Daily Archives: April 4, 2012

One Flew Over the Cuckoo’s Nest – Demystified

Warning, this post may contain triggering content or themes.

Having been sick the last (zillion) several days, I’ve been laying around watching a lot of TV and movies. When the idea of watching One Flew Over the Cuckoo’s Nest came up, I don’t know if it was a feverish stupor or the fact that I’d never seen it before, but watching it seemed like a grand idea.

Instead, when I reached the end of the film I was mortified and had a terrible time trying to sleep the night after.

One Flew Over the Cuckoo’s Nest is considered to be one of the 20 Greatest Films by the American Film Institute. It won Best Picture at the Oscars and is one of only three films to have swept all of the top 5 categories.

For those that are unfamiliar with this movie, Jack Nicholson plays R.P. McMurphy, a man who has been sent from a prison work program to a mental hospital to be evaluated for his outlandish behavior. He is crass, energetic, and attempts to liven things up around the hospital, failing to succumb to the monotonous and stifling ways of the hospital.

Louise Fletcher plays Nurse Ratched, head nurse of the facility who is perpetually manipulating and crushing the spirits of the patients. Having heard this description before, I expected her to be brutish and forceful, but instead the character in the movie appears largely patient and softspoken, using these attributes as a shield to hide the power she is holding over the patients.

As you’d expect, a power struggle ensues between the two.

The book, by Ken Kesey, was published in 1962. The movie, directed by Milos Forman, was released in 1975.

There are a lot of themes around stifling individuality, sexuality, and a whole gamut of other things. There are aspects of counterculture playing a role in the story, racism, and the list goes on and on. What concerns me about this movie, though, is this:

the story takes place in a mental hospital. 

This is a fact that is ever-present throughout the movie, so how could people not walk away from this with a long list of stereotypes about the things that happen in mental institutions?

I think there are a lot of things that people don’t understand about this film, and that is something that has been coloring people’s perceptions of what mental hospitals are like [in real life] for the last 30 some odd years.

I realize that most people have not been inside of a mental hospital, they have no way to discern what is real from what is fiction in this film. Luckily I have had the pleasure of spending time in no less than 3 psychiatric facilities, so though I don’t consider myself an expert per se, I have quite a bit more experience in this realm than the average joe.

That said, there are a few points I’d like to address.

1. The time period in this film is supposed to be in the early 60’s. Now, what I don’t think people are taking into account when seeing this film is that a) this is a hollywood depiction of the goings on in a mental hospital (in other words, this isn’t a true story), and b) mental facilities have changed dramatically since the 1960’s.

Yes, there are a few elements of truth (as far as how many current facilities function), and I can’t personally compare the setting with hospitals in the 1960’s (though the depiction of the hospital in Girl, Interrupted takes place in 1967 and had some common themes), but knowledge alone that Kesey (who wrote the book) got a lot of information for his setting from his job (he was working as an orderly in a mental hospital) would hold more weight for me if he hadn’t admittedly been taking LSD at the time while working there.

What I’m trying to say is that this film is in almost no way representational of current mental facilities (based on the time period alone), but the setting is largely swaying the beliefs of what people believe to be real, in regard to mental hospitals today. I think if people can get a grasp that this is a fictional period piece, we’d all be much better off.

2. The patients were portrayed in such a way in this film that I was left feeling a little annoyed. Physical oddities (with no apparent nod at any sort of actual mental condition) abounded. I don’t know what the criteria was for being admitted to a mental hospital was in the 1950’s and 60’s, but I am pretty certain this was a device used by the creators of the film to make the group of patients look collectively “odd”.

From my experience, the most bizarre thing about the patients that I’ve seen in any situation of hospitalization has been that they all look deceptively normal. That said, don’t expect to find an abundance of people who others are ashamed of the way they look hanging out in a mental hospital today. You certainly can expect a broad spectrum of ages and races -depending on the population of your locality, of course.

3. The security of hospitals today, unlike the film, is considerably more intense. Of course, that will vary depending on the hospital (and who is sent there, there are hospitals specifically for patients who are considered more dangerous), but at any facility you can expect to be thoroughly searched before entry (something that doesn’t quite happen in the movie) and it is not unheard of to have personal items withheld if they can be considered potentially dangerous in any way.

In the film, orderlies are somewhat easily bribed, and that is something I would not count on in present day hospitals. In some, furniture is bolted to the floor (so it can’t be thrown through windows) and in others, windows only lead to courtyards in the center of the hospital (not outside) so trying to flee from them would be entirely fruitless. What I’m trying to say, is don’t expect to escape from one of these facilities unless you have gained enough trust to be walking around on your own or are willing to escape through conventional (convincing them to let you out) means.

4. “Not Crazy, Just Dangerous” – this is McMurphy’s final diagnosis by the psychiatrist in the film, but somehow they don’t let him go.

I talked with a friend of mine about this recently, not this situation in particular, but the idea that you’re more likely to be held longer in a mental health facility if you claim to be fine and that there is nothing wrong. People who are willing to embrace getting help in these facilities and be open about their issues have a much higher chance of being released than people (even sane ones, statistics show) who claim they are fine and would like to leave. This leads me to:

5. Voluntary vs. Involuntary is a funny thing. Being held involuntarily means you do not have any voice in when you get to leave. In the film, McMurphy is astounded nobody told him that he had just spent weeks pissing off the only person who had the power to free him. He asks all of the voluntary patients if they could just get up and walk right out the door, and though they say yes, they are too timid to do so.

Now I want to clarify something important, because there are two types of voluntary treatment. One involves being able to check out whenever you desire, and the other involves only being able to check out when your treatment team decides you may leave. For anyone who has an emergency facility on file for where to go for big episodes, you may want to know ahead of time which method your hospital of choice takes with its voluntary patients. Personally, I have been in both types of facility and there is certainly a trade-off that happens with both.

6. The shock treatment scenes in this film have been the number one complaint I’ve heard from psychiatrists in regard to the portrayal of mental health treatment in any movie ever. Most doctors complain that the use of ECT (electroconvulsive therapy) is not more widely used today because of this film, but after seeing these scenes I thought they were the least of my worries in regard to the entire film.

So a quick reminder, the film takes place in 1963. This is a hollywood, dramatized version of a fictitious story. Now, what you see in the film is in no way representative of how ECT works today. There isn’t any convulsing that happens, they don’t use the giant metal prongs on your head, there aren’t 8 people holding you down… that’s just movie “magic”.

What I found much more disturbing was the time leading up to these “shock treatment” scenes, and I would venture to guess that this is where the chief complaint is for many psychiatrists today. Any portrayal of a treatment that involves dragging adults down hallways kicking and screaming in terror just to get there is not one you’d probably have any luck at pitching to patients in real life.

7. Nurse Ratched was very difficult for me to handle in this film, and though I imagine this is one of the few things people would write-off in the grand scheme of how mental hospitals actually operate, the unfortunate truth is that I’ve seen this sort of character in my travels before.

I am not saying you’ll find a Nurse Ratched type character in every mental health facility, I’m sure many have excellent, professional staff. Unfortunately, every so often there can be someone (like in any field) that feels the need to abuse the power that they wield over others, and when you’ve put your faith in the hands of professionals that are supposed to help take care of you, it is easy not to see it coming.

The result in the film with Billy’s death is something I can’t take very lightly. After having a nurse withhold my medication until I was having withdrawals and then, in that point of extreme vulnerability, try to manipulate me into thinking I had an eating disorder, tell me I was a terrible girl, and that she absolutely wouldn’t help me… seeing Nurse Ratched’s final blow on Billy’s psyche hit way too close to home.

Obviously I didn’t commit suicide when this happened, but it turned me into an extremely non-compliant patient for a very, very long time.

8. Lobotomies are something that genuinely terrify me to an overwhelming degree, particularly because I know the fear of having my rights being subject to the whims of a psychiatric institution, but also because if I had been born some 70 years ago this is something that could have happened to me. 

Lobotomies reached a peak of popularity in the 40’s and 50’s and involved damaging portions of the nerves in and around the brain to “change the behavior” of patients. Sometimes patients were able to still function somewhat normally, and other times (like in the film) a lobotomy could render someone to a vegetative state. The procedure was done blind (meaning instruments were inserted without the technician being able to see where the instruments were in the skull) which is what partially accounts for the large range of mixed results. Between 40,000 and 50,000 lobotomies were performed in the U.S. before the first anipsychotic drug (Thorazine) became the new preferred method of treatment.

Today, receiving a lobotomy in a mental health facility would absolutely be considered illegal, so I wouldn’t let the fear of this sort of thing keep you from seeking treatment. Neurosurgery for Mental Disorders (NMD) is used today (though rarely) as a last resort for extreme cases of things like obsessive compulsive disorder and epilepsy, but even in that situation you can expect to sign a stack full of documents before they get anywhere near your head.

Honestly, I understand that it is a film and that it is fiction, but I can’t help but feel like One Flew Over the Cuckoo’s Nest is a harmful representation of mental hospitals in general. If there was more indication that the content is fiction or that it takes place in the 60’s, I think it wouldn’t bother me so much… but I think those are both things that people don’t always walk away realizing.

If you haven’t seen it, I’m not sure I would recommend it, simply because the last 10 minutes of the film pack a big, extremely intense wallop. If you have endured any sort of abuse during a psychiatric hospitalization, I would highly recommend avoiding this film. Otherwise, knowing heading into it that it is fiction and a period piece can help a lot with the potential discomfort you my feel.