I realise I haven’t told you about the recent New Zealand Psychological Society annual conference in Hamilton. Other than getting snowed on as we returned via the Desert Road.
As well as the usual presentations and workshops, it was also a place for academics and practitioners to talk about the revision of our code of ethics, a discussion about scopes of practice, and the vexing topic of psychology assistants.
The keynote speeches took place in the University of Waikato’s stunning new events space, The Pā. One of the speakers was Keith Petrie, professor of health psychology at the University of Auckland, whose work I’ve written about before.
He took the audience through what we know about the placebo effect – a positive health response to an inactive substance – and its “lesser-known sibling” the nocebo effect: when we experience a negative outcome in the absence of a valid cause.
Placebo effects are commonly considered to have been first described by US anaesthetist Henry Knowles Beecher, who noted that injured World War II soldiers appeared to feel pain-relieving effects when administered saline rather than painkillers (when the painkillers ran out).
We’ve since learnt a lot about placebos and nocebos, in no small part due to Petrie’s work. We know some portion of medicine-related benefit – above what the medicine itself does – is due to the placebo effect. We know branded medications work better than non-branded versions of exactly the same drug.
After his talk, Petrie alerted me to a paper he’d read about the “Rumpelstiltskin Effect”, which he duly dug up and sent me.The name Rumpelstiltskin will be familiar from a Grimms’ fairytale in which the titular imp spins straw into gold for the miller’s daughter in return for her firstborn child, unless she can guess his name.
The Rumpelstiltskin Effect was coined in a series of articles by philosopher Alan Levinovitz, of James Madison University, Virginia, and Case Western Reserve University, Ohio, psychiatrist Awais Aftab.
Just as placebo researchers have shown people feel better when they’re given a branded medication, the “Rumpelstiltskin Effect” is Levinovitz and Aftab’s term for the relief from symptoms many people experience when a credible someone gives them a clinical diagnostic label for those symptoms.
This relief is often apparent even when the diagnosis doesn’t explain the cause of the condition or inform treatment. People, particularly those who’ve experienced symptoms for a long time, just feel better having a label to hang them on.
Levinovitz and Aftab draw off other people’s research that shows receiving a diagnosis has at least five types of effects. All have an upside and a downside, with the upside generally more common.
For example, diagnosis often gives people a sense that they have a direction to move in, but also sometimes the uncertainty of whether the condition can be resolved.
People often report greater understanding from close others, and better support from professionals, but some also worry about losing support if they disclose their diagnosis. In terms of psychosocial impact, many people feel their experience to be validated: their symptoms were “real” and therefore can be more visible to others.
But sometimes people experience stigma associated with ignorance of their conditions.
This shouldn’t surprise us. Being told by an Emergency Department registrar that you are having a heart attack is a double-edged sword – you’re having a heart attack, but at least you’re not wasting anyone’s time with acute indigestion.
