What’s in a name? According to the lovesick Juliet, not very much. As she says in Shakespeare’s famous tragedy, “That which we call a rose by any other name would smell as sweet.”
Juliet did not believe that a label could change the nature of things but others would disagree. In the classic Grimm’s tale, Rumpelstiltskin, a young woman promises her firstborn child to a little man who spins straw into gold for her. When it becomes time to collect his debt, she begs for mercy and he offers her a way out. She must guess his name. She runs through every possibility she can think of but with no luck. At the very last minute, a spy overhears the little man singing his name–Rumpelstiltskin. When she says it aloud, he stomps his foot so hard into the ground a chasm opens up and he disappears forever. Problem solved.
Apologies to Juliet but I agree with Rumpelstiltskin. Names have power. This is a recurring theme in folk tales and beyond. Across cultures and time, to name something is to access it, to define it, or to exert influence over it.
This is especially true in medicine. Naming an illness can have a therapeutic effect. Diagnoses can be medical interventions in themselves. I had a patient who found tremendous relief when she was diagnosed with bipolar disorder. It was a turning point. The ups and downs she had been cycling through during her late teens and early twenties finally made sense. She wasn’t “crazy,” she wasn’t unhinged. She had a mental illness and it could be treated.
Researchers at James Madison University and Case Western Reserve University discuss the therapeutic power of naming a clinical diagnosis in a recent paper. They call this phenomenon the Rumpelstiltskin Effect.
“There’s something fascinating that happens when a patient hears an official name for what they’re experiencing – the unknown becomes knowable and manageable just by being named, which can relieve physical and mental suffering” observed Alan Levinovitz, one of the authors.
A diagnosis can bring relief, validation, and even lessen self-blame. But it can also do harm.
A person diagnosed with an anxiety disorder may decide it is best to avoid anxiety-provoking situations. It can also shift a person’s self-concept. As the authors observe, “Particularly worrisome is when patients internalize the idea that their diagnosis identifies a chronic, intrinsic deficiency, which can foreclose on agency and turn diagnosis into a self-fulfilling prophecy.” A psychiatric diagnosis can also alter a person’s behaviors and how they understand their symptoms. It can undermine self-worth and make recovery seem out of reach. When a diagnosis becomes central to identity, I have seen it become a shield to explain behavior rather than something to work on. Just because a person can name their pattern does not mean they have ever done anything about it.
When a patient presses me for a diagnosis, I ask what they hope it will give them. I also ask them what they hope it will change. A name matters most for what we do with it. Used well, a diagnosis can add insight to the story we tell about ourselves. Held too tightly, it can become the whole story.
Whatever the diagnosis, the key is to grow beyond it.
I wish you all the best,
Dr. Samantha Boardman
