I have seen patients receive a diagnosis in clinic many times. With broken bones the consultant can point to the images: it was broken; it’s now fixed. Pain clinics are different because pain does not show on any scans or in any blood tests. MRIs and test results are displayed and they are often showing the absence of sinister things you don’t want to see — but they are not showing pain. It is powerful to watch the relief patients feel when they meet a doctor who understands what they’ve been going through and who can give them a name for their suffering.

Last year I was seeing a clinical psychologist because my partner described me as “tricky” in our relationship. I learned I had face-blindness in my early thirties, (that diagnosis explained much of my experience), and for a while I’d suspected I was “a bit ADHD or something” — but I had zero interest in being tested because I got by. The psychologist offered me a working diagnosis, and like the pain doctor there were no scans or blood tests, but she carefully laid out the reasons why her diagnosis accounted for a lot of my trickiness. Despite not seeking this explanation I felt some understanding and relief nevertheless.

There is a fairy tale where an imp comes to collect a woman’s first born child as the price for a bargain made when he had spun straw into gold for her. The imp says he’ll release her from her promise if she can guess his real name in the next three nights. By the third night she has cleverly discovered the name. At first she feigns ignorance, then she says, “Rumpelstiltskin!”  With that word she is freed.

The real name has a power that an ordinary description lacks. “Funny little man” describes the imp well but has no power.  The language is important. The consultant delivered his diagnoses in medical words which have power beyond ordinary language. If my psychologist’s diagnosis had merely been, “you’re tricky” in ordinary language there would have been no clarity or relief for me. 

Ordinary language has blame and shame, it focuses on agency. Medical language has a focus on mechanisms. At the personal level I felt clarity and lighter in my heart realising that some of the sheer effort of living, and fitting in, and trying so hard not to be tricky with the few people I allow to get close — is likely better explained by medical language than the ordinary language of agency.  

There are a few important potential and real negative aspects to this Rumpelstiltskin effect.*  Two things stand out for me: one is the way a diagnosis has the potential power to define your identity. The other is the way the language of the consultant and the psychologist has the appearance of science but, when you think about it, the diagnoses are still at the level of description. And yet we feel relief. This is a blog about the power of language to shape our reality, and an invitation to consider how it manages to do that. 

Oli

A Moodscope member

* This is the paper which coined the term “Rumpelstiltskin effect”. 

https://doi.org/10.1192/bjb.2025.10137