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[!summary]Getting a diagnosis can bring relief by explaining feelings and struggles. It helps some people feel understood and find support. But labeling mild symptoms may sometimes cause harm or limit how people see themselves.
Highlights
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Something similar happened to a co-worker, and a cousin in his 30s, and an increasing number of people I met covering mental health. It wasn’t always A.D.H.D. For some of them, the revelation was a diagnosis of autism spectrum disorder: After years of inarticulate unease in social situations, they felt freed by the framework of neurodivergence, and embraced by the community that came along with it.
Efecto rumpelstinkin en el caso del TEA puede ir de la mano con la glorificación de la victimización asociada a la identidad. Un poco en la línea de lo que plantea la entrevistada del podcast de Ezra Klein.
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Others say it’s not helping people with milder illnesses, either, especially if they are young. Diagnosis, they say, can set in motion a self-fulfilling prophecy. By reporting mild or transient symptoms as disorders, we may create an “expectation of illness,” as the Irish neurologist Suzanne O’Sullivan puts it, where “there is little or no disease.”
Expectativa de enfermedad como un caso de profecía auto cumplida asociada al efecto rumpelstinkin.
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Researchers, digging into the downstream effects of diagnoses, are beginning to see this effect play out over the long term. Diagnoses do lock you in. They suggest biological inevitability, not a rough patch.
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While diagnosis can lead to concrete benefits like treatment and accommodations, its psychological benefit “seems to go beyond” either of these, said Dr. Aftab, a clinical associate professor of psychiatry at Case Western Reserve University. It resembled the placebo effect — an improvement, generally attributed to positive expectation, that occurs after receiving an inert treatment, and which doctors have employed for centuries.
Relación del alivio del diagnóstico con el efecto placebo.
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What the phenomenon needed was a name. The paper that Mr. Levinovitz and Dr. Aftab published in August in BJPsych Bulletin called it the “Rumpelstiltskin effect,” after the imp in the Brothers Grimm fairy tale. In the story, a desperate woman falls under the power of a malicious spirit, who demands that she surrender her firstborn child to him. The imp offers her one way out: If she can guess his name, she will be free. So she guesses every name she can think of, until she lands on the right one, and the imp slinks away, stripped of his power. The authors suggest that something similar occurs at the moment of diagnosis, relieving both ambiguity and self-blame. “The therapeutic effect of feeling like you have an explanation for something, an official explanation, it’s really remarkable,” Mr. Levinovitz said. “People talk about how we are narrative creatures, and we tell stories to make sense of ourselves. This is a special kind of story, a diagnosis.”
Creación del concepto y relación con faceta narrativa del ser humano.
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autism diagnosis changed so many things. It provided, as she put it, an “explanatory model for why I was struggling.”
Una narrativa.
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“It’s like you’ve spent your whole life at the bottom of a set of stairs, and there is a Greek chorus telling you: ‘Why can’t you just take the stairs? Why are you such a screw-up? Are you lazy? Are you trying to be difficult?’” said Ms. Latour, a writer and educator in Boston. “It’s great, at age 50, to realize you didn’t have the tools you needed to take the stairs.”
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After trying a few different treatments, she has accepted that there’s most likely no magic bullet. Maybe, she told me, what will ultimately remain is frustration, that “this thing never changes about me.” But still, she said, she’d take it. The symptoms may still be there, but they no longer stir up self-hatred. “I still think I prefer it,” she said, “to thinking that I’m a bad person.”
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evidence is emerging that over the long term, diagnosing milder conditions doesn’t help. Yes, there is a positive effect of lowered self-blame. But there is a negative effect, as well, of greater pessimism about recovery.
Idea de reel sobre este tema, acompañándolo de la evidencia disponible.
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The results, she said, follow the logic of a self-fulfilling prophecy. Diagnoses set up expectations: Young people who are told that they have anxiety may withdraw from social situations and miss opportunities to build relationships, which are known to protect mental health.
Profecía autocumplida