The island called Shutter Island, located near Boston , houses the Ashecliffe Psychiatric Hospital for the insane.
The island is used to lock up and treat, mainly, people with severe mental disorders who have committed some kind of crime. Agent Edward Daniels and his partner Chuck Aule are sent here to investigate the disappearance of an inmate, Rachel Solano, who was admitted to the facility after drowning her three children. Both investigators will try to solve the case, but throughout his investigation Daniels will see a number of strange elements that the case hides from him much more than he expected.
This brief paragraph introduces us to the plot of Shutter Island, a film directed by Martin Scorsese and released in our country in 2010. Based on the novel of the same name written in 2003 by Dennis Lehane, Shutter Island is a film in the form of a psychological thriller set in the 1950s, a turbulent period for psychiatry and psychology as regards the treatment of individuals with mental disorders. That is why analyzing and outlining a brief psychological overview of the film can be really interesting both to deepen the meaning of the plot and the history of psychiatry.
Please note that this article contains SPOILERS regarding the film, so its reading is recommended only to those who have already seen it, do not want to see it or do not care that the development and conclusion of the film is gutted.
Entering the sinister island: a review of his argument
The story begins with agents Daniels and Aule arriving on the island, where they have been sent to investigate a disappearance. Upon arrival at Ashecliffe, the island’s psychiatric hospital, and after being briefed on security measures by the staff, the agents meet with the centre’s director, Dr. Cawley. He tells them that the missing person is Rachel Solano, a patient who was admitted to the centre after drowning her children and who has disappeared without trace.
Inspector Daniels proceeds to ask him to let them see the records of the professionals who attended the patient , which the director refuses to do despite allowing them to question the staff. The exception would be the psychiatrist who was taking the patient, who was on vacation at the time.
Both officers proceeded to investigate the case by inspecting the island and the hospital, questioning psychiatrists and other patients. However, throughout the process, the agents see various strange and disturbing details, such as the fact that they are not allowed to visit the island’s lighthouse or the attitude of the psychiatrists, and even that at a certain moment another resident tells the protagonist to flee the place, leading them to believe that there is something strange about the situation.
In addition, Edward Daniels presents throughout the research a series of visions along with flashbacks of his involvement in the war. During a dream his wife appears to him, who died with her children in a fire caused by a certain Andrew Laeddis who also happened to be admitted to the sanatorium where they are staying and then disappeared. In his dream, she tells him that his murderer and Rachel are still inside the island.
The Mystery Note
In the cell where Rachel was locked up, the missing inmate . Edward finds a note in which is written “The law of four: Who is 67?”, which causes him to decide to investigate the patient with that number, being convinced that it is the person who set the fire that killed his family.
Clues and the questioning of one of the patients seem to indicate that lighthouse lobotomies are being performed and that unethical experiments are being carried out on the inpatients. Because of these facts, the obstacles he encounters to investigation and the comments of the residents make the officer think that a conspiracy is being forged against him so that he cannot expose the actions carried out in the sanatorium.
Eventually Rachel Solano is found and presented to the investigators by the doctors , but agent Daniels still sees something suspicious about the case and the location. After discovering a way to get into the lighthouse, both agents decide to risk investigating inside it to collect evidence and then flee the island and expose the psychiatric hospital, after which Chuck Aule disappears. Shortly thereafter, Agent Daniels discovers the real Rachel Solano in a cave, indicating that she was a psychiatrist at the facility who was committed for trying to expose the practices and experiments carried out at the facility. The next day, the centre’s officials claim that Officer Daniels arrived on the island alone, which leads him to believe that his partner has been kidnapped for experiments. For all these reasons, he finally decides to break into the lighthouse, where he meets his partner and Dr. Cawley.
The identity of Andrew Laeddis
At this point the plot takes an unexpected turn: the doctor and Chuck explain to Daniels that he is actually Andrew Laeddis, a war veteran and dangerous patient of the centre who was admitted there after murdering his wife Dolores Chanal.
The whole situation and the investigation he was carrying out was a theatre organized by the people in charge of the centre as a last chance to make him come back to reality as an alternative to lobotomy, since Laeddis suffers from a psychotic disorder which prevents him from facing the events and given his military training he is one of the most dangerous residents of the centre. In fact, the patient I was investigating, Rachel Solano, does not exist (the woman the doctors presented to them as such was an employee pretending to play her role) but her name has been constructed from that of his wife, who, as was said of Rachel, drowned his children while suffering a depressive episode.
In the final bars of the film it seems that Andrew has finally accessed the memories of his family’s death, remembering who he is and what led him there. Thus, the doctor’s plan would have succeeded in bringing him back to reality, being able to advance in the treatment of the problem. But soon after, the protagonist talks to what he previously believed his partner Chuck, actually a psychiatrist at the center, indicating that they must escape from that place. This leads to finally being considered to have regressed and due to the dangerousness of the case they decide to lobotomize the patient.
While there is a possibility that he may have actually relapsed, the last sentence he utters before he is taken to the lighthouse (“This place makes me wonder what would be worse. Living like a monster or dying like a good man”) makes you think that his supposed regression is not such, but an act. Thus, the end of the film would suggest that Andrew Laeddis, despite recovering his sense of reality, decides that it is preferable to be lobotomized and free himself from the burden of knowing what he has done than to be treated differently and accept and assume that he has killed his wife and lost his children.
Psychology and psychiatry reflected in the film
Shutter Island is a film that, due to its subject matter and plot twists, may or may not appeal to those who watch it . But regardless of this, throughout the film we can observe different psychological or psychiatric elements that have been worked on throughout the film and that are even the basis of its plot.
Some of these elements are as follows.
History of Psychiatry: From Asylum to Deinstitutionalization
It was mentioned at the beginning of this article that the film is set in the 1950s, a turbulent time for psychiatry. This is because it was during this decade and the next that the so-called psychiatric revolution originated, after a difficult “war” (mentioned directly in the film) in which two opposing currents clashed.
Until this time, people with severe mental disorders were locked up and isolated in psychiatric institutions, also known as madhouses, where they were treated as prisoners and isolated from the world and from a normal life. In these institutions, patients were treated through controversial procedures such as insulin coma, electroconvulsions or ablation of parts of the brain as in the case of lobotomy.
As a reaction to this type of treatment and to the social exclusion and annulment of patients, anti-psychiatry would be born, which would advocate greater use of psychotherapy and the abolition of practices such as those mentioned.
The prolonged confrontation between both positions would end with the confluence of both in a new psychiatry , more focused on the search for the normalization of the patient’s life. The consequence was the closure of most psychiatric institutions (a process known as deinstitutionalization) and the search for another type of approach to the treatment of disorders, such as pharmacological treatments, ceasing the application of most of the controversial medical therapies of the time and restricting them to cases of great severity that could not be solved in any other way.
Looking into Andrew Laeddis’ mind: his disorders
As we have seen, throughout the story it is reflected how the character played by Leonardo DiCaprio suffers from some kind of mental disorder.
It is important to bear in mind that we only know part of the disorder that torments the protagonist, as well as that generally mental disorders do not occur in a pure state but contain characteristics of other disorders. A correct exploration of the patient would be necessary to be able to determine with more accuracy the disorder that suffers, although it is possible through the symptoms shown to have an idea of the problems in question.
From the symptoms that are reflected throughout the history, it is possible to suspect the presence of post-traumatic stress disorder or PTSD. The fact of having been exposed to traumatic events that have caused deep emotional distress, the re-experimentation in the form of flashbacks and dreams, the dissociation of his personality and the difficulties of sleep and concentration that are seen throughout the film correspond to this type of disorder. Also, the fact that the mental disorder is linked to a specific event seems to indicate PTSD as one of the most likely diagnoses.
However, since it is not possible to diagnose this disorder if another person explains the symptoms better, and since the patient presents a way of acting characterized by the presence of hallucinations and delusions (much of the film depicts them), it is much more compatible with the case that Andrew Laeddis suffers from a psychotic-type disorder.
The delusions and hallucinations would have in this case a persecutory character (since he feels persecuted) and self-referential (the character sees himself as an investigator who seeks to help), and would be used by the protagonist as an unconscious mechanism to escape from reality. Within psychoses, the set of symptoms would suggest a paranoid schizophrenia, although the high systematization of delusions could also indicate the option of suffering a delusional disorder.
Treatments visible during film
Throughout the film you can see how different types of psychiatric and psychological treatments were applied at this time, some of which have been refined over time.
The bulk of the film can be explained as an attempt by doctors to force the patient’s return to reality through the representation of the patient’s fantasies. This technique has a certain resemblance to psychodrama, a technique in which the psychic conflicts of the patients are represented in order to help them face up to them and internalise them. However, applying this technique to psychotic patients is complex and can be counterproductive, as it can reinforce their delusions and make the situation worse .
The pharmacological treatment of psychotic problems is also visualized in Andrew Laeddis himself. The character in question was treated with chlorpromazine, an antipsychotic that kept hallucinations and flashbacks at bay. In fact, as explained in the film, the tremors and headaches that the character suffers throughout the film are produced in part by the abstinence syndrome to this drug. When he stops taking the medication, flashbacks from his past and various hallucinations also reappear strongly, as when he talks to what he considers the real Rachel Solano.
The last treatment applied to the protagonist is the prefrontal lobotomy, a technique through which the connections of part of the frontal lobe are removed or cut. Since the frontal lobe governs the executive functions, its ablation produces a state of continuous sedation and severe limitation of mental functions. It was used as a last resort in the most serious and dangerous cases. In time it would be replaced by the use of other psychoactive drugs.