"Rare migraineurs have strange symptoms where the diagnosis may be lurking just down a rabbit hole" (Evans & Rolak, 2004).
Alice in Wonderland syndrome is an unusual perceptual phenomenon most often caused by migraine headaches, but also seen in association with epilepsy and Epstein-Barr virus. The most well-known symptoms are:
- Alteration of body image: the sizes of parts of the body are perceived incorrectly.
- Alteration of visual perception: the sizes of external objects are perceived incorrectly.
Patients are aware of the illusory nature of their perceptions and are sometimes reluctant to admit to them for fear of being thought insane. This sensation of formed body distortions, a type of metamorphopsia, appears to be caused by migrainous ischemia. Most authorities believe, based in part on direct electrical stimulation studies of the brain, that these body distortions ... arise primarily in the posterior parietal lobe, especially in the nondominant [right] hemisphere. Migrainous ischemia and irritability in this area produces the bodily distortions.Extensive [permanent] damage to the right parietal lobe can result in hemispatial neglect, where the patient ignores the contralateral (left) side of space, including the left side of the body. The visual illusions of metamorphopsia (as opposed to body distortions) have been associated with altered blood flow in the right temporo-occipital region (Heo et al., 2004).
Vaughan Bell, primary author of the Mind Hacks blog, revealed that he experienced Alice in Wonderland syndrome as a child but grew out of it as an adult (see Three impossible things before breakfast). He linked to a Guardian article by journalist Rik Helmsley, who described his symptoms in detail:
Floors either curved or dipped, and when I tried walking on them, it felt as though I was staggering on sponges. When I lay in bed and looked at my hands, my fingers stretched off half a mile into the distance...I graduated and took a job as a system administrator in a new town, but instead of going away, my symptoms just got worse. Everything was now distorted, all the time. Walking down the road, parked cars appeared the size of Corgi models, while I'd feel disproportionately tall. At work, my chair seemed enormous, while I seemed to have shrunk.The German expressionist artist Käthe Kollwitz may have suffered from AIWS, according to a recent article by Graeme Drysdale (2009). Kollwitz was known for her etchings, drawings, and woodcuts that portrayed graphic levels of suffering due to poverty, illness, and war. Her work often contained distorted depictions of hands and heads.
Poverty, 1893-94 (or Misery), by Käthe Kollwitz
Drysdale's hypothesis is that Kollwitz's art was heavily influenced by AIWS symptoms caused by migraine or epilepsy:
In her diary, Kollwitz self-described symptoms of Alice in Wonderland Syndrome during her childhood. She complained of episodes where objects appeared to grow larger or smaller and perceptual distortions where she felt she was diminishing in size. This may explain why Kollwitz’s artistic style appeared to shift from naturalism to expressionism, and why her artistic subjects are often shaped with large hands and faces. The distortion present in her visual art may have less to do with a deliberate emphasis of the artist’s feelings and more to do with her perceptual experience.
Die Witwe I (The Widow I), 1922-3. Woodcut on paper.In her diary, she described frightening visual hallucinations:
‘Then there was a horrible state I fell into when objects would begin to grow smaller. It was bad enough when they grew larger, but when they grew smaller it was horrifying’.So it's possible that the expressionistic distortions in the work of Käthe Kollwitz were brought on by Alice in Wonderland syndrome. To me that seems more plausible than psychoanalytic speculation on the role of "oral birth fantasies, sex fantasies and suppressed emotion."
Drysdale, G. (2009). Kaethe Kollwitz (1867-1945): the artist who may have suffered from Alice in Wonderland Syndrome. Journal of Medical Biography, 17 (2), 106-110 DOI: 10.1258/jmb.2008.008042
Evans RW, Rolak LA. (2004). The Alice in Wonderland Syndrome. Headache 44:624-5.
Heo K, Cho YJ, Lee SK, Park SA, Kim KS, Lee BI. (2004). Single-photon emission computed tomography in a patient with ictal metamorphopsia. Seizure 13:250-3.
Johnny Depp as the Mad Hatter, in Tim Burton's adaptation of Alice in Wonderland.
Alice: "If I had a world of my own, everything would be nonsense. Nothing would be what it is, because everything would be what it isn't. And contrary wise, what is, it wouldn't be. And what it wouldn't be, it would. You see?"
'Oh, you can't help that,' said the Cat: 'we're all mad here. I'm mad. You're mad.'
'How do you know I'm mad?' said Alice.
'You must be,' said the Cat, 'or you wouldn't have come here.'
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