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Neurobiology

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Alice in Wonderland Syndrome

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Abstract

The symptoms characteristic of Alice in Wonderland syndrome are usually subtle in nature, in the sense that they tend to affect only a minor aspect of a person’s full perceptual experience. As a consequence, everything is perceived just as before, except that, for example, all vertical lines are slanted, as happened to Paul; or time is found to slow down, the way this is experienced by Neo in The Matrix [1]; or one’s body is experienced as shrinking to the height of a thimble, as happened to Alice in the story and to Ms. Rembrandt in real life and so on, in accordance with any of the numerous variations that we have encountered so far, and indeed, many, many more. Sometimes these symptoms occur in conjunction with each other, although they mostly present as isolated perceptual distortions, leaving the rest of what we perceive intact. What is more, even when several symptoms are present, they tend to be experienced in the same sensory modality, being all visual in nature, or all somatosensory and so on. As far as we know, based on the limited number of extant case descriptions, only 15% of all people with Alice in Wonderland syndrome report symptoms in more than one sensory modality [2]. The remaining 85% of them report unimodal experiences—which, as we just saw, tend to consist of a single symptom.

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Notes

  1. 1.

    To be totally accurate, I must point out that V4 is a bilateral structure and that, therefore, both parts would need to be switched off in order to make us see the world in black and white. When only one is switched off, we see half of the visual field in black and white and the other half in colour.

  2. 2.

    This example of akinetopsia confirms that the brain is not a video camera. For a video camera to create the illusion of smooth movement, it only needs to play back the recorded series of images at the speed of 24 frames per second; for many purposes, even 16 frames per second would be sufficient. The brain, however, needs to switch on V5 to perceive this as smooth movement. No matter how many frames per second we would add, without V5 functioning properly, the net result will be a succession of images rather than a seamless flow.

  3. 3.

    These parts include the basal ganglia, the cerebellum, parietal cortex, extrastriate visual cortex , anterior cingulate cortex, posterior cingulate cortex, premotor cortex and frontal cortex. Of note, the cerebellum has been implicated in timing durations in the milliseconds range rather than the seconds-to-minutes range and found to be compromised in patients diagnosed with migraine, making them significantly overestimate the duration of such short intervals of time [27].

  4. 4.

    A candidate structure for such a ‘receptor function’ in time perception has been suggested by Craig, who described the role of the insula , or the brain’s ‘fifth lobe’, in collecting and integrating information from within the body as a whole, including information that has bearing on the subjective experience of time [28].

  5. 5.

    In a way, Dimitri’s story was similar to that of Mr. Salvatore’s. Even though he had been diagnosed with schizophrenia (whereas Mr. Salvatore had not), he suffered from several types of perceptual aberration that were at least reminiscent of metamorphopsia s. Looking back, they might well have been caused by the illicit substances that he had been using in the past. In Dimitri’s case, they included cannabis (which he had been smoking since the age of 15, in quantities of up to 4 joints a day), XTC , herbal XTC, mushrooms , Ephedra and Salvia . Although he had used the latter substances only occasionally, all in all, it was enough to justify the hypothesis that his metamorphopsias had something to do with his prior substance abuse . He, too, had been treated for years on end with various medicines. This had helped him to keep his paranoid delusions and disorganisation under control but, as we saw, not the distortions .

  6. 6.

    The Amsler grid was developed around 1945 by the Swiss ophthalmologist, Marc Amsler (1891–1968). It consists of a card with intersecting vertical and horizontal lines, which is used by ophthalmologists and optometrists to test visual disturbances caused by retinal and macular disorder s.

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Authors and Affiliations

  1. Parnassia Psychiatric Institute, The Hague, The Netherlands

    Jan Dirk Blom

  2. Leiden University, Leiden, The Netherlands

    Jan Dirk Blom

  3. University of Groningen, Groningen, The Netherlands

    Jan Dirk Blom

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Blom, J.D. (2020). Neurobiology. In: Alice in Wonderland Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-030-18609-8_5

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  • DOI: https://doi.org/10.1007/978-3-030-18609-8_5

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