Based on the novel of the same name, Shutter Island is a psychological thriller directed by Martin Scorsese and featuring a star cast that consisted of actors such as Leonardo DiCaprio, Mark Ruffalo and Ben Kingsley. The film follows Teddy Daniels, played by DiCaprio, who travels to Ashecliffe Hospital in Shutter Island, to look into the disappearance of a patient. As the film progresses, we see the increasing impossibility of the disappearance and Daniels getting even more unsettled as he becomes victim to various hallucinations and migraines.
Eventually we find out that Daniels’ true motive is to find Andrew Laeddis, an arsonist who was responsible for the death of his wife and children, and he believes that he is held somewhere at Asheville. His search eventually leads him to discover that Teddy himself is Andrew Laeddis. We find that he has been sent here after he killed his manic depressive wife for killing their children and burning down their house. We learn that Andrew is undergoing delusions due to his guilt and that the whole plot was a ruse set up by the doctors to “cure” him.
Given that this movie has a strong focus on psychiatry and abnormal behavior, this blog post will try to assess the symptoms of Andrew Laeddis and understand which disorder he shows signs of, as per DSM-V. In addition to this, this paper will also explore the various treatment methods used on Laeddis during his time at Asheville and whether or not they would truly be effective for Laeddis’ condition in an off-screen setting.
First, Laeddis shows symptoms of persecutory type delusional disorder given the fact that he is in constant suspicion of the people working at Asheville and believes them to be actively working against his goal of being able to “find Laeddis” by drugging him via the food, drinks and cigarettes they have been offering him. He even begins to feel his partner is no longer reliable. Moreover, the setup at Shutter Island provides Laeddis with a way to support his elaborate delusions and only serves to heighten his confusion and paranoia. However, he does not fully adhere to the symptoms of persecutory type delusional disorder. While he experiences intense feelings of paranoia, he actively tries to get rid of these feelings and is working to find out “what is really going on” (Cohen, 2003). He also shows signs of delusions of grandeur, often believing himself to be a savior of the island and the one who will finally expose Shutter Island and its administrators for what they really are.
Despite this, a difficulty in diagnosing Laeddis would be the fact that he is extremely high functioning. Despite being driven by suspicion, he shows clear thinking and rationality in most situations. He would come off to others as being an intelligent and disturbed man but not one that is suffering from a serious disorder. We can even see how this might support his delusions, where he explains away the physical symptoms of withdrawal from his earlier medication by using a fictional person who tells him that he is being drugged by the people at Asheville. This provides some evidence that supports the notion that his high functioning mind might also enable him to construct detailed delusions that even incorporate things that cannot be ignored.
Regardless of this, it is clear that delusions are the main characteristic of the disorder that Laeddis seems to be suffering from and this would be the focus of a DSM analysis. The nature of his symptoms have been highlighted but one delusional theme does not persist over others. His delusions have also shown to be persisting for over a month and not as a result of any substances, mood issues and schizophrenia. As a result, I would diagnose Laeddis as suffering from mixed-type delusional disorder, according to DSM-V standards (American Psychological Association, 2013).
It must be noted that this analysis is of a fictional character, whose symptoms do have some element of dramatization to them and in a real-life setting, a lot more factors will have to be considered for an accurate diagnosis to be made.
Second, how would one go about prescribing a treatment for such a condition? The approach the doctors at Asheville took was to prescribe antipsychotic drugs. However, Laeddis is shown to be a high-functioning individual and as a result his delusions are structured like the reality (Lieberman & Tasman, 2006) that he is experiencing, so any antipsychotic drug that he took would only serve to impair his cognitive functioning given his delusions do not show typical patterns of psychosis. Another disadvantage could also be that any form of medication could lead to heightened feelings of paranoia and distrust against the ones administering them. As a result, antipsychotic drugs can only take one so far while treating delusional disorder.
Another treatment method that can be used is psychotherapy, which is what we saw the doctors at Asheville attempt to do in some way by forcing Laeddis to be part of this elaborate setup. However, it actively worked against them as it enabled Laeddis to further support his delusions and the final outcome of directly challenging his delusions did not lead him to recover from his delusions. One should focus on addressing more realistic goals in a less aggressive and more consistent manner, instead of directly challenging his delusions in one, aggressive therapeutic interaction (Munro & Mok 1995).
Finally, it is already established that lobotomies are dangerous and not ethical whatsoever. No patient should be treated as “beyond treating” and it should go without saying that “treatments” like lobotomies should not be treated as a last resort.
In conclusion, Shutter Island’s portrayal of an individual with delusional disorder is realistic in some aspects, given it matches criteria listed in DSM-V. The movie’s portrayal of treatment is also not misrepresented as Shutter Island is inspired by the “snake pit” hospitals of the mid 20th century which provided extremely poor conditions for patients suffering from mental disorders. In addition, the ice-pick frontal lobotomy was a treatment that was in wide use during that time period. Given this movie’s portrayal of clinical psychology, one can express relief at how far the field has come and how much better treatments and conditions for people suffering from these disorders are in the present today.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Cohen, B. J. (2003.) Theory and Practice of Psychiatry. New York, NY: Oxford University Press.
Lieberman, J. A., and Tasman, A. (2006.) Handbook of Psychiatric Drugs. Chichester, UK: John Wiley and Sons, Inc.
Munro, A., & Mok, H. (1995). An Overview of Treatment in Paranoia / Delusional Disorder. The Canadian Journal of Psychiatry, 40(10), 616–622. https://doi.org/10.1177/070674379504001008
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