The Rumpelstiltskin Effect: Meet the Name for the Relief a Diagnosis Brings
Alan Levinovitz (Professor of Philosophy and Religion at James Madison University) and I have a new article out today in BJPsych Bulletin, “The Rumpelstiltskin Effect: Therapeutic Repercussions of Clinical Diagnosis,” in which we give the healing power of diagnosis a befitting name. The article is open access, and we encourage you all to read it. The following is an abbreviated version of the original.
Clinicians across medical disciplines are intimately familiar with an unusual feature of descriptive diagnoses. The diagnostic terms, despite their non-etiological nature, seem to offer an explanatory lens to many patients, at times with profound effects.
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.”
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 a few.
Their 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 a clinician or the patient.
We call this the Rumpelstiltskin Effect.
In the classic Grimms’ folktale, “Rumpelstiltskin,” a young woman promises her first-born child to a little man in exchange for the ability to spin straw into gold. When he comes to collect, she begs for mercy, and he offers her a way out. She must guess his name.
Now a queen, the woman runs through every name in the German language, as well as every colloquial nickname she can think of. None work. Finally, her servant discovers the little man’s highly esoteric name—Rumpelstiltskin—and she is released from her obligation.
Crucially, the source of the queen’s severe distress does not have a familiar name. Nor can she substitute a layperson’s description like “funny little man.” Esoteric knowledge of an official name is required to gain control over what ails her. As soon as she knows the name, the problem takes care of itself.
This type of folktale (Aarne-Thompson Tale Type 500) appears in numerous cultures. The details vary, but the theme is identical. Discover the esoteric name, control, and destroy the source of suffering. Traditional exorcism works according to a similar principle. Ordinary terms exist for the afflictions attributed to demons: sloth, mendacity, gluttony, and so on. However, when normal efforts to overcome sloth are inadequate, an exorcist is brought in. Discovering the demon’s name is crucial to controlling it—not merely sloth, but Belphegor, the demon of sloth—which is why demonological treatises and exorcists spend so much time on names, from ancient China to modern England. Other examples abound, from cultural practices of keeping true names secret to contemporary literature such as Ursula Le Guin’s classic Earthsea book series, in which mages can only control what they correctly name.
This principle is also at work in modern medicine. If a clinical diagnosis can have a therapeutic effect, then, at least in some instances, diagnoses are medical interventions in themselves, and ought to be treated and researched as such. Likewise, self-diagnosis can be understood as an attempt to secure the therapeutic effect of a medical intervention to which patients do not have official access.
Though the phenomenon has not been extensively studied under this name, research already points to its reality. Systematic reviews of diagnostic labeling (O'Connor et al, 2018; Sims et al, 2021) show that a new name for an old struggle often brings validation, relief, and empowerment. It provides a common language for talking to doctors, family, and peers. It can enable connection to supportive communities and advocacy movements. Rumpelstiltskin effect also seems a plausible cousin to the placebo effect, where expectations alone produce measurable changes in symptoms.
Possible mechanisms
1) Clinical lens and hermeneutical breakthrough
Fundamentally, a clinical diagnosis invites patients to see their experiences through a medical lens. The medical interpretive framework recognizes suffering in ways that everyday language often cannot because the latter tends to characterize problems as personal inadequacies. Clinical language is also more standardized than everyday language, which offers at least the appearance of a cohesive explanatory framework for a person’s impairment.
The philosopher Miranda Fricker uses the example of postpartum depression to illustrate how the act of naming a phenomenon can serve as a transformative moment of understanding. In her 2007 book Epistemic Injustice, she quotes a woman describing her first encounter with postpartum depression as a medical diagnosis:
“In my group people started talking about postpartum depression. In that one forty-five-minute period I realized that what I’d been blaming myself for, and what my husband had blamed me for, wasn’t my personal deficiency. It was a combination of physiological things and a real societal thing, isolation. That realization was one of those moments that makes you a feminist forever.” (p 149)
The lack of a recognized concept for postpartum depression created a “hermeneutical darkness,” a gap in collective understanding that deprived individuals of the ability to fully comprehend their experiences.
In addition to a medical label, a diagnosis also functions as a social tool for making previously unarticulated suffering comprehensible. Feeling understood, by oneself and others, is a psychological good that could contribute to the Rumpelstiltskin effect. The official name serves as a bridge between individual experiences and generalized patterns.
2) Learned associations, the power of rituals, and the sick role
The act of diagnosis is in most cases a prelude to medical care and treatment. Another mechanism at play in the Rumpelstiltskin effect may be an acquired association between the naming of a condition in a medical context, the promise of relief, and access to the “sick role.” When a patient receives a diagnosis, it offers hope and reassurance. The association can continue to play out even in situations where a diagnosis is made but treatment is not sought or none is available.
This process is further amplified by the power of culturally sanctioned rituals. Diagnostic terms are ritualized constructs imbued with institutional authority. When a condition is officially named by a specialist, it acts as a conditioned stimulus, evoking an expectation of care and recovery that has deep roots in human societies. The anticipatory relief would be particularly effective within cultural contexts that position medical diagnoses as authoritative and transformative.
3) Relief from cognitive ambiguity
Receiving a diagnosis resolves the cognitive ambiguity that attends unexplained suffering. Patients with undiagnosed problems frequently struggle with confusion and have difficulty communicating their experiences to others and even to themselves. A descriptive diagnosis provides a prototypical explanation that alleviates these difficulties. Although it does not offer an etiological answer, descriptive diagnosis functions as a framework that organizes disparate symptoms into a legible and standardized pattern: a recognized problem shared by people across the world with core symptoms that have been described in textbooks and studied by experts. A diagnosis alleviates uncertainty by introducing a categorical label around which a narrative can be built. A diagnosis gives patients the tools to construct a story that explains their suffering and renders it comprehensible.
Interestingly, we see this potential mechanism in the origins of the Rumpelstiltskin story. The etymology of the little man’s strange name is typically traced to a German household imp, “little rattle stilt,” who was blamed for unexplained noises and mysterious movement of objects. This esoteric name is actually an explanation of the otherwise inexplicable.
Diagnosis and iatrogenic harm
Medical diagnoses also have potential downsides. A diagnosis can also bring fear, stigma, and unintended self-limitation. It can alter how people see themselves and how others see them, sometimes in alienating ways. In psychiatry especially, labels can carry cultural baggage, lead to discrimination, or encourage looping effects in which the diagnosis shapes behavior and identity in self-reinforcing cycles. Some people reject diagnostic framing entirely, preferring to see their experiences as spiritual, creative, or otherwise outside the language of disorder. For them, the official name can feel intrusive, even harmful. And when a diagnosis is misunderstood as a fixed defect, it can undermine agency, turning into a self-fulfilling prophecy. The initial therapeutic bump can also fade if the promised benefits, such as effective treatment and a supportive community, do not materialize.
Clinical implications and research directions
If the Rumpelstiltskin effect is as real and common as we suspect, it raises practical questions. Clinicians should be aware that part of a patient’s improvement may stem from the naming itself, not just the treatment. 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. We call for a structured research program to explore and quantify this effect and understand its relationship to related phenomena such as the placebo effect. Such work could refine clinical practice and help patients access the benefits of naming without falling into its traps.
The Rumpelstiltskin effect reminds us that the symbolic, the cultural, and the narrative are woven into the fabric of medicine. Naming can be a part of healing. It is time we study this effect with the attention it deserves.
Read the full article in BJPsych Bulletin: “The Rumpelstiltskin Effect: Therapeutic Repercussions of Clinical Diagnosis.
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This is so salient to the 4th edition of the book I am editing.
Quoted you "“When patients exhibit a desire for a particular diagnosis during a clinical interaction, clinicians should be sure to make space to explore the role that diagnosis would play for the patient, potentially touching on the mechanisms we lay out here to determine whether they apply to the patient’s interest in diagnosis.” (p.4)".
Thank you again for such an important contribution.
Interesting. Thx for sharing! This piece reminds me a lot of a section in my book "Scale-Smart" where I use the idea of a "Rumpelstiltskin effect" a bit more generally, but essentially with the same overarching theme: name it to tame it!
Here's the book section:
» The first core operation on mental matter is conceptualizing—or, in a phrase, name it to tame it. Much like in the fairy tale Rumpelstiltskin, the moment we give something a name, we begin to gain power over it. Until then, it stays fuzzy, slippery, lurking at the edges of thought. But once named, a concept crystallizes. It becomes a unit you can see, hold, think about—and, crucially, work with. To conceptualize is to give form to the formless. It’s the act of shaping mental mist into a defined object. And the tool we use for that is language. A name—no matter how arbitrary—acts like a handle. Without a handle, an idea might still exist, but it’s hard to pick up, turn over, or connect to anything else. With a handle, everything changes. Now you can grasp the idea. Move it. Share it. Build on it. This isn’t just a poetic metaphor. Research in cognitive science, linguistics, and psychology confirms a simple truth: naming is one of the most powerful acts the mind can perform. When you give something a name—be it an emotion, a challenge, or a recurring pattern—you’re not just labeling it. You’re mapping it into your inner world. You lift it to become a citizen in your personal mental ecology. In that sense, conceptualizing is how our World 2 carves meaning out of the chaos of World 1. Your brain doesn’t just absorb information—it interprets it through concepts. And concepts are made up of categories, distinctions, and—crucially—names.[^wittgenstein] Say you’re concerned about your weight, your back aches, and you’ve caught a cold. When you label this cluster “unhealthy,” you compress a web of sensations into a single idea: health. That unit becomes easier to monitor, talk about, and influence. Psychologists call this a chunk.[^miller] Linguists call it a signifier.[^saussure] Neuroscientists might call it a label that rewires perception by engaging regulatory circuits in the brain.[^lieberman] In every case, the function is the same: to make something handleable. That’s why naming an emotion—“anxiety,” “resentment,” “anticipation”—can reduce its grip. Studies show that labeling feelings calms the amygdala and activates the prefrontal cortex.[^lieberman] It’s like naming the monster in the dark: it doesn’t vanish, but it becomes less terrifying. Once you can name what you’re feeling, you’ve already begun to work with it.