Crazy Psychological disorders

November 3, 2016

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***Warning: This blog entry is one big spoiler alert, so if you haven't seen "Shutter Island" but want to then please refrain from reading this until you've paid your ten dollars and fifty cents.

"Shutter Island" is one of those films that rips the rug out from under your expectations with the frequency and intensity of a magican's act. Initially, we think we are watching a well-intentioned U.S. Marshall named Teddy enter an insane asylum/prison hoping to uncover the whereabouts of a recently-disappeared patient/inmate. 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 it's 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 creepy, suicidal wife (whom he promptly put out of misery). Although such an experience would seem to virtually garuntee 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 then 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 addictions (the bottle is no longer a problem) or schizophrenia (much too socially savvy, and his delusions are not bizzare - "aliens landed in my kitchen"). As the DSM-IV further classifies Delusional Disorder via 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!)

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.'

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.k.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 if not vindictive psychiatrists, outdated if not illogical treatment approaches and helpless if not martyred patients is 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...

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