Stories We Tell Ourselves – Part 2


StoriesIn Stories We Tell Ourselves, Seeing ThingsPart 1, Michelle Herman recounts that her daughter’s perception of her Getting-Smaller-and-Getting-Bigger was idiopathic, meaning the doctors had no explanation for it, but that did not make her feel any better. Time went on, and Michelle kept notes about Grace’s experiences, sensing she would write an essay about them at some point.  Then at a writer’s conference in Vancouver, she shared this with a friend, Joe who said: “You’re not serious!”, and confessed that this odd perception occurred to him quite often as a child, but he never told anyone and hadn’t thought about it many years.  “Why didn’t you tell anyone?” Michelle asked.  Joe replied: “Are you joking?  I was eight or nine when it started.  I figured that either a) this was the way everyone saw the world, and they would think I was crazy for bothering to mention it, or b)  I was the only one who saw things this way – in which case I was crazy.  Either way, I was crazy.”  Michelle decided to run all this by Steven Katz, a neuro-ophthalmologist at OSU with whom she was friendly.  They met at a small table at Cup O’Joe, a Columbus Institution, surrounded by college kids immersed in their laptops.

Here is Dr. Steven Katz’s self-introductory YouTube video on the OSU website, and at the 2:13 mark he says something quite pertinent.

“There is a tendency for some people to think that there is a paradigm that fits everybody.  But everyone has different genetics, and everyone has different environmental influences, and nobody responds the same way to a disease, and diseases don’t read textbooks and don’t always present classically so there is not a one size fits all approach to Medicine.”

Michelle had done what most parents would do when faced with a diagnosis of idiopathic origin.  She went to the Internet where she came upon terms such as micropsia and macropsia related to size illusions of known objects appearing larger or smaller.  Dr. Katz listened, and reasoned that whatever Grace had it wasn’t likely she had a macular problem because that wouldn’t create the zooming out and looming in effects – it would be one or the other.  The next step would have been an MRI, but a CT scan was at least a step in the right direction, seeking the origin of Grace’s illusions in her brain more so than in her eyes.  There was some suggestion that the subjective reports such as what Grace offered could be related to migraines.  The zooming out and looming in often occurs in a similar time frame that an aura builds and then subsides — a 15 to 20 minute interlude of scaling in the effects of visual field and intensity

In her own research, searching the Internet, Michelle had come across a constellation of symptoms that seemed to best describe what Grace was experiencing.

 

Alice

 

Alice in Wonderland Syndrome.  Although neither Grace’s pediatrician nor psychiatrist had encountered it before, it may be less uncommon than they thought, perhaps signified by self-help discussion groups for it.  Through her writer’s network Michelle made inquiries, and 24 people responded that they experienced exactly what Grace was reporting when they were a child.  And most of them were considered to be “weird” children, though many learned to wear that title as a badge of distinction.  None of them reported experiencing migraines.  Michelle realized she was paddling her way into very deep waters, and felt the need to go further.  She found her way to Paul Grobstein, a neurobiologist whose ideas led her to the title of her book, and who describes his expertise and interests this way:

“I’m a neurobiologist, biologist, philospher, and educator with a life-long interest in understanding why people behave the way they do, and how they can continually expand their capabilities. I am interested as well in the nature of biological, cultural, and intellectual change, complex systems and general information processing principles, and the character of human understanding and the relationships among its different forms.”

But, Michelle declares, experts on the way our minds work are in short supply, if there are any.  It turns out that your guess is really as good as mine, or as a neurobiologist’s.  Grace is now 18, and away at College, and her Alice in Wonderland experiences have considerably subsided.  There’s nothing that happens in life that Michelle finds unworthy of looking into for possible meaning.  Getting-smaller-and-getting-bigger warrants trying to make sense of, for it seems that what we call “symptoms” results from emotions so extreme and insistent that they have to make their way into consciousness.  Dreams simply aren’t a large enough canvas for the artist that is the unconscious, and the scriptwriter of those dreams.

Helen Stapinski wrote a nice article about Alice In Wonderland Syndrome in the New York Times two months ago, which contains a link to Grant Liu’s neuro-ophthalmology presentation on the Syndrome.  This is welcome, because it takes these transient distortions or illusions of body image and space out of the realm of Jefferson Airplane and more into the arena of natural neuroscientific phenomena vividly encountered in childhood.

Michelle finishes her essay with a flair:

“To make sense of everything we do, or feel, or see, or are is a hopeless undertaking.  But just as art is meant to be contemplated, engaged with, speculated about, felt – and inevitably, interpreted – we are surely meant to contemplate the ‘work’ of the unconscious as it reveals itself in each of our lives, and to appreciate its artistry.  We can only look – and see what we shall see.”

Although Alice in Wonderland Syndrome may be relatively rare, there is another syndrome we encounter with children whose eyes are apparently fine, and whose visual abnormalities likely reside in the realm of the unconscious.  Rather than size and distance changes, their zooming effects thwart clarity and create a tunnel vision illusion.  I’ll bet Dr. Streff would have had some interesting thoughts about Alice in Wonderland Syndrome.

 

12 thoughts on “Stories We Tell Ourselves – Part 2

  1. Perhaps, the Alice in Wonderland illusion is a result of size constancy. A person, for example, looks life-size whether we see him right next to us or a room’s distance away. When the man is a room’s distance away, his image on our retinas is much smaller than when he is close to us. However, our brain, using multiple cues to determine his distance from us, makes an adjustment for his small retinal image size and gives us the perception that he is life-size. When I first learned to see in 3D, everything that wasn’t very close, looked slightly bigger. When I was stereoblind, the world appeared more contracted and compressed. With stereovision, the world expanded and objects appeared further away. My brain adjusted by giving me the perception that the objects were bigger. In other words, our brain is very flexible in how it perceives size, and perhaps this contributes to the Alice in Wonderland illusion. Since Grace had strabismus, she might have fused images between the two eyes intermittently so that she sometimes saw with stereopsis and, at other times, did not. As a result, the distance between herself and other objects may have appeared to shift. Perhaps, this helped to trigger the size illusions.

  2. Excellent points, and that is certainly a possibility, Sue. In her essay Michelle does not make any connection between Grace’s early onset strabismus, the eye muscle surgery, and the size/distance perceptual illusions her daughter experienced. We know nothing about Grace’s level of binocular vision, and although Grace volunteered her observations at age 7 we have no idea when she first began experieincing this. There is an intriguing article I came across that subcategorizes individuals with strabismus into classifications: 1) having stereopsis and stereopscopic size constancy 2) having stereopsis but no stereoscopic size constancy 3) having neither. (http://www.iovs.org/content/38/13/2800.full.pdf) The study was done with patients having albinism, but the take-home message is that current clinical tests of stereopsis have very little to do with how patients having strabismus may or may not use some level of binocular integration to judge depth in general and size constancy in particular. To your point, periodically existing in different visual states may be a trigger. This may speak to our friend Greg Voth’s notion of “putting himself into stereopsis”, and the possibilty that this may occur unconsciously or relatively passively – and that there are varying degrees of perceptual conflict, ambiguity, confusion, but also intrigue in contemplating these apparent illusions. How the brain codes and uses this information is something that we gloss over because we usually address field expansion or contraction in two dimenstional terms. It is deeper than that.

  3. In the mid 1960s a 39yr old PhD in English Literature came to my office with an unusual depth perception problem. Her stereopsis at distance was 100%. Her stereopsis at near was 100%. Yet, she could not judge the distances between near and far with any accuracy. Refractive and binocular status was within normal limits. She also could not hold down a job. When aiming at an intermediate object her eyes would jump to near or far. VT to expand her peripheral space was successful in resolving her condition. There was no “standard” diagnosis for her at that time.

    Must leave for the moment. Part two comes later.

  4. As she was progressing in the development of her total visual space, she referred her friend, of the same age, to me. The friend had strabismus and was surgically treated SEVEN times with poor results. There was no history of VT or Orthoptic care. Both the cosmetic and social and economic consequences left her with no purpose in life and employment at the lowest level in the publishing industry.

    After extensive testing, I explained to her that there was no magic bullet to redress her circumstances. Nor was there any way to undo the unsuccessful results of the surgical care. We would have to work on rebuilding her visual function system. The anisometropic refractive condition was first addressed through the fitting of contact lenses. Monocular skills were developed in conjunction with peripheral fusion. Space was then developed through the combination of visual, kinesthetic, and auditory stimuli. I explained to her that we were developing a parallel system to the one she was using at the time. As the parallel system took hold, a gradual application to her work and social life using the new system was introduced until the old way of seeing things was replaced. At this point, I explained to her that she must use the new system at all times, even though she was aware of the existence of the old system. This would take time, until the new way of seeing would fully take over the old one.

    Follow-ups would not only watch for any regression, but also help her with any tasks that she could not perform with the new system.

    Not only was her visual functioning improved, but so was her whole live and economic livelihood improved. She ended up retiring from the publishing industry after she had become Editor in Chief at a major publishing house.

    Alls well that ends well.

  5. Phenomenal, Michael. Thanks for sharing. My instinct is to say that people like your patient, who are in the publishing industry, should consider publishing their experiences. Not everyone has the skill or determination of a “Stereo Sue”, but we need patients whose lives have been turned around like this to put it in print.

  6. Pingback: Reaching Down the Rabbit Hole | The VisionHelp Blog

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