The "Rumpelstiltskin Effect": When Just Getting A Diagnosis Is Enough To Start The Healing

Sometimes, just receiving a diagnosis can be enough to help someone start to feel better. This phenomenon has been noticed by patients and clinicians, but until now it didn’t have a name. Now, thanks to a pair of US-based researchers writing in a recent paper, it’s been dubbed the “Rumpelstiltskin effect”.

The rest of this article is behind a paywall. Please sign in or subscribe to access the full content.

In case you’re unfamiliar with the Grimm fairytale, a miller’s daughter promises her first-born child to a strange little man in exchange for the gift of being able to spin straw into gold, to save her from being executed by a tyrannical king. She later suffers buyer’s remorse when it comes to actually handing over the baby, but the man kindly offers her an out: all she has to do is guess his name. Unfortunately for her, his name is Rumpelstiltskin, which proves very difficult for her to guess, being not a real word. 

In the end, she figures it out thanks to someone who overheard ol’ Rumpel boasting loudly about his unusual name (not the wisest idea, if you ask us).

The point, according to authors Alan Levinovitz and Awais Aftab in their new paper, is this idea of knowing something’s true name in order to be able to control it. “This type of folk tale appears in numerous cultures,” they write. “The details vary, but the theme is identical.”

The same principle, they argue, can be true for medical diagnoses. Sometimes, the very act of naming someone’s condition can have a therapeutic impact, even before any formal treatment is started.

The duo refer to several previous studies as evidence for the Rumpelstiltskin effect. Researchers have documented that diagnoses can provide “feelings of relief, validation and empowerment.” They may unlock access to support groups for people with particular conditions that patients may find helpful. 

Receiving a diagnosis also serves to validate the patient’s feelings about the symptoms they’re experiencing. Patients with unexplained symptoms have reported greater satisfaction rates when doctors give them more definitive statements about diagnosis and treatment. 

Levinovitz and Aftab also point to the rise in self-diagnosis – since this doesn’t typically open the doors to formalized medical treatment, it stands to reason that any benefits these patients gain come from the diagnosis itself. 

Lastly, they mention the placebo effect, reasoning that “if a purely psychological intervention […] can produce changes in psychological and somatic symptoms, then it makes sense that another such intervention, namely the diagnosis, could also”.

“Clinicians should be aware that part of a patient’s improvement may stem from the naming itself, not just the treatment,” said Aftab in an interview with PsyPost. “When a patient seeks a specific diagnosis, it can be useful to explore what they expect that diagnosis to give them and to consider whether those needs can be met alongside or apart from the label.”

There can also be a dark side to all this, as the pair note: “Diagnostic categories, especially in psychiatry, carry a fraught cultural heritage.” Particular diagnostic labels may open people up to stigma and discrimination. Some diagnoses more than others carry negative connotations that patients may have already internalized.

In a written response to the paper, Professor Emeritus of Psychiatry Ronald W. Pies acknowledged this, but said that best practice for clinicians is to emphasize “that the person in treatment is not exhaustively defined by his or her diagnosis.”

Right now, there’s also a lack of robust clinical research to show exactly how widespread the Rumpelstiltskin effect might be – unsurprising, as it never had a name until now. The authors call for much more investigation, which they say “will surely yield many surprises” (much like a small man appearing in your prison cell in the dead of night and offering to purchase your baby).

“[I]f the Rumpelstiltskin effect is as important and widespread as we believe, both the research and the adjustments will improve the welfare of patients and point us in promising new directions for clinical practice,” they conclude.

The paper is published in the journal BJPsych Bulletin.