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

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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.

 

[rvallee]

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.

There are all sorts of people with all sorts of beliefs out there but it would be nice if health care research took into account the fact that most of us aren't superstitious weirdos, that although this may affect a small number of people, this reads as ridiculous nonsense that gives beatific powers to people who are basically just functionaries.

It's just a job, get over yourselves. I have absolutely none of this sort of vibes with health bureaucrats. Most of the times the diagnoses they think of are wrong anyway, which completely deflates the delusion of those very narcissistic beliefs they have about themselves. Explanations are useless if they aren't accurate, if they change nothing. Making a therapeutic / religious ritual out of this only makes it more ridiculous.

Good grief take the hubris 100 notches down, then keep going, and quit your damn hopium addiction.

 

[Hutan]

Other relevant research concerns the impact of how.healthcare providers communicate with patients. In a notable randomised controlled trial, Thomas6 studied patients with medically unexplained symptoms. The study revealed that patients showed greater improvement when their GP provided a firm diagnosis with a positive prognosis, compared with those who received neither. This improve- ment occurred regardless of whether patients received actual treatment. Savage and Armstrong7 found that patients expressed higher satisfaction when doctors made definitive statements about diagnosis and treatment, rather than soliciting patient input in a more collaborative approach.

It's more of the BPS line of
'Give the patient a name for their unexplained symptoms, and give it confidently. Tell them things will be all right. This is enough to allow the clinician to feel that they have done something useful.'

 

[MrMagoo]

I hate the “why are you so keen to be labelled” I’ve had it a few times, last one was when I thought I had mumps. On that occasion I wanted to be tested (labelled if you like) because it’s a notifiable disease and NHS advice was to see GP for a test.

I also remember early on in Me/CFS being told quite often “well we know it isn’t cancer!” Who thought I had cancer? Not me, certainly.

I really don’t know why these people feel the need to psychologise and pontificate on everything. If £500 disappeared from their bank account and then they later found out who took it and why, they would be relieved. People don’t like open-ended problems for which there is no support, advice or kinship.

 

[dratalanta]

Not sure the journal was named - this is in BJPsych Bulletin, which is the house journal of the Royal College of Psychiatrists.

This paper appeared in its Cultural Reflections section, the goal of which is to support psychiatrists to provide “excellent culturally informed practice to deliver what our patients need from us”.

Which makes it notable that the literary reference at the centre of this paper is, as Hutan pointed out, as confused and uninformed as its science. Were the peer reviewers too busy to notice? Or is it that BJPsych welcomes papers on ME/CFS which are, to use Harry Frankfurt’s technical term, bullshit, i.e. no one in this journal cares whether an ME/CFS paper is true or not, provided it sounds plausible to its readership.

I wonder whether BJPsych Bulletin would be interested in a paper called “On bullshit in ME/CFS research”. Let us know, BJPsych Bulletin editors. S4ME could facilitate all the culturally informed practice your members could wish for.

 

[MrMagoo]

I was certain I remembered having the ladybird book of Rumplestiltskin, and it was because he put his foot through the floorboard!

The internet tells me, when the Queen said his name he stamped so hard in anger, his foot went through the floorboard and was stuck. In a rage, trying to pull it free he tore himself in half, and disappeared.

BSPsych writers might want to have a think about what kind of metaphors they’re mixing…

Pictured: Ladybird books Rumplestiltskin who stamped so hard in anger at being outwitted by a woman, then losing a chance to steal a child, that his foot went through the floor

 

[MrMagoo]

In fact, the miller tells lies that his daughter can spin straw into gold, so the king has her locked in a room with straw and a wheel, with a deadline to turn the straw to gold by morning- otherwise she will be killed.

It’s kind of easy to see why she promises her first born child to Rumples- her life depends on it.

He spins the straw to gold, the King is happy, decides to let her live and to marry her. This is why we need women’s rights.