Research: Alice in Wonderland syndrome
Alice in Wonderland syndrome was named after Lewis Carroll’s 19th-century novel Alice’s Adventures in Wonderland. In the story, Alice, the titular character, experiences numerous situations similar to those of micropsia and macropsia. The thorough descriptions of metamorphosis clearly described in the novel were the first of their kind to depict the bodily distortions associated with the condition. There is some speculation that Carroll may have written the story using his own direct experience with episodes of micropsia resulting from the numerous migraines he was known to experience. It has also been suggested that Carroll may have had temporal lobe epilepsy.
Alice in Wonderland syndrome (AIWS), also known as Todd’s syndrome or dysmetropsia, is a neurological disorder that distorts perception. People with this syndrome may experience distortions in their visual perception of objects, such as appearing smaller (micropsia) or larger (macropsia), or appearing to be closer (pelopsia) or farther (teleopsia) than they are. Distortion may also occur for senses other than vision.
The cause of Alice in Wonderland syndrome is currently unknown, but it has often been associated with migraines, head trauma, or viral encephalitis caused by Epstein–Barr virus infection.[6] It is also theorized that AIWS can be caused by abnormal amounts of electrical activity, resulting in abnormal blood flow in the parts of the brain that process visual perception and texture.
Although there are cases of Alice in Wonderland syndrome in both adolescents and adults, it is most commonly seen in children.
Classification
The classification is not universally agreed upon in literature, however, some authors distinguish true Alice in Wonderland syndrome based solely on symptoms related to alterations in a person’s body image. In contrast, they utilize the term “Alice in Wonderland-like syndrome” to encompass symptoms associated with changes in perception of vision, time, hearing, touch, or other external perceptions.
Signs and symptoms
With over 60 associated symptoms, AIWS affects the sense of vision, sensation, touch, and hearing, as well as the perception of one’s body image. Migraines, nausea, dizziness, and agitation are also commonly associated symptoms with Alice in Wonderland syndrome. Less frequent symptoms also include: loss of limb control and coordination, memory loss, lingering touch and sound sensations, and emotional instability. Alice in Wonderland syndrome is often associated with distortion of sensory perception, which involves visual, somatosensory, and non-visual symptoms. AIWS is characterized by the individual being able to recognize the distortion in the perception of their own body and is episodic. AIWS episodes vary in length from person to person. Episodes typically last from a few minutes to an hour, and each episode may vary in experience.
Visual distortions
Individuals with AIWS can experience illusions of expansion, reduction, or distortion of their body image, such as microsomatognosia (feeling that their own body or body parts are shrinking), or macrosomatognosia (feeling that their body or body parts are growing taller or larger). These changes in perception are collectively known as metamorphopsias, or Lilliputian hallucinations, which refer to objects appearing either smaller or larger than reality. People with certain neurological diseases may also experience similar visual hallucinations.
Within the category of Lilliputian hallucinations, people may experience either micropsia or macropsia.
Micropsia is an abnormal visual condition, usually occurring in the context of visual hallucination, in which the affected person sees objects as being smaller than they are in reality. Macropsia is a condition where the individual sees everything larger than it is. These visual distortions are sometimes classified as “Alice in Wonderland-like syndrome” instead of true Alice in Wonderland syndrome but are often still classified as Alice in Wonderland syndrome by health professionals and researchers since the distinction is not official.
Hallucinations
Zoopsias involve hallucinations of either swarm of small animals (e.g. ants and mice, etc.), or isolated groups of larger animals (e.g. dogs and elephants, etc.). This experience of zoopsias is a shared symptom of a variety of conditions, such as delirium tremens.
In addition, some people may, in conjunction with a high fever, experience more intense and overt hallucinations, seeing things that are not there, and misinterpreting events and situations.
Depersonalization/derealization
Along with these size, mass, and shape distortions of the body, those with Alice in Wonderland syndrome often experience a feeling of disconnection from one’s own body, feelings, thoughts, and environment.
Hearing and time distortions
Individuals experiencing Alice in Wonderland syndrome can also often experience paranoia as a result of disturbances in sound perception. These disturbances can include the amplification of soft sounds or the misinterpretation of common sounds. Other auditory changes include distortion in pitch and tone and hearing indistinguishable and strange voices, noises, or music.
A person affected by AIWS may also lose a sense of time, a problem similar to the lack of spatial perspective brought on by visual distortion. This condition is known as tachysensia. For those with tachysensia, time may seem to pass very slowly, similar to an LSD experience, and the lack of time and space perspective can also lead to a distorted sense of velocity.
For example, an object could be moving extremely slowly in reality, but to a person experiencing time distortions, it could seem that the object was sprinting uncontrollably along a moving walkway, leading to severe, overwhelming disorientation. Having symptoms of tachysensia is correlated with various underlying conditions, including substance use, migraine, epilepsy, head trauma, and encephalitis. Regardless of an individual’s disease diagnosis, tachysensia is often included as a symptom associated with Alice in Wonderland Syndrome since it is classified as a perceptual distortion. Therefore, a person can be described as having Alice in Wonderland syndrome even if that person is experiencing tachysensia due to an underlying condition.
Causes
Because AlWS is not commonly diagnosed and documented, it is difficult to estimate what the main causes are. The cause of over half of the documented cases of Alice in Wonderland syndrome is unknown. Complete and partial forms of the AIWS exist in a range of other disorders, including epilepsy, intoxicants, infectious states, fevers, and brain lesions.[12][28] Furthermore, the syndrome is commonly associated with migraines, as well as excessive screen use in dark spaces and the use of psychoactive drugs.
History
The syndrome is sometimes called Todd’s syndrome, about a description of the condition in 1955 by Dr. John Todd (1914–1987), a British consultant psychiatrist at High Royds Hospital at Menston in West Yorkshire. Dr. Todd discovered that several of his patients experienced severe headaches causing them to see and perceive objects as greatly out of proportion. In addition, they had altered sense of time and touch, as well as distorted perceptions of their own body. Despite having migraine headaches, none of these patients had brain tumors, damaged eyesight, or mental illness that could have accounted for these and similar symptoms. They were all able to think lucidly and could distinguish hallucinations from reality, however, their perceptions were distorted.
Dr. Todd speculated that author Lewis Carroll had used his own migraine experiences as a source of inspiration for his famous 1865 novel Alice’s Adventures in Wonderland. Carroll’s diary reveals that, in 1856, he consulted William Bowman, an ophthalmologist, about the visual manifestations of the migraines he regularly experienced. In Carroll’s diaries, he often wrote of a “bilious headache” that came coupled with severe nausea and vomiting. In 1885, he wrote that he had “experienced, for the second time, that odd optical affection of seeing moving fortifications, followed by a headache”. Carroll wrote two books about Alice, the heroine after which the syndrome is named. In the story, Alice experiences several strange feelings that overlap with the characteristics of the syndrome, such as slowing time perception. In chapter two of Alice’s Adventures in Wonderland (1865), Alice’s body shrinks after drinking from a bottle labeled “DRINK ME”, after which she consumed a cake that made her so large that she almost touched the ceiling. These features of the story describes the macropsia and micropsia that are so characteristic to this disease.
These symptoms have been reported before in scientific literature, including World War I and II soldiers with occipital lesions, so Todd understood that he was not the first person to discover this phenomenon. Additionally, as early as 1933, other researchers such as Coleman and Lippman had compared these symptoms to the story of Alice in Wonderland. Caro Lippman was the first to hypothesize that the bodily changes that Alice encounters mimicked those of Lewis Carroll’s migraine symptoms. Others suggest that Carroll may have familiarized himself with these distorted perceptions through his knowledge of hallucinogenic mushrooms. It has been suggested that Carroll would have been aware of mycologist Mordecai Cubitt Cooke’s description of the intoxicating effects of the fungus Amanita muscaria (commonly known as the fly agaric or fly amanita), in his books The Seven Sisters of Sleep and A Plain and Easy Account of British Fungi.
Bibliography