In Session with “Shutter Island” with Dr. Weber

This week Dr. Sam & Dr. Fran discuss our second psychological thriller, Shutter Island, as part of October’s Spooky Session Series. Join the doctors and Teddy Daniels as they embark on a journey to Ashecliffe Hospital in search of a missing patient. 
This week, Dr. Emily Weber, a forensic psychologist, joins as we discuss the evolution of forensic hospitals and treatment as well as trauma, delusions, and hallucinations. Are transorbital lobotomies still a major form of treatment for the “criminally insane?” What does “criminally insane” even mean? 
Most importantly, does Teddy uncover and thwart a mass conspiracy to experiment on patients and create “ghost soldiers?” Dr. Sam pulls out her spy notebook and the doctors work to get to the bottom of what is really happening at Ashecliffe. 
Which would be worse—to live as a monster? Or miss this week’s episode of Freudian Scripts?  

Glossary of Terms

Intrusive thoughts – unwelcome or distress thoughts or memories, often associated with traumatic events

Criminally insane – no longer used, refers to someone that has likely been found Not Guilty By Reason of Insanity

Not Guilty By Reasons of Insanity (NGRI) legal defense indicating that, at the time an offense was committed, the individual had mental health symptoms that interfered with their ability to determine right for wrong.  Once determined NGRI, the individual is evaluated to be placed in the least restrictive therapeutic environment (e.g., psychiatric hospital)

Violence risk assessments – forensic assessment used to attempt to predict the likelihood that an individual will commit a violent act in the future

Static risk factors – historical factors that are never going to change (e.g., history of violence, the severity of the crime)

Dynamic risk factors – risk factors that can be changed (e.g., taking medications, participating in treatment, level of insight, substance use)

Collateral information – part of the psychiatric or forensic interview where information on the patient is collected from multiple sources (e.g., medical records, close contacts)

Psychotic symptoms a cluster of psychiatric symptoms that may include hallucinations, delusions, agitation, and speaking incoherently

Delusion a fixed belief that doesn’t change even when presented with conflicting evidence

Persecutory delusions a specific set of delusions that involve believing that others are planning to hurt them, despite a lack of evidence

Paranoia – a psychological phenomenon involving feelings of persecution and unwarranted mistrust

Cognitive-behavioral therapy (CBT) – a common type of therapy focused on challenging unhelpful thoughts and improving coping skills, can be used to treat posttraumatic stress disorder

Prolonged exposure a type of CBT where individuals gradually approach trauma-related memories and reminders to reduce symptoms of posttraumatic stress disorder


We discussed the impact of the Rosenhan experiment on today’s episode- learn more about the experiment here and read some of Dr. Rosenhan’s thoughts here. We also want to acknowledge that there is some controversy around this study– find out why in this article.

Take a deeper dive into the overlap between trauma and psychotic symptoms in these three articles.

We also covered a new diagnosis today! Read more about delusional disorder here.

Interested in learning more about the best treatments for PTSD? Read here! And what about treatments for psychotic disorders? We have an article for that too.