Summary:

In 1954, U.S. Marshal Edward "Teddy" Daniels (Leonardo DiCaprio) and his newly assigned
partner Chuck Aule (Mark Ruffalo), go to the Ashecliffe Hospital for the criminally insane on Shutter
Island located in Boston Harbor. They are investigating the disappearance of Rachel Solando, a patient
who apparently vanished from a locked room, leaving a note behind that reads:

THE LAW OF 4
WHO IS 67?

Dr. John Cawley (Ben Kingsley), the head psychiatrist, explains that Rachel was institutionalized after
drowning her three children, but has been refusing to accept the reality of being in a mental hospital.

During the search for Rachel, Teddy sees a lighthouse but is told that it has already been searched. He
asks to see the hospital personnel files; Cawley refuses, but allows the Marshals to question the staff.
They are frustrated to learn that Rachel's psychiatrist, Dr. Sheehan, left on vacation after her
disappearance. That night, Teddy has a strange dream in which he sees his wife Dolores Chanal
(Michelle Williams), who was killed in a fire two years earlier. She tells Teddy that Rachel is still on the
island, as is Andrew Laeddis, the arsonist responsible for her own death. Daniels then concludes that
"67" from Solando's note is Laeddis, whom he believes to be the institution's allegedly non-existent
67th patient.

In the morning, they interview patients from Rachel's group therapy sessions, one of whom distracts
Chuck and warns Teddy to run. Later, Teddy reveals to Chuck his ulterior motive for taking the
investigation. Andrew Laeddis was sent to Ashecliffe for his crime and then disappeared, motivating
Teddy to investigate the institution. He met a former patient, George Noyce, who claimed that Ashecliffe
experimented on patients. Teddy is determined to bring the institution down.

Cawley informs Teddy that Rachel has been found and presents her to him. The delusional Rachel (Emily
Mortimer) mistakes Teddy for her husband who died in World War II, and then becomes very agitated.
Later, Teddy develops increasingly severe migraine headachesaccompanied by hypersensitivity to light.
In his sleep he has more strange dreams, followed by waking hallucinations. He is now determined to
search for Laeddis in Ward C, which houses the most dangerous patients. There he finds Noyce (Jackie
Earle Haley) who is afraid of being taken to the lighthouse, where lobotomies are performed, and tells
Teddy that the entire investigation is a game constructed for him.

Teddy rejoins Chuck and they head to the cliffs surrounding the island, intending to reach the
lighthouse. Eventually, Chuck suggests that continuing is too dangerous and Teddy goes to the
lighthouse alone. He is unable to reach it, and when he returns, Chuck has disappeared. Looking for him
at the foot of the cliff, Teddy finds a woman hiding in a cave who confirms his suspicions by revealing
that she is the real Rachel Solando (Patricia Clarkson). She says that she was a psychiatrist at Ashecliffe
until she found out about the experiments. She was forcibly committed to ensure her silence. She
explains that the hospital is using psychotropic medication in an attempt to develop mind
control techniques and create "sleeper agent" spies. She says that Teddy has been similarly drugged
since he arrived on the island.

Teddy returns to Ashecliffe, where Dr. Cawley tells him that he came to the island without a partner –
nobody seems to know Chuck. Teddy eventually makes it to the lighthouse but finds nothing unusual on
his way up the stairs, contrary to what he expected. At the top of the lighthouse, he finds Dr. Cawley
who reveals that Teddy is not Edward Daniels, but ex-Marshal Andrew Laeddis. Cawley says that he has
been a patient at Ashecliffe for two years since he murdered his manic depressive wife in a fit of rage
after discovering she had drowned their children. Cawley explains that Rachel Solando never existed,
neither as patient nor psychiatrist. "Chuck" then arrives and reveals himself as Dr. Sheehan, Andrew's
psychiatrist; the woman who was presented as Solando the patient turns out to be a nurse. Sheehan
and Cawley state that Andrew lived the fantasy of still being an active U.S. Marshal, searching for
Andrew Laeddis as a means to disassociate himself from what he had done. They show him that the
names "Edward Daniels" and "Rachel Solando" are anagrams of "Andrew Laeddis" and "Dolores Chanal",
respectively, thus constructing "the law of 4" (four names) and affirming Laeddis as being "67".

Cawley explains that Andrew has gone through repeated cycles of realizing the truth, only to regress
into his fantasy again, during which he has injured multiple orderlies and patients, leading the
administrative board to demand a lobotomy as a permanent solution to his problem. Sheehan and
Cawley explain that they decided to try an experimental therapy, in which they created the role play of
"Rachel's" disappearance based on Andrew's fantasy. They say they hoped that by failing to uncover his
mind-control conspiracy, Andrew would see reality and return to it permanently. Andrew appears to
accept Sheehan's and Cawley's explanations, blaming himself for ignoring Dolores' mental illness until
she killed their children. Experiencing yet another migraine, which causes a flashback of the traumatic
event of his wife's and children's death, Andrew faints.

The next morning, Andrew once again calls Sheehan "Chuck" and mentions exposing the Island's doings
to the outside world. Sheehan silently signals to Cawley, and orderlies approach to take Andrew for the
lobotomy. Andrew asks Sheehan whether it would be worse to "live as a monster, or die as a good
man". He then walks off calmly with the orderlies.
Diagnosis: Paranoid Schizophrenia

DSM: DSM code 295.30 for Paranoid type- a type of schizophrenia in which one of the following criteria are
met:

A. Preoccupation with one or more delusions frequently auditory hallucinations

B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat
or inappropriate affect.

Manifestations: Andrew Laeddis/Teddy Daniels exhibits Positive symptoms are symptoms that most
individuals do not normally experience but are present in the disorder. Examples are hallucinations, delusions,
bizarre behavior, and illusions.

Nursing Diagnosis:

Ineffective Denial related to post traumatic stress

Ineffective Coping related to post traumatic stress

Dysfunctional Family Processes related to denial

Complicated grieving related to denial

Risk for self-directed violence

Nursing Medical management:

Anti – psychotic medication may be given to combat the positive signs example is chlorpromazine.

ECT may be an option.

Psychosocial therapy is also widely recommended for schizophrenia.

Character: Leonardo Dicarpio played the role of Andrew Laeddis: Andrew Laeddis is a psychiatric patient at
Ashecliffe Hospital who shot his wife after she murdered his children. Laeddis is in denial of his crime, and
believes he is still a U.S. Marshall named Teddy Daniels and that his wife was really killed by a fire that
"Andrew Laeddis" caused.