You look down at your hands.

They’re gigantic—swollen to three times their normal size, fingers like sausages, impossibly huge.

You look at the room around you. It’s shrinking. The walls are closing in. The ceiling is descending. Everything is becoming tiny while you expand to fill the space.

Or wait—are you shrinking? The room is growing massive. The doorway has become a cathedral entrance. Your hands are doll-sized. You are small, impossibly small, while the world balloons around you.

Time stretches. Seconds become hours. Or compress—hours flash by in seconds.

You know, intellectually, that none of this is real. Your hands haven’t changed size. The room is the same. Time is moving normally.

But your perception is screaming the opposite. What you’re seeing, what you’re feeling in your body, contradicts what you know to be true.

This is Alice in Wonderland Syndrome.

And Lewis Carroll, the author who wrote about Alice’s size-changing adventures in Wonderland, almost certainly experienced it himself.

The Syndrome

Alice in Wonderland Syndrome (AIWS), also called Todd’s Syndrome, is a neurological condition that distorts perception of size, distance, time, and body image.

During an episode, people experience:

Micropsia: Objects appear much smaller than they are.

Macropsia: Objects appear much larger than they are.

Pelopsia: Objects appear closer than they are.

Teleopsia: Objects appear farther away than they are.

Body image distortions: Parts of your own body feel or appear dramatically wrong-sized—head too big, hands too small, limbs stretched or compressed.

Time distortion: Time seems to speed up or slow down dramatically.

Episodes typically last minutes to hours, though some can persist for days. They’re often preceded by migraine auras or accompanied by headaches.

The person experiencing it knows it’s not real. They can usually reason through it: “My hand can’t actually be this big. This is a perceptual distortion.”

But knowing doesn’t make it stop. The perception persists, vivid and disturbing, contradicting reality.

Lewis Carroll’s Migraines

Charles Lutwidge Dodgson, who wrote under the name Lewis Carroll, suffered from severe migraines throughout his life.

His diaries and letters describe episodes of visual disturbances, headaches, and perceptual anomalies.

In “Alice’s Adventures in Wonderland,” Alice repeatedly changes size:

She grows so tall her head hits the ceiling. She shrinks so small she nearly drowns in her own tears. She becomes too large to fit through a door, then too small to reach the key.

The imagery is specific, vivid, and experiential. Not just “she was small,” but the sensation of the world becoming gigantic around her, of her body becoming incomprehensible to herself.

Many neurologists believe Carroll was describing his own migraine experiences through Alice’s adventures.

He was translating the bewildering perceptual distortions of AIWS into narrative form—making sense of the senseless by giving it a story.

What Causes It

AIWS is most commonly associated with:

Migraines: Particularly migraines with aura. The visual and perceptual distortions often occur during the aura phase before the headache begins.

Infections: Particularly Epstein-Barr virus (which causes mononucleosis). Many childhood cases of AIWS occur during or after viral infections.

Epilepsy: Seizures affecting the temporal or parietal lobes can produce perceptual distortions.

Brain lesions: Tumors, strokes, or injuries affecting regions that process visual information or body schema.

Drugs: Both recreational (LSD, cannabis) and prescription (antihistamines, antidepressants) can trigger episodes in susceptible individuals.

The common thread: disruption of the brain regions responsible for integrating visual information and body perception.

The Neuroscience of Distortion

To understand AIWS, you need to understand how your brain constructs your perception of reality.

You don’t experience the world directly. You experience your brain’s model of the world—a construction built from sensory data, past experience, and expectations.

Size perception involves:

  • Visual input (retinal image size)
  • Distance perception (stereoscopic vision, visual cues)
  • Prior knowledge (how big things usually are)
  • Context (relative size of surrounding objects)

Your brain integrates all of this to produce your perception of how big something is.

In AIWS, this integration fails.

The visual input might be processed incorrectly. Distance cues might be misinterpreted. The prior knowledge of “normal size” might be temporarily inaccessible or distorted.

The result: your brain constructs a model where objects are the wrong size, even though intellectually you know that can’t be right.

The same process applies to body perception. Your brain maintains a body schema—a map of where your body parts are and how big they are. This schema integrates:

  • Visual information (seeing your hand)
  • Proprioception (feeling where your hand is)
  • Touch (sensing the boundaries of your hand)
  • Motor feedback (moving your hand and feeling the movement)

In AIWS, the body schema gets distorted. Your visual and proprioceptive systems are telling you contradictory things, or your brain’s internal map of your body becomes temporarily corrupted.

You look at your hand. It looks normal size. But it feels enormous. The sensations don’t match.

Or you look at your hand and it looks gigantic, but when you try to touch things, it behaves like a normal-sized hand.

The mismatch between perception and reality is profoundly disorienting.

The Experience

People who’ve experienced AIWS describe it as deeply unsettling.

One patient described her hands looking “like Mickey Mouse hands—huge, cartoonish, not belonging to me.”

Another described the floor appearing to rush up toward his face while simultaneously seeming miles away.

A child described his head feeling “as big as a house” and being terrified it would explode.

The perceptual distortions are accompanied by a sense of unreality—feeling detached from your body, questioning whether you’re dreaming, struggling to trust your senses.

Some people experience panic during episodes. The world has become unpredictable. Your own body feels alien. Nothing is stable.

Others become fascinated, describing the experience as similar to being in a dream or on hallucinogens—disturbing but also compelling.

The Terror of Distorted Reality

Imagine experiencing this as a child with no framework to understand it.

You look at your mother’s face. It’s suddenly distorted—stretched, compressed, wrong. She looks monstrous.

The room warps. Dimensions shift. You don’t have the words to explain what’s happening.

You might scream. You might cry. You might freeze, terrified.

Your parents see nothing wrong. The room is normal. You appear fine physically.

But your reality has collapsed into something unrecognizable.

Many childhood cases of AIWS are initially mistaken for psychological problems, hallucinations, or attention-seeking behavior until someone recognizes the specific pattern of perceptual distortions.

Historical Cases

The first clinical description was by British psychiatrist John Todd in 1955, who named it after Lewis Carroll’s story.

But descriptions of similar experiences appear throughout history:

Medieval mystics described visions where their bodies felt enormous or tiny, where the world distorted around them. These were often interpreted as religious experiences.

Some researchers suggest that historical descriptions of witchcraft experiences—feeling small, feeling gigantic, flying through space—might have been AIWS episodes triggered by migraines or toxic substances.

In the 1960s, when LSD became widely used, many descriptions of LSD trips included AIWS-like distortions. The drug was triggering the same neural disruptions that migraines or infections can cause.

The Diagnostic Challenge

AIWS isn’t in the DSM-5 (the standard psychiatric diagnostic manual). It’s not a psychiatric disorder—it’s a neurological symptom.

But it’s also rare enough and strange enough that many doctors haven’t encountered it.

A patient describes their hands looking enormous and time slowing down. Without knowledge of AIWS, a doctor might consider:

  • Psychosis (hallucinations)
  • Anxiety/panic disorder (perceptual distortions during panic)
  • Drug use (hallucinogen intoxication)
  • Conversion disorder (psychological symptoms manifesting physically)

All of which are wrong.

AIWS is a specific perceptual syndrome with neurological causes. Treatment depends on identifying the underlying cause:

If it’s migraines, migraine prevention may help.

If it’s infection, treating the infection resolves the symptoms.

If it’s epilepsy, seizure control eliminates episodes.

But first, someone has to recognize what it is.

The Persistence in Childhood

AIWS is particularly common in children, especially in association with:

  • Migraine (even in children too young to describe headache pain)
  • Epstein-Barr virus infection (mono)
  • Fever

Many children experience AIWS episodes during high fever—rooms appearing to shrink, toys looking huge, time moving strangely.

Parents often dismiss this as “fever dreams” or confusion. Sometimes it is. But AIWS during fever is a specific neurological phenomenon, not just general delirium.

Most children outgrow AIWS. As the brain matures and migraine patterns change, episodes become less frequent and usually stop by adolescence.

But some people continue experiencing episodes into adulthood, particularly if they have chronic migraines.

The Philosophical Implications

AIWS reveals something profound about the nature of perception:

Reality is not directly accessible to you.

You experience a model of reality constructed by your brain. Usually that model is accurate enough to navigate the world.

But it’s still a model. A construction. An interpretation.

AIWS shows what happens when the construction process malfunctions. The model your brain builds no longer matches objective reality.

You can know intellectually that your hand is normal-sized. You can measure it. You can reason through it.

But you can’t make your perception match that knowledge. The model is corrupted, and you’re stuck experiencing the corrupted version.

This raises disturbing questions:

How do you know your “normal” perception is accurate?

If your brain can construct a reality where objects are the wrong size, what else might it be getting wrong in your everyday experience?

Is there any way to access “true” reality, or are we all just living in models constructed by our brains that usually happen to be useful enough to function?

Living with AIWS

For people with chronic AIWS, episodes become a recurring disruption.

You learn to recognize the signs. The world starts to feel off. Proportions seem wrong. You know an episode is coming.

You can prepare: sit down, close your eyes, wait it out.

You can remind yourself: this isn’t real. It will pass. Your hands are normal. The room is normal. Time is moving normally.

But you can’t stop it.

Some people describe developing a kind of dual awareness: experiencing the distorted perception while simultaneously maintaining awareness that it’s distorted.

You see your hand as enormous, but you know it’s not. Both perceptions exist simultaneously—the distorted experience and the intellectual knowledge.

This dual awareness can be protective (prevents panic) but also exhausting (constantly having to reality-test your own perceptions).

The Treatment

AIWS episodes typically resolve on their own, lasting minutes to hours.

Long-term treatment focuses on addressing the underlying cause:

For migraine-associated AIWS: Migraine prevention medications (beta-blockers, anticonvulsants, antidepressants) can reduce episode frequency.

For infection-associated AIWS: Treatment of the infection usually resolves symptoms.

For epilepsy-associated AIWS: Seizure medications prevent episodes.

There’s no specific medication that directly treats AIWS itself. You treat what’s causing it.

Some patients find that recognizing and accepting the episodes reduces their distress. Knowing “this is AIWS, it will pass” is less terrifying than “I’m going insane, reality is breaking.”

The Carroll Connection

Whether or not Lewis Carroll actually experienced AIWS, his writings capture the phenomenology remarkably well.

Alice’s confusion about her changing size mirrors what AIWS patients describe:

“I wonder if I’ve been changed in the night? Let me think: was I the same when I got up this morning? I almost think I can remember feeling a little different. But if I’m not the same, the next question is, ‘Who in the world am I?’ Ah, that’s the great puzzle!”

That sense of identity disruption—when your body doesn’t feel like your body, when you can’t trust your perception of yourself—is central to AIWS.

Alice’s world is a world where nothing is stable. Size changes unpredictably. Rules shift. Reality is negotiable.

For someone with chronic AIWS, that’s not fantasy. That’s life.

The Mystery of Perception

AIWS cases are usually explainable in medical terms: migraine, infection, epilepsy.

But the phenomenon itself points to deeper mysteries:

How does the brain construct stable perception from unstable sensory data?

What determines “normal” size perception?

Why do distortions cluster in specific patterns (too big, too small) rather than producing random chaos?

And perhaps most importantly: if your perception can be this wrong while your intellect remains intact, what does that say about the relationship between perception and reality?

AIWS patients experience a world that is objectively impossible. They know it’s impossible. They can reason through why it must be wrong.

But they can’t make it stop being their experience.

Perception is not under conscious control. You can’t decide to see accurately any more than you can decide not to see the distortions.

All you can do is endure the episode and wait for your brain to reconstruct reality correctly again.

The Return to Normal

When an AIWS episode ends, it typically ends suddenly.

The distortions simply… stop. The world snaps back to normal proportions. Time resumes its usual pace. Your body feels like your body again.

There’s often a sense of relief and exhaustion. The perceptual turmoil was overwhelming, even when you knew it wasn’t real.

But there’s also lingering uncertainty: will it happen again? When? Can you trust your perceptions going forward?

Some people develop anxiety about future episodes, which can itself trigger migraines and create a vicious cycle.

Others develop a kind of philosophical acceptance: perception is unstable, reality is constructed, and sometimes the construction fails.

You live with it. You adapt. You learn not to panic when your hands look enormous or the room shrinks.

Because in a few minutes or hours, it will probably pass.

And “normal” reality—whatever that is—will return.

Medical Sources:

  • Todd, J. (1955). “The syndrome of Alice in Wonderland.” Canadian Medical Association Journal, 73(9), 701-704.
  • Lanska, J. R., & Lanska, D. J. (2013). “Alice in Wonderland Syndrome: Somesthetic vs visual perceptual disturbance.” Neurology, 80(13), 1262-1264.
  • Blom, J. D. (2016). Alice in Wonderland Syndrome: A Systematic Review. Neurology: Clinical Practice, 6(3), 259-270.
  • Brumm, K., Walenski, M., Haist, F., Robbins, S. L., Granet, D. B., & Love, T. (2010). “Functional MRI of a child with Alice in Wonderland syndrome during an episode of micropsia.” Journal of AAPOS, 14(4), 317-322.

Next in the series: The Feral Child Cases - Children raised in isolation, and the haunting question of whether there’s a point of no return for becoming human.