First of all, Edward aka Teddy Daniels would've never been permitted to leave the island if he was truly "criminally insane":
The picture above is a snapshot of the boat in which Teddy and his partner Chuck Aule went to the island. And Teddy was walking around the boat without being closely watched; a criminally insane individual could never have all that freedom inside a boat, unless he is well attached. Also, when Teddy and Chuck were interviewing the patients as shown in the picture below, the patient who had axed her husband made Chuck go away by asking him a glass of water, and she secretly wrote a note for Teddy saying "run", warning him that he is in danger. We could never discover the reason why this patient wanted to give the warning only to Teddy... That is because she knew that Chuck was working with Dr Cawley and the other doctors.
If you read a more detailed article on the subject, you will see that even the doctors contradicted themselves after saying that there were no lobotomy taking place on the island. Furthermore, when Teddy met Rachel Solando (the real one) in the cave, everything she told him seemed to match the situation Teddy was facing, including the drugged cigarettes, the drugged aspirins, and the bad dreams. The picture below shows one of Teddy's horrific nightmares. In this one, he's holding his deceased wife, while blood is coming out of her and she is turning into dust.
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