Delusional Disorder

Name: Marshal Edward “Teddy” Daniels (Andrew Laeddis)

Source: Shutter Island (movie, 2010)

Background Information

Marshal Teddy Daniels is a hard working investigator in his mid-thirties. He is a Caucasian male who seems to be highly intelligent and somewhat healthy. Teddy smokes several cigarettes a day and tends to abuse alcohol. He served in World War II and encountered many traumatic experiences at the Dachau Concentration Camp in Germany. Little is known about his family history or life situation when he was young. Teddy did, however, have a wife and three children and it is stated that his wife was emotionally unstable. Teddy is very goal orientated and spends many hours concentrating on work. His work ethic keeps him detached from family and friends. When he encounters conflict he becomes angry quickly, which interferes with his ability to control his temper. Teddy’s current investigation involves the disappearance of Rachel Solando from Ashecliffe Mental Institution, located on Shutter Island.

Description of the Problem

Edward (Teddy) Daniels claims to be an investigator at Ashecliffe Mental Institution located on Shutter Island. As Teddy enters the facility with his partner, Chuck, the patients doing yard work creepily smile and wave as if they know him. Teddy asks for records of every patient on the island and is denied. He does not understand why the officials will not hand over the documents because he is well respected military personnel on a mission to discover facts about the disappearance of Rachel Solando. Teddy becomes frustrated with the institution’s faculty and decides to end his mission.

A storm develops preventing Teddy to leave the island. During the storm he has delusions in which he believes patient number 67 is being kept a secret. The delusions convince him that the patient is Andrew Laeddis. He then ventures out to Ward C, which he has not been granted permission to investigate, in search of Laeddis. Upon entering Ward C, Teddy discovers George Noyce, a schizophrenic patient, who then informs Teddy about a conspiracy theory that the institution is performing lobotomies in the nearby lighthouse. Teddy begins having dreams of a little girl asking him to save her. His wife continues to appear in hallucinations, telling him that Laeddis is still in the institution and Teddy must find him and kill him.
After the storm, the institution provides Teddy with a set of dry clothes and a fresh pack of cigarettes. The clothes happen to be those that the patients wear. The lightning from the storm affects Teddy and he begins to experience migraines. The institution then provides him with headache medication. Shortly after waking up the next day he ventures out to the coast again in search for the lighthouse. Through the hallucination of meeting a former psychiatrist in a cave, he is convinced that the institution has drugged from through the pain medications and cigarettes, causing him to experience wild dreams, sleepless nights and migraines. He feels as though everyone in the institution is purposely attempting to keep him as a patient.
Teddy makes his way to the lighthouse, finding absolutely nothing unordinary. He finds his psychiatrist in a room at the top. He confronts the psychiatrist about the conspiracy theory and how he needs off of the island to report the institution to the government. The psychiatrist debriefs Teddy about his Delusional Disorder. The psychiatrist tells Teddy that he has been a patient for over two years. He explains to Teddy that he created fictional characters by using anagrams from his name, and the names of his loved ones. The psychiatrist informs Teddy that he murdered his wife after coming home to find his children floating in a pond. Teddy refuses to believe that he murdered his wife or that he had children. The psychiatrist persists in explaining that he had been trying a new type of therapy known as role-play therapy. The role-play therapy is used in hope for Teddy to realize on his own that he is Andrew Laeddis.

Teddy begins to have flash backs of the afternoon he came home and found his children dead. He realizes the little girl from his dreams is his daughter. He remembers that he killed his wife in the spring of 1952. He finally realizes that he is the lost patient, Andrew Laeddis. He realizes his partner, Chuck, is actually his specialty psychiatrist who had to be with him at all times because he is the most violent patient on Shutter Island. Teddy, now Andrew, is eligible to be released from Ashecliffe Mental Institution. He says to his specialty psychiatrist “What now? We need to find a way to get off of this island”. Teddy fakes a relapse because he did not want to go out into society and possibly hurt anyone else. The officers at the institution escort Teddy to have a lobotomy to “cure” his disorder.

Diagnosis

The diagnosis for Edward Daniels is Delusional Disorder, Mix Type (297.1)

1. Non-Bizarre Delusions for at least one month.
   1. Teddy experiences non-bizarre delusions over the course of two years. The delusions are not due to Schizoaffective Disorder, nor Mood Disorder. He does not have an alcohol dependency nor is he chronically depressed.
2. Criterion A for schizophrenia has never been met.
   1. Teddy does not show flat inappropriate affect. He is very sociable and his delusions are not bizarre.
3. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.
   1. Teddy is able to function normally. He is sociable and is able to properly communicate.
4. D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.
   1. Teddy is generally in a good mood. He is not depressed or anxious. He is always looking forward to catching new hints about Rachel. He gets angry when people refuse to give him want he thinks he needs, such as case files for patients in the mental hospital.
5. E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
   1. Teddy does smoke and drink however; he does not have negative episodes which develop from the substance abuse, but not alcohol dependence. He takes medications which help his migraines to go away.
6. Specify Type
   1. Mixed Type

i. Delusions characteristic of more than one type.

1. Grandiose Type
   1. Delusions which are inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.

i. Teddy believes that he is a valued marshal with specialized privileges to the mental hospital. He feels that people should obey his requests.

1. Persecutory Type
   1. Delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.

i. Teddy feels that the employees of the mental institution are trying to commit him at a patient. He feels that they are controlling him by giving him special medications other than simple pain killers. Teddy is also convinced that the cigarettes the institution provides are laced with drugs to cause him to become powerless

Accuracy of Portrayal

The portrayal of Delusional Disorder was accurate throughout the film. It was not apparent until the end of the film that he was suffering from a disorder, and not an actual investigator. The delusions were believable to those who do not have a complete understanding of psychology and psychotic disorders.

Treatment

The treatment psychiatrist used in the film was ultimately performing the lobotomy. Lobotomies were accepted in the fifties as reasonable treatments for psychotic disorders. In current treatment procedures lobotomies are unethical. The lobotomy procedure is the use of an ice pick type probe which is inserted through the eye in order to dismantle the brain. This develops a calming effect on the patient.

Recent treatment used for Delusional Disorder would include both medications and psychotherapy. Medicinal treatments may involve anti-psychotics and antidepressants such as SSRI and Clomipramine. Psychotherapy treatments involve supportive therapy and cognitive therapy. The treatment used for patients must be individualized. The treatment for Andrew Laeddis should consist of cognitive therapy combined with medication.