Chasing the Wild Duck: Ethical Considerations and Repercussions of Psychiatric Diagnosis

Abstract

Levinovitz and Aftab’s (2025) formulation of the Rumpelstiltskin effect captures a familiar clini- cal phenomenon in which receiving a diagnosis in itself can be therapeutic. This paper analyzes the structure and ethical implications of this effect in psychiatric diagnosis. We suggest that this effect may be amplified by what Gilbert Ryle termed a category mistake, in which descriptive diagnostic categories are mistaken for underlying monocausal neurobiological essences. This misinterpretation increases the perceived explanatory power of a diagnosis and may contribute to its thera- peutic effect. If so, the relief afforded by diagnosis may depend on what Henrik Ibsen described as a “life-lie,” a stabilizing but potentially misleading understanding of one’s condition. We term this the “wild duck dilemma”: an ethical situation in which correcting a potentially misleading explanatory belief could undermine relief or coherent self-understanding, while leaving it unchal- lenged may fix the person within a limiting framework and inflict a loss of trust in psychiatry if the life-lie is later revealed. To show how explanatory beliefs may limit patients, we draw on Heideggerian existential hermeneutics and argue that psychiatric diagnosis is not merely descriptive but world-disclosing: it orga- nizes how a person understands their past, present, and future possibilities. Heidegger’s account of solicitude is presented as a conceptual lens to articulate the dilemma by offering orientation and understanding without fore- closing the patient’s possibilities for self-interpretation. Finally, we show how associated debates in the ethics of disclosure and deontological versus utilitarian per- spectives may clarify the moral tensions and practical implications of the wild duck dilemma.