their doctors, many will enter therapy without even getting a checkup. Making biology explicit reduces harm.
Reduces stigma. We move from “You are X disorder” to “These processes are active and changeable.” Adaptive/unadaptive language matters — it recognizes that behavior that looks wrong in one context can be survival in another.
Targets treatment. Instead of tossing meds at a label, clinicians can match intervention to the weakest domain: medical workup, skills training, behavior change, or environmental interventions.
Better research. Groups defined by process (inflammation + high rumination + trauma exposure) are more meaningful than groups defined by a checklist of symptoms.
What needs to happen next
Were I in the research game, this is what I’d want to do to verify that this method operates and provides the benefits that I think it can. Since it’s unlikely I’ll ever get that opportunity, this is the pirate treasure map that could help someone else.
Prototype the one-page snapshot. Make a clinician and a patient version; test for clarity.
Pilot studies. Collect EMA plus standard measures and a minimal biomarker panel in a few clinics. See whether TMDM-guided treatment leads to better or faster outcomes than usual care. Also monitor if it avoids pitfalls of the current method, like labeling effects.
Build norms and cultural baselines. Determine what “common” and “adaptive” mean in different cultures.
Create a clinical code and crosswalk. For hospitals and insurers, map TMDM thresholds to existing ICD/DSM codes during a transition period. Dual documentation lets clinicians use TMDM without losing billing.
Privacy, safety, training. EMA needs strong consent, red-flag protocols, and clinician training so these profiles are used ethically and effectively. This would be critically important.
Advocate for system change. Real change means convincing clinicians, payers, and policy makers that process-based, whole-person care saves money and suffering.
A short example
Maria is exhausted, can't sleep, and is irritable. Under DSM she might get a depression label. Under TMDM her snapshot shows:
Biology: CRP elevated; on prednisone for an autoimmune flare.
EmotionReg: good awareness but low impulse control.
Mental events: frequent body sensations and intrusive images of a recent assault (common/unadaptive).
Behaviors: avoidance of social contact (common/unadaptive).
Environment: domestic violence ongoing (high severity).
The treatment plan becomes obvious: medical review of prednisone and inflammation, immediate safety planning (environmental), trauma-focused work for intrusive images, and DBT skills for impulsive responses. The “depression” label is less useful than this targeted, life-saving plan.
Want to help build it?
As I already mentioned, having the opportunity to test this framework is a long shot from where I’m currently standing. But stranger things have happened.
If this resonates, and others out there are adventurous enough, they’d want to give it a whirl, I’d need collaborators: clinicians who’ll pilot a one-page snapshot, researchers to help validate norms, and designers to make the profile readable for patients.
We could begin just by talking about it.
The DSM was useful at one time. But it’s time for a transformation, replacing one-size-fits-all labels. The Total Mind Diagnostic Model is a practical first step toward a more humane, accurate, and useful approach to mental health.
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Further Reading
Diagnostic and Statistical Manual of Mental Disorders, Text Revision Dsm-5-trby the American Psychiatric Association
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About
Diogenes in Exile began after I returned to grad school to pursue a master’s degree in Clinical Mental Health Counseling at the University of Tennessee. What I found instead was a program saturated in Critical Theories ideology—where my Buddhist practice was treated as invalidating and where dissent from the prevailing orthodoxy was met with hostility. After witnessing how this ideology undermined both ethics and the foundations of good clinical practice, I made the difficult decision to walk away.
Since then, I’ve dedicated myself to exposing the ideological capture of psychology, higher education, and related institutions. My investigative writing has appeared in Real Clear Education, Minding the Campus, and has been republished by the American Council of Trustees and Alumni. I also speak and consult on policy reform to help rebuild public trust in once-respected professions.
Occasionally, I’m accused of being funny.
When I’m not writing or digging into documents, you’ll find me in the garden, making art, walking my dog, or guiding my kids toward adulthood.
Hi!! I absolutely love this idea!! I’m an MSW student and intern designing educational materials. I’d love to chat more on anyway I could help!