Most rep­utable doc­tors tend to refrain from diag­nos­ing peo­ple they’ve nev­er met or exam­ined. Unfor­tu­nate­ly, this cir­cum­spec­tion does­n’t obtain as often among lay folk. When we lob unin­formed diag­noses at oth­er peo­ple, we may do those with gen­uine men­tal health issues a seri­ous dis­ser­vice. But what about fic­tion­al char­ac­ters? Can we ascribe men­tal ill­ness­es to the sur­re­al menagerie, say, in Lewis Carroll’s Alice’s Adven­tures in Won­der­land? It’s almost impos­si­ble not to, giv­en the overt themes of mad­ness in the sto­ry.

Car­roll him­self, it seems, drew many of his depic­tions direct­ly from the treat­ment of men­tal dis­or­ders in 19th cen­tu­ry Eng­land, many of which were linked to “extreme­ly poor work­ing con­di­tions,” notes Franziska Kohlt at The Con­ver­sa­tion. Dur­ing the indus­tri­al rev­o­lu­tion, “pop­u­la­tions in so-called ‘pau­per lunatic asy­lums’ for the work­ing class sky­rock­et­ed.” Carroll’s uncle, Robert Wil­fred Skeff­in­g­ton Lutwidge, hap­pened to be an offi­cer of the Luna­cy Com­mis­sion, which super­vised such insti­tu­tions, and his work offers “stun­ning insights into the mad­ness in Alice.”

Yet we should be care­ful. Like the sup­posed drug ref­er­ences in Alice, some of the lay diag­noses now applied to Alice’s char­ac­ters may be a lit­tle far-fetched. Do we real­ly see diag­nos­able PTSD or Tourette’s? Anx­i­ety Dis­or­der and Nar­cis­sis­tic Per­son­al­i­ty Dis­or­der? These con­di­tions hadn’t been cat­e­go­rized in Carroll’s day, though their symp­toms are noth­ing new. And yet, experts have long looked to his non­sense fable for its depic­tions of abnor­mal psy­chol­o­gy. One British psy­chi­a­trist didn’t just diag­nose Alice, he named a con­di­tion after her.

In 1955, Dr. John Todd coined the term Alice in Won­der­land Syn­drome (AIWS) to describe a rare con­di­tion in which—write researchers in the Jour­nal of Pedi­atric Neu­ro­sciences—“the sizes of body parts or sizes of exter­nal objects are per­ceived incor­rect­ly.” Among oth­er ill­ness­es, Alice in Won­der­land Syn­drome may be linked to migraines, which Car­roll him­self report­ed­ly suf­fered.

We might jus­ti­fi­ably assume the Mad Hat­ter has mer­cury poi­son­ing, but what oth­er dis­or­ders might the text plau­si­bly present? Hol­ly Bark­er, doc­tor­al can­di­date in clin­i­cal neu­ro­science at King’s Col­lege Lon­don, has used her schol­ar­ly exper­tise to iden­ti­fy and describe in detail two oth­er con­di­tions she thinks are evi­dent in Alice.

Deper­son­al­iza­tion:

“At sev­er­al points in the sto­ry,” writes Bark­er, “Alice ques­tions her own iden­ti­ty and feels ‘dif­fer­ent’ in some way from when she first awoke.” See­ing in these descrip­tions the symp­toms of Deper­son­al­iza­tion Dis­or­der (DPD), Bark­er describes the con­di­tion and its loca­tion in the brain.

This dis­or­der encom­pass­es a wide range of symp­toms, includ­ing feel­ings of not belong­ing in one’s own body, a lack of own­er­ship of thoughts and mem­o­ries, that move­ments are ini­ti­at­ed with­out con­scious inten­tion and a numb­ing of emo­tions. Patients often com­ment that they feel as though they are not real­ly there in the present moment, liken­ing the expe­ri­ence to dream­ing or watch­ing a movie. These symp­toms occur in the absence of psy­chosis, and patients are usu­al­ly aware of the absur­di­ty of their sit­u­a­tion. DPD is often a fea­ture of migraine or epilep­tic auras and is some­times expe­ri­enced momen­tar­i­ly by healthy indi­vid­u­als, in response to stress, tired­ness or drug use.

Also high­ly asso­ci­at­ed with child­hood abuse and trau­ma, the con­di­tion “acts as a sort of defense mech­a­nism, allow­ing an indi­vid­ual to become dis­con­nect­ed from adverse life events.” Per­haps there is PTSD in Carroll’s text after all, since an esti­mat­ed 51% of DPD patients also meet those cri­te­ria.

Prosopag­nosia:

This con­di­tion is char­ac­ter­ized by “the selec­tive inabil­i­ty to rec­og­nize faces.” Though it can be hered­i­tary, prosopag­nosia can also result from stroke or head trau­ma. Fit­ting­ly, the char­ac­ter sup­pos­ed­ly affect­ed by it is none oth­er than Hump­ty-Dump­ty, who tells Alice “I shouldn’t know you again if we did meet.”

“Your face is the same as every­body else has – the two eyes, so-” (mark­ing their places in the air with his thumb) “nose in the mid­dle, mouth under. It’s always the same. Now if you had two eyes on the same side of the nose, for instance – or the mouth at the top – that would be some help.”

This “pre­cise descrip­tion” of prosopag­nosia shows how indi­vid­u­als with the con­di­tion rely on par­tic­u­lar­ly “dis­crim­i­nat­ing fea­tures to tell peo­ple apart,” since they are unable to dis­tin­guish fam­i­ly mem­bers and close friends from total strangers.

Schol­ars know that Carroll’s text con­tains with­in it sev­er­al abstract and seem­ing­ly absurd math­e­mat­i­cal con­cepts, such as imag­i­nary num­bers and pro­jec­tive geom­e­try. The work of researchers like Kohit and Bark­er shows that Alice’s Adven­tures in Won­der­land might also present a com­plex 19th cen­tu­ry under­stand­ing of men­tal ill­ness and neu­ro­log­i­cal dis­or­ders, con­veyed in a super­fi­cial­ly sil­ly way, but pos­si­bly informed by seri­ous research and obser­va­tion. Read Barker’s arti­cle in full here to learn more about the con­di­tions she diag­noses.

Relat­ed Con­tent:

Lewis Carroll’s Pho­tographs of Alice Lid­dell, the Inspi­ra­tion for Alice in Won­der­land

See The Orig­i­nal Alice In Won­der­land Man­u­script, Hand­writ­ten & Illus­trat­ed By Lewis Car­roll (1864)

See Sal­vador Dali’s Illus­tra­tions for the 1969 Edi­tion of Alice’s Adven­tures in Won­der­land

Josh Jones is a writer and musi­cian based in Durham, NC. Fol­low him at @jdmagness.