One Flew Over the Cuckoo’s Nest

One Flew Over The Cuckoo’s Nest is a classic of American cinema, and Jack Nicholson’s most well-remembered cinematic role. The movie was based on an earlier theatrical production, and upon the the Ken Kesey novel of the same name, One Flew Over the Cuckoo’s Nest, which had been loosely based upon his experiences working as a janitor or orderly in a VA mental hospital in California, where he also volunteered for LSD experiments.
A lesser-known fact is that having been released in 1975, as a cinematic retelling of a story set some 10-20 years earlier, it is an extremely realistic portrayal of what State mental institutions were like until fairly recently, insofar as how the facilities were set up and what the available treatments were.
Nurse Ratched is easily vilified and has become synonymous with representatives of institutionalized cruelty in our age, and McMurphy observes that she likes to “play with a rigged deck”. However, though some of her policies are merely protective of institutional inertia (what can putting the World Series game on the ward’s television hurt?), certain of her actions are an attempt to impose order upon chaos and good habits upon pathology; in many cases, she engaged in such restrictive measures as withholding other patients’ cigarettes in an effort to stem the negative influence upon the other patients on the part of McMurphy, who had started gambling with the other patients and had won much of their existing supply of money and cigarettes. Though the patients possess wishful thinking of winning these items back, if enabled to gamble some more, Ratched holds out no such hopes and is immune to McMurphy’s charisma. She thinks the regimen of the institution, if strictly adhered to, can at least partially “fix” McMurphy and the other patients, but McMurphy’s fellow inmates welcome the excitement and fun McMurphy’s stunts bring into their drab world. In an interview with Dr. Spivey, the chief psychiatrist, Randall Patrick McMurphy admits that the reason he got sent to prison, and subsequently to the mental institution was, “as near as I can figure out, it’s ’cause I, uh, fight and fuck too much”. This movie is as much about the way society deals with such a nonconformist as much as it is about the personal conduct of such an individual himself; as the behind-the-scenes deliberations of the doctors and Nurse Ratched are shown and the workings of the various bureaucracies dealing with McMurphy are put before the audience. The treatment team make the fateful decision to “keep him (McMurphy) on the ward”, rather than exercising the other options available to them of sending McMurphy to another ward with more “disturbed” patients, or, as the head of the hospital wanted, sending him back to the prison work farm, on the grounds that McMurphy wasn’t technically mentally ill, and that therefore he could well be returned to the penal system, rather than remain in the mental health system.

Though the medical and psychiatric knowledge of the time had decided that McMurphy was “not crazy, but he is dangerous”, modern-day audiences view this picture with a different perspective than people did when it was released in the 1970s. These days, folks are likely to ask, upon seeing McMurphy’s provoking manner, if perhaps, he “has ADD”, which, back then, was not considered possible in an adult. Some speculate that he might have been a sociopath. Modern audiences also express shock at what was then a common procedure, and, during the time period referenced by the original book upon which the movie is based, the only game in town, electroshock therapy without anesthesia, which is now banned in the US, being widely considered barbaric and cruel.
At one point when a melee erupts in the ward, and McMurphy and the Chief are among those taken away immediately to get electroshock treatment, ostensibly to calm their agitated, violent states, but actually because it is the prevailing punishment this particular bureaucracy can dispense. While McMurphy and the Chief are sitting on a bench outside the electroshock room, waiting their turn, McMurphy does the chief the small kindness of offering him a stick of gum. Chief thanks McMurphy for the gum, and with surprise, McMurphy notes that the Chief “can talk” and is thus not “deaf and dumb” as he had previously been described by others in the ward. (Chief actually came off more as a catatonic to me). The Chief warns McMurphy about people “working on him” by telling him the tragic story of his own bedevilled and alcoholic father. Nevertheless, McMurphy continues his antics and continues to get himself and others into escalating amounts of trouble.
Though the predominant disability portrayed in this movie is mental illness in various forms and degrees, both by actors and by authentic patients who had roles as “extras”, there is the occasional wheelchair user shown at various times and places in the hospital, and it is not uncommon to see stray manual wheelchairs left unattended, and easily commandeered by the able-bodied. Though the hospital was built well before the ADA became law, and is probably not designed with wheelchair accessibility in mind, the patients’ swimming pool has a concrete ramp on which an older male patient in a wheelchair is gently rolled into the pool, wheelchair and all.
There were no shortage of “acquired disabilties” in the mental institutions of the time: in the past, when electroshock was the predominant form of treatment, and was given in much the same way in real life as it was to Jack Nicholson, it was tacitly acknowledged that some brain damage was part of the deal.
Lobotomies were a common form of treatment in mental institutions in the past, and while dramatic loss of intelligence and personality was not always the direct result of lobotomization, in this movie, an individual who has had a lobotomy is portrayed as a drooling, incontinent zombie, and McMurphy is shown as passive and silent, and no longer “him”, following his lobotomy.

Helen

Helen starts out as a seemingly happy, successful college professor with a teenage daughter, a second marriage, and a spacious house and a car.  The onset of Helen’s major depression comes slowly, almost imperceptibly, as she sits brooding in the dark and tells her husband “it’s nothing”.  It only starts to become more obvious that she has a combination plate of depression and anxiety when she has a seemingly unprovoked panic attack when returning student essays in class.

The true depth of Helen’s problem only becomes apparent when her husband finds her curled in front of the clothes dryer in a fetal position.  When he brings her to the hospital, the doctor sends them to a neurologist, who goes through the depression inventory as Helen sits sullenly, and her husband initially answers the questions.  To his surprise, her husband discovers that she has made a previous trip there 12 years ago, several years before they married.  He expressed amazement that he had missed seeing the serious nature of her condition for so long.  The neurologist told him; “some people hide it very well.  You should see some of the clowns we have on suicide watch”.  He prescribes an antidepressant and Ativan for the anxiety.

Meanwhile, one of her music students is experiencing a similar, albeit more dramatic, downward spiral into clinical depression.  The movie intercuts to show the parallel track they take as their conditions increasingly impair their peace of mind and ability to function in society.

(I love the scene where Mathilda bangs her head against a glass partition in the hospital and cracks it.  The The image very plainly portrays the collective frustration of any number of people with the medical and mental health systems as they exist in America today.)

When Helen’s medication seemingly fails to work and she makes a suicide attempt, her husband goes to the psych ward for help, and gets a different doctor who says she will change Helen’s medication, but will not hospitalize Helen against her will.  Her husband is clearly frustrated, as Helen has made more suicide attempts, and he feels he can’t watch her constantly; to him, her need to be hospitalized seems obvious.  This is not the case for the doctors who are not living with Helen, and who cite mental health laws as being meant “to protect people like her”, in this instance, by not society having people committed at the drop of a hat.

Meanwhile Helen grows worse, and her teenage daughter eventually ends up leaving her home to move in temporarily with her biological father (who has conveniently been waiting in the wings)

It is only after Helen experiences another non-lethal mental health crisis (she has taken too many Valium and won’t wake up) that the powers-that-be allow her husband to have her committed involuntarily.

It is then that Helen wakes up in the hospital.  Helen and Mathilda meet as fellow psych ward patients and become friends and peers in a way that they probably would not have, had they remained teacher and student.

Of the two, Mathilda is the more damaged, and she is not only damaged by depression herself, but also indirectly.  Her mother committed suicide and left her a house (a nice, clean beach house with giant picture windows) all ready for her and Helen to move in.  Somehow, they seem to have enough money for groceries and utilities, even though neither of them have jobs, or were seen to file for disability benefits (I wonder how many of the mentally ill have prime beachfront real estate?).

Helen initially panicked at ECT (electroconvulsive therapy) being suggested for her, and argues when the doctor tries to talk her husband into consenting to ECT for her, but later, after her release from the hospital, chooses ECT of her own volition when she comes to the belief that by making the choice to have ECT, she is actively choosing the state of sanity.  “Modern ECT” complete with general anaesthesia, an oxygen mask, and more, is depicted.  The ECT experience is portrayed as a dream (the convulsions being muted by succinylcholine), and she is seen waking up (undoubtably with a huge headache) from a soft bed with a pillow.

This movie could be considered a modern-day morality play for the mental health system. As Helen spouts platitudes about mental health, and is presumably continuing her medication, she slowly returns to her normal activities prior to the depressive episode, and the dimmer switch in her home is turned up.

Mathilda, by contrast, deteriorates conspicuously.  She is non-compliant (whether or not her medication(s) actually work and what sort of side effects they have is not made clear to the viewers), drinks alcohol (if you are in fact taking SSRIs, you are officially advised to steer clear of both alcohol and pot), and has sexual encounters in alleys with different men.  It is not made clear whether she is engaging in the unconventional sexual activity from her own free will, or if the men involved are threatening or blackmailing her, or if she’s paying  her living expenses with prostitution.

After Helen leaves the house for the ECT (it takes at least a day to recover from the anaesthesia given in modern ECT, and she apparently has a couple of ECT sessions in a row, so the timeframe amounts to at least a couple of days) she returns to find the home environment showing evidence of neglect, disorganization, and “impulse control issues”.

The cast interviews included on the DVD were revealing.

Ashley Judd said that the scene where Helen is eating dinner with her family while undergoing major depression reminded another movie crew member of what it was like for her family when her mother had major depression.

Alexa, who played Helen’s teenage daughter Julie explained that the character she played went to live with her biological father for the sake of self-preservation even though she knew her mother “would be devastated by it”.  Alexa added that she wasn’t sure if she’d be strong enough to do what her character did if she were in a similar situation with her family.

“The people around the person that’s depressed are often affected as well, and this film does a good job of showing that”.