Dissociative Identity Disorder: Shutter Island
This paper discusses insights obtained from studying dissociative identity disorder or DID. In order to improve the learning experience, the movie entitled Shutter Island served as a visual aid. In the said film, Academy Award winning actor Leonardo DiCaprio played the lead role. His character, Andrew Laeddis, was a World War II veteran who suffered from post-traumatic stress disorder. One can argue that it was his alcoholism and other abnormal behavior that drove his wife to the edge. As a result, she murdered their three children. Overwhelmed with guilt and different levels of traumatic events, Laeddis experienced a mental breakdown and had to be confined to a mental institution. However, the film does not start with the revelation of the truth; rather, it starts with the delusions of Andrew Laeddis who was part of a role-playing game designed to cure him. In the said role-playing experiment, he was U.S. Marshall Teddy Daniels, working with his fellow partner U.S. Marshall Chuck Aule.
According to the DSM-5 classification, DID was formerly known as multiple personality disorder. However, it is important to point out that DID is not a personality disorder, it has always been known among psychiatric professionals as a dissociative disorder (Dissociative identity disorder, n.d.). It is also crucial to mention that practitioners attribute the emergence of DID to the aftermath of a serious case of abuse in childhood. Experts in this field refer to this phenomenon as the end-result of “overwhelming experiences, traumatic events or abuse” that occurred before the age of 5 (Dissociative identity disorder, n.d.). The impact of such an episode forces victims to create an “alter” or an imaginary figure that has to come in and take their place in order to deal with a traumatic event. It also makes sense to argue that DID is associated with early childhood development problems because, at this stage, children are prone to have imaginary friends and companions. Recent studies have revealed that symptoms are manifested between the ages of 5 and 10, which proves the idea that DID is linked to early childhood abuse issues. In addition, most patients suffering from DID report traumatic past experiences, especially in the area of sexual and physical abuse.
Although it is imperative to highlight the implications of recent research outcomes, it is also important to point out that practitioners regard DID as a complex form of post-traumatic stress syndrome. Using the DSM-5 diagnostic criteria, it is easier to fit DID into the film’s narrative. In the recent guide released by the APA, DID is a “disruption of identity,” which is characterized by the emergence of two or more distinct personality states (Dissociative identity disorder, n.d.). As a result, there is an abnormal disruption in the person’s sense of self, which is manifested in the abnormal modification of behavior, memory, perception, and cognition (Dissociative identity disorder, n.d.). Furthermore, there are gaps in memory recall and impairment in social functions. Memory gaps do not just refer to a certain level of forgetfulness because, in the context of DID, the patient exhibits symptoms like those suffering from amnesia. According to the DSM-5, it is crucial not to associate the emergence of personality states with imaginary playmates or fantasy play because the symptoms are more serious than the expression of certain cultural practices. It is also critical to establish if the symptoms are not linked to physiological effects that occur after the consumption of certain substances and are not the result of medical conditions like seizures or related health issues (Dissociative identity disorder, n.d.).
Application of DSM-5 Criteria
It is crucial to highlight the fact that, aside from the manifestation of two or more personality states, another major distinctive sign of the DID problem is significant gaps in memory. In the case of Andrew Laeddis, the expression of multiple personality states is made obvious at the end of the movie. However, in this particular case, there were only two personality states. The real one was Andrew Laeddis and the second one was Teddy Daniels. Laeddis was a former soldier suffering from post-traumatic stress disorder who experienced a serious mental breakdown after he discovered that his wife had murdered their three children. In addition, the patient also suffered from severe gaps in memory, so it is possible to diagnose him with amnesia. However, it is also accurate to say that the gaps in memory were the result of the suppression of traumatic memories.
The expression of two personality states was a means to deal with traumatic events in the past. Teddy Daniels was the “alter,” the so-called alternate personality that was brought out by Laeddis whenever he had to go through an uncomfortable phase. In the movie, Terry Daniels was summoned every time the character tried to suppress the memories of murder and tragic events in his family. As a result, Daniels was the one chasing after the person who murdered Laeddis’ wife. In other words, Laeddis had difficulty accepting the fact that he was the one who killed his wife. He had to create an elaborate story or an alternate reality wherein he was the hero trying to vanquish the villain. In the movie, the dissociation was also expressed in alterations when it comes to perception and cognition. As the alternate personality, Daniels had to conjure other characters to support an alternative reality. Thus, he had to invent George Noyce as a person who gave him the idea that the mental institution he was visiting was actually a government-funded facility using mentally ill patients as subjects in human experiments. Due to the creation of an alternate personality and an alternative reality, Laeddis was able to escape the guilt and other undesirable feelings related to his past actions. In addition, he was not aware of the fact that he was admitted to the mental health facility for two years.
Experts in the field of psychiatry agree that there no treatment that is more effective than psychotherapy. In other words, psychotherapy is the primary method of intervention and treatment for DID. It is interesting to note that the simplest definition of this treatment modality is a talking therapy. One can point out that, in the movie, Dr. Cawley hinted at the superiority of psychotherapy as an effective means of treating the symptoms exhibited by Laeddis as opposed to conventional treatment modalities that include surgery, lobotomy, and the use of psychotropic drugs. He had a thought-provoking way of describing his choice of treatment modality when he said that if the doctor-patient relationship progressed to earnest discussion and sincere desire to uncover the problem, then a breakthrough would be possible. Dr. Cawley simply wanted to talk to patients and allow them to figure out the problem without using drugs and physical methods because these strategies simply act as sedative agents or means of restraining the patients without getting an understanding of the causes of the issue.
Using insights gleaned from the recommendations of DSM-5, it appears that Laeddis would have a better chance of recovery if psychotherapy was used instead of lobotomy or the ingestion of powerful drugs. However, it is imperative to clarify the objective of psychotherapy, which is not to achieve a deeper understanding of the root cause of the problem. In fact, it is best to manage the impact of the traumatic events. It is more important to deal with the alternative personalities so that the patient understands the reasons for the manifestations of two or more alternate personality states.
It is only at the end of the movie when the audience has a complete picture of the activities that occurred within the mental institution. It is revealed later on that the riddle at the beginning of the film when Teddy Daniels discovered a scrap of paper detailing the phrase “the power of 4 and who is number 67?” had so much to do with the treatment modality that was used to bring Laeddis back to the real world. The power of 4 refers to the 4 most influential leaders in the facility. Two of them favored the use of psychotherapy while the others preferred lobotomy and the use of psychotropic drugs.
It is also discovered later on that Dr. Cawley developed a sophisticated form of psychotherapy. He created some form of a role-playing game where the characters were chosen to deal with gaps in memory. Therefore, the names Terry Daniels and Rachel Solando were anagrams of real-life couple Andrew Laeddis and Dolores Chanal. This role-playing or the application of psychotherapy techniques enabled Dr. Cawley to reach out to Laeddis, and like a drowning man brought out of slumber, he was able to save his life. In the end, Laeddis realized that he was just using the alternate personality for the purpose of burying the painful memories of his past. However, the twist in the story was Laeddis’ inability to live in the real world. He was drowning in guilt, fear, and loneliness, and that is why he pretended to regress and expressed symptoms of DID in order to force his doctors to give him the ultimate intervention. It is implied that after he underwent the lobotomy surgery, he died peacefully as a man without the need to deal with his past.