Shutter Island: The Strange History of Mental Institutions

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Shutter Island takes place in a shocking, macabre world that has been largely unseen on the movie screen: that of the 1950s psychiatric institution, in an era when treatment for those at the farthest and most violent reaches of madness was about to undergo a major revolution. As the dark days of “warehouse-style” asylums gave way to a new era of powerful brain surgeries and neurological drugs, it was a time when some patients were lost in a Kafkaesque system while others were part of cutting-edge experiments that forged many of our contemporary theories about criminal insanity. In the midst of Shutter Island’s tangled mystery, Martin Scorsese provides a transporting glimpse into this darkly compelling world that was long hidden from view.

Asylums for the insane date all the way back to the Middle Ages but, even before then, societies agonized over what to do with those too mad to function safely in the outside world. Some have even posited that the term “ship of fools” referred to roaming vessels that carried the insane offshore as an early form of institution.

European asylums of the 16th and 17th Centuries were the progenitors of asylums in the U.S. They were essentially prisons, not treatment centers, bleak hellholes in which the patients were chained and abused like animals, beaten into submission and “stored away” in gruesome conditions, often until death. Perhaps the most infamous example was the large, intensely grim asylum at London’s Bethlehem Hospital, a name which was soon shortened to Bedlam Hospital, and in turn gave rise to the word bedlam, meaning “house of confusion.” The hospital opened its doors to visitors, allowing them, for the price of a penny, to watch, poke and instigate the chained prisoners into bizarre reactions. With the inhabitants viewed by society as willing tools of the Devil, there was little compassion for their plight. (Intriguingly, by contrast, medieval asylums in Persia were relatively enlightened, initiating the use of soothing baths, music therapy and early forms of talk therapy to try to return patients to everyday life.) Bedlam would also come to be a 1946 Val Lewton film, with its poster proclaiming: “Sensational secrets of infamous mad-house EXPOSED!”

It was in 1792 that an asylum in Paris first experimented with cutting patients’ chains and turning the facility from a windowless dungeon into a sun-lit retreat. They were encouraged when a few patients actually recovered, which was previously thought impossible. Thus began the slow-dawning era of “New Treatment,” with a greater emphasis on seeking cures, although sometimes by extreme and brutal means. Unfortunately, what emerged initially was a ghastly legacy of experimental treatments ranging from spinning patients at high speed in special chairs to “calm their nerves” to literally torturing them to “bring them to their senses,” a process that only further sealed the reputation of asylums as horror-filled realms from which few returned to normal society.

Over the next century and a half, Western asylums remained places surrounded by fear and revulsion. The first asylum in the fledgling United States was started by Benjamin Rush in 1769 at Williamsburg, Virginia and remained the only such facility in America for the next 50 years. In those years, most of the mentally ill in America wound up in poorhouses or prisons, but in 1827 an “Act Concerning Lunatics” forbid the confinement of insane persons in jail and a number of institutions were built around the country. Though there were some progressive exceptions, most notably the Quaker asylums in Philadelphia, Boston and New York, these were still largely unwelcoming places by today’s standards, where common treatments included placing the patients in straitjackets in order to teach them restraint over their behavior, and even bloodletting and purging.

There also emerged a new category of the mentally ill, those whose madness inspired terrible crimes. In 1859, New York opened the first State Lunatic Asylum for Criminal Convicts.

By the end of World War I, in the wake of Freud’s revolutionary theories and with thousands of war veterans suffering from post-battle psychological trauma, treatment facilities began to improve. Treatments themselves, however, often remained shockingly harsh. For example, Dr. Henry A. Cotton, who headed the New Jersey State Lunatic Asylum, pioneered a series of surgeries in the 1920s that involved the removal of teeth, tonsils, intestines and sexual organs believed to be the sites of madness-inducting infections. In the 1930s, Dr. Egas Moniz, a Portuguese neurologist, began experimenting with a new form of what became known as the prefrontal lobotomy, a radical surgery that severed nerve fibers in the part of the brain associated with emotions. The treatment did indeed calm those suffering from schizophrenia and intractable psychosis, albeit at tremendous cost to the patient’s personality. Moniz was eventually awarded the Nobel Prize for his discovery of the technique.