Alice in Wonderland syndrome

   Also known as Alice in Wonderland effect, Wonderland syndrome, and syndrome of Alice in Wonderland. The term syndrome of Alice in Wonderland was introduced in or shortly before 1955 by the British psychiatrist John Todd (1914—1987) to denote a rare group of symptoms that include subjective feelings such as derealization, depersonalization, and somatopsy-chic duality, and perceptual symptoms such as illusory changes in the size, distance, or position of stationary objects within the subject's visual field (i.e. *metamorphopsias such as *micropsia, *macropsia, *macroproxiopia, *microtelepsia, *teleopsia, and *plagiopsia), illusory feelings of levitation, and illusory alterations in the passage of time (i.e. the * quick-motion phenomenon and other types of *time distortion). The nature of these symptoms suggests that especially the parietal lobe may be involved in their mediation. Todd also includes *hyperschematia or left size distortion, a condition associated with neglect, which in turn is associated with lesions affecting the right hemisphere. Today many of the *body schema illusions (such as *splitting of the body image) are also included in the operational definition of the Alice in Wonderland syndrome. As noted by Todd in 1955, there are few examples of the complete Alice in Wonderland syndrome to be found in the literature. Most reports are concerned with one or more separate symptoms occurring in association with * migraine aura, * psychic aura, temporal lobe epilepsy, cerebral lesions, *delirium of fever, * hypnagogic and * hypnopompic states acute labyrinthine vertigo, a clinical diagnosis of * schizophrenia, or a history of psychoactive substance abuse (notably the use of * hallucinogens such as * dextromethorphan, LSD, or mescaline). Occasionally, the symptoms of the Alice in Wonderland syndrome are mentioned as early signs of a viral infection (such as mononucleo-sis infection, Epstein—Barr virus infection, and Coxsackie virus B1 infection). In some cases the symptoms belonging to the Alice in Wonderland syndrome are classified as variants of * psychic aura. The term Alice in Wonderland syndrome refers to the protagonist in the book Alice's Adventures in Wonderland by Lewis Carroll (1832—1898) whose experiences are reminiscent of symptoms such as micropsia, macropsia, * microsomatognosia, and * macrosomatognosia. Since Carroll himself probably suffered from migraine, it was suggested in 1952 by the American neurologist Caro W. Lippman (1886—1954) that the author may have experienced at least some of these symptoms himself. An alternative explanation for Carroll's references to the perceptual symptoms noted above was suggested by the American historian and author Michael Carmichael. According to Carmichael, Carroll had either read about the hallucinogenic effects of the mushroom Amanita muscaria or possibly even experimented with the mushroom himself.

   References

   Carroll, L. (1865). Alice's adventures in Wonderland. New York, NY: D. Appleton and Co.

   Lippman, C.W. (1952). Certain hallucinations peculiar to migraine. Journal of Nervous and Mental Diseases, 116, 346—351.

   Todd, J. (1955). The syndrome of Alice in Wonderland. Canadian Medical Association Journal, 73, 701—704.

   Carmichael, C. (1996). Wonderland revisited. London Miscellany, 28, 19—28.

   Kew, J., Wright, A., Halligan, P.W. (1998). Somesthetic aura: The experience of "Alice in Wonderland". The Lancet, 351, 1934.

   Fig. 3 Alice in Wonderland. Illustration by John Tenniel