Case 10 Shutter Island

Name: Marshal Edward “Teddy” Daniels (Andrew Laeddis)
Source: Shutter Island (movie, 2010)
Description of the Problem ( Skip this part of you have already seen the movie)
Edward (Teddy) Daniels claims to be an investigator at Ashecliffe Mental Institution located on Shutter
Island. Teddy asks for records of every patient on the island and is denied despite him being well
respected military personnel on a mission to discover facts about the disappearance of Rachel Solando.
Teddy becomes frustrated with the institution’s faculty and decides to end his mission.
A storm develops preventing Teddy to leave the island. During the storm he has delusions in which he
believes patient number 67 is being kept a secret. The delusions convince him that the patient is Andrew
Laeddis. He then ventures out to Ward C, which he has not been granted permission to investigate, in
search of Laeddis. Upon entering Ward C, Teddy discovers George Noyce, a schizophrenic patient, who
then informs Teddy about a conspiracy theory that the institution is performing lobotomies in the
nearby lighthouse. Teddy begins having dreams of a little girl asking him to save her. His wife continues
to appear in hallucinations, telling him that Laeddis is still in the institution and Teddy must find him and
kill him.
After the storm, the institution provides him with a set of dry clothes that happen to be those that the
patients wear. The lightning from the storm affects Teddy and he begins to experience migraines. The
institution then provides him with headache medication. Shortly after waking up the next day he
ventures out to the coast again in search for the lighthouse. Through the hallucination of meeting a
former psychiatrist in a cave, he is convinced that the institution has drugged from through the pain
medications and cigarettes, causing him to experience wild dreams, sleepless nights and migraines. He
feels as though everyone in the institution is purposely attempting to keep him as a patient.
Teddy makes his way to the lighthouse, finding absolutely nothing unordinary. He finds his psychiatrist
in a room at the top. He confronts the psychiatrist about the conspiracy theory and how he needs off of
the island to report the institution to the government. The psychiatrist debriefs Teddy about his
Delusional Disorder. The psychiatrist tells Teddy that he has been a patient for over two years. He
explains to Teddy that he created fictional characters by using anagrams from his name, and the names
of his loved ones. The psychiatrist informs Teddy that he murdered his wife after coming home to find
his children floating in a pond. Teddy refuses to believe that he murdered his wife or that he had
children. The psychiatrist persists in explaining that he had been trying a new type of therapy known as
role-play therapy. The role-play therapy is used in hope for Teddy to realize on his own that he is
Andrew Laeddis.
Teddy begins to have flash backs of the afternoon he came home and found his children dead. He
realizes the little girl from his dreams is his daughter. He remembers that he killed his wife in the spring
of 1952. He finally realizes that he is the lost patient, Andrew Laeddis. He realizes his partner, Chuck, is
actually his specialty psychiatrist who had to be with him at all times because he is the most violent
patient on Shutter Island. Teddy, now Andrew, is eligible to be released from Ashecliffe Mental
Institution. He says to his specialty psychiatrist “What now? We need to find a way to get off of this
island”.
Diagnosis
The diagnosis for Edward Daniels is Delusional Disorder, Mix Type (297.1)
1. Non-Bizarre Delusions for at least one month.

1. Teddy experiences non-bizarre delusions over the course of two years. The delusions
are not due to Schizoaffective Disorder, nor Mood Disorder. He does not have an
alcohol dependency nor is he chronically depressed.
2. Criterion A for schizophrenia has never been met.
1. Teddy does not show flat inappropriate affect. He is very sociable and his delusions are
not bizarre.
3. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly
impaired and behavior is not obviously odd or bizarre.
1. Teddy is able to function normally. He is sociable and is able to properly communicate.

4. D. If mood episodes have occurred concurrently with delusions, their total duration has been
brief relative to the duration of the delusional periods.
1. Teddy is generally in a good mood. He is not depressed or anxious. He is always looking

forward to catching new hints about Rachel. He gets angry when people refuse to give
him want he thinks he needs, such as case files for patients in the mental hospital.
5. E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition.
1. Teddy does smoke and drink however; he does not have negative episodes which
develop from the substance abuse, but not alcohol dependence. He takes medications
which help his migraines to go away.
6. Specify Type
1. Mixed Type
i. Delusions characteristic of more than one type.
1. Grandiose Type
1. Delusions which are inflated worth, power, knowledge, identity, or special relationship
to a deity or famous person.
i. Teddy believes that he is a valued marshal with specialized privileges to the mental hospital. He feels
that people should obey his requests.
1. Persecutory Type
1. Delusions that the person (or someone to whom the person is close) is being
malevolently treated in some way.
i. Teddy feels that the employees of the mental institution are trying to commit him at a patient. He
feels that they are controlling him by giving him special medications other than simple pain killers.
Teddy is also convinced that the cigarettes the institution provides are laced with drugs to cause him to
become powerless
Treatment
The treatment psychiatrist used in the film was ultimately performing the lobotomy. Lobotomies were
accepted in the fifties as reasonable treatments for psychotic disorders. In current treatment
procedures lobotomies are unethical. The lobotomy procedure is the use of an ice pick type probe
which is inserted through the eye in order to dismantle the brain. This develops a calming effect on the
patient.
Recent treatment used for Delusional Disorder would include both medications and psychotherapy.
Medicinal treatments may involve anti-psychotics and antidepressants such as SSRI and Clomipramine.
Psychotherapy treatments involve supportive therapy and cognitive therapy. The treatment used for
patients must be individualized. The treatment for Andrew Laeddis should consist of cognitive therapy
combined with medication.

Case 10 Shutter Island

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Case 10 Shutter Island

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Name: Marshal Edward “Teddy” Daniels (Andrew Laeddis)

Source: Shutter Island (movie, 2010)

1. Non-Bizarre Delusions for at least one month.

1. Teddy is able to function normally. He is sociable and is able to properly communicate.

1. Teddy is generally in a good mood. He is not depressed or anxious. He is always looking

i. Delusions characteristic of more than one type.

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