One Flew over the Cuckoo’s Nest (group 3)

The ward in Cuckoo’s Nest differs from earlier mental institutions we’ve seen in a number of ways. Most patients remain voluntarily; there’s a clear emphasis on community therapy and some reference to democratic possibilities; we see nothing like the filth of Blackwell’s Island or Byberry, and the long-term use of restraints is plainly discouraged. If not by any means cheery, the look of the place seems to be decidedly clean, clinical, orderly, and professional, with polished floors, starched uniforms, and immaculate glass windows. One of my favorite but very minor characters is “Public Relation” who guides tours through the facility, in a way somewhat reminiscent of Bedlam in the 1700s, while asserting how different this hospital is: “What a cheery atmosphere, don’t you agree? . . . Oh, when I think back on the old days, on the filth, the bad food, even, yes, brutality, oh, I realize ladies that we have come a long way in our campaign!”

But if Ratched’s ward makes discipline and control less outwardly brutal and visible to tourists, it shows how fully under the watchful eye of authority the hospital remains. Authority is just exercised differently, through group therapy sessions, the piped music, and silent observation from behind glass walls. It’s striking to me how visible and vulnerable these patients are, despite the tendency to use physical coercion only as a very last resort. In Cuckoo’s Nest more than any asylum we’ve seen, medicine, the protocols of actual and professionalized treatment, become the mechanisms of control. It’s a historical progression that allows for educational tours and good public relations while providing an intensely repressive atmosphere for the patients. Perhaps that’s why visitors see nothing amiss while the chief has visions of inmates crucified on the wall.

What do others see as changes in the Cuckoo’s Nest ward?

6 thoughts on “One Flew over the Cuckoo’s Nest (group 3)

  1. William Koch

    I echo Joey’s sentiment and that the ostensible democracy being discussed below is a guise in order to convince the patients at the asylum that they have some semblance of agency in their lives. On one hand, there does seem to be more, for lack of a better term, civilization and culture present in the asylum than those we’ve studied, although the presence of a TV and a radio in the asylum make it easier for the transmission of events outside the asylum to within. The faux democracy present in the asylum is in line with Nurse Ratched’s prioritization of order within. She evaluates the happenings at an artificial level of therapy, the most therapeutic practices at the forefront and she attempts to quell any disruptions to the order of the institution. This, however, feels in line with the asylums that we’ve discussed to date. Although they are retrospectively barbaric and operate in many cases on disproven science, I don’t think it is fair to say that the operators of these asylums were sadistic overlords hellbent on torture. Ratched, like many historical operators of asylums, wants dismissal, as the successful dismissal of a patient reflects successful rehabilitation on her end. Yes, she prioritizes power and maintaining control over the happenings among the patients, but it is because she views her authority as the effective means of rehabilitation and the internal control necessary for that rehabilitation.

  2. Alexandra Lawson

    I agree with Hailey, one difference in this ward is the interactions of the different groups of patients specifically the “Vegetables” , “Chronics” , and “Acutes.” In previous asylums, we might expect different severity of patients to be totally separated. Like Hailey I think that this tactic served as a fear mechanism. Time and time again the threat of ‘shock’ treatment comes up. One specifically salient example is the story of Maxwell Taber who demanding information about his medication and as a byproduct was given the “shock treatment,” which made him docile. As was discussed in the powerpoint, the shock treatment often was successful in calming down patients simply due to the fact that they experienced brain damage. Importantly, the fact that the ‘acutes’ are able to see the fate of other patients, such as Taber, has the effect of keeping them in check without specific physical restraint. Instead they are restrained by fear.

    What is interesting to me is the way that Bromden views the ward, as he is very perceptive. While the ward does appear different from earlier institutions in the sense that it is not outwardly filthy and inhumane, Brombden’s views see past that. I think his dream about Old Blastic is especially telling. While day to day Nurse Ratched seems to run an orderly ward, on a deeper level the ward is little different from previous medical institutions, as it remains a sort of slaughterhouse where individuals go to die. As Joseph noted, the difference might indeed simply be the perception of freedom. Despite being kept to a strict schedule, stripped of freedom, and the threat cruel punishment in the form of ‘treatment’, patients still seem to view the place as one of freedom. Indeed they may be free to leave, but they appear almost brainwashed by a fear that prevents them from re-entering society. All of this is due to the daily setup of the ward, and patients seem to eventually simply accept the harsh treatment for fear of something much worse. I think in giving patients some luxury and some instances of “freedom”, Nurse Ratched and others are able to maintain this illusion. Unlike previous institutions the patients seem to mostly buy into the treatment, which likely makes the jobs of the nurses and others much easier. Yet this difference does not make it any more humane.

  3. Haley Glover

    As Joseph mentions, the ward is ruled by the rigid moralistic Ratched and her “Black boys”, rather than physicians. Despite society’s shift toward more medically based treatment methods, doctors are pushed to the periphery in the novel to allow Nurse Ratched and her Black boys to shine. Such a focus on the nurses and employees of the ward highlights the proliferation of treatments deemed to be easily trainable and not requiring surgical skill, such as the transorbital lobotomy. The ward compounds earlier conceptions of moral treatments in the form of Nurse Ratched with rising surgical treatments seen through the “Shock Shop.” Further, the divide between patients differs from earlier conceptions of mental institutions. While in the asylum, different levels of patients seldom interacted and were even divided into different wings of the institution, in the ward both “Acute” patients and “Chronics” are placed together in the day room. Although acute and chronic patients are separated across the room, they are at least given the opportunity to mingle between groups, as McMurphy makes clear upon arrival. Such a set up puts the Chronics in clear view for the Acutes and acts as a reminder of their fate if they choose to digress from treatments. Nurse Ratched uses this dynamic to retain order through fear. Bromden sates, “[Nurse Ratched] point[s] out to the Acute, whenever he goes into a sulk, that you boys be good boys and cooperate with the staff policy which is engineered for your cure, or you’ll end up over on that side” (Kesey 14). Nurse Ratched exercises clear authority in the ward and constructs its facade as a free institution; yet, under the surface, even the freedom to socialize is underpinned with immobilization grounded in fear.

  4. Joseph Levine

    I agree with Dan that the ostensible democratic privilege given to the patients was strikingly different from what I expected. Ratched mentions how she wants the ward to be a kind of microcosm with similar privileges of a free person, so that when the patients leave for the outside world they are well-prepared. Obviously, like most practices in the hospital, the privilege is superficial and hardly improves the patients’ experience. We see the limits of their democracy when Ratched arbitrarily declares the voting closed when McMurphy is trying to rouse the ward to protest the daily TV schedule in anticipation of the World Series. The patients’ freedom is on Ratched’s terms, and so long as they are confined within the walls of the hospital they are only as free as the Head Nurse says they are. Although McMurphy does succeed in gaining approval to watch the Series, it appears Ratched only allows it to preserve the illusion that the patients have agency in determining their day-to-day. After all, the patients do not decide when they go to sleep, shave, eat, or medicate, and no vote would be heeded by Ratched that would allow for those to change. Perhaps one of the main differences between this asylum and the ones by Public Relations is that here the patients are pacified into believing they have some freedom, whereas in previous institutions no patient in a straight jacket would ever venture to believe he had any privilege.

  5. Michael Frank

    The departure from medically-driven reform seems like a notable regression from the progress documented in our readings. Though partially a dramatic choice to demonstrate Ratchet’s domineering character, it also critiques the intention at the heart of all psychological practice. While psychological institutions saw a shift from rigid purification to medically-founded analysis in the early 1900s, perhaps very little changed in the morals that guided the healing process. While a doctor is present in the ward, he has little de facto power in any meetings, ceding all authority to Ratched who mostly chides and diminishes the patients. This indicates that despite all of the progress that the institutions allegedly made over the past centuries that the heart of the old-school asylum was intact. Dan references how Nurse Ratched seems to justify everything to the patients, though, much like the scientific justification of the institution, this structure may just be illusory. I know that we will speak more about the masculinity-focused approach in this narrative, but it is true that early mental institutions sought to break down their patients into some morally pure ideal. Even the name Ratched (Ratchet) evokes a crushing clamp or the turning of a bolt into place. Scientific justification aside, that may have been true well into the 1960s.

  6. Dan Cielak

    One theme that I kept seeing throughout the novel is how the ward’s administration places a huge emphasis on the therapeutic benefits of the ward’s design. Repeatedly, Nurse Ratched will bring down MacMurphy’s ideas, I.e., the fishing trip, shutting off the music, allowing the patients to form a basketball team, allowing the patients to watch the world series during the non designated television time, by arguing that the ward’s protocol is curated for the benefit of the patients and any disturbances would undermine the therapeutic value they can obtain. Reinforcing this idea of benefit to the patients contrasts the themes written about in other works related to mental institutions. In the previous works we read, mental institutions do not seem to try and justify their protocols to the patients; they just enforce them. However, in Cuckoo’s Nest, because most of the patients are voluntarily instituted, Nurse Ratched, the black boys, and Public Relations need to justify everything in order to keep everyone instituted.
    The other glaring difference I saw with this portrayal of the mental institution is the deceptive image of democracy that is advanced throughout the piece. Although Nurse Ratched seems to always have the upper hand, she at least tries to give the patients somewhat of a voice by having them vote on changes to ward policy and allowing them to record incidents in their log books to be discussed in their communal meetings. Similar to effect of emphasizing the benefits of the protocol, the fraction of “free-speech” that is allotted to the patients is designed to enhance the palatability of the ward and keep the patients thinking that being instituted is doing them good.

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