Introduction
Edward ‘Teddy’ Daniel (the real name Andrew Laeddis) is the main character of the movie Shutter Island, an investigator, who is sent to an asylum together with his partner Chuck to search for an escaped patient. Throughout the whole movie, the vivid reality, in which Teddy lives, can be seen, as the main character suffers from delusional disorder. The condition developed after his wife drowned their three kids in the lake, and then he himself shot her. Not being able to cope with inner feelings of guilt and remorse, for he could not save his family, Andrew created a character named Teddy, and a fake story. In one moment of the movie, doctor Crawley tells him that he relapsed nine months ago and that he is like a tape playing over and over, which is one of the characteristics of the delusional disorder. Shutter Island portrays the mental disease in a perfect manner, providing the audience insight on how psychologists can help patients suffering from this condition.
Delusions are strong beliefs of an individual, which do not change, even when conflicting evidence is being presented. According to the World Health Organization (n.d.), delusional disorders are classified as code F22.0 (p. 28). The science distinguishes several types of the illness, such as:
- Erotomanic, a belief that an individual of a higher social status is in love with them:
- Grandiose, an idea of having unrecognized talent, a special knowledge or skill, or relationship with a famous person or even God;
- Jealous, a conviction of partner’s unfaithfulness;
- Persecutory, a paranoid belief of being cheated, spied on, followed, or drugged;
- Somatic, a physical sensation of a dysfunction of a body part, for example, insects crawling under the skin, or nasty odors;
- Mixed, a state characterized by more than one type (Psychology Today, 2015).
The classification includes a big range of conditions in which “long-standing delusions constitute the only, or the most conspicuous, clinical characteristic and which cannot be classified as organic, schizophrenic, or affective” (World Health Organization, p. 84). Such a disorder is characterized by the presence of delusions, lasting for more than a month. Other psychopathology is typically absent, but there is a chance for depressive symptoms and hallucinations developing. The speech and behavior of the person are always normal, apart from their actions related to the episodes disconnected with the reality. The individual’s life circumstances also impact the content of delusions, and the timing of their appearance.
The diagnosis matches the main character of Shutter Island, as he experiences the delusions for more than one month, and he does not prove to have a differential diagnosis. His condition is not a result of mood problems, which could indicate a depressive or bipolar disorder (F32.0). Moreover, it is not a consequence of drug addiction, thus, the disorder is not dependence syndrome (F1x.2). The diagnosis of schizophrenia (F20.6) can be excluded, as well, as the character is sociable and his delusions are not bizarre. A specialist can note that Teddy suffers from a mixed type delusional disorder. It can be proved by the fact that his mind generates grandiose ideas, such as being a noble investigator. In addition, there are paranoid thoughts, such as the idea of him being drugged by the personnel through cigarettes. However, to completely exclude differential diagnoses of the character, more details on his mental state could be necessary. An important question, which his therapists could answer, is about his Post-Traumatic Stress Disorder from the war, and its possible influence on the development of the current disease.
The Physicals and History of Delusional Disorder
The History and Theories of Delusional Disorder
Historically, the diagnosis of delusional disorder has been actively researched, as it has many controversial points. The origin of the word “delude” is “from Latin and implies playing or mocking, defrauding or cheating” (Chaudhury, 2020, p. 3). In the past, this condition has been treated as madness. Today, it is established that delusion cannot be objectively described, because it develops within subjective dimensions. The study of delusions as a single symptom has been conducted since the end of the 19th century. In 1999, there appeared 39 studies on an empirical cognitive psychology literature about the phenomenon, and now this number has increased and exceeds 200 works (Garety & Freeman, 2018). The first reviews provided a basis for the further development of “cognitive models of positive psychotic symptoms” (Garety & Freeman, 2018, p. 327). It highlights the importance of psychological mechanisms, involving emotional and reasoning processes. Thus, stress may trigger certain changes in emotional and cognitive states, which can lead to anomalies of conscious perception, such as auditory hallucinations.
The Physical Characteristics of Delusional Disorder
There are certain characteristics, which help to manifest the diagnosis. The average age of the symptoms appearance is 40, although, it ranges from 18 to 90 years (Joseph & Siddiqui, 2020, para. 9). The mood of the patient is usually consistent with the state, for example, “a grandiose patient may be euphoric, or a paranoid patient may be anxious” (Joseph & Siddiqui, 2020, para. 13). The perception of the individual is normal, although, in some cases, there are auditory hallucinations. The most important feature of the disease is the type of the patient’s ideas, as their delusions are clear and systematic, and not bizarre, as can be seen with schizophrenia. This perception of the difference between these mental illnesses has not changed in time, and has been proved by the psychological science more than once.
Delusional Disorder Treatment
Standard Delusional Disorder Treatment Opportunities
In case an individual is experiencing delusional symptoms, their screening begins with a physical examination and tests, required for excluding physical diseases, which might cause the signs. If such a medical condition is not found, the patient is appointed to a psychiatrist valuation. It is important that an individual suffering from delusions seeks professional help. However, people experiencing this phenomenon often do not see a problem because they believe their delusions are real. In this case, close relatives are responsible for helping the person to find help. In some cases, there is a need for psychiatric hospitalization, especially if the individual presents a danger to themselves or others.
A typical treatment for this condition usually includes a combination of drugs and therapy. Medications may include:
- First-generation antipsychotics, aimed at blocking dopamine receptors situated in the brain, which are considered to be connected with the development of delusions;
- Atypical antipsychotics, targeted at blocking dopamine and serotonin receptors of the brain;
- Tranquilizers, prescribed to cope with anxiety, or problem of sleep deprivation;
- Antidepressants, used for treating depression in case a patient is suffering from mood disorders (Morin, 2020).
In order to select a proper medication scheme, patient’s history of medication compliance should be taken into consideration. An antipsychotic should be used according to a certain scheme, usually “started for a trial period of 6 weeks after which there is an evaluation of the effectiveness of the medication” (Joseph & Siddiqui, 2020, para. 21). The treatment should begin with low doses, with a later increase if required, and “another drug from another class can be tried after six weeks if no benefit is noted from initial treatment” (Joseph & Siddiqui, 2020, para. 21). In case therapy with antipsychotics does not help, “a primary indication drugs like lithium, valproic acid and carbamazepine” cannot be considered as additional treatment (Joseph & Siddiqui, 2020, para. 22). In each case, the scheme is selected, after considering all the medical information of the patient.
Typically, treatment may bring better results in combination with psychotherapy, which may include cognitive behavioral therapy (CBT), intended to help the individual learn to recognize and cope with unnecessary thoughts. Family therapy is also a means for helping such patients, allowing relatives to learn to support them. Handling the environment is another effective measure, for example, if the individual thinks they are being followed, it is better not to let them go out alone. The recent studies illustrate that “self-esteem, worry, insomnia, feelings of powerlessness, poor belief flexibility <…> are identified as causal factors for distressing delusions, and these become the actual targets for intervention” (Garety & Freeman, 2018, p. 331). In this case, improving each of the mentioned factors should help with reducing the number of delusional episodes.
The Main Character of Shutter Island Treatment
In Shutter Island, the traditional cruel way of treating patients in an asylum is depicted. However, the movie also demonstrates advancements in psychoanalysis, as Dr. Crawley proposes a progressive solution, hoping that it would help Teddy. In the movie, they gave the patient aspirin and Chlorpromazine to help him fight migraines, tremors, and hallucinations. The ultimate treatment for a delusional disorder pictured in the movie is the lobotomy. This procedure was accepted in the middle of the 20th century, at the time when the movie takes place, and back then it was the only reasonable solution, capable of calming the patient. In current circumstances, the lobotomy, aimed at dismantling the brain, is regarded unethical. There was a high percentage of lethality in the result of the operation, and due to this reason the use of lobotomies quickly faded in the end of 1950’s.
The Treatment Changes to Be Done to Help Teddy Daniels
The main character of the movie could probably have escaped the worsening of his condition. In the asylum, Dr. Crawley could have tried cognitive therapy instead of using drugs. They could also have done Electric Convulsive Therapy (ECT) before their experiment, so that further events might have had a different outcome. If the character was living in the 21st century, Andrew Laeddis would require therapy performed by professional psychologists together with traditional treatment, which would include antipsychotics, such as Chlorpromazine, Haloperidol, and Fluphenazine. The doze would be approximately 50-300 mg in oral tablet or an injection of 25-50 mg per day. It is important the physical therapist is aware of the patient’s state, and controls such factors as heart rate, respiration, and blood pressure. In case of severe side effects, the medication may be changed to another one, and the doze might be lowered or increased, depending on the effectiveness. A professional help of a social worker could also help the patient, as their role in such cases is supporting and being compassionate, what is an important factor in the process of recovery.
The Accuracy of Diagnosis Depiction in the Movie
Shutter Island is a good example of an accurate depiction of the changing methodology in clinical treatment of the mental diseases. However, to people, unfamiliar with the history, the way this film portrays the asylum in the 1950s might seem confusing about the current practices. The movie is good at depicting the character suffering from such a complex condition, and gives the audience an idea of how an individual with such a disease might act. Though, it might be hard for a viewer to believe the extremity of Teddy’s delusional disorder, as it is a difficult diagnosis to recognize even for experienced psychologists.
Conclusion
Delusional Disorder is a complex diagnosis, which has been studied since the 19th century and continues to be researched. However, there remain many mysteries, unclear even to the most experienced psychologists. The condition is characterised by strong beliefs of the person that everything they see in their head is true, and in time they have difficulties distinguishing the fake from the reality. The main character of the movie Shutter Island is a good example of a person suffering from this disorder. The film has a great way of depicting a person with mental illness, providing the audience with an idea of the way such an individual may act and react to different circumstances.
The movie shows a shift in the clinical methodology and changes in the approaches to treating the disorder. It depicts the treatment that was used in the middle of the 20th century, including the ultimate measure of lobotomy, which was used to calm patients, who were causing inconveniences. While today, the procedure is no longer used, as it resulted in many lethal cases. Instead, modern psychological science offers ways for treating the disorder with the help of medications, combined with cognitive therapy, which is targeted at supporting the patient and helping them to cope with the symptoms of the disease.
References
Chaudhury, S. (2020). Understanding delusions. Industrial Psychiatry Journal 18(1). Web.
Garety, P. A., & Freeman D. (2018). The past and future of delusions research: From the inexplicable to the treatable. Cambridge University Press.
Joseph, S. M., & Siddiqui, W. (2020). Delusional disorder. National Center for Biotechnology Information, U.S. National Library of Medicine.
Morin, A. (2020). What is a delusion? Verywell Mind.
Psychology Today (2015). The Psychology of Delusions.
World Health Organization (n.d.). The ICD-10 classification of mental and behavioural disorders.