The Syndrome of Alice in Wonderland

The Alice in Wonderland Syndrome (AIWS) was first coined by the British psychiatrist John Todd and was based upon the childhood story, Alice’s Adventures in Wonderland by Lewis Carroll in 1865. “Todd's patients felt they were too small, too tall, or parts of their bodies were changing shape, size, or relationship to the rest of their bodies. Some recalled the feeling of their bodies expanding or contracting in closed spaces or splitting in half.” (Fine, 2013). Coincidentally, such experiences were extremely similar to the novel’s main character, Alice. Alice would often find herself becoming remarkably tall or remarkably short during her adventures in her dreams. She would also sometimes become aware of other, more subtle changes in herself and her environment, such as addressing herself as though she were two people on occasion (Todd, 1955). However, these experiences were not limited to the fantasy world, and when such symptoms were found in his patients, Todd appropriately termed the infliction the ‘Alice in Wonderland’ syndrome. Another fascinating reason behind the chosen name was to acknowledge the fact that the author of the novel, Charles Lutwidge Dodgson under the pseudonym Lewis Carroll, also suffered from migraines himself. It was then speculated that Dodgson may have possibly experienced such symptoms himself, before weaving his illusory experiences into a story.

The AIWS is a group of symptoms generally associated with migraine, epilepsy, infections and intoxications (Todd, 1955). Patients under the influence of AIWS will undergo periods of distorted space, time and body image. Illusory changes in size, distance, position of stationary objects in ones visual field, illusory feelings of levitation and illusory alterations in the sense of the passage of time are often experienced. An example can be seen in American neurologist Caro Lippman’s patient who often suffered from “bilious headaches”. During severe attacks she would frequently experience the following hallucination of her body image: “I get all tired out from pulling my head down from the ceiling. I’ve been pulling it down all night long. … On the second day of this attack, a bad one, my head fell into a deep hole under the head of the bed – it was a very deep hole.” (Lippman, 1952 ).

AIWS can often be quite difficult to diagnose. It was common for people suffering from AIWS to keep their experiences locked away within the confines of their own minds, often terrified of the thought of revealing their experiences to the public as they constantly feared that they were on the path to insanity, that they would be labelled ‘crazy’. The majority of Lippman’s patients would often confide in him: “I never mentioned this to anyone until…[you]…asked some questions recently about my experience. I have never told anyone else, as I have not wanted to be called or thought of as queer, and even a supposedly understanding doctor might lift his eyebrows at some of the happenings of a migraine victim…” (Lippman, 1952) From this we can see that most victims are extremely unwilling to confess to having suffered from experiences as queer as those of the AIWS, unless carefully prompted by a doctor they trust. In the present, diagnosis of AIWS has become much easier as we know that the syndrome can often be associated with migraines, epilepsy, infections and intoxication. In the past however, without this knowledge, such symptoms may have even be passed off for psychiatric evaluations or treated with psychotropic drugs. Furthermore, left unnoticed, AIWS being linked to a wide variety of potential causes would naturally also require rather specific treatment depending on the underlying condition. Hence, if not brought to attention, AIWS can often be easily missed and left untreated. Fortunately, once identified, treatment is generally affective (Farooq and Fine, 2017).

Unfortunately, knowledge on the specific causes of AIWS is still extremely limited. A significant project conducted by Yung-Ting Kuo along with a team of specialist doctors in paediatrics and nuclear medicine used nuclear medicine techniques to provide information on cerebral perfusion and metabolism, aiming to detect possible ideas as to abnormally functioning areas involved with AIWS. Technetium-99m was absorbed into the brain via intravenous injection and left to remain in the brain for 24 hours. It was discovered that during episodes of AIWS, decreased cerebral perfusion in various regions of the brain were detected, namely the frontal, parietal, temporal and occipital lobes. As a result, it has been postulated that any decrease in the perfusion in the visual pathways or visual centers of the brain related conditions may be responsible for the syndrome (Kuo et al., 1998), however further research is required to confirm these results and determine other potential causes of AIWS.

In conclusion, although much more is known about the AIWS today, many areas are still a mystery. Intensive further research must be conducted to ascertain the exact causes of AIWS and increased awareness of the syndrome should be introduced to the public. This would be effective in order to minimise psychological distress in those who may be experiencing these unique and disorienting symptoms and provide comfort that the syndrome is completely normal – they are not ‘crazy’.