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.
Kudos to Prof. Levinovitz and Dr. Aftab for a rich and important conceptual piece on "diagnosis" and naming. There is much that can be said on this topic, but here are a few off-the-cuff comments.
* First, the act of "naming" something--or changing a name--has mythic and spiritual resonances going back to Biblical times; e.g., when, after he wrestles with an angel, Jacob's name is changed to Israel, meaning "One who struggles with God." [1]
* Although a "diagnosis" certainly does have a "naming" function, the etymology of the term points to its epistemic content (gnosis) and value; literally, the term means, "knowing the difference between" (dia=across or between; gnosis=knowledge or knowing). So when, after a careful evaluation, the physician provides a "dia-gnosis", he or she is both naming something and also asserting, "I have determined the difference between your condition and many, many others that you do not have." And in this area, a conversation with the patient may begin, as regards the nature and significance of the diagnosis and its referent (e.g., rheumatoid arthritis, schizophrenia, or whatever).
* As a psychiatrist, I have found that a carefully-obtained diagnosis--when presented tactfully and tentatively, and with adequate information--can indeed be affirming, validating, and relieving to the patient. For example: I have treated many patients whose mood swings and erratic behavior went undiagnosed for many years, until finally, bipolar disorder was "named", diagnosed, and successfully treated. Just hearing the name "bipolar disorder" can be a source of relief and epistemic value for the patient, whose symptoms and dysfunction are no longer attributed to lack of self-discipline, "stress", failure of self-understanding, etc. (Of course, these and various psycho-social/cultural factors may sometimes be contributing or exacerbating factors).
*Yes, a diagnosis--more accurately, the name of a diagnosis--can sometimes be unsettling and anxiety-provoking, especially some that carry pejorative connotations. In psychiatry, the term "borderline" (as in Borderline Personality Disorder) is one example. And if a diagnosis is presented to the patient as a fixed and essential feature of his or her personhood, damage may be done. The careful clinician takes pains to avoid such a (mis)presentation by emphasizing that the person in treatment is not exhaustively defined by his or her diagnosis; that there are aspects of the condition over which he or she can exercise control; and that nothing is "written in stone." Many patients recover from their illnesses and most can be treated effectively. (And, in case it needs re-stating, many problems treated by psychiatrists and psychologists are not diseases or disorders, but variations of "normal" or dimensional features, such as poor attention span, anxiety, etc.)
* There is a curious cultural-linguistic bias that often attaches to psychiatric diagnoses; i.e., they are often referred to as "labels." We do not find this term used with reference to conditions in general medicine--nobody says, "I was labeled with cancer"-- or even in neurology, where many conditions do not have a well-characterized pathophysiology or etiology. For example, nobody speaks of being "labeled" with migraine headaches, or "labeled" with idiopathic facial pain. This is a topic I intend to explore further in another venue, in relation to what I view as a form of anti-psychiatric prejudice.
Thank you again for a stimulating article and discussion!
I have to respectfully disagree. Society would be better served by stretching the boundaries of “normal” more generously, and accommodating wider ranges of behavior, rather than coming up with a name for every deviation. “Learning disability” is a way of placing the onus of a disability on a perfectly normal person with a different learning style, rather than expanding methods of education. “Rape trauma syndrome” medicalizes into a syndrome some socially understandable responses to horrific physical attack. “Depression” is sometimes a completely justifiable response to living a life of stress, pressure, and unavoidable obligation ( caretakers of people with Alzheimer’s/ single mothers). And don’t get me started on turning prolonged grief over the loss of a mother or spouse or child into a mental disorder. We were, as a whole, better off when people were described as “odd” or “eccentric” or “grumpy” or “so easily distracted.” None of us are perfect, but I am grateful that my quirks have not yet been pathologized (So far).
I believe the idea of "name it to tame it" is powerful. You write:
> "Learning disability” is a way of placing the onus of a disability on a perfectly normal person with a different learning style
--- but what are "learning styles" if not named-to-tamed differences? I see the problem only in calling it a "disability," not in "coming up with a name for every deviation." I know the problem in blaming, calling something "unhealthy."
Also, "normal" has become a loaded word, but it just means "typical". You seem to have attached a value judgment to the word that it does not have. Normal is neither good nor bad. It just states what is common and what is not.
I have to disagree that "normal" has no connotations. If you are told by your doctor that you have an abnormality, that is generally not good news. If you have a baby and you are told it's not normal, that's not 'neither good nor bad.' Our society expects certain behaviors from its members, and the question is always, what are the consequences for deviating. Vance says people should be institutionalized for being homeless and yelling in the street. (Presumably MAGA people who are housed and yell at transgender people are exempt from this). I have represented people who are institutionalized for psychiatric disabilities for forty years, and always marvelled at how society decides which behavioral deviations have to be involuntarily segregated. Certainly when I worked in Montana in the 1980s, many of the people at the State Hospital took second place in the category of mental and emotional disturbance to many of the people who were living in the mountains.
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.
Kudos to Prof. Levinovitz and Dr. Aftab for a rich and important conceptual piece on "diagnosis" and naming. There is much that can be said on this topic, but here are a few off-the-cuff comments.
* First, the act of "naming" something--or changing a name--has mythic and spiritual resonances going back to Biblical times; e.g., when, after he wrestles with an angel, Jacob's name is changed to Israel, meaning "One who struggles with God." [1]
* Although a "diagnosis" certainly does have a "naming" function, the etymology of the term points to its epistemic content (gnosis) and value; literally, the term means, "knowing the difference between" (dia=across or between; gnosis=knowledge or knowing). So when, after a careful evaluation, the physician provides a "dia-gnosis", he or she is both naming something and also asserting, "I have determined the difference between your condition and many, many others that you do not have." And in this area, a conversation with the patient may begin, as regards the nature and significance of the diagnosis and its referent (e.g., rheumatoid arthritis, schizophrenia, or whatever).
* As a psychiatrist, I have found that a carefully-obtained diagnosis--when presented tactfully and tentatively, and with adequate information--can indeed be affirming, validating, and relieving to the patient. For example: I have treated many patients whose mood swings and erratic behavior went undiagnosed for many years, until finally, bipolar disorder was "named", diagnosed, and successfully treated. Just hearing the name "bipolar disorder" can be a source of relief and epistemic value for the patient, whose symptoms and dysfunction are no longer attributed to lack of self-discipline, "stress", failure of self-understanding, etc. (Of course, these and various psycho-social/cultural factors may sometimes be contributing or exacerbating factors).
*Yes, a diagnosis--more accurately, the name of a diagnosis--can sometimes be unsettling and anxiety-provoking, especially some that carry pejorative connotations. In psychiatry, the term "borderline" (as in Borderline Personality Disorder) is one example. And if a diagnosis is presented to the patient as a fixed and essential feature of his or her personhood, damage may be done. The careful clinician takes pains to avoid such a (mis)presentation by emphasizing that the person in treatment is not exhaustively defined by his or her diagnosis; that there are aspects of the condition over which he or she can exercise control; and that nothing is "written in stone." Many patients recover from their illnesses and most can be treated effectively. (And, in case it needs re-stating, many problems treated by psychiatrists and psychologists are not diseases or disorders, but variations of "normal" or dimensional features, such as poor attention span, anxiety, etc.)
* There is a curious cultural-linguistic bias that often attaches to psychiatric diagnoses; i.e., they are often referred to as "labels." We do not find this term used with reference to conditions in general medicine--nobody says, "I was labeled with cancer"-- or even in neurology, where many conditions do not have a well-characterized pathophysiology or etiology. For example, nobody speaks of being "labeled" with migraine headaches, or "labeled" with idiopathic facial pain. This is a topic I intend to explore further in another venue, in relation to what I view as a form of anti-psychiatric prejudice.
Thank you again for a stimulating article and discussion!
Ronald W. Pies MD
Professor Emeritus of Psychiatry
I have to respectfully disagree. Society would be better served by stretching the boundaries of “normal” more generously, and accommodating wider ranges of behavior, rather than coming up with a name for every deviation. “Learning disability” is a way of placing the onus of a disability on a perfectly normal person with a different learning style, rather than expanding methods of education. “Rape trauma syndrome” medicalizes into a syndrome some socially understandable responses to horrific physical attack. “Depression” is sometimes a completely justifiable response to living a life of stress, pressure, and unavoidable obligation ( caretakers of people with Alzheimer’s/ single mothers). And don’t get me started on turning prolonged grief over the loss of a mother or spouse or child into a mental disorder. We were, as a whole, better off when people were described as “odd” or “eccentric” or “grumpy” or “so easily distracted.” None of us are perfect, but I am grateful that my quirks have not yet been pathologized (So far).
I believe the idea of "name it to tame it" is powerful. You write:
> "Learning disability” is a way of placing the onus of a disability on a perfectly normal person with a different learning style
--- but what are "learning styles" if not named-to-tamed differences? I see the problem only in calling it a "disability," not in "coming up with a name for every deviation." I know the problem in blaming, calling something "unhealthy."
Also, "normal" has become a loaded word, but it just means "typical". You seem to have attached a value judgment to the word that it does not have. Normal is neither good nor bad. It just states what is common and what is not.
I have to disagree that "normal" has no connotations. If you are told by your doctor that you have an abnormality, that is generally not good news. If you have a baby and you are told it's not normal, that's not 'neither good nor bad.' Our society expects certain behaviors from its members, and the question is always, what are the consequences for deviating. Vance says people should be institutionalized for being homeless and yelling in the street. (Presumably MAGA people who are housed and yell at transgender people are exempt from this). I have represented people who are institutionalized for psychiatric disabilities for forty years, and always marvelled at how society decides which behavioral deviations have to be involuntarily segregated. Certainly when I worked in Montana in the 1980s, many of the people at the State Hospital took second place in the category of mental and emotional disturbance to many of the people who were living in the mountains.