It has been over 40 years since Ken Kesey’s One Flew over the Cuckoo’s Nest was published. The book was a counter-cultural classic, selling millions of copies and ushering in the era of psychedelics and hippie radicalism. Cuckoo had enormous impact on public perceptions of psychiatry and mental illness. It has been blamed and credited for the decline of electroconvulsive therapy and psychosurgery, it shaped the attitudes of a whole generation and it is well worth examining its appeal. The novel is set in a ward of an Oregon mental hospital in the late 1959 recounted in flashbacks by Chief Bromden, the catatonic narrator. Bromden is a giant half-Columbian Indian, who once lost his native village to a government hydroelectric dam. He has lived in the ward for 15 years receiving over 200 shock treatments and retreating into feigned deaf and dumbness. He sweeps the ward, all the time observing, or hallucinating, the operations of a giant influencing machine, the combine. The combine controls the world, adjusting the Outside as well as the Inside. It spreads dense fog over the ward, clouding the Chief’s brain, slowing time and shrinking and swelling everything with electric beams. Its agent in the ward is Nurse Ratched, the Big Nurse. She sits in her office before “a web of wires like a watchful robot, tending her network with mechanical insect skill…dreaming of a whole world of precision, efficiency and tidiness where the schedule is unbreakable” (27). All the machines, real and imaginary, are directed by her: the fog machines, clocks, radios, television, floor magnets, microphones in Chief’s broom handle, the gears and tubes in everybody else, that are checked monthly by X-rays. The Big Nurse also controls the Black boys, her attendants, hand picked. Dr Spivey, the chief medical doctor is dominated by Nurse Ratched. He is largely absent, coming only to group meetings.
The all male population of the ward is a jumbled group of obsessive, hysterical, botched lobotomies, epileptics, manic’s, catonic’s, and schizophrenics, separated in Acute’s, wheelers and Chronics, vegetables and walkers. Many are voluntary and all are passive, institutionalized and fearful, rabbits according to one character and victims of the matriarchy. Big Nurse manages the ward and its unchanging routines of sedation and group meetings, ECT and psychosurgery with military precision. Sefelt, an epileptic with sore gums from Dilantian sums it up, “What a life, give us some pills to stop a fit, give the rest shock to start one” (146). Into the cuckoo’s nest with a laugh “loud and free” comes redheaded Randall Patrick McMurphy, in biker cap and cowboy boots. In a prison farm for assault and rape, he has maneuvered his transfer to the State Hospital to avoid work. When Dr. Spivey reads out his provisional diagnosis “psychopath” at his first group meeting, McMurphy is already challenging: “I fight and I fuh, pardon me ladies, means I am, he put it, overzealous in my sexual relations. Doctor is that real serious?…Do I look like a sane man?” (41). For most, the answer is an energetic yes. McMurphy’s sanity takes the ward by storm. He jokes and plays pranks, organizes gambling syndicates and basketball games, and campaigns for the World Series to be shown on T.V., while taking bets on whether he can defeat Nurse Ratched, or the ball cutter and her rules. The Chief immediately warms to McMurphy as his lost father, an aristocratic American Indian dispossessed and driven to an alcoholic death by the government. It comes about when the Chief, fighting against his fears of the combine, votes with McMurphy to watch the World Series, Nurse Ratched’s command is loosened. Bromden’s fog and hallucinations reduce and he begins to find his voice.
McMurphy’s war with the Big Nurse continues through twists and turns. One day, McMurphy leads 12 disciples to the Outside, on a fishing trip, organized by his Aunt Candy, a prostitute. The men take control of the boat and break out into jubilant laughter, while McMurphy goes below deck with Candy. But the showdown with Nurse Ratched is inevitable. After a fight to stop the Black attendants abusing a patient, McMurphy and Chief are sent to the Shock Shop. For the first time, Chief, following McMurphy’s example, fights off the after-effects of ECT. McMurphy organizes a party on the ward, with whiskey and wholes, drinking cough syrup with alcohol. When Chief sees everyone “drunk and running and with laughter and carrying on in the centre of the combine’s most powerful stronghold” (243) he realizes the combine is not invincible. But when Ratched returns in the morning she humiliates Billy, a patient who McMurphy has set up with Candy for his first sexual experience. When Billy cuts his throat McMurphy assaults Big Nurse, and ripping her uniform off, exposes her as a woman, not a machine. He is straitjacketed and led away for a lobotomy, to return a vegetable. In a final sacramental scene Chief Bromden takes McMurphy out of his mindless body by smothering him to death. Then lifting a control panel in the showers Chief smashes his way to freedom and the natural world of his childhood. The power of the Big Nurse is broken. The voluntary patients all sign out. The cuckoo’s nest is liberated.
At one level it is a simple story of good versus evil. McMurphy is the lone Western hero, teamed with Chief, the noble Red Man. They are the Lone Ranger and Tonto, fighting Nurse Ratched, the civilizer, administrator of machine culture, and deadly matriarchal destroyer of manhood. This is the battle for the Old West of self-reliance, anarchic humor and the masculine physical life, against the humorless, conforming forces of modern civilization, hydroelectric dams and women. McMurphy is a savior and redeemer whose madness is not insanity but a gift. He is the lost father, so to speak, returning to be sacrificed and martyred on an electric crucifix so disciples can be reborn. So strongly present are these symbolic heroes and villains that the novel can be read solely as a comic strip melodrama. The Chief describes the ward as a cartoon world. Big Nurse is evil, a robot and a castrating matriarch. McMurphy is a Holy Fool, Bromden a Nobel Primitive. These one dimensional stereotypes lead to a sentimentalized oversimplification of the moral problems posed by the novel. The symbolic conflict between the characters is heightened even further in the theatre.
The novel is very convincing in its descriptions of the regulations and rituals of a mental hospital at the end of the 1950’s. Kesey carefully builds up pictures of the ward, with its corridors, showers and seclusion, its day-room and nursing station, and its schedules of sedation and confinement, eating and sleeping. The descriptions of the group meetings and the way they are “theoretically democratic”, but in reality coercive are truly accurate. The descriptions of the ECT and lobotomy are accurate in technical detail. The realism is compelling and scary, but not an exaggeration. The only difference is the ward is seen through the schizophrenic mind of Chief Bromden. Cuckoo became part of an era that saw several celebrated critiques of psychiatry arise. It was a kind of golden age for social psychiatry and anti-psychiatry. In 1975 the film, directed by Milos Forman, was released. The film reflected a different era. The nickname “Big Nurse” is never mentioned in the film. Nurse Ratched becomes less of a misogynist’s nightmare and more a smiling organizational type who knows protocol is on her side. She can even generate sympathy. McMurphy is no long a Western loner. The cowboy boots, biker cap and red curls are gone. Instead we have slicked-hair Jack Nicholson with his charismatic menace and half-smile of hostility, playing his ultimate non-conformist role, to be repeated in many later films. Nicholson has taken over the image of McMurphy in the popular imagination. He is no Christ figure or flower child. The film also removes the narrative of Chief Bromden and the fogs, hallucinations and machines of the combine. It becomes a third person objective account of the struggle between an individual and the establishment. At the end of the film only the Chief leaves, and the others stay on.
The film gives a documentary realism, even down to the film’s location. Even Dr. Dean Brookes, the Superintendent of the hospital played the role of Dr. Spivey, and many of the patients at Damasch State Hospital, Salem, Oregon were extras are assistants to the film crew. Looking at the film now one is struck by how strangely tame it seems. Even the famous ECT scene only reveals Nicholson’s facial grimaces. There are no failing convulsive limbs or attendants grimly holding him down. Family television has nightly depictions of violence more vivid that this, a measure perhaps of how far our thresholds for being shocked have changed. But that the depiction of ECT was shocking in 1975 is not to be doubted. The film let the public into mental hospitals in ways that had never happened before, and the reaction is emotionally charged. The images from the cuckoo’s nest are still powerfully present today in public consciousness.
The author, Ken Kesey, died in late 2001. His poetic-paranoid vision left the public sensitive about psychiatry but it did serve to reduce stigma. It helped curb excesses of treatment, and advanced the causes of advocacy and patient’s rights. Votes to ban ECT and psychosurgery were successful in California and Oregon in the 1970’s but legislation was never enacted. ECT has now recovered a place in treatment, but in a safer and better monitored forms and more specific indications. Notions of mental illness as rebellion and creative breakthrough from oppression and the schizophrenic patient as seer have lessened. Neurobiological and genetic theories have risen to dominance over psychosocial treatments. There are no therapeutic communities any more. The asylums are closed. McMurphy would no longer manipulate his way out of prison. He would be incarcerated for a long sentence, probably for juvenile sexual abuse. The other characters would be tranquillized and left to shuffle off to homelessness and isolation as R. Porter discusses in Madness: A brief History.
In his documentary Completely Cuckoo about the making of the film, Charles Kiselyak returned to Damasch. The progressive policies led by Dr. Brooks in 1975 have disappeared. The hospital is hard to get in to, not out of. Security guards escorted the crew, barbed wire proliferated and bureaucratic regulations flowered. Kiselyak Reports, “Ratched is now running the institute” not as a nurse but as a managed care supervisor with a business degree. The combine is still with us, more pervasive than ever, with electronic surveillance and invasion of privacy, malpractice suits and infinite data collection. Meanwhile, the marketing by pharmaceutical cartels is reshaping treatment and diagnosis.
It has been almost 50 years since the effort to move the severely and chronically mentally ill from institutional to community settings in the U.S. was initiated. During this half century, we have faced numerous problems, designed numerous solutions to those problems and then periodically reassessed our progress toward our goal. The U.S. represents the largest and most unsuccessful example of what we now call deinstitutionalization. At the end of the year 1955, America came to the realization that after 200 years of increases in the population of mental institutions, something unprecedented and unpredicted had happened, the census of severely and chronically mentally ill in psychiatric hospitals had decreased according to J.A. Talbott in Toward a Public Policy on the Chronic Mental Patient. People whose behaviors violate norms often are called mentally ill. It is a common response to deviant behaviors that we don’t understand. Mental illness is a label that contains the assumption that there is something wrong within people that causes their disapproved behaviors. All of us have troubles. Some of us face a constant barrage of problems as we go through life. Most of us continue the struggle, encouraged by relatives and friends, motivated by job, family responsibilities and life goals. Even when the odds seem hopeless we carry on the best we know how. With this book and film we can see how the medical profession has medicalized many forms of deviance, claming that they represent mental illness instead of just being problem behaviors.
Kesey, Ken. One Flew Over the Cuckoo’s Nest. New York: Viking, 1962.
One Flew Over the Cuckoo’s Nest. Screenplay by Lawrence Hauben and Bo Goldman. Dir. Milos Forman. Prod. Saul Zaentz & Michael Douglas. Videocassette. United Artists/Fantasy films & Warner Home Video, 1997, c1975.
Porter, Roy. Madness: A brief History. New York: Oxford University Press, 2003.
Talbott, J.A. “Toward a Public Policy on the Chronic Mental Patient.” American Journal of Orthopsychiatry 50 (1980): 43-53.