ALICE IN WONDERLAND SYNDROME: WHEN REALITY GOES DOWN THE RABBITHOLE
WHEN REALITY GOES DOWN THE RABBIT-HOLE
Kat Lougheed had an odd childhood: reality would distort and twist, making her feel the size of a hobbit. Alice in Wonderland Syndrome is truly bizarre – but helps us understand the mind of an anorexic.
They say it is what’s inside that counts. Yet how we view ourselves always seems linked to what we see in the mirror. Close your eyes and the ‘ inner you’ navigating your imagination probably looks a lot like the outer version everyone else sees (if perhaps a bit better-looking). But very odd things start to happen when the normal link between these two versions of ‘ you’ gets broken. Take a journey with me down the rabbithole…
As a child, I occasionally experienced the unsettling sensation that my limbs had grown to a size approaching that of a small planet. I now know that this wasn’t the onset of insanity, or the beginnings of my metamorphosis into a superhero, but a condition known as Alice in Wonderland Syndrome (AIWS). For a sufferer like me, AIWS may mean you perceive your body to be ballooning, shrinking, or distorting in shape. A truly bizarre condition, the cause is often unknown although it has been linked to some viral infections including influenza. It is also sometimes experienced by epileptics or during a migraine – making it tempting to speculate that migraine-sufferer Lewis Carroll found inspiration for his fantastical stories from this condition. Of course, his laudanum habit may also have helped.
The Alice in Wonderland Brain
What goes on in the brain of an AIWS sufferer to make them believe they are shape-shifting is a bit of a riddle – but one that Kathleen Brumm and her colleagues from San Diego State University have tried to solve. They used magnetic resonance imaging on a 12-year-old boy with viral-onset AIWS to watch what goes on in the brain (a technique called functional MRI). During an AIWS episode they saw some unusual activity in the regions of the brain involved with making sense of what we see and for processing the sensations we feel. The boy’s brain seemed to be misfiring and incorrectly processing information arriving from his eyes, which made him think that objects around him were much smaller than they were in reality. When AIWS is triggered from an infection (as with my episode) it seems likely that the virus inflames such brain areas, and effectively messing around with the normal firing patterns. But fully understanding a rarely-diagnosed condition isn’t an easy task, especially when the number of people who suffer AIWS (in the absence of other conditions) is vanishingly small. I grew out of my AIWS, but a few can be stuck with this sometimes debilitating condition forever.
Voodoo dolls and phantom limbs
It turns out that Kathleen Brumm’s study is just one of many where a specific area of the brain – called the parietal lobe – has been linked to problems with the mind’s construction of body image. Building our inner perception of our outer self relies on our brain building a complete point-for-point map of our body (see image). Like a giant voodoo doll, the physical body transmits information from different body parts to this map, which acts as a switchboard, piecing together physical sensations to form our personal experience of the world. However, the brain map on the inside doesn’t always match up with the body on thr outside, which can lead to us perceiving ourselves differently from how we actually are.
One of the leading names in this field of body image research is Vilayanur Ramachandran from the University of California. His work revolutionised our understanding of phantom limbs – the phenomenon that causes amputees to continue to feel the presence of an arm or leg long after it has been removed. As a member of his laboratory explained, “Our brain has to dynamically update our internal representation of our body, but this doesn’t happen instantaneously.” It seems that, in its effort to make sense of a sudden loss of sensory information, an amputee’s brain effectively ‘borrows’ signals and sensations from other parts of the body to trick itself into believing the limb is still present. But what happens when it is the inner map that is ‘missing a limb’? Body Integrity Identity Disorder is a rare condition in which purportedly sane people find the presence of a healthy limb so intrusive that they express the desire for it to be chopped off – often seeking an amputation. In these cases, the brain’s sense of body ownership appears to not include the offending body part. Even more distressing, a disorder known as Cotard’s syndrome takes this feeling of ‘not belonging’ to its extreme: a person becomes so disconnected with the outer version of themselves that they believe themselves to be dead, or decaying, or sometimes immortal – despite all evidence to the contrary.
A link to anorexia?
While such disorders have been linked to changes in normal brain activity (as Kathleen Brumm’s work found), cause and effect can be difficult to tease apart. What comes first — the changes in the brain or the delusional behaviour? Eating disorders are one case in point: Workers in Vilayanur Ramachandran’s laboratory have proposed that similar brain ‘errors’ could partially explain eating disorders such as anorexia nervosa. Author of the study Laura Case has considered the following conundrum: people with anorexia feel large, but why can’t they look in a mirror and use the accurate visual image of themselves to correct their distorted sensations? Her theory is that anorexics have difficulty incorporating sensory information into a correct body image. If true, this explanation adds an extra dimension to the well-known psychological issues that occur in such disorders.
‘Who in the world am I? Ah, that’s the great puzzle!’ says Alice.
In the words of Francis Crick, co-discoverer of the structure of DNA: “You, your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules. As Lewis Carroll’s Alice might have phrased it, ‘ You’re nothing but a pack of neurons.’” Each of us faces the ‘great puzzle’ of who we are and how we see ourselves. Thanks to the work of people like Brumm and Ramachandran, we now possess some, but not all, of the pieces.
• Brumm K. et al. Functional MRI of a child with Alice in Wonderland syndrome during an episode of micropsia. J AAPOS. 2010;14(4): 317–322.
• Ramachandran VS. et al. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci. 1996;263(1369):377-86.
• Case LK., et al. Diminished sizeweight illusion in anorexia nervosa: evidence for visuo-proprioceptive integration deficit. Exp Brain Res. 2012;217(1):79-87.
• Ramachandran, VS. Consciousness and body image: lessons from phantom limbs, Capgras syndrome and pain asymbolia. Philos Trans R Soc Lond B Biol Sci. 1998; 353(1377): 1851–1859.
LEFT: The location of the parietal lobe.
LEFT: A rough layout of how the brain maps out the body’s surface sensations located inside the parietal lobe.