J. Dirk Blom - Alice in Wonderland Syndrome

Jan Dirk Blom

Alice in Wonderland Syndrome

Jan Dirk Blom

Parnassia Psychiatric Institute, The Hague, The Netherlands

Leiden University, Leiden, The Netherlands

University of Groningen, Groningen, The Netherlands

ISBN 978-3-030-18608-1 e-ISBN 978-3-030-18609-8

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

Springer Nature Switzerland AG 2020

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Contents

No-one wants to be illand yet, some disorders have such intriguing names that they inspire more than just aversion. For me, Alice in Wonderland syndrome is such a name. It conjures up images of golden afternoons in a beautiful garden filled with bright flower beds and cool fountains where the Cheshire Cat appears and disappears with a grin and Hatter and Hare drink tea while the Dormouse sleeps. It certainly sounds better than cardiac arrhythmia or pneumonia, to mention just two other afflictions. Even so, names can be deceiving. Therefore, lets consult someone with first-hand experience before we accept too readily that Alice in Wonderland syndrome is as fun as the name might suggest.

Let us ask Ms. Artemis, for example: a bright, intelligent woman of 20-something who came to see me on a balmy summer day at my outpatient clinic in The Hague. Some months beforehand, she had been using a combination of amoxicillin , clarithromycin (both antibiotics ) and pantoprazole (a proton pump inhibitor used to decrease the amount of acid produced in the stomach) to treat a Helicobacter pylori infection that had been causing her nausea and discomfort for over 2 years. As the nausea had subsided within a few days, she was glad that her family physician had given her the prescription, and, for the first time in many months, she was able to go to work without any physical ailments. However, 3 or 4 days into treatment, she had woken up to find that she was seeing everything through a purplish haze that gradually faded over to orange at the top of her field of vision.

Chromatopsias such as these are rare but well-known side effects of antibiotics. I had never before heard of that particular combination of purple and orange, whereas during treatment with such medicines, seeing things in a single hue for a while does happen occasionally. However, what Ms. Artemis experienced next was even stranger. Whereas Alice had had the White Rabbit to guide her down into Wonderland, what Ms. Artemis got was a squirrel: an orange-brown, life-size squirrel that was sitting opposite of her in an empty seat on the morning train, quietly gazing into the distance. She stared at it with a mixture of surprise and bemusement, wondering how such a shy little animal might have wound up in this train coach. Squirrels are native to the Netherlands, but their numbers are small, and, in rural areas, they are rarely sighted, let alone in train stations or on coaches.

The squirrel stayed putbut when another traveller passed between the two of them, it disappeared. Ms. Artemis got off the train wondering where it had gone, but it did not take long for it to reappear. In fact, it did so several times that same day, in a garden, on her desk at work and in many other places where squirrels are not usually found. Whenever she saw it, it was right in front of her and stayed there each time for a duration of about 3060 s (or so she guessed afterwards). Ms. Artemis was well aware that no-one else reacted to the squirrel, and, therefore, no-one else appeared to be seeing it. She tried to touch it several timeshowever, whenever she extended her arm, it invariably disappeared. Having read the information leaflet accompanying her medication, she decided that this must be some sort of hallucinatory side effect of the antibiotics she was using. This was something I was able to confirm by the time she had come to consult me (although I suspected that the proton pump inhibitor, rather than the antibiotics, was to blame). Ms. Artemis stopped taking the medication, and, one week after they had entered her life, both the squirrel and the colours disappeared without any further intervention.

Nevertheless now, in their place, a new phenomenon presented itself: again, for a duration of 3060 s, she started to experience spells (as she called them), during which she saw the objects on her desk rise silently into the air, all the way up to the ceiling, where they would start to rotate around each other. These episodes ended as abruptly as they had begun, and, afterwards, Ms. Artemis mental acuity was always clear. All that she felt in the aftermath was a slight headache near the left temple, not anything even coming close to the pain of a classic migraine .

If the squirrel had been a remarkable phenomenon, by comparison, the floating and gyrating objects were something truly peculiar, something that her family physician and neurologist had never encountered before. And neither had Inot once during two decades of intensive contact with psychotic patients. Nevertheless, it was clear to me that this was neither illusion nor hallucination.

Hallucinations are percepts, experienced during wakefulness, which lack an appropriate source in the external environment. Seeing a squirrel that isnt there (as Ms. Artemis had done), feeling a hand upon ones shoulder while there is no-one around and hearing a voice when one is all alone are common examples of hallucinations. Illusions , on the other hand, do have a source in the external worldbut one that is either misperceived or misinterpreted. Perhaps, like me, while walking in the dark, you may have caught a glimpse of someone stepping out of the bushes, only to find that it was a branch or a plastic bag moving in the wind. Similarly, you may sometimes have heard music in the drone of an air conditioner or in the sound of your computer fanor, when you are a parent, the voice of your child calling out your name. I have experienced all these types of illusion. None of them ever lasted very long. In all cases, there was something out there that evoked them, and, in all cases, it took maybe a second or so for me to realise what had caused it. Occasionally, illusions may last longerfor example, when we discern a face or an animal in a cloud or a coffee stain; but, even then, we are well aware what evokes the image, and we never confuse it for what it really is.