When experiencing extreme distress and trauma, Alice fixates on maggots and worms, which represent unwanted change. After Alice experiences severe bodily injury while on LSD, she’s forced into an institution and makes the comparison: “They tell me my worms aren’t real and yet they’re sending me to a place that’s worse than all the coffins and the worms put together. I don’t understand why this is happening to me” (148). Unable to accept the harsh reality into which she’s forced, Alice confuses her hallucinations about worms and maggots as real, representing her resistance to losing control of her body and life. She can’t claw her way out of the psychiatric institution like she attempted to do with her imagined creatures; she must face the reality of a strict authoritarian environment.

Alice first experiences intrusive thoughts about maggots and worms when her grandparents die, which is another unwanted change. After Gran dies suddenly in her sleep, Alice feels “so depressed all [she] can think about is worms eating [Gran’s] body. Empty eye sockets with whole colonies of writhing maggots. [She] can no longer eat” (133). Alice struggles to accept the idea of life without her grandmother, continuing to focus on her decaying body.