One Flew Over the Cuckoo's Nest - An analysis

Just recently this writer had the opportunity to experience the 1975 movie, One Flew Over the Cockoo's Nest. How in all her years of interest in the field of psychology has she missed this film, is quite a mystery. This writer was absolutely shocked and horrified as she watched this movie, “One flew over the cuckoo’s nest” unfold. Although she had heard rumors of these mental institutions and the stereotypes that had carried over all these years, she failed to realize the scope of injustice that was done onto the patients. While analyzing this movie, the writer found herself feverishly writing notes regarding the ethical, therapeutic, and humanistic violations that were depicted, and now as she sits to write, finds it difficult to limit herself to discussing only a few.

The main perpetrator of the movie was nurse Ratched. Although we are unclear of her qualifications, one would presume that she were a psychiatric nurse practioner. And while this title would suppose that she had received education and training pertinent to this field, her title should be used loosely.. as she did not deserve to hold the authority that she did. If one were to critique her leadership abilities and place a style to it, it would be leader-directed or leader-oriented. And while she would be then called to lead a group, she failed to understand each client’s needs and structure group focus to meet those needs, (Lantz, 2001). In the leader-directed approach, she would have been responsible for providing information and educating the clients on the chosen topic. Because these clients appear to be mentally functioning at a child-like level, structured group activities should also be intermingled with lecture, as attentions can easily wane, and hands-on activities has been shown to be tremendously effective at keeping the client focused on the topic, (Jacobs, Masson & Harvill, 2009) and broadening their depth of understanding. While the goal in working with groups is to maintain a singular focus, it is sometimes necessary to shift if as a leader, one recognizes a disconnect or the client’s inability to attend to the topic. Continued attempts to persevere will surely end in the client becoming disruptive, resentful, and tuning out to the topic, however one must impress that the change in topic remain therapeutic and healthy for the clients as a whole, nothing like that depicted in the movie.

If one further attempted to analyze the group dynamic and the supposed therapeutic nature of this group, isolated from the facilitator, they would also find it quite unhealthy. In an effort to analyze this the characteristics of effective group therapy, Yalom (1995) finds a number of factors, which can substantially contribute to the group process and success. These factors can include; instillation of hope, universality, imparting information, altruism, the corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis, and existential factors. In the three scenes that the viewer was privy too, not one time did there appear to be a single focus or topic, instead the discussion was based around the facilitator’s choice for belittlement of the day and the group also served as a arena for the clients to air their grievances about treatment, and each other without being heard or redirected. It appeared that no group format existed, besides the time allotment, and no rules were presented or adhered to. At one point, nurse Ratched referred to the group as being therapeutic, but even to the most unskilled eye, this was a ridiculous assumption. No therapy was being conducted in these groups, no understanding of disorder, treatment, healthy living, self-esteem building, no realizations, and even worse, the clients appeared become increasingly distraught throughout group, then were left hanging without the opportunity to process. These clients were brought together based on their ability to attend to the group, but never really pre-screened for compatibility, i.e. level of disorder, commonality between issues and ailments, in short, this created chaos. Due to the dynamics of the group, coupled with the dictator-like, uncompassionate, judgmental leader, these clients failed to progress. And while all of these clients arrived to the facility wounded, fearful, lonely, and ashamed, they may have ended up worse than when they initially presented for treatment. This writer believes that therapeutic groups can only begin to have individual progress when the participant him or herself feels as though they are safe, accepted, understood, and can see the “light” or hope for the future, but none of these feelings were facilitated for the clients in this ward.

Above all other problems, is that of ethics. The American Counseling Association, realizing that there were great disparities in treatment of mentally ill clients, created their first code of ethics in 1952, (Code of Ethics, 2005). While we then know that there was such a guideline for therapists, we must then assume that the practioners depicted in the movie were not taught such principles during their training, nor could there have been any consequences for failing to adhere to these rules. If in fact, these guidelines had been taught, reviewed, and therapists been penalized for not implementing them, almost all of the issues could have been avoided.

If this writer were called to evaluate and consult for this facility, she would have found herself outraged on the first day, maybe even the first hour. Her recommendations would have been simple and drastic. All employees would have been placed on “leave” until they could receive their own psychiatric evaluations, and if found competent, received proper training. All Electro-Convulsive therapies would have been halted, as these were preformed for the wrong purpose, by unqualified staff, and the practice of lobotomizing clients would have been terminated. A competent and skill staff would be temporarily placed within the facility and all clients would have been re-evaluated and placed in wards according to their disorder, competency level, and need. The practice of medicating, or should we say, sedating all patients into compliance would have gradually waned (for fear of withdrawal symptoms), during which time the clients would be re-assessed for proper medications. The new group leaders would be well trained in group dynamics, and new groups would be formed. These groups would follow a model outlined by Yalom (1995) and others, which would allow for a group purpose, rules, and phases, to allow for proper processing. And the ACA code of ethics (2005) would be the law of the facility, the credo, “Do no harm” would be repeatedly drilled into the employees heads, so that no one lost sight of this again! Only after these changes were made would the clients actually be treated, instead of becoming worse, and even some may one day be able to leave the facility as functioning members of society.
Stephanie Lowrance-Henckel

References

Code of Ethics. (2005). American Counseling Association. Washington, DC.
Jacobs, E., Masson, R. & Harvill, R. (2009). Group counseling: Strategies and skills (6th ed.). ThomsonBrooks/Cole. Belmont, CA.
Lantz, J. (2001). Play time: An examination of play intervention strategies for children with autism spectrum disorders. The Reporter, 6(3), 1-7, 24.
One flew over the cuckoo’s nest. (1975). Milos Forman (Director). Fantasy Films, Oregon. Video recording.
Yalom, I. (1995). The theory and practice of group psychotherapy (4th ed.). BasicBooks. New York, NY.