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Sara M. MartinProfessor Jonniann ButterfieldSOC 3700-W1November 13, 2012

Media Analysis: One Flew Over the Cuckoo’s Nest

Sociological Model of Mental Illness Mental illness is defined through subjective social judgments: judgments are based on emotional views and/or preconceived ideas, and are usually stereotypical assumptions.Mental illness reflects a particular social setting as well as individual behavior or biology: an individual’s unacceptable behavior derives partly from violating social norms, and not entirely from psychological or biological reasons. What may be considered “normal behavior” in one social group may be determined as “abnormal” in another.Persons labeled mentally ill may experience improvement regardless of treatment, and treatment may not help: When therapist and patient do not share the same views in what is best, clash in treatment options may occur.Medical treatment for mental illness sometimes can harm patients: because of the politics of psychiatric diagnosis, mental illness may be misdiagnosed. One such reason may be the changes in definitions for certain mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) that were once considered a mental illness, and now are not.

Looking at psychologist David Rosenhan’s 1973 experiment gives evidence supporting the Sociological Model of Mental Illness where he and seven of his assistants pretended to be mentally ill (hearing voices, etc.) and admitted themselves in twelve different mental facilities. After being admitted, all began to behave “normal”, and it took 19 days for these “mentally ill” patients to be released from the hospitals, but their symptoms were still recognized by the staff as being “in remission.”

Medical Model of Mental Illness

Mental illness is defined by objectively measurable conditions: mental illness is like a biological disease in the brain, creating “symptoms”. These “symptoms” need to be measured by a licensed physician.Mental illness stems largely or solely from something within individual psychology or biology: mental illness derives from only from abnormalities of the brain and/or the body.Mental illness will worsen if left untreated but may improve or disappear if treated promptly by a medical authority: if a patient does not receive some form of medical treatment (medication or a type of therapy), the mental illness will worsen. With medication or therapy, patient’s mental illness will improve.Medical treatment of mental illness can never harm patients: medication and/or therapy for mental illness can not affect a person in a negative manner.

The most common evidence supporting the Medical Model of Mental Illness is through the treatment of medication, either through over the counter medicines or via doctor-prescribed

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medications. For example, Prozac, prescribed for the treatment of depression and/or anxiety levels out the imbalanced serotonin levels. Other examples are through the use of Monoamine Oxidase Inhibitor (MAOI) drugs such as Nardil, Marplan, Parnate, and Manerix.

One Flew over the Cuckoo’s Nest

1) Who defined the main character as mentally ill (or in need of institutionalization)? The officials from the work farm at the correctional facility that the main character, Randall P. McMurphy, was at previously were the ones who originally wanted him evaluated to identify whether he needed permanent institutionalization or not, as they believed he was fabricating his insanity. (See also question #3)

2) What words were used by mental health professionals to describe the main character? After Mr. McMurphy takes a group of his peers on a fishing trip following the hijacking of the facility’s bus (joy ride), the physicians have a board meeting about McMurphy’s recent behavior. Dr. Spivey, presumably the medical director, asks everyone if the patient is dangerous. One physician says, “I think he’s dangerous…he’s not crazy.” Dr. Sanji says, “I don’t think he’s overly psychotic, but I still think he’s quite sick.” Nurse Ratched, who is considered as the person closest to the patient says, “…in my opinion, if we send him back to Pendleton or we send him up to Disturbed, it's just one more way of passing on our problems to somebody else…so I'd like to keep him on the ward. I think we can help him.”

3) What behaviors did the main character exhibit that led to the label of “mentally ill” (or in need of institutionalization)? Shortly after R.P. McMurphy arrives at the mental health facility, he is taken to speak with Dr. Spivey as an initial interview to inform the patient of the intended plan for his stay. After some idle chit-chat, Dr. Spivey asks Mr. McMurphy if he knows why he is there, to which the patient denies knowing the answer. Dr. Spivey reads Mr. McMurphy’s file from the penitentiary stating that he has been “belligerent…talked when unauthorized…resentful in attitude towards work…lazy.” He further states that Mr. McMurphy’s reasons for being in the penitentiary is for five arrests for assault, statutory rape, and “they think you’ve been faking it [insanity] in order to get out of your work detail.”

4) How was mental illness defined through subjective social judgments? For Mr. McMurphy, because the staff knew that he had arrived from jail, there most likely was an automatic social stigma that he was a rude and obnoxious individual. That being exposed to that type of environment was one of many possible reasons for his behavior. Mr. McMurphy’s instigating, outspoken and loud behavior and vulgarities, especially toward Nurse Ratched, did not help his case in evaluating reasons for sanity. Nurse Ratched seemed untouchable with a calm demeanor, and this added more negative points for Mr. McMurphy.

Also, toward the beginning of the film, after being admitted into the mental health facility, Mr. McMurphy seemed baffled with the behaviors of the other patients, of which he probably believed they themselves were mentally ill in the sense of the actual clinical definition as he understood it.

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5) How did the doctors, nurses, and staff contribute to the continuance of the main character being labeled as mentally ill? In two different group therapy sessions, there is the issue of “importance” for Mr. McMurphy about viewing the World Series. In the first session, he requested a vote of raising hands about who wants to have a field trip to Yankee Stadium to watch the opening of the event, but no one raised their hand. In the next day’s session, the World Series was brought up again by another patient, Mr. Cheswick, who requested another vote. After much coercion by Mr. McMurphy, there were not enough raised hands, and Nurse Ratched declared the meeting adjourned and that the voting session was closed. Her decision disturbed Mr. McMurphy, where he became extremely loud and rude. He demanded the nurse to turn the television on, but she refused instead, turning on a classical music record for the patients to listen to. Frustrated, Mr. McMurphy faces the television and begins to imagine he is watching the World Series as if he were broadcasting the events live. His actions peak the interest of the other patients, who begin to join in his imagination, creating a group “disturbance” - by Nurse Ratched’s viewpoint.

6) How did being labeled mentally ill (or being institutionalized) affect the main character? The label did not seem to affect Mr. McMurphy at all; he even poked fun at being labeled crazy by the penitentiary, for not being able to resist the female teenager he was accused for statutory rape. It seemed that he viewed himself as “normal” compared to the other patients in the facility, especially when he tried to enforce the rules during a poker game that another patient, Martini, seemed unable to comprehend what Mr. McMurphy was trying to explain.

7) In what ways did being labeled mentally ill (or being institutionalized) lead the main character to display behaviors that were considered “deviant?” What were those behaviors? The day after the World Series imagination scene, Mr. McMurphy meets with Dr. Spivey and another health official to talk about the patient’s progress. He explains his frustrations about Nurse Ratched. Dr. Spivey then informs Mr. McMurphy that after four weeks of observation, he sees no evidence of mental illness, believing he has been faking his insane behavior. Here, the patient displays with facial gestures (drooling, “crazy” looking eyes) and hand gestures (masturbation) of what he believes is considered as being mentally ill. Mr. McMurphy also asks the doctor if that is crazy enough for him, or if he would like him to defecate on the floor, which would also indicate an example of mental illness, according to Mr. McMurphy.

8) Did the medical treatment provided to any of the patients cause harm to them? If so, please describe. From a non-medical or non-health professional point of view, the electric shock therapy given to Mr. Cheswick and McMurphy would probably seem as harmful. Also, while it is unknown what medications the patients were receiving, one would assume the daily medications were probably impairing their judgments.

9) Did any of the patients experience improvement during the film? If so, under what circumstances? A few circumstances may seem controversial; however I believe that Mr. McMurphy’s consistent confrontations with Nurse Ratched influenced the other patients to gain a sort of mental “strength” to be able to voice their opinions. For example, when Mr. Cheswick voiced during the second group therapy session, that he wanted a second vote to

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watch the World Series. (Granted, Mr. McMurphy’s influence also contributed to some group disturbances, creating defiance among the other patients as mentioned above.)

Another example was toward the end when a patient, Chief, felt he had the inner strength to leave the institution after seeing what happened to Mr. McMurphy (unnecessary brain surgery). In the weeks prior, after finding out that Chief really was not deaf or dumb, Mr. McMurphy spoke to him like a “normal” person, carrying “normal” conversations, all the while asking Chief why he just didn’t leave if he didn’t need to be there.

I believe that Mr. McMurphy’s encouragement of Billy’s date with one of the young ladies (that broke into the facility late at night) gave Billy that extra push he might have wanted, to be able to have a sexual encounter (deviance) with a woman, like a “normal, average” person. However, as the events following the next morning show, the results of his actions along with Nurse Ratched’s comments about his mother’s reaction to his behavior, created a negative outcome for Billy.

Critical Reflection

Do you consider the main character to be mentally ill? Why or why not? I do not consider the main character, Mr. McMurphy, to be mentally ill at all. In all honesty, I thought his deviant behaviors - from the vulgarities, to the confrontations and instigations with Nurse Ratched, to the disruptions with the rest of the patients - were quite comical. I say this because it was evident his actions were created to frustrate the staff. He knew they were observing his behavior, and he treated his stay there as a vacation from the penitentiary. His performance at the institution indicated his time there was a game, and he was going to have as much fun with it. However, if anyone got hurt in the process, was far beyond his expectations. Using the words “crazy and/or “dangerous” by the physicians earlier in the film, may imply that Mr. McMurphy is not necessarily a danger to his overall health, but that he is disruptive in his manner of defiance toward authority or rules and regulations. It would seem that he is not intentionally putting others at risk, but that he is unfocused (clueless) as to the consequences of his actions, and does not seem to be bothered much by those consequences unless something severely drastic happens, such as the incident with Billy’s suicide.

Do you think that the Medical Model of Mental Illness or the Sociological Model of Mental Illness is more useful in today’s society? Provide evidence to support your claim. I believe that both the Medical and Sociological Models of Mental Illness are useful in today’s society. They should be used together in order to assess an individual’s behavior simply because social norms and societies in different parts of the country have changed drastically over the decades. One example could be the issue of abortion and/or sexual promiscuity. Years ago, when abortion was illegal and unspoken of, there were countless stories of young girls who became pregnant out of wedlock who were sent away. Years ago, this type of behavior (sexual promiscuity) was considered deviant and abnormal. Aside from the trauma of either losing the baby, or giving the baby up for adoption, the negative social stigma related to pregnancy out of wedlock decades ago gave reason for parents to believe there was something (mentally) wrong or abnormal with their daughter. This created even more deviant behavior, the daughter believing herself that she is mentally ill as well, therefore giving more

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reason to have her medicated. Today, or in more recent years after abortion was legalized, this is not as much considered as deviant behavior by many families across the country because what was considered negative is now more widely accepted (abortion and sexual promiscuity); still frowned upon, but accepted for the most part.

Please provide any reflections, observations, or critiques of the video that you would like to add. As mentioned above, I thought it was quite comical and thoroughly enjoyed this film. I have watched it years ago, but did not fully grasp the social and medical concepts of the film. I mentioned in our last discussion the discovery of Oppositional Defiant Disorder (ODD) when a teacher-friend of mine spoke of it about one of her students. I had never heard of this term; however, in viewing this film, I am willing to bet that the main character, Mr. McMurphy, would have been diagnosed with this disorder! He displayed almost all of the “symptoms” for this disorder: persistence, disruptiveness, negativity, defiance, disobedience, hostility, etc. While this disorder is probably more diagnosed among young children, I am sure there are quite a few adults who also display this behavior…The film was great, and I really enjoyed it.

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References

One Flew Over the Cuckoo’s Nest. Dir. Milos Forman. Perf. Jack Nicholson, Louis Fletcher, and Michael Berryman. Fantasy Films, 1975. Film.

Mayo Foundation for Medical Education and Research (MFMER). The Mayo Clinic, 26 Jan. 2012. Web. 13 Nov. 2012.