Shutter Island

Shutter Island is a 2010 American post-apocalyptic psychological horror thriller film written by Laeta Kalogridis and directed by Martin Scorsese. It stars Leonardo DiCaprio and also starring Mark Ruffalo, Ben Kingsley, Michelle Williams, Emily Mortimer, Patricia Clarkson and Max von Sydow.
The film is based on Dennis Lehane's 2003 novel of the same name.
==Plot==
In 1954, two U.S. marshals (Leonardo DiCaprio and Mark Ruffalo) investigate the disappearance of a patient from a psychiatric hospital for the criminally insane on an island in a rural Massachusetts. They run into trouble when they are deceived by the hospital's crew chief administrator, a natural disaster hits and an inmate riot traps them on the shutter-looking island.
==Cast==
*Leonardo DiCaprio as Teddy Daniels, a U.S. marshal investigating the disappearance
*Mark Ruffalo as Chuck Aule, a U.S. marshal and Teddy's partner
*Ben Kingsley as the hospital's crew chief physician, Dr. John Cawley
*Michelle Williams as Dolores Chanal, Daniels' ex-wife
*Emily Mortimer as the escaped patient Rachel Solando
*Max von Sydow as Dr. Jeremiah Naering, one of the hospital's physicians
*Jackie Earle Haley as George Noyce
*Ted Levine as the Jail Warden of the Hospital
*John Carroll Lynch as McPherson, a security guard at the Hospital
*Elias Koteas as Andrew Laeddis
*Patricia Clarkson as Ethel Barton
*Ruby Jerins as Little Girl
*Robin Bartlett as Bridget Kearns
*Christopher Denham as Peter Breene
== Psychological Synopsis ==
The Wiki Knights research group in the Department of Psychiatry at Rutgers Robert Wood Johnson Medical School formulates Shutter Island as a fictional case of Delusional Disorder depicted by US Marshal, Edward “Teddy” Daniels. Consistent with this diagnosis, Teddy experiences delusions over the course of two years; longer than the required one-month duration1. Teddy’s delusions do not appear to be due to Schizophrenia. Testament to this is that apart from the impact of the delusions, Teddy’s functioning is not otherwise markedly impaired2.  Furthermore, the disturbance is not attributable to the physiological effects of a substance or another medical condition. While Rachel Solando refers to “opioid-based sedatives” and “neuroleptic narcotics,” opioids are not able to induce a psychotic disorder. Despite the onset of Teddy’s psychosis being incident to the discovery of his children’s deaths (and his subsequently murdering his wife, Dolores), another mental disorder such as posttraumatic stress disorder (PTSD) is unlikely to account for the depicted breech in reality testing. Major Depressive Disorder (MDD) evolving from Persisting Complex Bereavement Disorder is another diagnostic consideration. As such, Shutter Island may be included with similar fictional accounts of this disease progression such as The Sixth Sense (1999) and Phantom of the Opera (musical)3.    
Teddy’s Delusional Disorder is likely of “mixed type.” This specifier is reserved for cases when no single delusional theme is dominant, and therefore the diagnosis cannot be clearly determined or described as one specific type4. The two types of Delusional Disorder that most accurately describe Teddy’s behavior are Grandiose Type and Persecutory Type. The Grandiose subtype is characterized by inflated worth, power, knowledge, or identity. For example, Teddy’s delusions led him to believe he was a US Marshal investigating a missing person. He assumed special privileges and became irritable when individuals at the hospital would not follow his requests. In the Persecutory subtype, the individual believes they, or someone they are close with, are being malevolently treated in some way5. For example, Teddy feels that the employees of the mental institution were trying to commit him as a patient. He felt that they were controlling him by giving him “special medications” other than the painkillers they claimed to be prescribing. Teddy is also convinced that the cigarettes in which the institution provides are laced with drugs to cause him to become “more compliant”6. 
1.	American Psychiatric Association. (2022). Schizophrenia spectrum and other psychotic disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
2.	Delusional disorder. PsychDB. (2021, December 14). Retrieved November 22, 2022, from https://www.psychdb.com/psychosis/delusional-disorder
3. Tobia A, MD, Ilaria S, MD, et al. The Phantom of the Opera: A Case Study of Severe Major Depressive Disorder with Psychotic Features, Journal of Depression and Anxiety, 2017, 6:4 DOI: 10.4172/2167-1044.100028 
4.	 Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.20, DSM-IV to DSM-5 Psychotic Disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t20/
5.	Delusional disorder: Causes, symptoms, types & treatment. Cleveland Clinic. (n.d.). Retrieved November 22, 2022, from https://my.clevelandclinic.org/health/diseases/9599-delusional-disorder
6.	Professor Bill Pelz and Pelz, P. B. (2017, March 16). Abnormal psychology. Delusional Disorder | Abnormal Psychology. Retrieved November 22, 2022, from https://courses.lumenlearning.com/suny-hccc-abnormalpsych/chapter/delusional-disorder/
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