The Rumpelstiltskin effect: therapeutic repercussions of clinical diagnosis, 2025, Levinovitz & Aftab

[Dolphin]

The Rumpelstiltskin effect: therapeutic repercussions of clinical diagnosis | BJPsych Bulletin | Cambridge Core

The Rumpelstiltskin effect: therapeutic repercussions of clinical diagnosis

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https://www.cambridge.org/core/serv...eutic_repercussions_of_clinical_diagnosis.pdf ​

The Rumpelstiltskin effect: therapeutic repercussions of clinical diagnosis​

Published online by Cambridge University Press: 22 August 2025
Alan Levinovitz and Awais Aftab

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Summary​

Clinicians across medical disciplines are intimately familiar with an unusual feature of descriptive diagnoses.

The diagnostic terms, despite their non-aetiological nature, seem to offer an explanatory lens to many patients, at times with profound effects.

These experiences highlight a striking, neglected and unchristened medical phenomenon: the therapeutic effect of a clinical diagnosis, independent of any other intervention, where clinical diagnosis refers to situating the person’s experiences into a clinical category by either a clinician or the patient.

We call this the Rumpelstiltskin effect.

This article describes this phenomenon and highlights its importance as a topic of empirical investigation.

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Keywords​

Classification sick role medical ritual hermeneutics placebo

 

[Hutan]

Well, I think the point of the naming of Rumpelstiltskin was that it made him go away, never to be seen again.

For me, if the naming doesn't eventually lead to the problem going away or some prospect of it going away, it's rather disappointing. If the farmer's daughter had said Rumplestiltskin's name, but he had then stuck around, stealing her children and generally being a pest, knowing his name would not have been terribly helpful.

Consider the following clinical scenario: a 42-year-old history professor seeks a psychiatric evaluation for dealing with low mood, anxiety and poor self-esteem. Despite a successful academic career, she feels that she has not lived up to her potential and her efforts have been plagued by a persistent inability to focus, a tendency to procrastinate and difficulty completing tasks without last-minute pressure. These struggles have been present since childhood but were dismissed by her parents and teachers as laziness, to be remedied via rigorous self-discipline. Over the years she internalised these judgements, developing a harsh and critical attitude towards herself.

During the initial psychiatric assessment, her psychia-trist identifies characteristic signs of attention-deficit/hyperactivity disorder (ADHD), a diagnosis that is subse-quently supported by neuropsychological testing. When informed of the results, she expresses a sense of tremendous relief at finally having an explanation. The official diagnostic term, despite its merely descriptive nature, seems to offer an explanatory lens that she had previously lacked. The new lens, in turn, had a profound therapeutic effect with improvements in mood, anxiety and sleep.

This clinical anecdote is a composite one for illustra-tion, but it captures a real and widespread effect of diagnosis. In a New York Times story about ADHD diagnoses in older adults, a woman diagnosed at age 53 described her reaction as follows:‘I cried with joy,’ she said.‘I knew that I wasn’t crazy. I knew that I wasn’t broken. I wasn’t a failure. I wasn’t lazy like I had been told for most of my life. I wasn’t stupid.’1

Clinicians in a variety of disciplines and settings see this dynamic play out in diverse diagnoses: tension headache, tinnitus, chronic fatigue syndrome, restless leg syndrome, insomnia disorder, irritable bowel syndrome, functional dyspepsia, chronic idiopathic urticaria and autism spectrum, to name but a few.

Their experiences highlight a striking, neglected and unchristened medical phenomenon: The therapeutic effect of a clinical diagnosis, indepen-dent of any other intervention, where clinical diagnosis refers to situating the person’s experiences into a clinical category by a clinician or the patient.

Perhaps there is a benefit to the patient just from the naming of their disease, but that benefit mostly depends on the disease actually being a clinically distinguishable thing (as opposed to the ragbag collection of things that is supposed to be Functional Neurological Disorders).

I think that it's actually the clinicians who seem to enjoy having descriptive diagnoses the most. It's not much work to just say 'ah, you are Tired All the Time', or 'you have Exhaustion Syndrome' or 'Chronic Fatigue Syndrome' or 'Functional Gait Disorder'. There's no need to understand any real biology, or bother with rigorous treatment trials.

The really important thing for patients is whether the naming makes life significantly easier.

It seems to me that the authors might often be mistaking patients' short-lived hope that they have found a clinician who is taking their condition seriously and might know how to do something useful with the 'profound effect' that they believe flows from simply naming the disease the patient has.

I'm not impressed with the idea that people with 'chronic fatigue syndrome' like having that label because it allows us to externalise the reasons for our failure to properly participate in society.

 

[Utsikt]

I want a label because although society is supposed to help based on needs, and needs alone, they won’t help me unless those needs are accompanied by a diagnosis they think can create my needs.