Analysis of Delusional Disorder and

Its Treatment in Shutter Island

Siddhi Chauhan and Vaishnavi Shetty

Department of Psychology, Jai Hind College (Autonomous)

Dr. Archana Mishra

(Presented at an Intercollege Research Competition organized by St. Andrew’s College, Mumbai

in 2021)
Introduction

Martin Scorsese’s “Shutter Island,” is a psychological thriller based on Dennis Lehane’s 2003 novel
with the same name. The movie which hit theatres in 2010 had left the audience confused with an
open-ended jaw-dropper. It chronicles the story of Edward Daniels or “Teddy”, a US marshal
investigating the mysterious missing case of one of the patients in the psychiatric facility of Shutter
Island. He sets out to find Rachel Solando (missing patient) with the hidden motive of getting his
hands on Andrew Laeddis, who he believed was the reason behind his wife’s death. Teddy suspected
that someone was surveilling him and that something was wrong within the island. He believes that
Laeddis is in the lighthouse where he presumes the unethical practice of lobotomy takes place.
Teddy reaches the lighthouse and realizes that the patient number 67 a.k.a Andrew Laeddis was no
one else but him. He had been a patient in the psychiatric facility for two years on the charges of
murdering his wife after she had drowned their three kids in a river during her manic episode. He
suffered from Delusional Disorder and him investigating the hospital was an elaborate roleplay to
make him confront that his delusions were irrational and impossible. The movie ended with an
ominous note where Andrew, no longer delusional, chose lobotomy rather than living in guilt.

The film portrays three mental disorders- delusional disorder, bipolar disorder and post-traumatic
stress disorder. This paper focuses on the analyses of the depiction of delusional disorder and its
treatment in Ashecliffe hospital, a mental institution in 1954.

Literary Context

Delusional disorder

Delusions are unshakable false or imaginary beliefs that an individual holds. It further defies any
rational counter-argument. Such credence is often the one that is considered bizarre in the culture
the individual belongs to (Gilleen and David [2005], pp. 5–6). There are various types of delusional
disorders which include-erotomanic, grandiose, jealous, persecutory and mixed. In Shutter Island,
Andrew suffers from Delusional disorder mixed type, wherein more than one type of delusions are
present. According to the symptoms, he portrays he suffers from Grandiose and persecutory
delusions.

Grandiose delusions

In Grandiose delusions, a person believes they have a great talent or has made an important
discovery, have an exaggerated sense of their worth and importance. Conversely, these delusions
are present across various psychological disorders including bipolar disorder, schizophrenia and
substance abuse disorder. An individual without any psychological disorder may indulge in grandiose
thoughts which fail to meet delusional criteria (Knowles, McCarthy-Jones, Rowse; 2011). In the
movie, Andrew Laeddis was off the delusion that he was a military officer on the mission to find a
missing patient. He thought he was a person of authority and could unravel the mysterious missing
case. Subsequently, grandiose delusions arise following a tragic incident or long term exposure to
distress, despair or depression (Gunn, Bortolotti, 2018). In the movie, the death of his three children
and the murder of his wife led to the formation of delusions. Andrew felt guilty over the loss of the
people most important to him. The inability to cope resulted in him forming the delusion and taking
up the identity of Teddy. The delusion of grandeur is a prime example of Systematized and
Elaborated delusions mostly seen among schizophrenic patients wherein there are several themes
which comprise complex, elaborate narrative (Bortoloti, 2016). The movie proves the research right
as one can see Teddy’s delusions are quite elaborative wherein he believes his wife, Dolores was
killed in a fire and holds Andrew Ladessis responsible for it.

Persecutory Delusions

In Persecutory delusions, individuals believe they are being conspired against, drugged, spied on,
obstructed from carrying out their goals. Andrew believes he was being drugged on the island and
kept under the radar. He thought he would not be able to leave the island. The formation of delusion
begins with a precipitator, a stressful situation or drug misuse, which lead to subtle cognitive
experiences, which leads to the search for meaning (Freeman, 2016). Andrew believes in delusions
because of the hallucinations, involuntary hand tremors and migraines he's been having. Veritably,
these are the withdrawal symptoms of the antipsychotic medications he used to take. When Andrew
returns wet after the storm, he is given clothes worn by the patients to wear, which further fuels his
belief. Additionally, in the climax scene, he confronts Dr Cawaly and claims Rachel Solando told him
how he was on neuroleptics. The doctor reveals to Andrew that this interaction never took place but
was a product of his delusion.

Treatments

The events in the film transpire during the post-war period of the 1950s. It was a time when
industrialised countries built mental asylums all over for the treatment of mental illnesses.
Institutions kept patients in isolation and treated them with electroshock therapy, lobotomy and
antipsychotic medications. The conditions in these asylums deteriorated which led to the
deinstitutionalization movement in the 1960s to more community-based care (Fakhoury, Priebe,
2007). The Ashecliffe Hospital is a similar institution, the difference being Dr John Cawley, a
progressive chief medical director. He believed in treating his patients with respect. More
importantly, he favoured therapy over neuroleptics and invasive surgeries. Roleplay therapy was the
main treatment practised in the film. Instead of suppressing the delusions, Andrew played them out
for two days. Everyone in the hospital played a part in it, his primary psychiatrist Lester Sheehan
became his partner Chuck to keep him safe. The intention behind this was to make him confront the
delusions and make him realise and rationalise how impossible and untrue they are. He created the
persona Teddy to forget the guilt of murdering his wife, which he ultimately acknowledges in the
climax scene.

Therapeutic roleplay is utilised predominantly in anxiety disorders like PTSD and phobias. The
research on the treatment of the delusional disorder is sparse. Nevertheless, most frequently used
treatments include- Cognitive behavioural therapy(CBT), psychotherapy, antipsychotic drugs,
antidepressants, and mood-stabilising medications ( Skelton et al. 2015).
Neuroleptics and Lobotomy

For the first two years in Ashecliffe, Andrew was on Chlorpromazine. A medication instrumental in
the introduction of pharmacotherapy in psychiatry(Ban, 2007). Conventionally, used for
schizophrenia and other mood disorders. It became available worldwide in 1952, therefore a new
medication at the time. We can safely assume that this neuroleptic did work for Andrew leading
them to switch to therapy. Due to the withdrawal symptoms of this medication, Andrew had been
experiencing hallucinations and migraines.

In the 1950s, institutions considered Transorbital lobotomy safe and inexpensive to use. The
procedure involved applying electroshock to the patient, then lifting the eyelid and inserting a sterile
instrument to inject formalin into the frontal lobe(Jones & Shanklin, 1950). At the end of the movie,
hospital employees had leucotome and mallets in their hand, indicating Andrew being taken to be
lobotomised.

Critical Analysis

The movie portrays an accurate picture of the mental institutions and their practices in the 1950s.
The representation of the conditions of asylums and the treatment of patients is precise. It captures
the bizarre and complex nature of the delusional disorder and the distress Andrew goes through
humanely. The audience was able to connect to his trauma empathetically.

Moreover, it gives us a glimpse of the adverse effects of untreated mental illness. Andrew Laeddis's
time in the war led him to become an alcoholic. That causes his wife, Dolores, suffering from bipolar
disorder to become more distressed and manic, leading her to burn down their apartment. Dolores
later drowns their kids leading him to kill her. In denial of guilt, he becomes delusional and creates
another persona named Teddy.

Dr Cawley's experimental therapy proved to be a dangerous attempt to cure a patient, at the

expense of his other patients and staff. The doctor knew Andrew was a violent patient, he still put
them at risk. Letting Andrew roam free knowing how brutal his actions can be, despite the security,
was a dangerous plan.

Lastly, the therapy used proved to be glaringly unethical. Although the intent was noble, it was
nonconsensual. In modern psychology, therapeutic role play takes place in a safe setting with the
patient's consent, none of which was present in the movie.

Hence besides being unethical, in the quest of carrying out the most radical, elaborated role play in
history, one can confidently say that Dr Cawley failed miserably.

Conclusion

Shutter Island paints an accurate picture of what a person with severe psychotic disorder looks like.
Although, it would be a little difficult for a person with no prior knowledge of psychology to
differentiate the nuances of disorder and withdrawal symptoms from the medication. The treatment
depicted is not used in reality, is dangerous and unethical even though it presumably worked in the
movie. Ashecliffe Hospital portrays the truth about the state of mental health institutions during the
1950s.

In conclusion, the Martin Scorsese movie proved to be successful in depicting a complex disorder
realistically but failed to illustrate a factual treatment for the same. Nevertheless, it emerged as an
outstanding psychological thriller.

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