Mental Illness and One Flew Over the Cuckoo's Nest
This is a review of the mental illness movie One Flew Over the Cuckoo's Nest. For those looking for mental health support/resources/information, consult NAMI.org
Before we begin
I have a reason for choosing to review this movie, an axe to grind if you will. For those suffering from mental illness, stigma can become a terrible burden as well as an unnecessary one. In the first half of the 20th century there were many cases of illnesses like schizophrenia which were basically incurable. But now modern medicine can treat these illnesses often to the point where symptoms completely disappear. Yet with mental illness, stigma remains a large issue because there is so much misinformation out there. The film One Flew Over the Cuckoo's Nest won five oscars and contains a great deal of misinformation. This is not to say it was not a powerful film, but I think it greatly misunderstood. This mental illness movie has a number of complex themes.
One Flew Over the Cuckoo's Nest: Synopsis
In this mental illness movie, Randal McMurphy, a man with long criminal record, figures life will be easier in a mental hospital than in prison. Contemptuous of order he stirs the ward up with plenty of trouble. In doing so he crosses Nurse Ratched who insists on order and routine in her ward. The situation escalates until Randal tries to strangle Ratched in a fit of rage. McMurphy comes back to the ward like a placated zombie (presumably from a lobotomy or some other horrible brain destroying control mechanism).
The movie is complex, so I'm not going to just slam it for inaccuracy. To start I'll note McMurphy's faults. When McMurphy gets into the ward, he immediately insists that everything be done his way. This ranges from scamming the ward patients from a black jack table, insisting the ward change to accommodate his preferences: including the ward's music and television schedule. He escapes the facility to commandeer a boat for a fishing trip joy ride. Then one night he brings alcohol and women into the ward, which ends up looking more like a drunken frat party than a hospital. Essentially, McMurphy is arrogant, impulsive, and undisciplined. Not a hero.
Nurse Ratched's Virtues
On the other side, is nurse Ratched. On the back cover of the movie, she is described as the "soft-spoken Nurse Ratched, among the most coldly monstrous villains in film history" However, in this entire mental illness movie, one gets only a few snippets of Nurse Ratched's point of view. She is not perfect, but this is not because she is an incarnation of evil, but because she can be an overbearing. Her monstrosity only appears because this movie doesn't explain anything about the actual challenges of dealing with the mentally ill.
Running a Real Mental Hospital
First things first, there are almost no people in One Flew Over the Cuckoo's Nest that are actually mentally ill. When McMurphy tells the members of the ward that none of them are any crazier than the average guy on the street he is correct. The only characters that might have problems is the terrified child Cheswick and the developmentally disabled Martini. What this film fails to take into account is that there is such a thing as mental illness.
Mental illness is a fact. Medication can treat mental illness. Stigma remains only because of ignorance. So let's go through the real problems facing actual hospitals today. They've changed a great deal since '63 when Kesey wrote his book, but the challenges remain the same:
- Mental illness may disrupt or have disrupted socialization, or the process by which one learned proper and improper behavior in society. The illness, if early in life, may have disrupted the process of socialization before it finished, or the illness may be so severe that the sufferer finds it difficult to conform to society's standards. And when I say "society's standards" I mean things like taking a dump in the toilet or not having a temper tantrum in public. These are not things that society has crushed into our soul. These are basic behaviors most people do for their own benefit. In order to socialize individuals patients are kept in groups and attend group therapy.
- There is a great deal of stress that accompany mental illness. Stigma is one, but so too is the compulsion to engage in inappropriate if not dangerous behavior that results from an illness in the brain (the organ of behavior). Learning adaptive coping skills is a great key to conquering mental illness. Coping skills are usually discussed in group therapy.
- Mental illness, especially with depression and schizophrenia, often results in a lack of self care and an inability to act in an ordered fashion. For people suffering from these problems, an organized routine enforced by nursing staff is necessary. This is why Nurse Ratched is so insistent on routine. This lack of self care (and the illness that is causing it) are aggravated by isolation, which is why Ratched insists on keeping people in a group.
- Some patients are hospitalized because of medication side effects or needed medication changes. This switch can be terribly disorienting and benefits from having active staff when a problem arises.
- Since some or all of these issues may or may not be the issue, and individual care too time consuming, the hospital program attempts to enact them all. Scheduling this kind of care is not easy, hence Ratched is insistent on keeping things on schedule.
So, in short, there are medical reasons for many of Nurse Ratched's
behaviors. She is not monstrous but she isn't goldilocks either. She is relentless and terrifying. This comes out
well in the therapy sessions. If a problem was to be discussed in a
therapy session Ratched never lets it go. No matter how difficult it may
be to discuss an issue, she remains stern, so stern that therapy
becomes a menacing affair. One might argue her behavior, even when one considers the needs of the ward, represents her
desire to be a petty dictator (better to be queen of hell...). Yet there
is a scene where Nurse Ratched, given the chance to rid herself of the
troubled Murphy, specifically states she doesn't want to simply pass the
buck to another ward--that she can help him. Whether this is an
inability to accept defeat or an honest desire to help is left to the
viewer. It's hard to guess Nurse Ratched's motives, particular when the
actress who plays her (Louise Fletcher) looks like she has a permanent
scowl and no facial muscles above her lips.
So, in summary, McMurphy is no one to look up to, Ratched isn't an evil dictator bent on squashing individuality, and the movie does not reflect the realities of today's mentally ill. Beyond these cons, however, is a concept that One Flew Over the Cuckoo's Nest nails: culture shock. McMurphy lives in a world where society is constantly locking him up because he "fights and f**ks too much". When he discusses his problems with his doctor it's clear that he has no remorse for his actions. There's no indication that McMurphy couldn't stop his behavior if he wanted, (which is a clear sign he's not mentally ill) but shows no desire to do so. As such, McMurphy goes in and out of jail-- jail just being the place you go when you get caught--and then you wait it out until you can start fighting and f**king again. He fakes mental illness he because he believes the hospital will be easier on him.
Oops. He enters the hospital and acts just the way he did in prison:
starting a black jack table with cigarettes for instance. In the scene
where he commandeers a fishing trip boat, he rejects the idea that he's
going to get in any trouble for it. "They'll just send us back to the
feeb farm!" He even suspects he'll be out of the hospital as soon as his
In prison he can just wait out his sentence, and go back to fighting and f**king as soon as possible. But the hospital does not just let people go. It waits until it is certain the person has conquered their mental illness. Moreover, McMurphy is shocked that so many people on the ward are voluntary patients. They are looking for the hospital to heal them, while McMurphy is still treating the place solely as a place of incarceration. Nurse Ratched, on the other hand, is working from a medical model. In such a model, the mental patient is considered sick when they persistently break rules, that their illness is the cause. Thus McMurphy's actions demonstrate to Nurse Ratched a patient out of control. She is consistently at odds with him because she can find no way of creating boundaries that McMurphy will honor. Her attempt to establish boundaries comes in the form of refusal of petty privileges. (This is still standard procedure.)
Ratched comes off as autocratic as
she refuses McMurphy the most basic amenities, but these actions are an
attempt to establish a degree of control that (as mentioned earlier) is
often necessary to build a self-disciplined personality.
It turns out that this kind of control just seems to bounce off McMurphy
who is in fact not mentally ill. McMurphy, on the other hand, seems
oblivious to the hospital's aim at rehabilitation, used to (as he must
be) to the revolving door in prison--to the hospital that intends to keep you until it's convinced there will be no relapse. This is the dynamic The war between these two viewpoints is what gives the film some power. It replicates the feeling of a mental hospital--that it's
terribly disorienting and, as mentioned, you can go through a lot of
boring crap and seemingly arbitrary rules during commitment. So the
movie does occasionally shine, but if you're looking for a mental
illness movie you're probably better off with Girl Interrupted,
Beautiful Mind, or Pi.I've also heard, not surprisingly, that Ken Kesey's book One Flew Over the Cuckoo's Nest is much better.