Migraine and Inspiration

C.L. Dodgson's migraine and Lewis Carroll's literary inspiration: a neurolinguistic perspective ¹
Peter van Vugt, Unit of Neurolinguistics, CNO Antwerp University, Belgium

Abstract

Lewis Carroll's Alice's Adventures in Wonderland (AW) and Through the Looking-Glass (TLG) have, since their publication in 1865 and 1871, been interpreted in the most various (and curious) ways. As early as 1952 Lippman pointed out that the author of AW and TLG might have suffered from migraine attacks, preceded or accompanied by body image distortions (BIDs). The present paper argues that not only C.L. Dodgson's (alias Lewis Carroll's) BIDs served as a source of inspiration, but that also the visual and auditory illusions, false perceptions and sensory distortions, which the author may have experienced during some of his migraine attacks, were crucial in creating and describing the strangeness of Wonderland. Indeed, recent studies report that up to 30% of migraine patients experience two or more neuropsychological phenomena such as scotomas and other visual disturbances and illusions, dreamy states, a variety of language disturbances, transient amnesia, BIDs,uditory, olfactory and gustatory hallucinosis. Special attention is paid to Dodgson's right-sided deafness, which in combination with migrainous ischemia (Wolberg & Ziegler, 1982) or migrainous cortical spreading depression (Lauritzen, 1994) in the posterior temporal and parietal cortex might have caused auditory distortions or even hallucinosis (Paquier et al., 1992). Several descriptions of such auditory phenomena, found in AW and TLG, are highlighted.

1. Introduction

"Every text is open to interpretation." becomes almost an understatement when one tries to map the various interpretations that have been proposed for Lewis Carrolls best known fairy tales. His Alice's Adventures in Wonderland (AW) and Through the Looking-Glass (TLG) have, since their publication in 1865 and 1871, been considered classic examples of nonsense literature. The very slight relationships between the subjects, objects and actions described in the texts and the every day experiences of the reader (one of the main characteristics of the nonsensical genre) are undoubtedly at the root of the innumerable interpretations that have been proposed. Very soon, Carroll's contemporary readers were eager to point to the "hidden" social and religious criticisms of the Victorian society. Some psychoanalytically oriented students have tried to explain the sometimes disturbing incongruities of AW and TLG by suggesting the presence or influence of unconscious, erotic or Oedipal processes during the creative writing act. For others Carroll's neurotic personality traits were very apparent. Still others have been struck by the puns, clang associations, nonsense poetry, odd conversations, the peculiar and sometimes defective reasoning of the Wonderland characters and by their movements, which actually imitate particular moves on the chessboard; indeed, AW and TLG have been analyzed from the standpoint of linguistics, logic, and mathematics (Gardner, 1978; Fordyce & Marello, 1990; Van de Velde, 1992). The interaction between Lewis Carroll's text and John Tenniels pictures has also been explored and held essential for the creation of the illusory wonderland (Nieres, 1990).

Alice's preoccupation with the art of conversation is remarkable, certainly for the adult reader of AW and TLG. "This was not an encouraging opening for a conversation," is her first reaction when the caterpillar answers curtly (AW, p. 67). The footman-frog "might answer questions" (AW, p. 81). The grunting pig is told: "that's not at all a proper way of expressing yourself" (AW, p. 86). Moreover, Alice is well aware of certain functional aspects of speech: "Alice didn't like being critized, so she began asking questions." (TLG, p. 202). A pragmatically oriented approach of the communicative behaviour depicted in AW and TLG thus comes not as a surprise. Lakoff, in her 1993 paper, emphasises that several conversations in AW and TLG are in fact "dyscommunications". Alice's uncertainty concerning her identity ("Who in the world am I ?, AW, p. 37) is, at least partially, responsible for these communicative failures. Certain text fragments (e.g. the Jabberwocky poem) are perfectly norma at the level of syntax, but comprehension is rendered almost impossible by a marked lack of real content words. Songs and poems are introduced and announced, but current genre rules are not respected. Several characters, a.o. the White Knight (TLG, p. 306-307) seem incapable of respecting the presuppositions, rules and techniques of a normal conversation. These and a few other observations lead Lakoff (1993) to the conclusion that AW and TLG might be considered as (pragmatically) "subversive" texts. She sees Lewis Carroll as a Grice (p. 377), a Wittgenstein (p. 379), or a Searle (p. 381) avant la lettre.

Although Lakoff (1993) in this well founded and convincing paper opens new interpretative horizons, it is, we think, equally important to point to the implicit faith in man's rationality which obviously underlies her analysis of AW and TLG. Alices's shrinking or her sudden growing bursts, phenomena like the totally or partially disappearing Cheshire Cat, and the fact that objects rise from their shelves when stared at are interpreted as a foreshadowing of the Uncertainty Principle or as examples of Carroll dissociating from Victorian physical theory (Lakoff, 1993: p. 381). Without wishing in any way to discount the part played by Carroll's, or rather C.L. Dodgson's, highly developed rational sense or his subtle intellect in the writing process, we shall, in this paper, look further into the possibility of a pathological source to the inspiration behind AW and TLG. More particularly, we want to focus on another, perhaps inexpected pathology, which requires not so much the Hinein nterpretation of the postmodern-schizofrenic aspects of AW and TLG (cf. Lakoff, 1993: p. 382).

2. Nature and nurture

To avoid any misunderstanding we want to emphasise that in Lewis Carroll's writings the interaction between spontaneously surging inspiration ("[...] sometimes the sentences come almost too quick for me to write them down." Cohen & Green, 1979, p. 687) and carefully, well considered shaping is perhaps more prominently present than in any other fiction. In other words, the writing process is influenced by two poles which we may identify for the sake of simplicity as nature and nurture. Firstly, let us examine some aspects of Dodgson's "nature". It is difficult to deny that several very personal facts and circumstances played a significant role in the creation of AW and TLG. That Dodgson was very fond of children and that he spent much of his time with his little girl friends is well-known. In the prefatory verses as well as in Dodgson's diary AW is presented as a story told to the three Lidell sisters during a rowing expedition on the Thames. In order to understand the relevance of this side of Dodgson's nature to his narrative performance one has to bear in mind 1 that in 1861 he took deacon's orders, but a constitutional stammer prevented him from seeking the priesthood and 2 that the stuttering disappeared when speaking to little girls (Lebrun, 1987). Also the mirror image theme has roots in Dodgson's nature. Gardner (1978) connects Dodgson's asymmetrical physiognomy and his mirror image obsession. That there is indeed more than a strong interest for mirror reflections is illustrated by the way the theme is treated in TLG, but it is also deliberately and obviously present in the photographs arranged and made by Dodgson (Cohen & Green, 1979, pp. 60-61, 704-705) . Another aspect of Dodgson's nature are his levographic skills. Mirror writing is frequent among left-handed first-formers (Lebrun, 1987); remarkable, however, is the fact that the left-handed Dodgson preserved this particular skill, which he occasionally used to entertain his girl friends (Cohen & Green, 1979, pp. 517, 993) , till an advanced age. The Jabberwocky poem in TLG has to be read by Alice by means of a Looking-glass, and the opening stanza actually appears in reversed form in most editions, as intended by the author. It is clear, then, that personal experiences form the foundation of both AW and TLG: their indeniable impact on the two texts may be traced to the fact that Dodgson committed himself to the literary practice of "automatic writing" (Gardner, 1978).

On the other hand, one should not overlook the controlling power of the "ratio" of a well educated, refined and inquisitive mind. That Dodgson's writing involved more than a spontaneously "automatic" process may be illustrated by the numerous puns, portemanteau words, (obvious and more private) jokes, as well as by the frequent use of acrostic (Gardner, 1978, p. 345), emblematic, parody or burlesque poetry, etc. The chess game that forms the background to TLG can hardly be other than thought out when one considers the mimetism that exists between the false moves and the absent-mindedness of the personages-pieces. Numerous references to the world of science, to inventions and gadgets as well as to philosophico-logical issues (the dream of the Red King, Alice's discussion with Humpty Dumpty on the meaning and function of words) reflect certainly many of the preoccupations of Dodgson the mathematician. One's opinion of Dodgson as a well-considered writer is confirmed when confronted with the fact that most of the poetry used in AW and TLG seems to be a parody or pastiche of preexisting texts. The limits of rationality are reached, however, when one takes into account how many of the nonsense poems in AW and TLG are Carroll's revised versions of his own already published parodies of well-known poems or song lyrics (Gardner, 1978, pp. 50, 133, 140, 158, 191, 307, 333). Here one is confronted, as it were, by parodies to the second degree.

3. Migraine and inspiration

3.1. Migraine and body image

The preceding paragraphs may have convinced the reader that in the case of Dodgson, personal experiences and literary inspiration are strongly interwoven. Moreover, this finding may be corroborated by several (rather neuropsychological) observations. On several occasions, Dodgson committed to his diary that he suffered from protracted "bilious headaches" (Cohen & Green, 1979, p. 837, 839). Frequently, they were preceded by visual disturbances. (Lippman, 1952). Occasionally, a radiating pain reaching face and neck is reported (Cohen & Green, 1979, p. 89). A physician will recognize several elements of the protean symptomatology of classic migraine.

The first report of a migraine patient describing migraine attacks preceded by an unusual body sensation (the patient felt as if some parts of his body were doubled in size) was by Oppenheim (1923). Lippman (1952) in a comprehensive review of the BID symptomatology quotes several of his patients. Occasionally one of patients feels very small "about one foot high". Another patient complains frequently of her left ear "ballooning out 6 inches or more". A third patient experienced the right half of his body to be twice the size of the left half. Patient J.C. describes her attacks in a letter:"It was at these times that I experienced the sensation that my head had grown to tremendous proportions and was so light that it floated up to the ceiling, although I was sure it was still attached to my neck. I used to try to hold it down with my hands. This sensation would pass with the migraine but would leave me with a feeling that I was very tall." (Lippman, 1952, pp. 348-349). Victims are aware of the illusory nature of their perceptions, but most of the time they can't resist looking in the mirror to be sure. The similarities between these BIDs and the descriptions of Alice's fluctuating size are so striking that it becomes extremely tempting to speculate that Dodgson, known to have suffered from migraine attacks, also may have suffered from BIDs, and that he used this extraordinary sensations in creating his "Wonderland" (Lippman, 1952; Rolak, 1991). Moreover, it is not only physicians that have been struck by the resemblance, patients also refer explicitly to AW and TLG: two of Lippman's (1952) patients report a feeling of being short and wide, one of them referred to this sensation as her "Tweedle-Dum or Tweedle-Dee feeling". If we accept that Dodgson was subject to migrainous BIDs, another explanation for the recurrence of the mirror image theme emerges: in the case of strong BID feelings a mirror would reassure him his body was still perfectly normal.

A migrainous spasm of small cerebral vessels (Wolberg & Ziegler, 1982) or a migrainous cortical spreading depression (i.e. a short-lasting depolarization wave moving across the cortex at a rate of 3-5 mm/min., cf. Lauritzen, 1994) in the parietal cortex have been postulated to be the inciting factor of the described migrainous hallucinosis . The scintillating scotomata due to such a dysfunction propagating across the visual cortex are well known in migraine. The more cortical tissue is involved, the more neurological and neuropsychological signs can be observed: distortion of time sense, paresthesias, BIDs (parietal lobe), numbness or weakness of arm or leg (posterior part of the frontal lobe), or even olfactory hallucinosis. With respect to the distortions of the sense of time patients report that they felt "as if I was going too fast" or on the contrary, "that every-one was talking too fast", and thus that they were acting too slowly (Rolak, 1991). The reader of AW and TLG will remember how Alice describes her fall down the Rabbit-Hole which seems not to come to an end, as well as her high-speed flight with the Red Queen. Ardila & Sanchez (1988) observed a few other intriguing neuropsychological symptoms and dysfunctions in their migraine population. Comparable descriptions of these signs found in Dodgson's literary production are indicated between brackets: depersonalization (AW, II & V), macropsia (puppy, AW, IV), palinopsia (Cheshire Cat), the so-called "dreamy states" ("Hardly knowing what she did, [...]" AW, p.64; "[...] and half believed herself in Wonderland, [...]" AW, p. 163; "So I wasn't dreaming, after all." TLG, p. 293), acalculia (Humpty Dumpty's arithmetic hesitations,TLG, VI).

3.2. Dyscommunications in neuropsychological perspective

Frequently occurring, and thus very well-known, are the visual disturbances preceding the migraine attack (Bana & Graham, 1986). Up to 30% of migraine patients experience two or more prodromes such as scotomas, other visual disturbances and illusions, dreamy states, a variety of language disturbances, transient amnesia, BIDs, auditory, olfactory and gustatory hallucinosis. Certainly worth mentioning are the language related phenomena, occurring together with sensori-motor and/or visual sensations: 9.5 % in Bana & Green's (1986) report, and 40 % in Ardila & Sanchez's (1988) paper . Most frequent are the word-finding difficulties (anomia), but also semantic paraphasias (to say table instead of chair) and articulatory deficiencies are reported. Occasionally, auditory or reading comprehension are affected (Ardila & Sanchez, 1988). In these patients the migraine attack interferes with the processing of visual or auditory input.

In AW and TLG several instances of disturbed or distorted auditory processing can be found: the grunting (or is it the sobbing?) of the pig (AW, VI); "[...] and, all the other queer noises, would change [...]" (AW, p. 163); music coming from under a tree (TLG, IV); the Lion's voice sounds like an enormous bell (TLG, VII); deafening drums: "Where the noise came from, she couldn't make out: the air seemed full of it, and it rang through and through her head till she felt quite deafened." (TLG, p. 290). Several instances of distorted voice perception can be found: "the Beetle's hoarse/horse voice" (TLG, III); in the carriage Alice is addressed by silent and distant voices, she also hears a chorus of voices (TLG, III); "And a great many voices all said together ("like the chorus of a song", thought Alice) [...]" (TLG, p. 217; "Oh, much better! cried the Queen, her voice rising into a squeak as she went on." (TLG, p. 252); the screams of the White Queen "were so exactly like the whistleof a steam-engine, that Alice had to hold both hands over her ears." (TLG, p.249); "And hundreds of voices joined in the chorus." (TLG, p.329); "The White Queen murmured into Alice's other ear, in a voice like the cooing of a pigeon." (TLG, p. 333 ). Sometimes, noises change into words, like the snoring of the Queens that gets more distinct every minute "at last [Alice] could even make out words." (TLG, p. 327). Interesting from a communicative as well as from a neuropsychological point of view is a series of other phenomena. The paraphrasing voices in the carriage (TLG, III) are reminiscent of palilalia, as well as Alice repeating her own words with occasional phoneme substitutions (AW, I; TLG, VII); and fragments like: "[...] the words of the old song kept ringing through her head like the ticking of a clock [...]" (TLG, p.230); [the White Queen] kept repeating something that sounded like "Bread-and-butter, bread-and-butter" (TLG, p. 254). The conversation between Alice and the Fawn contains a clear example of anomia: "[...] she went on, rather surprised at not being able to think of the word." (TLG, p. 226). Alice's feeling of being "ordered about" by the Rabbit, the mice (AW, IV), and by the Gryphon (AW, IX en X) and the fact that she obtains an answer to a non-articulated question "just as if she had asked it aloud" (AW, p. 73) are descriptions resembling those of patients suffering from auditory hallucinosis.

There are more aspects of Carroll's work that point to neuropsychological disturbances: in Wonderland conversation partners fail to communicate: Humpty Dumpty: "This conversation is going on a little too fast." (TLG, p. 265); sometimes this failure is due to phoneme substitutions (a.o. "Did you say 'pig' or 'fig'?" said the Cat." (AW, p. 90)); elsewhere the actors stuck to a particular word (ground for numerous puns and odd interpretations). These instances deserve special attention, certainly in view of Dodgson's right-sided deafness, which possibly is a sequelae of parotitis epidemica (mumps) (Cohen & Green, 1979, p. 156). One may assume this deafness was a serious handicap, causing a certain degree of isolation: it was quite obvious to his girl friends (Cohen & Green, 1979, p. 580) and it was never overlooked when dinner or concert seats had to be assigned (Cohen & Green, 1979, p. 945). One can easily imagine how a vivid and imaginative mind like Dodgson's would follow its own path with only partially perceived conversation fragments. However, to reduce the dyscommunications observed in AW and TLG to Dodgson's right-sided deafness seems a too simple explanation. If one takes into account the relatively high frequency with which auditory illusions and false perceptions have been described in hearing disabled patients (Paquier et al. 1992), the already mentioned auditory phenomena and dyscommunications acquire additional sense. Dodgson's right-sided deafness may certainly not be overlooked as an communication disturbing factor. More speculative, though not to be dismissed, is the hypothesis that due to this partial stimulus deprivation, Dodgson's psychoacoustic cortex was more susceptible to incidental auditory hallucinosis. It is even more difficult to decide whether a process of autostimulation (comparable to the process leading to visual experiences reported by the blind) or a migrainous ischemia (Wolberg & Ziegler, 1982) or migrainous cortical spreading depression (L auritzen, 1994) is to be considered the inciting factor. It is, however, clear that each of these physiological processes, when occurring (separately or in combination) in the temporal or parietal cortex, may cause feelings and sensations very similar to those described in AW and TLG.

In analysing the similarities between Alice's strange adventures in Wonderland and some pathological phenomena known in the neuropsychological literature, we certainly do not intend to offer a once-and-for-all final explanation of AW and TLG. We want, rather, to point out that the inspiration for AW and TLG should not be accounted solely and exclusively to Carroll's ability to create something out of nothing. The use of one's own pathological experiences as a source of inspiration is far from being a rarity (Fuller & Gale, 1988; Sacks, 1985 & 1992; Sno et al., 1992). It may have been a contributing factor in the creation of a still fascinating Wonderland. Though, the use to which this inspiration was put must be attributed to Dodgson's intellect.

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