From The Rainbow Machine: Tales from a Neurolinguist’s Journal by Andrew T. Austin.
An explanation can become convincing because everyone repeats it. A suggestion made at the beginning of an emergency may travel through several people and several forms until it looks like an established fact. Once that happens, later observations may be forced into the original story.
The “Phobia” chapter of The Rainbow Machine contains an account that I now understand very differently from when I wrote it. Correcting that account matters. It also brings into focus a separate practical issue: helping someone with fear requires accurate information about what is happening, including what they fear the treatment itself will do.
The snakebite explanation I accepted
During my work in accident and emergency, we received advance notice of a man arriving with severe anaphylaxis, reportedly following a snakebite. He had been working outdoors, some distance from easy access to help. The department prepared to receive him urgently.
When a colleague and I removed his clothing as part of the emergency response, I noticed his heavy trousers and high boots. The story of a snake biting his lower leg no longer seemed to fit what I was seeing. At the time, I made an extraordinary interpretive leap: perhaps he had become critically ill through the suggestion that he had been bitten.
That was not established by the observation. Clothing that appeared inconsistent with the reported mechanism did not demonstrate a psychological cause for anaphylaxis. Nor could I infer what the patient believed simply from the information that had reached the department.
A possible error in the chain of information
My later understanding is that a much more ordinary process may explain the snakebite account. Someone sees a colleague collapse while working in undergrowth and suggests a snakebite. That explanation is passed to the ambulance service, enters the handover information and is copied into the receiving department’s paperwork.
At each stage, the fact that the information has been recorded can make it look more secure. Several records may appear to confirm each other while all derive from the same initial guess. The people responding to the emergency are then working within an explanation they did not originate and may not have had time to question.
This reconstruction is itself an interpretation made later, not a verified account of every conversation at the scene. The actual trigger of the man’s anaphylaxis is unknown to me. Food or medication were possibilities I considered afterwards, not diagnoses I can now assign. He survived, but I cannot supply a complete account of his subsequent recovery.
The defensible lesson concerns the assumptions of the observers, including me. I had no basis for presenting the incident as evidence that suggestion caused the patient’s anaphylaxis.
An allergy is not a phobia of the immune system
I also used an analogy between allergy and phobia that I no longer regard as sound. Describing both as learned responses does not establish that they use the same mechanism or that changing one psychological pattern will change an allergic response. Similar language can conceal very different processes.
Anaphylaxis is a life-threatening allergic reaction requiring emergency treatment. It should not be treated as a belief problem or managed with a phobia technique. Suspected anaphylaxis requires immediate emergency help, including calling 999 in the UK and using a prescribed adrenaline auto-injector as directed.
The correction does not reduce the importance of psychological experience. It keeps the claim within what the evidence can support. An interesting metaphor is not a medical explanation.
A woman who feared blood and injections
A separate case involved a woman who needed a blood test for an important assessment. Her response to blood and injection-related language was extreme: even mentioning the subject could be followed by loss of consciousness. The practical problem was not a vague dislike of needles but a substantial obstacle to receiving care.
The short book account omitted a useful detail. I assessed her first, then she left and I considered what to do. The subsequent work happened at another appointment. Leaving out that interval makes an intervention look more immediate and effortless than its preparation actually was.
I have sometimes drawn too sharp a distinction between phobia and ordinary fear on the basis of fainting. Fainting is not required for a phobia. The NHS description of phobias includes a range of emotional and physical reactions and the effect on everyday life. The person’s actual response needs assessment rather than a test of whether it resembles the most dramatic case a practitioner has seen.
Why the prospect of improvement can feel threatening
A person may reason that having a needle phobia currently protects them from being given an injection. If the fear is removed, they expect the injection to follow. From their present frightened position, being “cured” can therefore sound like being brought closer to the very event they are trying to avoid.
In NLP terms, treatment and the feared event have become linked in meaning. Understanding that link can explain reluctance without describing the person as obstructive or secretly unwilling to improve. The person may want greater freedom while also fearing that help will remove their control.
A useful conversation makes the terms explicit. What will happen at this appointment? What will not happen without agreement? What choices remain available? A person needs to be able to ask questions, pause and decline. Confidence is difficult to develop if the helper’s intentions remain uncertain.
Slowing down an imagined procedure
My impression was that this woman had frightening ideas about what an injection involved without a clear, realistic understanding of the procedure. I drew on nursing material to explain it slowly and in detail. The aim was to make the event understandable instead of leaving a rapid sequence of alarming images unexamined.
I remember the explanation taking roughly forty to forty-five minutes, although it felt longer. It was deliberately unhurried. The point was not to deliver an elaborate hypnotic performance but to allow ordinary information to acquire a manageable shape and sequence.
The historical account also includes her fainting and my unconventional response when she recovered. That is not a procedure to reproduce. Loss of consciousness requires appropriate assessment and protection from injury. Guy’s and St Thomas’ guidance on needle fear distinguishes fainting-related responses from panic and describes support that can include applied tension or talking therapies. The approach should fit the person’s physical response.
The significance of where the box was placed
Equipment used for familiarisation was kept in a closed box at the back of the room, away from me. I explained what was in it. The location mattered because I did not want to appear to be concealing an object I might suddenly produce and impose on her.
Some people have experienced others teasing or frightening them with a feared object. A therapy appointment should not recreate that expectation. The arrangement was intended to separate an opportunity to approach from an instruction to comply.
After the explanation, she began considering whether to look in the box. I left the decision to her instead of directing each movement with suggestions. In current practice, preserving choice also means responding clearly to requests for reassurance or permission. Silence should not create a new uncertainty about whether the person is safe or allowed to stop.
This story concerns consent, preparation and the organisation of an encounter. It is not a guide to handling needles or performing injections. Any clinical procedure or use of sharps belongs with appropriately trained staff, suitable equipment and infection-control arrangements.
What a practitioner’s success story can tell us
I recall this general approach as helpful in many of the cases where I used it. I also recall a woman with a wasp phobia whom I could not help after three sessions. I could not identify a clear feature that explained the difference. That unsuccessful work belongs in the account too.
These recollections do not provide a controlled success rate or establish that every phobia has the same structure. Fear may involve an earlier experience, learned expectations, beliefs about danger, bodily reactions and fear of other people’s responses. Listening carefully to the particular person remains more useful than assuming a named technique has already supplied the explanation.
More from The Rainbow Machine
Browse the Rainbow Machine article index for related writing on assumptions, clinical claims, communication and the organisation of change.