The film Shutter Islands holds value for students of psychology, psychiatry and nursing for its portrayal of complex mental illness. The film should be evaluated separately on two counts – first, its entertainment value and second, its relevance to the medical profession. Obviously, the parameters used for the respective evaluations are different. In my view, the film is highly impressive in both these counts. But this essay will focus on the second aspect, and argue that the film is full of key insights into the pathology of delusion and the range of therapeutic approaches in dealing with it.
Firstly, director Scorsese intertwines war-induced mental trauma of Teddy Daniels with personal tragedy of Andrew Laeddis. This compounds the confusion for the audience, but also adds a political dimension to what is an exposition on psychiatric illness. Toward the end of the film it is unveiled how the whole of the Shutter Island is a set up to play along the illusions of Andrew Laeddis. So, when we construct the film from backwards, it is obvious that Laeddis is the only ‘patient’ there is. The mysterious disappearance of Rachel Solando is a ploy designed to put Laeddis in situations of acute emotional tension, with the aim of correcting his aberrations. Perhaps, even all the ‘inmates’ of the wards A, B and C were part of the ploy, or perhaps not as mentally ill as is conveyed to Laeddis/Daniels. As the story unfolds, we see how only a porous line separates the dreams and realities of Laeddis. At first, Laeddis, in his persona of Teddy Daniels, is given a warm welcome by the hospital staff and their chief Dr. Cawley. But soon he becomes “increasingly suspicious of the doctor and his staff, and when he begins experiencing fierce migraines and vivid visions of tragedies in his own past, he begins to fear that he has become Cawley’s latest experiment.” (Thomson, 2010)
For nurses and therapists, one of the questions at the center of the film is the debate in the choice of lobotomy and drug therapy. During the 1950s when the film is being set, this was a dominant debating point in psychiatrist circles. Even Dr. John Cawley talks about this debate and his preference for non-interventionist methods. He suggests that he would first try humanitarian methods of talk-therapy, failing which the patient would be tried drug-therapy. It is only as a last resort that surgical procedure would be prescribed. This is a very sensible position to take, for today’s psychiatry suffers from ready resort to medication, eschewing thorough talk-based therapies. At the same time, today’s psychiatry is not as gung-ho about surgical interventions as was the tendency toward the latter half of the twentieth century. The lobotomies talked about by Dr. Cawley would only be applied to the rarest of rare cases today.