Shutter Island, the recently released psychological thriller, fortified by the Scorsese-DiCaprio combo, brings to light the dark history of psychiatry (I will not reveal any spoilers, so no need to fret if you plan on seeing this movie). I definitely recommend this film- it’s gripping, eerie and suspenseful, and not gratuitously scary. I watched the movie with several of my psychiatry co-residents, and most of us were quite impressed.
The story is set in the 1950’s, which happens to be a revolutionary period in psychiatry. Two key medications were discovered around that time to treat severe mental illnesses once thought to be unmanageable. Lithium, a mood stabilizer, was used in 1948 to successfully treat bipolar disorder and Thorazine was found to be the first effective antipsychotic medication to treat schizophrenia in 1952.
The use of medications to treat mental illnesses, or psychopharmacology, was instrumental to paving the way to deinstitutionalizing psychiatric patients- that is, transitioning patients from living permanently in locked institutions to living functionally in the community. Prior to the practice of psychopharmacology, many of the therapeutic methods of psychiatric treatment in the early part of the twentieth century were not only experimental, but harsh, cruel, and extreme. The one that undoubtedly ranks at the top is the lobotomy.
Lobotomy is a surgical procedure performed to damage the frontal lobe of the brain, which sits directly behind the forehead. This region of the brain is essentially what differentiates us from other animals. It functions to help us make complex decisions, express our unique personalities, and engage in acceptable social behaviors. Without a functional frontal lobe, we would be no better than a donkey (and I’m not referring to the one in Shrek– that donkey has personality, albeit inappropriate). The most infamous type of lobotomy was the transorbital lobotomy, developed by Dr. Walter Freeman in 1946. He made it a 10 minute “office procedure” using mainly an ice pick and a hammer, approaching the brain through the roof of the eye socket (you’ve got to click on the link to see for yourself).
The premise behind the lobotomy was that psychiatric illnesses were a result of malfunctioned nerves connecting the frontal lobe to other brain regions. In turn, severing the faulty nerves will allow for new healthy ones to regenerate, thus relieving the psychiatric symptoms. This hypothesis proved costly to be invalid and wrong, at the expense of many patients. Sadly, despite being a controversial procedure even since its introduction in 1936, it was commonly used and widely accepted by the medical profession in the 40’s and 50’s. By 1951, almost 20,000 lobotomies were performed altogether in the US.
Fortunately, with the advent of the antipsychotic medications in the 1950’s, lobotomy died off almost as abruptly as it rose up (although psychosurgery is still currently indicated and effective for severe OCD). The beginning era of psychopharm helped move psychiatry into its current and brighter age.
As if in the darkness of the time period in psychiatry’s history during which Shutter Island takes place, DiCaprio uses matches to light his way on the creepy island. The film’s storyline is just as disturbing and dark as its historical and scenic backdrop, if not more.