‘Cuckoo’s Nest’ Hospital is now a museum

From The New York Times: Once a ‘Cuckoo’s Nest,’ Now a Museum

March 31, 2013
Once a ‘Cuckoo’s Nest,’ Now a Museum
By KIRK JOHNSON

SALEM, Ore. — Nurse Ratched slept here.

The punctiliously cruel psychiatric ward tyrant in the book and movie “One Flew Over the Cuckoo’s Nest” was brought to cinematic life by the actress Louise Fletcher during filming here at the Oregon State Hospital in the 1970s.

But the melding of real life and art went far beyond the film set. Take the character of John Spivey, a doctor who ministers to Jack Nicholson’s doomed insurrectionist character, Randle McMurphy. Dr. Spivey was played by Dr. Dean Brooks, the real hospital’s superintendent at the time.

Dr. Brooks read for the role, he said, and threw the script to the floor, calling it unrealistic — a tirade that apparently impressed the director, Milos Forman. Mr. Forman ultimately offered him the part, Dr. Brooks said, and told the doctor-turned-actor to rewrite his lines to make them medically correct. Other hospital staff members and patients had walk-on roles.

Now jump cut to the present: the office and treatment rooms of the hospital, which opened in 1883, have been turned into a Museum of Mental Health — one of only a few around the world that are part of a still-functioning hospital, which sprawls behind the old brick structure.

In the museum, a steel examination table sits near a photograph of the Oregon State Insane Asylum baseball team, which once played against local challengers in and around Salem, Oregon’s capital. A straitjacket and a spilled bag of handcuffs fill another display, with a notation from the night watch book recorded at 2 a.m. on Feb. 25, 1913. “Mrs. Bernard would not remain in bed,” an attendant wrote. “Restrained her with jacket and belt.”

The juxtaposition of real and celluloid, truth and fiction, that emerged on the “Cuckoo’s Nest” set continues. A photograph of Ms. Fletcher’s character, steely smile and nurse’s cap in place, adorns a wall near a television that blares the movie itself on a continuous loop showing the movie’s patients watching that very television, which was retrieved from a hospital trash bin and saved after the filming ended.

The result — physical evidence of the hospital’s past alongside the Hollywood portrait — creates questions that McMurphy and his cohorts might have asked. What is real and what merely seems real? Was the hospital, which had a large number of voluntary admissions in its early years, a place of sanctuary, an old definition of the word “asylum,” or of confinement? Darkness and dread, or escape?

Dr. Brooks, now 96, and living near the hospital in a retirement home, minces no words when he says that mental health treatment in years past had its flaws. But anyone looking back, he said in an interview, should also look hard at the present. Institutions like the Oregon State Hospital, which he supervised for nearly 30 years — from the mid-1950s to the early ’80s — might not have been perfect, he said, but they were at least out there and trying to help. Today, he said, prisons have taken over the job, with barely a pretense of treatment. “Three-fourths of all mentally ill people are in jails or penitentiaries,” he said.

But the new museum raises questions about what the hospitals themselves were created to do, and how many patients were actually mentally ill by modern definitions.

In its early days, the museum’s records suggest, there was no pattern to admissions at all. Alcoholics, dementia patients, syphilis sufferers and others given the catchall diagnosis of “mania” were all taken in. And for part of its history, in the early 20th century, a majority of patients were women, at least a few of whom would occasionally leave for visits with their families. That suggests, museum volunteers said, that domestic trouble or abuse, in a time before easy divorce and when officers spent little time on marital violence cases, may have created a sense of safety for women behind the hospital walls that has since been forgotten in the wave of harsh imagery in films and books like “Cuckoo’s Nest,” which was written by Ken Kesey and published in 1962.

The old model of an “insane asylum” coincided with an era that revered the value of work. Patients were expected to sew or cook or grow the food they ate — not just to make the place self-sufficient, which it mostly was, but because work itself was considered elevating and therapeutic. Patients even made their own leather restraints, said Kathryn Dysart, a museum volunteer.

In the new hospital, music and art therapy areas line a corridor that includes rooms where patients can practice skills they will need when they are released, like handling money. One was created to look like a bank and allows patients to withdraw funds that their families have deposited — money that can then be used to buy clothes at a room made to look like a store.

“As real as possible,” said Rebeka Gipson-King, a spokeswoman for the Oregon State Hospital, in describing the mimicry, which she said was aimed at making the outside world less alien after a patient’s discharge.

Other preconceptions about the outside world do not hold up so well. Ms. Fletcher, who won an Oscar for her portrayal of Nurse Ratched — the film won five Oscars, including Best Picture, in 1976 — came to the Mental Health Museum’s opening last fall, and turned out to be, in reality, very nice.

“Charming lady,” said Hazel Patton, the president of the museum’s board of directors.

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.

It’s Kind Of A Funny Story

It’s Kind of a Funny Story, a movie based on It’s Kind of a Funny Story by former NYPress columnist Ned Vizzini, is a (mostly) realistic portrayal of a high-achieving teenager who also has a case of high anxiety and projectile “stress vomiting”. Craig Gilner, a 16 year old in a prestigious, competitive NYC high school with a stable, middle-class family, has a lot of “little” problems, but the pressures to succeed academically, join a prestigious summer program, and work towards going on to a good college and a good job are building up on him, and he is having suicidal thoughts, including a vivid dream of jumping off the Brooklyn Bridge.

He initially calls a suicide hotline, but ends up just showing up at a fictional hospital, walking into the ER, and checking himself in on the grounds that he is suicidal. In the waiting room of the ER, he meets Bobby, a character he initially thinks is a doctor, but whom he later discovers to be a patient in the hospital’s psych ward when he ends up there.

Craig and Bobby in the ER

Craig and Bobby meet in the Emergency Room

One of the deleted scenes included on the DVD version of the movie shows a call to a suicide hotline which is largely ineffective except for the volunteer’s recommendation that he should go to a hospital because “suicide is a medical illness”. As such, when he gets to the hospital, he fully expects to be given a pill or a shot, along with a few words of encouragement, and quickly released. Not so. He is told that he will be staying for at least 5 days.

To Craig’s surprise, the adolescent wing is “under renovation”, thus requiring the hospital to place adolescent patients in the adult psychiatric ward. In New York, it is perfectly legal to have adolescents 13 and over committed to mental hospitals and wards serving an adult population. It is also legal to send children age five and over to mental hospitals where adults are committed.

In fact, such a situation is more common than not in New York City. New York has a dearth of adolescent mental health services, and adolescent-only wards or institutions are small population and relative rarities.

Craig is given the tour of the ward and discovers that his new roommate is a middle-aged depressive named Mustafa who never gets out of bed. Unlike Mustapha, Craig still “functions” and does so well enough for there to have been no obvious problems (he didn’t lose his place as an honor student, although he displays some serious anxiety about this possibility) other than his previous prescription for Zoloft. Bearded Bobby soon becomes a mentor and a father figure.

Among the unrealistic elements in the movie, patients routinely don doctors’ white coats and scrubs and sneak out of the psych ward incognito in this fashion. In of these instances, Bobby bribes the janitor with a couple of pills to let him and Craig have the use of an unrealistically large gymnasium, where the pair shoot baskets, and Bobby gives Craig advice on asking out Noelle, another teen patient in the facility. It might be realistic that in such a situation of adolescents confined with adults, an adult patient may become a mentor to a teen, but it is just as realistic that adults might take advantage of teens in multitudinous ways not shown or discussed in the movie, but implied when it is pointed out that there is no lock on the shower room door.
One of the other realistic elements in the portrayal of the psych ward would be the practical problems disclosed by many of the patients in the adult psych ward. Rarely do they have any money beyond petty cash, and even that takes some time and ingenuity to pool to have enough for a patients’ pizza party. Those who are getting released have to figure out where to go and what to do next. This is indirectly portrayed by muted but anxiety ridden phone conversations on the part of other patients who say things like “I don’t have a job lined up yet”, and Bobby’s upcoming interview for admission to a group home, for which Craig lends him a button-down shirt belonging to his father, because Bobby does not have a dress shirt with him in the ward, or anyone on the outside willing or able to bring him one.
Also somewhat unrealistically, in his five days in the hospital, Craig manages to cure his eating disorder, successfully develop a relationship with Noelle, find a record with Egyptian music that gets Mustapha out of bed and joining the patients’ pizza party, realize he wants to take an art class, stand up to his father, and becomes determined to return to the hospital and volunteer there.