Shutter Island, the movie (2010 directed by Martin Scorsese, with Leo DiCaprio and Ben Kingsley), presents an accurate but superficially treated part of the history of the modern psychiatric institution. To make matters worse, somehow the public did not catch the importance of that history in the flick; they were and continue to be thrown off by the question at the end of the movie and about what was DiCaprio’s character real mental state. It is promoted as a horror movie, which it is, so the historic part is lost in the shuffle. I must say parenthetically that this is, in my view, Leo’s best performance, and I have never been a fan of his.
One of the issues treated in the movie is the relation between violence and mental illness. “Treated” is a misnomer, more like ‘used’ to advance the thriller part of the plot. Nevertheless, the correct part of the history of psychiatry is the reference to the two different philosophies of mental illness in the 1800s relating to the treatment of violent people. Each developed its own treatment modality approach, vying to control the emerging business of mental health treatment.
One view, the ‘moral therapy’ approach, is represented in the movie by Ben Kingsley’s character (no spoiler: from the beginning of the movie we know he is a psychiatrist). His character could be a stand for Sammuel Woodward, the doctor who tried to reform the treatment of the mentally ill at the newly created (1833) psych hospital Worcester State Hospital in Massachusetts. This is not in the movie. The pro-surgery approach is represented by Max von Sydow’s character.
To better understand this ‘struggle’ of approaches, I recommend you read the book The History and Politics of Community Mental Health by Murray Levine. This is a MOST read book for anyone interested in that topic. You can read about ‘moral therapy’ on pages 16 to 21. While you wait to get the book, you can try reading those pages here: a sampler of the book at Barnes and Noble.
The part that I find superficial is this:
There is no mentioning that the failure of the ‘moral’ approach in the US was due to the sabotage inflicted by the pro-surgery faction on the work been done by Woodward, not because the compassionate-humanistic approach failed in itself.
In that battle for the business of mental illness, the pro-surgery attacked any effort that proved efficient without having to torture or submit a person to the cruelty of lobotomies and the new pharma therapies. In the case of Woodward’s work,they flooded the hospital with the most violent patients at a time when the hospital didn’t have the financial resources to deal with the influx. In addition, as we know today, there are ‘different’ levels of mental ‘dysfunction’. Mr. Woodward was focusing first on those who were less ‘psychotic’. The inability to ‘calm’ the aggressive patients led to them calling the approach a ‘failure’.
But in the movie, we see ‘competition’ between them as a fair one, with the pro-surgery literally sitting there waiting watching Ben’s approach fail. At the end, we are left with the feeling that ‘moral therapy’ is a TOTAL failure and that there is no other alternative than to go the way of the scalpel.
The only one who makes the connections in the movie about the ‘competition’ and immorality of the pro-surgical approach is Leo’s character, but it all gets lost in the ‘detective’ story, in the horror itself.
And then there is the question with which the movie ends:
The real question they are asking is about the benefits of psycho-surgery: would you prefer to live as a ‘monster’, a violent mentally ill person, or to be lobotomized and live as a “good man”, i.e., as a zombie? The question actually is one for ‘society‘, not for the individual with mental illness. No one in his or her ‘right or bad’ state of mind would choose to be a zombie: no one on either mental state, PERIOD, especially if it is done without his consent.
But as important as that is, is the assumption that you become “a good man” with lobotomy or drugs. The moral judgment about the ‘goodness’ of a person becomes unnecessary when a human being is turned into a zombie against his will, as we see in the movie with the many patients roaming the grounds. That person stops to be a human being without the capacity to judge his or her actions. The question could, then, be seen also as the mentally ill choosing suicide by lobotomy, not by his own hand. There’s no winning with lobotomizing a human being, at least not for the patient.
Psycho-surgery as a solution to mental illness, violent or not, shouldn’t even be a question, not on these ‘modern’ times after the horrific history behind that practice.
The moral question should have been: Is it morally right to dehumanize a person against his will so he or her is not a threat to a few? There are other relevant questions but it would be a spoiler for those who have not seen the movie. For example, can the person who committed the crime be considered “a monster”?
Psycho-surgery is live and well. With modernization comes the re-packaging of it with ‘new’ tools and ‘research’ to make the ‘appropriate corrections’ for past ‘mistakes’. The tools always change, the attitude always remain.
I recommend this movie for those of you interested in the topic. Watch it and make your own conclusions. It is a time well spend, the movie is good.