This is the story of a man (both Andrew and Teddy) who appears to have created a fantasy world in order to support his denial of an overwhelming trauma and of a psychiatrist attempting to help him accept the truth by staging an elaborate role-playing scenario at the hospital where he has resided for two years. Patients with Posttraumatic Stress Disorder commonly suffer amnesia for the traumatic event, but is it plausible that Teddy might lose memory of two years in a psychiatric hospital, including mistaking his psychiatrist for another US Marshal? Consider whether Chuck's dialogue with Teddy might constitute psychotherapy. Might Teddy's experience, like that of Truman in The Truman Show , provide a glimpse of what it might be like to suffer from Schizophrenia? Also, compare this film to The Machinist.
We learn that US Marshal Teddy's wife died in a fire and that Shutter Island holds a hospital for the criminally insane. (0:03)
We meet Dr. Cawley who seems to be the head psychiatrist. (0:09)
Dr. Cawley explains to Teddy that patient Rachel has escaped.(0:10) and that she harbors a delusion that the children she drowned still live. (0:12) Several people "play" Rachel during the film. Should we believe that Dr. Cawley created her "character" as an imitation of Teddy and/or his wife in the hope of leading him to reality?
The hospital day room. (0:14)
The first of many flashbacks to a Nazi prison camp during World War II. It is not always clear whether these are cinematic, imagined, dreamed, or hallucinated. (0:21, 0:23)
Psychiatrist Naehring: "You have outstanding defense mechanisms." (0:22)
Teddy's wife appears as in a nightmare confronting him about his drinking while holding a bottle. He tells her, "I killed a lot of people." She bleeds then turns to ashes after she tells him "You have to let me go." (0:27)
Dr. Cawley talks about "transorbital lobotomy" and the promise of newly approved Thorazine (chlorpromazine), a newly developed drug which shows promise of making the lobotomy obsolete. (0:31) The FDA actually approved Thorazine in 1954, the year in which the film is set.
Close-up of a needle and syringe and a group of nurses. (0:34)
Patient Kerns: "I hear enough voices myself." (0:36)
Teddy tells us about Andrew, the maintenance man and "firebug" whom he blames for his wife's death. He said Andrew claimed "voices told him to do it." (0:39)
Another flashback to the concentration camp, now identified as Dachau, where Teddy explains that the "Commandant tried to kill himself." He then talks about George who has led him to believe that people have been "experimented on" at Shutter Island. (0:42)
At a large meeting medical staff plan for an anticipated flood. (0:49)
Teddy interviews Rachel who talks about her children as though they still live. She tells Teddy, "You're dead." She assaults him in an agitated state and is dragged away by technicians. (0:51)
Dr. Cawley gives Teddy unidentified pills for a presumed migraine headache. (0:56)
Teddy's apparent dream includes another flashback to Dachau and a vision of Andrew offering a drink. (0:57)
A young girl asks Teddy, "Why didn't you save me?" Teddy seems to awaken but is once again confronted with a vision of his wife commanding him to kill Andrew. (1:01)
Teddy walks past cells full of naked inmates until he finds George who also tells him to "let her go." (1:11)
Climbing into a cave Teddy confronts another woman who claims to be Rachel. She says, "I was a doctor." Claiming to be a psychiatrist herself she talks about paranoia and defense mechanisms. She explains that she got in trouble when "I started asking about these large shipments of sodium Amytal and opium based hallucinogens." Teddy responds, "psychotropic drugs." Rachel: "You ever heard of a transorbital lobotomy? They zap the patient with electroshock then go through the eye with an ice pick. Pull out some nerve fibers... I asked about the surgeries too. I was an esteemed psychiatrist..." (1:24)
Psychiatrists probably paid little attention to hallucinogens of any kind in 1954, let alone any drug of that class that might have been "opium based." Electrshock (ECT) has been administered without general anesthesia, and in fact the patient loses consciousness, so the idea of "zapping" the lobotomy patient before the procedure is plausible, but probably was never done routinely. Lobotomy involved severing "nerve fibers" but not removing them.
Rachel continues: "Let me ask you. Any past traumas in your life?... it takes 36 to 48 hours for neuroleptic narcotics to reach workable levels in the bloodstream... brain surgery" (1:28) Could any narcotic be accurately described as neuroleptic?
Apparently fearing that psychiatrist Naehring will stop him from escaping, Teddy grabs a syringe from the psychiatrist's pocket and injects the psychiatrist. (1:39)
Dr. Cawley to Teddy: "How are the hallucinations... you're not on neuroleptics..." he goes on to tell Teddy that he has been at Shutter Island for two years and that his tremors may have resulted from withdrawal not from alcohol but from chlorpromazine which he has not taken for a while.
Dr. Cawley: (the tremors are getting pretty bad... how are the hallucinations." [Teddy again sees his wife.] "Your delusions are more severe than I thought." He explains that Teddy was committed there 24 months ago by a court order. "You're not on neuroleptics. You're not on anything." (1:47)
Dr. Cawley again: "They'll lobotomize you, Andrew." (1:52)
Dr. Cawley introduces Teddy to the man he thought was his partner Chuck as his primary psychiatrist, Lester Sheehan. He says they have staged the most "radical cutting-edge role-play ever attempted in psychiatry." (1:53)
In an apparent cinematic flashback, but possibly Teddy's own memory, we see him finding his children's bodies in a lake. (2:00)
Teddy awakens apparently accepting the truth about his wife and children. He tells how after she tried to kill herself she told him there was an insect inside her brain. He appears to blame himself for not handling her illness differently. Dr. Cawley explains that he regressed "like a tape." (2:04)
Teddy seems to revert to his fantasy world, addressing Dr. Sheehan as Chuck. (2:08)
A technician accompanied by Dr. Cawley approaches holding a steel instrument shaped like an ice pick and wrapped in sterile towels. (2:09)
Compare to The NInth Configuration.