Alice…In Wonderland

What we see or feel is often not the reality.

Alice in Wonderland syndrome (AiWS) is an unusual condition with a special name. It is also known as Todd’s syndrome, and it is a rare neuropsychological condition that in children is most common from age two to 13, with the average patient being six years old. More girls are affected than boys. Usually they grow out of it as they grow older.

It is characterised by distortions of visual perception, the body image, and the experience of time.

Alice in Wonderland syndrome was named after Lewis Carroll’s famous 19th-century novel.

The syndrome is sometimes called Todd’s syndrome in reference to a description of the condition in 1955 by Dr John Todd, a British consultant psychiatrist who discovered that several of his patients experienced severe headaches causing them to see and perceive objects as greatly out of proportion. They have altered sense of time and touch, as well as irreal perception of their own body.

Although having migraine headaches or epilepsy, none of these patients had brain tumors, damaged eyesight, or mental illness that could have caused similar symptoms. They were also all able to think lucidly and could distinguish hallucinations from reality, however, their perceptions were distorted.

The episodes are predominantly short in duration, often less than an hour, and may occur up to several times a day, with unpredictable onset of symptoms.

Essentially, patients suffering from AiWS experience distorted time, space and body image. They feel as though their bodies have been altered in size and they have visual hallucinations.

Todd speculated that Lewis Carroll, who was known to suffer from migraines and possibly epilepsy, 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 eminent ophthalmologist about the visual manifestations of the migraines he regularly experienced. Since Carroll had these migraine symptoms for years before writing “Alice’s Adventures”, it seemed reasonable that Carroll had used his own experiences as inspiration.

Perception depends on complex functions of the nervous system, and people may experience distortions in visual perception.

In the story, Alice experiences numerous situations of size distortion, similar to micropsia, a neurological condition affecting human visual perception in which objects are perceived to be smaller than they actually are, and macropsia, in which objects appear larger than normal, causing the person to feel smaller than they actually are.

Macropsia, along with its opposite condition micropsia, can be categorised as dysmetropsia, any of the group of visual illusions involving an alteration in the size or separation of perceived objects.

Alice in Wonderland syndrome is often associated with migraines, epilepsy, brain tumors and psychoactive drug use. It appears that AiWS is also a common experience due to a lack of sleep and at sleep onset.

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.

Individuals with AiWS can experience hallucinations or illusions of expansion, reduction or distortion of their own body image, such as feeling that their own body or body parts are shrinking or feeling that their body or body parts are growing taller or larger. Further, depth perception can be altered whereby perceived distances are incorrect. For example, a corridor may appear to be very long, or the ground may appear too close.

Perceived reality is an individual’s subjective experience of reality, in comparison to objective exterior reality. Patient-centered, humanistic-existential and corresponding phenomenological theories postulate that people act in alignment with understood reality, instead of objective reality.

After all, Alice is not a product of the author’s imagination, it is based on his own perceived reality, a subjective experience of reality.

Subjective reality is an experience caused by altered electrical impulses in the brain.

As Alice used to say: “It would be so nice if something made sense for a change.”

Best health wishes,

Maria Alice

By Dr Maria Alice
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Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service. Medical Director – Grupo Hospital Particular do Algarve/ Hospital S. Gonçalo de Lagos