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September 10, 2012

Shutter Island: Movie Review

Overview

In the movie “Shutter Island”, main character, Andrew Laeddis struggles with recognizing reality because he suffers from paranoid schizophrenia. The movie is set in 1954 at Ash Cliff, a treatment facility on Shutter Island for the “criminally insane”. Laeddis believes himself to be a U.S. Marshall who has come to the island with his partner, Chuck, to investigate the disappearance of one of the patients. As Laeddis continues the investigation, he reveals that he is actually investigating the island because he suspects that there is a conspiracy occurring in which all of the staff is involved. He suspects that clinicians are conducting inhumane experiments on patients and sending them back into the world as “ghosts” with their memories erased due to brain surgery. Laeddis often links this to the Nazi experiments on human subjects and is especially angered by this because of his experiences fighting for the United States in World War II. Throughout the film, Andrew Laeddis refers to himself as Edward ‘Teddy’ Daniels and believes that Laeddis is a man who killed his wife, Dolores, in a fire. At the end of the film, the psychiatrist reveals that he is actually Laeddis and that there is no missing patient, Rachel Solando, but only that Andrew created this fantasy so that he would not have to remember that his wife was “manic-depressive” and murdered his children, after which he murdered her.
Laeddis suffers from paranoid schizophrenia. According to the DSM IV-TR (2000), schizophrenia is a psychotic disorder characterized by at least two of the following five symptoms: hallucinations, delusions, disorganized speech, disorganized behavior, and negative symptoms (anhedonia, avolition, alogia, and flat affect). Symptoms also must impair social or occupational functioning, last longer than six months, must not be due to substance use or a general medical condition, and there must not have been any mood episodes (manic, depressive, or mixed). Laeddis qualifies for a specific type of Schizophrenia, referred to as the paranoid type. People suffering from paranoid type are highly suspicious and engage primarily in their delusions and hallucinations and do not have prominent symptoms of disorganized speech and behavior. Schizophrenia is prevalent in roughly 1% of the population and can be one of the most costly disorders due to need of repeated hospitalizations because of suicidal or homicidal behavior. Schizophrenia is also one of the most deteriorative disorders, and once there has been one episode, clients most often do not return to baseline and decompensate more and more as the disorder progresses.

Diagnostic Summary

Schizophrenia symptoms present differently in all clients. In “Shutter Island”, the symptoms that Laeddis experienced were more on the positive spectrum (delusions and hallucinations), and he did not present with as many negative symptoms. In clients with schizophrenia, it is much more common for clients experiencing more positive symptoms to have better life outcomes and return to baseline. However, in the film, Laeddis had been at the facility for two years and had been delusional for almost the entire time. The end of the movie remains ambiguous as to whether or not he was finally aware of reality. Also, in the film, Laeddis experienced many visual hallucinations, referred to as “walking nightmares”. In the general population, this is much more uncommon. Most people diagnosed with schizophrenia only experience auditory hallucinations. Laeddis also qualifies for a specifier, the paranoid type because he is highly suspicious of everyone around him. At first, he is kind to staff and then decides they are trying to hurt him. He believes that his partner has turned on him, and he is suspicious about everything that is happening on the island. Please see the chart below for other symptoms that Laeddis experienced.

DSM IV-TR Criteria for Schizophrenia How Symptoms Met Criteria in “Shutter Island”

Hallucinations: Laeddis experiences visual hallucinations of his wife, daughter, and a psychiatrist in a cave.

Delusions: Laeddis believes that he is still a U.S. Marshall investigating a case on the island. He believes that his Psychiatrist is his partner and that when speaking to clients, he is investigating them. He also believes that he murdered many people in WWII, which the psychiatrist denies at the end of the film.

Disorganized Speech: Laeddis found a note (left by himself) that read, “The rule of 4. Who is the 67th patient?” Other than this, Laeddis does not engage in other characteristic disorganized speech, such as neologisms, tangential speech, or loose associations.

Disorganized Behavior: Laeddis’ psychiatrist states that he is often agitated and easily provoked. Laeddis engages in violent acts when agitated, such as blowing up a car, attacking a guard and a patient, and injecting a Psychiatrist with a sedative.

Negative Symptoms: (anhedonia, alogia, avolition, flat affect) Laeddis does not demonstrate any negative symptoms. His affect is labile as he is calm and contemplative one moment and aggressive the next. Client still engages in pleasurable activities (investigating crimes), and he does not have any speech impairments.

Impaired Functioning: Laeddis is unable to live in the real world, as his experiences are so far from reality. Laeddis is suspicious of everyone around him and is violent when he becomes paranoid.

Paranoid Type: Laeddis shows complete preoccupation with his delusion of being a U.S. Marshall investigating the island. He is frequently suspicious of those around him and is violent when he feels threatened. While there is some disorganized behavior and speech present, it is not prominent.

For the most part, the disorder was accurately portrayed. Laeddis qualified for the symptoms of schizophrenia, paranoid type, which is how he was portrayed in the film. He did not have an over-abundance of symptoms, as occurs in some films. The only discrepancy would be that clients with less negative symptoms generally have better outcomes, but Laeddis had not gotten better after two years of treatment. However, the movie was set during a time period in which psychotropic medications were just beginning to be utilized, so although psychiatrists had attempted to use chlorpromazine, it may be that the treatment methods of the time were unable to aid clients at the same rate as they can today.

Etiology

Not much is known about Laeddis’ biology. There is no mention of any underlying general medical conditions. Laeddis did consume large amounts of alcohol and is portrayed as an alcoholic when his wife and children were still alive. Laeddis does not seem to have any physical disabilities or impairments. There is no mention of his parent’s health or mental health. Laeddis is in good physical shape and “highly intelligent”. However, Laeddis was taking an antipsychotic, chlorpromazine, for quite a while and recently stopped which caused him withdrawal symptoms (migraines and tremors). The symptoms of withdrawal caused him to believe that he was being given medications that would allow staff to take advantage of him and use him for experiments. Due to current research on schizophrenia, Laeddis probably suffers from enlarged ventricles and decreased levels of dopamine and serotonin.

Laeddis suffers from many psychological conditions. Other than his diagnosis as a paranoid schizophrenic, Laeddis also suffers from symptoms of Post Traumatic Stress Disorder (PTSD) which co-occurs with his schizophrenia and relates to his psychological themes of guilt and suspicion. While in WWII, Laeddis saw many dead bodies and felt a great amount of stress. He has frequent flashbacks and nightmares about the dead bodies and also the dead bodies of his wife and children. Laeddis engages in great efforts to avoid thinking about his memories from the war and his deceased children by engaging in delusions and avoiding talking about what happened. He is also hyper-vigilant and exceedingly agitated. One of the major contributors to his delusions is Laeddis’ guilt for not helping his wife obtain psychiatric treatment. Dolores had “manic-depressive” disorder and set their house on fire. Because Laeddis knew she needed help before she murdered the children, he takes responsibility for his children’s deaths as well as hers. The guilt he feels is so over-whelming that he does not know how to cope with it, other than by making himself feel like a hero on an important investigation.

Socially, Laeddis did not have much support before he was committed. Laeddis did not have anyone to talk to about Dolores and her mental health or about his horror from experiences at war. Laeddis was quite isolated and remains isolated within his mind on Shutter Island. Not much is said about his relationship with his parents other than that he was “raised by wolves” indicating a negative childhood experience. Although Laeddis felt isolated, he carried a high rank in society, was an esteemed Marshall, and had a comfortable lifestyle (he lived in a large and beautiful home on a lake). His feelings of isolation and the importance of maintaining his image as an important figure of society caused him to ignore his problems instead of face them. Now he is still attempting to use this method by living a fantasy in which he is a hero.

Social Work Prospective

Overall, the writers and directors of “Shutter Island” provided an accurate and believable portrayal of Paranoid Schizophrenia. Although the film is acute, Laeddis does not demonstrate symptoms that are more common among clients with schizophrenia. For example, there are usually more disorganized and also negative symptoms. Another potential problem with the accuracy of the diagnosis is that the movie will likely increase the stigma that “people with mental illness are dangerous” because it is set in a prison for the criminally insane. The general public has a negative perception of those who have mental illness because they believe they are impulsive, dangerous, and commit crimes for no reason, and this movie definitely portrays mental illness in a similar light. When choosing a film for the project, it seems that many dramas present mental illness in a negative light, whereas comedies often are more positive and de-stigmatizing.

As for the PODS, racial, and sexual issues of discrimination and oppression are not explored, as the characters are generally white and heterosexual. While the psychiatrists are all men, there are both male and female nurses, but issues of gender are not discussed. The main discussion of oppression in the film is that of the patients receiving treatment. Laeddis does not believe that the staff is humane, but is in fact conducting experiments on patients. He is somewhat correct but not in the way he believes. The staff is attempting a new type of treatment, client-centered therapy, which is more moral and humane. Throughout the film the psychiatrists highlight the dark past of mental health treatment and their hopes for the future of the field. In that regard, social justice seems to prevail in the hope that clients will be treated like people, and it may be the one aspect of the film that attempts to remove stigma from mental illness.

While “Shutter Island” is an excellent movie and accurately portrays paranoid schizophrenia, it may not be the best film for the general public to watch to learn about mental illness. It is quite educational relating to symptoms of the disorder, the mindset of a client, and the history of treatment, but it is not uplifting and certainly casts a negative light on clients. It is a good movie for social work students to watch as it relates to many topics in class, deals with diagnosis and treatment, and is a great movie, but I would not recommend it to the general public as a way to learn about mental illness.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.

Scoresese, M. (2010). Shutter island. Paramount Pictures.

Sadock, B. J., & Sadock, V. A. (2007). Kaplan and Sadock's Synopsis of Psychiatry (10th ed.). Philadelphia: Wolters Kluwer.

Posted by desolada at September 10, 2012 08:49 PM

Comments

Wow..this is a long review. Great insights there...thanks.

Posted by: arnx2001@yahoo.com at October 6, 2012 07:03 PM

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