Shutter Island

Say what you will about how psychoanalysis is outdated, but how could we make a good horror movie without the stock characters of the Freudian unconscious? The suffocating mother, the castrating father, the lover who steals one's soul - Martin Scorcese's new movie "Shutter Island" is cast from The Interpretation of Dreams. The only cliche it avoids, that famous cigar, finds ample substitution in cigarettes and even these, it turns out, may be poisonous. "Beam me up, Melanie Klein," I was thinking.

It's a poignant time for a movie that ultimately argues for depth psychotherapy of the very ill and uninsured. As health care reform succumbs to the sexy argument that we should get by with less care, third party payors don't reimburse for insight. If medication can make you feel better in thirty days, that's good enough. No wonder Shutter Island is set in the 1950s, when mental hospitals could still provide psychotherapy.


Stop here is you want to be surprised by the plot twist in the movie. Because on Shutter Island, the battle between the risks of insight and those of social conformity is stark and dangerous. Can a clinician help Teddy, a man lost in a delusion of his heroism, face his unbearable trauma before the men in the white coats take over? The harsh technique of institutional psychotherapy -- a Nazi doctor armed with insinuation, contempt, and a hypodermic -- has not reached the protagonist. Time is up. "When you see a monster," the doctor intones, "you must stop it." Instead, Teddy's illusions are finally breached by his analyst's willingness to surrender his authority and become his patient's loyal sidekick in his fantasy.

There is plenty to appreciate in this movie is you are an analyst sacrificing the rock-hard stability of a one-person psychology to dive into the shifting tide of a relational treatment. No wonder a hurricane is needed to shake protocol in the movie. Our institutions loathe the uncertainty and expense of human understanding and depend on the security of the empirical. Yet, in the novel from which "Shutter Island" is adapted, Teddy's belief in his delusion falters at the moment he notices his doctor's eyes are not implacable, but weary. It is the uncertainty of human connection that makes its occurrence such a potent force for change.

These are the moments we clinicians treasure: the dawning idea that the rules one has lived by belong to a time long past. The moment is tragic, too. It brings not only relief but regret for all one has misunderstood. Knowing more is seldom an easy thing, a truth with dramatic effect in the movie. Teddy says, "which is worse: to live as a monster or to die as a good man?"