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Shutter Island: Separating Fact from Fiction

The history of psychology is dissected and distorted in Shutter Island.

Warning: This blog post is one big spoiler alert, so if you haven't seen "Shutter Island" but want to, please refrain from reading this post.

"Shutter Island" is one of those films that rips the rug out from under you with the frequency and intensity of a magician. Initially, we think we are watching a well-intentioned U.S. Marshall named Teddy enter an insane asylum hoping to uncover the whereabouts of a recently-disappeared patient. Later, our strangeness barometer begins to beep and we recalibrate our assumptions. Now we think we are witnessing a brave and bereaved soul searching for damning evidence that will expose Shutter Island as an expensive, cutting-edge torture chamber. Only during the final act (unless you've connected the foreshadowing dots), when our barometer falls off the charts, do we realize that the narrative is really about tragic psychosis and elaborate role play.

Overall, I found the film to be a very intense, somewhat entertaining discussion of lines — the kind of elusive, easily blurred lines that exist between perception and reality, normalcy and insanity, even exceptional and subpar filmmaking. There is another extremely relevant though largely ignored line of which I'd like to discuss, the line between realistic and melodramatic portraits of clinical psychology. Although issues like delusions and 20th-century inpatient treatment are aggressively examined within the plot, many of its exclamation points are in fact question marks that warrant further discussion.

Does Teddy suffer from an actual psychological disorder?

Teddy is a strange case. In retrospect, he presents as an intelligent, high functioning individual, so much so that his traumatic experiences during WW II merely dented, rather than overwhelmed, his coping resources. However, the mild and (then) socially acceptable alcoholism and workaholism he exhibited as a family man provided just enough emotional detachment to blind him from the murderous insanity bubbling up within his bipolar wife.

One Saturday, an unsuspecting Teddy arrived home from a work trip to his three drowned children and a suicidal wife (whom he promptly put out of her misery). Although such an experience would seem to virtually guarantee the development of Post-Traumatic Stress Disorder, somewhere along the way his symptoms tipped into the very real but much less common psychiatric condition known as Delusional Disorder.

According to the DSM-IV you can be high functioning — cognitively, socially and emotionally — and not only suffer from delusions (fixed, adamant beliefs that run contrary to clear, consensual evidence) but experience such a state without clear mental hiccups. Teddy also meets this diagnosis, according to the manual, because he experiences the delusions for more than one month (don't ask me to explain the time cutoff) and not as the result of mood issues (he is not particularly depressed or anxious), drug addiction (the bottle is no longer a problem), or schizophrenia (much too socially savvy, and his delusions are not bizarre — "aliens landed in my kitchen").

As the DSM-IV further classifies Delusional Disorder via the content of the delusion, a psychologist might also note that Teddy suffers from a Mixed Type. His mind generates themes of grandiosity (I'm going to uncover a mass conspiracy!) and persecution (I'm going to be prevented from ever leaving this island!)

Is the film's diatribe against the mental health field warranted?

Suffice it to say that "Shutter Island" is not the most encouraging cinematic portrayal of mental health. Two main points that need to be addressed are the cave scene and the final scene.

The cave scene: In the early seventies — in real life, not fantasy — a researcher named David Rosenhan conducted an experiment that attempted to examine just how well the psychiatric community diagnosed craziness. It did not go well. A handful of research confederates posed as "fake" schizophrenics, entering an inpatient hospital with reports of hallucinations. Once inside, they proceeded to act like their normal, high achieving selves every single moment leading up to discharge. Unfortunately, they were not allowed to leave without a schizophrenia label and prescription for psychoactive medications.

You may recognize remnants of this study in the cave scene, as a psychologist (a figment of Teddy's imagination) rails against the catch-22 of being pronounced insane despite being sane. Of course, this scene is a major melodramatic leap from reality. Paranoid and vindictive psychiatrists, outdated and illogical treatment approaches, and helpless or martyred patients are the stuff of the distant past if not absurdist conspiracy. The current reality is that diagnosis remains a complex mixture of art and science with psychological training consisting of gold standard scientific measures and astute, non-judgmental clinical perspectives. In fact, the field has entered unchartered territory with regard to patient rights, a balanced power dynamic between treator and treatee and well-reasoned, empirically-supported treatment. If only the reality was as edge-of-your-seat suspenseful.

The final scene: Are we really to believe that the likable and accomplished Teddy (no prior history of mental illness on top of a clear pattern of resiliency), goes crazy from a familial trauma, then repeatedly breaks through his delusional mindset during treatment, only to revert back to crazy mode like a record stuck on repeat? Although individual differences and the delicate, volatile blend of genes, environment, and personality can make the prognosis of persistent illness an erratic, sometimes chronic endeavor, the stuck-on-repeat ending does not make sense. Once again "Shutter Island" is in need of an update, as mental illness is presented in the archaic medical model format in which a psychic "virus" arises, sneaks up on the mentally healthy mind with relative ease, causes irreversible damage, and refuses to ever let go. If you ask me this final scene is the craziest thing in the whole movie, and that's saying something.

Do places like Shutter Island really exist?

Without first-hand knowledge, I think it's safe to say that Shutter Island is a caricature. But it's a caricature inspired by the "snake pit" mental hospitals of the '50s and '60s, in which many chronically ill patients suffered a lifetime of filth and mistreatment. When public outrage finally caught up to the reality, a national deinstitutionalization commenced during the '70s that did little more than demote mental patients from marginalized status to homelessness status.

The movie also discusses the "ice pick" frontal lobotomy. Before you dismiss this as horror movie fiction, you should know that approximately 60 years ago, over 5,000 procedures were performed in the U.S. Yes, the procedure was performed with an ice pick-like instrument. Yes, the surgeon could be seen jamming the pick through the eyeball before proceeding with a frenzied wiggling motion. Yes, my attempt to save the image of psychiatric history from cinematic misrepresentation is backfiring...

Why did the movie receive poor reviews?

You've got a Dennis Lehane novel (penned "Mystic River" and "Gone Baby Gone"). You've got Martin Scorsese behind the lens and Leonardo DiCaprio in front of it. Yet the studio's post-academy award nominations release date implies a lukewarm ambivalence about its box office prognosis that is consistent with my audience's reaction. As the end credits rolled, I overheard viewer comments ranging from, "That was amazing" to "I don't understand..." to "I paid over 10 dollars for that..." And critics have largely been, well, critical.

To me, some of the stated flaws are undeniable. Teddy is kept at arms-length from us, we are hit over the head with the dark, ominous tone, and there are a few too many of those inherently aimless hallucination sequences. But critics of the general narrative structure should step back and realize that the narrative arc is perhaps the most accurate and admirable aspect, psychologically speaking.

Everything seems melodramatic as nothing is as it seems. Random moments are punctuated with inexplicably intense emotions. Goals constantly shift as disorganization triumphs. To watch this film is to become physically exhausted and cognitively frustrated. But everything makes perfect sense in retrospect once we realize we've entered the mind of a delusional patient with unblinking vividness. A risky but worthwhile ambition.

What is this film's overall verdict?

On the one hand, indictments of the mental health field in this movie range from unfortunate accuracies to melodramatic exaggerations to head-scratching distortions. On the other hand, we are provided with ultimately well-intentioned psychiatrists and memorable demonstrations of mental anguish. As far as this film's portrayal of clinical psychology is concerned, please email with your verdicts.

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