In Shutter Island’s opening shots, the titular island looms large, emerging from the thick grey air, as clear and cinematic a trap as there ever was. An equally ominous and fog-enshrouded ferry approaches. Aboard, we meet a grieving U.S. marshal (Leonardo DiCaprio) who is journeying to the island to track down a missing patient under the baleful eyes of hospital administrators, portrayed with effortless malice by Ben Kingsley and Max von Sydow. He is either a little or very crazy and certainly has cause to be, as his backstory encompasses every stock woe in the tool chest of a great American director. In quick order, we discover the marshal’s mentally scarring tour in the Second World War (Dachau is artfully rendered, full of emaciated heaps), the gruesome fate of his beloved wife and his history of alcoholism. Nazis! Grisly murders! Lead-heavy symbolism! Scorcese can't seem to resist bringing all the big guns to bear on what is, at heart, a drawn, tense little B-movie.

While set in the early ’50s and riffing on a potboiler story at least as old, the film has a relentlessly modern look and feel, suffering at times from the same atonal lack of authenticity as so many other big-budget mid-century period pieces. Perhaps regretfully, one aspect that hasn't been given the 21st century update is the often insensitive and lurid treatment of clinical madness — an indulgent cheap thrill in a film that sometimes transcends its baser instincts despite its sheer weight.

In more generous terms, Shutter Island works effectively (and almost exclusively) with archetypes. A pioneer of the gritty anti-hero saga, Martin Scorcese has long had a knack for tapping the heaviest emotions and drawing suitably intense performances from some of the best actors of the past two generations, although he's done so with more virtuosity than is on display here.

Shutter Island takes cues from the gamut of paranoiac thrillers, borrowing the shock chords and jarring cuts of late-century hack jobs like Gothika, the careful construction and veiled nature of The Haunting and the third act revelation of Canadian indie chiller Session 9. In the hands of a long-established master, the film is a confident elevation of an old idea more than a striking, unique vision. It works well when it plays to its strengths, successfully walking the line between paranoia and sinister conspiracy for a satisfying payoff in the third act while administering a number of less-than-therapeutic shock treatments. While the story isn't always quite large enough to fill the panoramic, desaturated screen, the streamlined engineering and strategically timed revelations of the finale are ample reward for taking the Sturm und Drang in stride.