`What a curious feeling!’ said Alice; `I must be shutting up like a telescope.’
And so it was indeed: she was now only ten inches high……First, however, she waited for a few minutes to see if she was going to shrink any further: she felt a little nervous about this; `for it might end, you know,’ said Alice to herself, `in my going out altogether, like a candle……
Soon her eye fell on a little glass box that was lying under the table: she opened it, and found in it a very small cake, on which the words `EAT ME’ were beautifully marked in currants. `Well, I’ll eat it,’ said Alice, `and if it makes me grow larger, I can reach the key; and if it makes me grow smaller, I can creep under the door; so either way I’ll get into the garden, and I don’t care which happens!’…..
`Curiouser and curiouser!’ cried Alice (she was so much surprised, that for the moment she quite forgot how to speak good English); `now I’m opening out like the largest telescope that ever was! Good-bye, feet!’ (for when she looked down at her feet, they seemed to be almost out of sight, they were getting so far off)….
In this iconic scene during Lewis Carroll’s Alice’s Adventures in Wonderland, one of the many psychedelic experiences the reader encounters during the book, Alice experiences something that surely could only occur within
the pages it is found. However, growing and shrinking like this – or rather the perception of it – is less fictitious than it sounds. First described in 1955, Alice in Wonderland Syndrome (AIWS) refers to a peculiar set of visual hallucinations and perceptual distortions that can accompany migraines. During an episode, someone suffering from AIWS can experience a perceived alteration in the shape and spacial placement of objects and body parts and the perceived enlargement or reduction in size of either themselves or their environment.
Relatively few cases of AIWS have been described, but those patients who have suffered from it report some truly scary experiences. Both adults and children seem to be affected and always report symptoms as predictors of a migraine. The exact hallucinations they experience seem to be largely arbitrary. Limbs can seem huge, while some
shrink and disappear completely. Colours and textures can disappear and swap and mirrors can appear to in fact shrink your reflection. A 52 year-old patient who had been suffering from these hallucinations for over 45 years described her experiences:
“I suddenly get a feeling that my hands are huge and I mean huge: ginormous; as though I am wearing triple boxing gloves—this lasts for a while, then I get a funny physical feeling while my hands are staying big that I am shrinking into a tiny, tiny, tiny little girl.”
“I sort of feel as though I am on spongy platform shoes like we used to wear in the ’70s. It’s really weird; I am only five foot and it’s the most peculiar feeling to suddenly feel that you are tall.”
But what is the cause of such a terrifying syndrome? Like most hallucinations and perceptual distortions the fault is not with the eyes, but with the brain’s interpretation of what it is seeing. Another parallel with most neurological disorders is the fact that the underlying cause is largely unknown and, seemingly, frustratingly enigmatic. In the few case reports, patients have been cured with a wide range of treatments. Sometimes the syndrome disappears by itself, while both common anti-seizure medications and anti-virals have been effective. It is thought that the hallucinations may occur due to some kind of damage to the occiptal lobe, the region at the back of the brain charged with deciphering the information delivered by the eyes. Exactly what form this damage takes is unknown – it has been suggested that the neurones in this region may become damaged and their ability to transmit impulses disrupted, while others have put forward viral and bacterial infections and oxygen deprivation to this area as alternatives.
While this is undoubtedly a curious syndrome, there are positives to be drawn. A positive aspect of all medical curiosities is what they can teach us about the human body. While our brain is what makes us what we are, we still know relatively little about it. Deciphering exactly what regions of the brain are damaged and what form this damage takes may help inform us about how the brain deals with different tasks. For example, detecting a lack of oxygen in a certain region of the occiptal lobe may tell us which region is tasked with interpreting the awareness of limb size and orientation.
This bizarre condition provides an insight into the strange world of neurological disorders, in which their manifestations really can be as curious as the most elaborate of fiction.
For those interested in Alice in Wonderland Syndrome, Chapter 8 of Progress in Brain Research – Literature, Neurology, and Neuroscience: Neurological and Psychiatric Disorders is the most thorough source of information. It is extremely tough to get hold of, both worth reading if you can.
I also thoroughly recommend Oliver Sach’s fantastic book, ‘The Man Who Mistook His Wife for a Hat’. It is a wonderful exploration of the curious world of neurological disorders and the struggle patients undergo to remain who they are.
‘Til next time…