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One flew Over the Cuckoo’s Nest

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The film “One flew Over the Cuckoo’s Nest” accurately depicts and presents the various psychological issues, such as the use of psychosurgery, institutionalism inside the psychiatric hospital and the medical and societal attitudes towards patients during the 1960s. Set in 1963, the film uses characters – patients and authority figures alike – and setting to accurately depict various aspects of psychological treatments, theories and concepts applied, before more ethical practices were introduced later in the 20th century.

The film itself was extremely powerful in presenting the methods it used by psychiatric asylums to treat its patients, and was credited with tarnishing the image of various mainstream mental health care techniques. The result of the film as a whole; it gave voice, gave life, to a basic distrust of the way in which psychiatry was being used for society’s purposes, rather than the purposes of the people who had a mental illness, or those that were deemed to have a mental illness.

Psychosurgery is the surgical intervention to sever fibres connecting one part of the brain with another or to remove, destroy, or stimulate brain tissue with the intent of modifying or altering disturbances of behaviour, thought content, or mood for which no organic pathological cause can be demonstrated. Psychosurgery has had a controversial history, in which medical, moral, and social considerations have intermingled. First described in 1936, and defined as a surgical ablation or destruction of nerve transmission pathways with the aim of modifying behaviour, the conventional “lobotomy” of the 1940s and 1950s flourished.

There was a strong desire to relieve overpopulation in asylums and hospitals, and lobotomy came to be seen as a means for calming down and even discharging a proportion of committed patients. Little attention was paid to patient consent or selection; almost immediately after its introduction, lobotomy was noted to have severe collateral effects on the patients.

Caregivers described their patients as lifeless, dull, dependant, apathetic, without a drive, passive, preoccupied and distant. The use of psychosurgery in the past, are ably depicted in the film, “One Flew Over the Cuckoo’s Nest”. In the film, McMurphy, a convicted apist/criminal named McMurphy who fakes insanity so he can finish his sentence in a mental hospital instead of a prison, causes a lot of problems in the hospital by encouraging the other patients to stand up to the head nurse’s ( Nurse Ratched’s ) abuses.

McMurphy eventually attempts to strangle the nurse because she’s partly responsible for the death of another patient (Billy Bibbit). Because of McMurphy’s violent actions, Nurse Ratched has him committed to a special ward for patients deemed “disturbed. ” He undergoes a lobotomy – an operation in which the connections between the frontal lobes and rest of the brain are severed.

The procedure leaves him in a vegetative state. Upon his return to the ward, another patient, Chief, remarks that “There’s nothin’ in the face. Just like one of those store dummies. ” In this scene, we see the depiction of the misuse of psychosurgery during the 1960’s – the way in which it was misused on patients who were not even mentally ill, but perhaps aggravated and violent, as a way of subduing their actions as a resort to curing the patients’ “disturbance”. Fast forward to the 20th century, surgeons no longer destroy large amounts of brain tissue in futile efforts to “cure” schizophrenia and neurosis.

Instead, they take pinpoint aim at millimetre-long clusters of cells to stop suicidal depression, disable obsessive-compulsive disorders, cripple anxiety, and control the uncontrollable rage and aggression that keep sick people in locked wards. Institutionalism refers to the term behaviourism, which itself refers to the school of psychology, based on the belief that behaviours can be measured, trained, and changed. It is a theory of learning based upon the idea that all behaviours are acquired through conditioning.

Conditioning occurs through interaction with the environment and Behaviourists believe that our responses to environmental stimuli shapes our behaviours. According to behaviourism, behaviour can be studied in a systematic and observable manner with no consideration of internal mental states. This school of thought suggests that only observable behaviours should be studied, since internal states such as cognitions, emotions and moods are too subjective.

There are two major types of conditioning: Classical conditioning and Operant conditioning (sometimes referred to as instrumental conditioning) which is a ethod of learning that occurs through rewards and punishments for behaviour. Through operant conditioning, an association is made between a behaviour and a consequence for that behaviour. Operant conditioning is the main conditioning used to treat patients in the film. The film’s representation of a psychiatric institution, is a relatively accurate portrayal of a typical psychiatric institution. In most institutions, the patients had to obey the staff’s instructions, which entailed adhering to a specific treatment.

If a patient stood out of line, he or she would be brought back by the use of either medication, seclusion or punishment (operant conditioning). Thus, in order to avoid “punishment” the patients had to remain in their “sick” roles and behave according to their diagnostic label. The negative effects of mental institutions on -”patients” could be summarised as follows: loss of control, apathy, resignation, dependence, alienation and depersonalisation, demotivation resulting from lack of choice, withdrawal because of boredom, loss of confidence and self – esteem and stigma and disempowerment.

It is in this context that the film “One Flew Over the Cuckoo’s Nest” is identified as a possible medium to investigate the nature and effect of a psychiatric system as accurately portrayed through this particular film, The film depicts the psychiatric system as rigid, leaving “patients” with little room to express their individuality. The effect of the staff-members’ behaviour on the “patient’s” psychotherapeutic growth, highlights the staff’s ignorance and lack of knowingness of their individual responsibility, contributing to the psychopathology of not only the “patients”, but also the system as a whole.

The interactional style of the psychiatric staff, as portrayed in the film, serves to contribute to the deterioration of the mental and psychological well-being of the “patients”, thus inhibiting their psychological growth. The majority of “One Flew over the Cuckoo’s Nest” takes place in the Day Room of the hospital. The setting adds to the feeling of confinement, with the men often resorting to playing games of chess or resorting to cards to pass their time.

The space of the institution itself is characterised by an obsession with routines, and adherence to control and confinement – that is, under Nurse Ratchet’s control. Medicine time, music time, recreation time – each are strictly designated and deviation from this structure resorts in punishment. McMurphy’s varied arguments with Nurse Ratched, such as the one in which he questions the effects of the pills that each patient takes, is deemed to be, in Nurse Ratched’s wary eyes, a ploy to overthrow the current system.

After causing trouble, McMurphy receives punishment through electroconvulsive therapy. The depiction of this particular treatment was used in psychiatric hospitals during the early to mid-twentieth centuries, alongside other methods including hydrotherapy – where a patient would be submerged in ice cold water, to help “cleanse” the minds of the patients, hypnotherapy – which examines techniques of hypnosis and group therapy – which involved a formation of ‘classes’ that invited the patients to explore each individuals’ problems.

The prevailing societal attitudes on mental hospitals is congruent with the one presented in the movie, “One Flew Over the Cuckoo’s Nest. ” Mental illness is viewed as lingering abnormality, and mental hospitals as total institutions in which patients who are not really sick are oppressed by controlling mental health professionals. The attitudes from both medical and societal populations depicted in the film presented two distinctive sides: the ‘insane’ patients of the psychiatric ward and the ‘normal’ people, such as the doctors and nurses.

In the film, the patients evoke warm, human emotions while the hospital workers are portrayed as cruel and cold hearted. Therefore the battle between these two groups is representative of not only the good and evil that exists between human beings, but within them. Insights into the film make us wonder whether certain types of mental disorders are actually based on some sort of illness or disease, or outside factors such as upbringing and social pressures.

The manner in which the inmates are treated is shameful, yet it mirrors the way in which many less fortunate members of society are treated. Billy is meant to show us that disobedience can have disastrous consequences, when Nurse Ratched drives him to suicide. Yet it is interesting to note that before he commits suicide and after he sleeps with a lady, that his stutter slowly disappears for a while, further emphasising that he does not actually have a mental disorder, but a fear of societal pressures. After his death, the idea is reinforced that

Nurse Ratched represents the establishment; she is powerful like the establishment, and she makes and enforces the rules ( like the rest of society). The Chief, a tall and strong Native American who pretends to be mute and deaf in order to protect himself from pain. represents the way society was very silent in the fifties until people finally couldn’t take it anymore and let their feelings be known with a vengeance. McMurphy rescues the Chief from his silence, and he returns the favor by rescuing McMurphy from life as a vegetable.

The film, “One flew Over the Cuckoo’s Nest”, provides an accurate representation of various psychological issues, such as the use of psychosurgery, institutionalism inside the psychiatric hospital and the medical and societal attitudes towards patients during the 1960s. From the film, it can be understood how various methods to treat psychologically related illnesses have changed and been developed into more effective technique in our current century.

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