Outliers Writing University Podcast Series

GET TO KNOW Rocker and Author Dee Snider

CRIMINAL MISCHIEF 13: Alice in Wonderland Syndrome

One pill makes you larger, and one pill makes you small
And the ones that mother gives you, don't do anything at all
Go ask Alice, when she's ten feet tall
From White Rabbit, The Jefferson Airplane
 
And then there was this excellent question from my friend and wonderful writer Frankie Bailey that was published in SUSPENSE MAGAZINE as part of my recurring Forensic Files column:
What Drugs Might Cause Side Effects in My Character With Alice in Wonderland Syndrome?
Q: I have a question about Alice in Wonderland Syndrome (AIWS) My character is in his mid-30s. From what I've gathered from reading about this syndrome, it is fairly common with children and with migraine sufferers and it is controllable. However, I want my character to have side-effects. In other words, even though the AIWS and his migraines are under control, he is increasingly erratic. Insomnia, impotence, and irritability would all be a bonus. Could he be dosing himself with some type of herb that he doesn't realize would have these side-effects when combined with the medication prescribed for AIWS. Or is there a medication for AIWS that might cause these kind of side-effects but be subtle enough in the beginning that the person becomes mentally unstable before he realizes something is wrong?
FY Bailey
A: Alice in Wonderland Syndrome is also known as Todd’s Syndrome. It is a neurologic condition that leads to disorientation and visual and size perception disturbances (micropsia and macropsia). This means that their perception of size and distance is distorted. Much like Alice after she descended into the rabbit hole and consumed the food and drink she was offered.
AIWS is associated with migraines, tumors, and some psychoactive drugs. It is treated in a similar fashion to standard migraines with various combinations of anticonvulsants, antidepressants, beta blockers, and calcium channel blockers. Both anticonvulsants (Dilantin, the benzodiazepines such as Valium and Xanax, and others) and antidepressants (the SSRIs like Lexpro and Prozac, the MAOIs like Marplan and Nardil,, and the tricyclic antidepressants like Elavil and Tofranil, and others) have significant psychological side effects. Side effects such as insomnia, irritability, impotence, confusion, disorientation, delusions, hallucinations, and bizarre behaviors of all types–some aggressive and others depressive. Beta blockers can cause fatigue, sleepiness, and impotence. The calcium channel blockers in general have fewer side effects at least on a psychiatric level.
As for herbs almost anything that would cause psychiatric affects could have detrimental outcomes in your character. Cannabis, mushrooms, LSD, ecstasy, and other hallucinogens could easily make his symptoms worse and his behavior unpredictable.
Your sufferer could easily be placed on one of the anticonvulsants, one of the antidepressants, or a combination of two of these drugs and develop almost any of the above side effects, in any degree, and in any combination that you want. This should give you a great deal to work with.
What is Alice in Wonderland (AIWS) Syndrome?
A neuropsychiatric syndrome—also know as Todd’s Syndrome after Dr. John Todd, the physician who first described it in 1955—in which perceptions are distorted and visual hallucinations can occur. Often objects take an odd size and spatial characteristics—-just as Alice experienced. They can appear unusually small (micropsia), large (macropsia, close (pelopsia, or far (teleopsia).
It can be caused by many things including hallucinogenic drugs, seizures, migraines, strokes, brain injuries, fevers, infections, psychiatric medications, and tumors.
Migraines are often preceded by auras—visual, auditory, olfactory.
Lewis Carroll was known to suffer from migraines. His own diary revealed he had visited William Bowman, an ophthalmologist, about the visual manifestations he regularly had when his migraines flared. So it just might be that he himself experienced AIWS and took his experiences to create Alice.
 
LINKS:
AIWS Wikipedia: https://en.wikipedia.org/wiki/Alice_in_Wonderland_syndrome
AIWS Healthline: https://www.healthline.com/health/alice-in-wonderland-syndrome#outlook
AIWS NIH Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909520/
AIWS and Tumor: https://www.livescience.com/64520-alice-in-wonderland-brain-tumor.html
AIWS and Visual Migraines: https://www.webmd.com/migraines-headaches/alice-wonderland-syndrome#1

CRIMINAL MISCHIEF 12: Fentanyl—A Most Dangerous Game

Fentanyl is a synthetic opioid that is as much as 300 times more powerful than morphine sulfate. It can be injected, ingested, inhaled, and will even penetrate the skin.
It is used in medical situations frequently for pain management, sedation, and for twilight-anesthesia for things such as colonoscopies.
Fentanyl is the number one cause of drug ODs.
Americans have a slightly higher than 1% chance of ultimately dying of an opioid overdose. That's better than one in 100 people. In fact, 60 people die every day from opioid ODs. That translates to over 22,000 per year. In fact, US life expectancy dropped slightly between 2016 and 2017 due to opioid overdoses.
Thirteen people suffered a mass OD at a party in Chico, Ca in January, 2019.
It is often added to other drugs such as heroin to “boost” the heroine effect. Unfortunately, Fentanyl is much more powerful than heroin and when the two are mixed it becomes a deadly combination. It’s also often added to meth and cocaine.
How powerful is fentanyl? A single tablespoon of it could kill as many as 500 people; 120 pounds as many as 25 million people. A recent bust, the largest in US history, recovered over 250 pounds of Fentanyl secreted in a truck crossing the US-Mexico border-—enough to kill 50 million people. 
When cops arrest people who possess or are transporting fentanyl they must take precautions not to touch or inhale the product as it could prove fatal. The opioid crises is the reason many cops carry Narcan (Naloxone) with them as either an injection or a nasal spray. It reverses the effects of narcotics very quickly. 
The “Dark Web” is a source for many things that can’t be purchased or the open market. Weapons, hitmen, and drugs. But even many of these dealers won’t deal Fentanyl.
Could fentanyl be used as a weapon of terror? Absolutely. A fentanyl aerosol sprayed into a room of people could easily kill everyone present in a matter of minutes. It is a powerful narcotic that acts very quickly and depresses respiration so that people die from asphyxia.
In 2002 a group of around 50 Chechen terrorists who took 850 people hostage in a Moscow theater. Many of the attackers were strapped with explosive vests. The standoff lasted 4 days until the Russians pumped Fentanyl-maybe carfentanil or remifentanil—through the vents and took everyone down. All the terrorists were killed but unfortunately over 200 of the hostages died before medical help could reach them. 
Carfentanil—-Been around since 1974 but just now entering the world of drug abuse. Used in darts as a large animal tranquilizer. AN analog of fentanyl but is 100X stronger.
The famous Kristin Rossum “American Beauty” case involved fentanyl.
Fentanyl Deaths Top Car Accidents: https://www.breitbart.com/politics/2019/01/15/accidental-opioid-deaths-top-car-accident-deaths-for-the-first-time/
Mass OD in Chico, CA: https://www.ems1.com/overdose/articles/393267048-Calif-mass-overdose-highlights-severe-new-phase-of-opioid-epidemic/
Narcan: https://en.wikipedia.org/wiki/Naloxone
Even many “Dark Web” Dealers won’t sell Fentanyl: http://www.newser.com/story/268019/even-dark-web-dealers-refuse-to-sell-this-drug.html
Fentanyl As Terror Weapon: https://www.breitbart.com/asia/2019/01/03/report-experts-insist-opioid-fentanyl-could-be-used-as-tool-of-terror/
Fentanyl as WMD: https://www.bloombergquint.com/business/killer-opioid-fentanyl-could-be-a-weapon-of-mass-destruction#gs.UwnsSzO8
Carfentanil Wikipedia: https://en.wikipedia.org/wiki/Carfentanil
Kristin Rossum Wikipedia: https://en.wikipedia.org/wiki/Kristin_Rossum
 

CRIMINAL MISCHIEF 11: Civil War “Limb Pit” and the History of Infectious Diseases

Here in the 21st century we know a great deal about infectious diseases. We can treat bacterial infections with antibiotics, immunize people against numerous diseases, understand how viruses work, and have a huge fund of knowledge about surgical sterility and disease prevention. This was not always the case. In fact, in the history of medicine, all of this is fairly new.
During the 14th century, Europeans didn’t understand infectious diseases so when the Bubonic Plague, also known as the Black Death, struck, they had no understanding of what was going on, how to prevent it, and, more importantly, how to treat it. They were at the mercy of a bacterium that currently is easily treatable. The Black Death killed between a third and a half of the population of Europe and dramatically altered the trajectory of world history.
The transition from ignorance to enlightenment concerning infectious processes was a long process and involved some of the giants of medicine. Names like Ignaz Semmelweis, John Snow, Louis Pasteur, Joseph Lister, and Robert Koch. The observations of these famous scientists were ultimately distilled into Robert Koch’s famous Koch’s Postulates, which proved the Germ Theory of disease. These postulates served as the foundation for our understanding of infectious diseases, and still do today. 
Simply put they say:
!-If an organism is causing a disease, it must be present in those who suffer from the disease and not in those who are healthy.
2-The suspected organism must be isolated from the diseased individual and grown in culture.
3-The cultured organism must then be given to a healthy individual and reproduce the disease.
4-The organism must then be isolated from this newly diseased individual and identified.
Each of these steps is necessary to show that a particular organism causes a particular disease and is transmissible from one person to another. Basically, this is how infectious diseases work.
Unfortunately, Koch’s Postulates were not put forward until the 1880s, a couple of decades after the Civil War.
During the Civil War, almost any battlefield injury could lead to death, most often from a secondary wound infection. A gunshot to the leg, or arm, or really anywhere could become infected quite easily and this infection could spread through the entire body causing sepsis, which would ultimately lead to death. More soldiers died from infection than from their injuries. Surgeons at that time understood the danger of infections, even though they didn’t know what caused it, and had no clue how to prevent or treat them. This meant that serious limb injuries were treated with amputation. Get rid of the injured limb and hopefully lessen the possibility of a secondary infection. Of course, post-surgical infections were also common and also lead to death.
Not only were sterile techniques and antibiotics unavailable at that time, but also any form of anesthesia was not to be found on most battlefields. Ether was around, having been first demonstrated by William T. G. Morton in 1846, but it’s use and availability wasn’t widespread. This means that a battlefield surgeon’s best skill was speed. Sort of the surgical equivalent of "ripping off the Band-Aid." Any surgery was agony and the quicker it was done, and the sooner it was over, the better for the victim. And the amputated limbs piled up.
It seems that Virginia's Manassas National Battlefield Park has yielded what can only be called a "limb pit." It is a place where surgeons deposited removed limbs. This discovery underlines the state of surgical treatment and its brutal nature during the 1860s.
LINKS:
http://www.newser.com/story/260874/first-civil-war-limb-pit-is-excavated.html
Germ Theory: https://en.wikipedia.org/wiki/Germ_theory_of_disease
Koch’s Postulates: https://en.wikipedia.org/wiki/Koch%27s_postulates
Joseph Lister: https://en.wikipedia.org/wiki/Joseph_Lister
Ignaz Semmelseis: https://en.wikipedia.org/wiki/Ignaz_Semmelweis
John Snow: https://en.wikipedia.org/wiki/John_Snow
Louis Pasteur: https://en.wikipedia.org/wiki/Louis_Pasteur
William T.G. Morton: https://en.wikipedia.org/wiki/William_T._G._Morton
History of General Anesthesia: https://en.wikipedia.org/wiki/History_of_general_anesthesia

GET TO KNOW Best-selling Author Tim Maleeny

TIM MALEENY is the bestselling author of the multiple award-winning Cape Weathers mysteries and the comedic thriller JUMP, which Publishers Weekly describes as “a perfectly blended cocktail of escapism.”  His latest is a global art heist called HANGING THE DEVIL, which Library Journal calls “relentlessly fast-paced with delightful dry humor” in a starred review. His short fiction appears in a number of leading anthologies and has won the Macavity Award for best story of the year. The Irish Times says, “If comic crime fiction is your thing, Maleeny delivers in spades.” He currently lives and writes at an undisclosed location in New York City.
https://timmaleeny.com/

GET TO KNOW Best-selling Author Tosca Lee

Tosca Lee is the award-winning, New York Times bestselling author of The Line Between, The Progeny, Firstborn, Iscariot, The Legend of Sheba, Demon: A Memoir, Havah: The Story of Eve, and the Books of Mortals series with New York Times bestseller Ted Dekker.
She is the recipient of two International Book Awards, Killer Nashville’s Silver Falchion, ECPA Book of the Year in Fiction, and the Nebraska Book Award. Her work has finaled for the High Plains Book Award, the Library of Virginia Reader’s Choice Award, two Christy Awards, and a second ECPA Book of the Year. The Line Between was a Goodreads Choice Awards semifinalist for Best Mystery/Thriller of 2019. In addition to the New York Times, her books have appeared on the IndieBound bestseller list, and Library Journal’s “Best Of” lists..
Tosca received her B.A. from Smith College and lives in Nebraska with her husband, three of four children still at home, and her 160-lb. German Shepherd, Timber.
https://toscalee.com/

CRIMINAL MISCHIEF 10: Rattlesnakes and Murder

https://www.mystatesman.com/news/local/police-caldwell-county-man-uses-rattlesnake-neighbor-dispute/NUFO8d5JNM4ggWDdliKS2I/
Snake Handling In Religion Wikipedia: https://en.wikipedia.org/wiki/Snake_handling_in_religion
Snake Handling Churches: http://www.cerm.info/bible_studies/Apologetics/snake_handlers.htm
Church of God With Signs Following: https://en.wikipedia.org/wiki/Church_of_God_with_Signs_Following
George Went Hensley—the First Snake Handler?: https://en.wikipedia.org/wiki/George_Went_Hensley
Punkin Brown: http://www.hiddenmysteries.org/religion/pentecostal/snakeskill-fool.shtml
Jamie Coots Wikipedia: https://en.wikipedia.org/wiki/Jamie_Coots
Cost Coots: https://www.dailymail.co.uk/news/article-6070685/Snake-preacher-gets-bitten-four-years-father-killed-rattlesnake.html
Salvation on Sand Mountain: https://www.amazon.com/Salvation-Sand-Mountain-Snake-Handling-Redemption/dp/0140254587?_encoding=UTF8&redirect=true
Original Sin: http://www.dplylemd.com/book-details/original-sin.html

CRIMINAL MISCHIEF 9: The Mysterious Human Brain

Head Trauma (Direct, Infectious, Anoxic, Vascular)
Physical Abnormalities
Behavioral Changes
Language/Communication
Brain Lobes:
Frontal: Controls personality, emotions, intellect, judgement, problem solving, attention, organizing, social skills
Broca’s Area: Speech, writing, particularly expressing
Parietal: Controls motor and sensory functions, and helps with vision and hearing
Temporal: Language, memory, emotions, perceptions
Wernicke’s Area: Impacts speech formation and understanding
Occipital: Vision
Aphasia: Receptive and expressive 
Memory:
Short Term: Prefrontal Cortex
Long Term: Hippocampus in Temporal Lobe
Amnesia: Global Partial, Retrograde, Anterograde
LINKS:
Brain Anatomy: https://mayfieldclinic.com/pe-anatbrain.htm
Head Injury and Communication: https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/communication-problems/
Aphasia: https://www.headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/communication-problems/language-impairment-aphasia/
Hannah Jenkins Case:
Newser: http://www.newser.com/story/266094/she-woke-up-from-bike-crash-and-couldnt-speak-english.html
BBC Story: https://www.bbc.com/news/disability-45804613
 
Mac Fedge Case:
NBC News Story: https://www.nbcnews.com/healthmain/different-person-personality-change-often-brain-injurys-hidden-toll-8C11152322
 
Subdural Info:
Subdural Hematoma Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/intracranial-hematoma/symptoms-causes/syc-20356145
 
Personality and Behavior Changes: https://www.omicsonline.org/open-access/personality-and-behavior-changes-subsequent-to-traumatic-braininjury-a-review-of-the-literature-1522-4821-1000196.php?aid=52259
 
CareGiver Post: https://www.caregiver.org/coping-behavior-problems-after-head-injury
 

GET TO KNOW Best-selling Author and Emmy-winning Reporter Hank Phillippi Ryan

HANK PHILLIPPI RYAN is the USA Today bestselling author of 15 psychological thrillers, winning the most prestigious awards in the genre: five Agathas, five Anthonys, and the coveted Mary Higgins Clark Award. She is also on-air investigative reporter for Boston's WHDH-TV, with 37 EMMYs and dozens more journalism honors. National book critics call her “a superb and gifted storyteller.” Her current novel is the page-turning standalone THE HOUSE GUEST, a story of psychological manipulation exploring the dark heart of marriage and friendship. Publishers Weekly says “Ryan is a master of suspense!” and Library Journal says "Ryan is has a gift for writing superb suspense." Hank is the co-host and founder of THE BACK ROOM, host of CRIME TIME on A Mighty Blaze, and co-host of FIRST CHAPTER FUN. 
https://hankphillippiryan.com/

GET TO KNOW Best-selling Author and Outliers Instructor Steven James

Steven James is a critically acclaimed author of nineteen novels and numerous nonfiction books that have sold more than 1 million copies. His books have won or been shortlisted for dozens of national and international awards. In addition, his stories and articles have appeared in more than eighty different publications, including The New York Times. He is also a popular keynote speaker and professional storyteller with a master's degree in storytelling. Since 1996 he has appeared more than two thousand times at events spanning the globe, presenting his stories and teaching the principles of storytelling to writers, speakers, teachers, and leaders. When he's not writing or speaking, he hosts the weekly podcast The Story Blender, on which he interviews some of the world's leading writers and storytellers. In 2020 he was inducted into the Christy Hall of Fame for excellence in fiction writing. Publishers Weekly has called him "[a] master storyteller at the peak of his game.”