Memory Politics: Psychiatric Critique, Cultural Protest, and One Flew Over the Cuckoo’s Nest
Since its 1975 release, One Flew Over the Cuckoo’s Nest (dir. Milos Forman) has maintained an intertextual relationship with the psychiatric discipline, serving as an icon of anti-authoritarianism and a barometer of the state of the field. The film’s popularity in the 1970s drew on a context of youth protest on one hand and anti-psychiatry mobilization on the other, both of which it also spurred. Yet how might One Flew read in a different historical moment? Here, in dialogue with my students’ reactions and analysis, I argue that the aftermath of dehospitalization and contemporary gender and racial politics have rendered One Flew a more ambivalent cultural artifact. Changing responses to the film in turn reflect the ways in which we draw on the discipline’s past in confronting our psychiatric present.
Psychiatry, Anti-psychiatry, One Flew Over the Cuckoo’s Nest, Electroconvulsive Therapy, Lobotomy, Asylum
My students have mixed feelings about One Flew Over the Cuckoo’s Nest.1 For several years now, I have assigned the film in my history of psychiatry survey course; for several years, and in different ways, they have pushed back on it. There is always a group that continues to respond to the countercultural allure of Ken Kesey’s book, refracted in the film. Yet most of the students react to the film as an object out of time: a political statement that has lost its logic, or a cultural artifact dispossessed of its context.
This paper reads the shifting fates of One Flew as a window onto the historical politics of psychiatry, both within and beyond the academy. Since the film’s 1975 release, it has maintained an intertextual relationship with the discipline, provoking debates about the validity of electroshock therapy, for example, or the efficacy of asylums more broadly. Though Kesey fans have long decried the film’s departure from the book’s more authentically countercultural spirit, it is Milos Forman’s film adaptation that has come to serve as an enduring cultural icon and a metonymic encapsulation of the state of the psychiatric field. In this regard, the consequential tête-à-tête between Jack Nicholson’s McMurphy and Louise Fletcher’s Nurse Ratched has staged the terms of the debate, with a freedom-loving, id-bearing anti-hero facing off against the constraints and abuses of a female-personified world of prohibitions.
Yet historical meaning is rarely stable. My students interpret One Flew quite differently. Some of them defend Nurse Ratched’s professional commitment in the face of McMurphy’s provocations. Very often, they decry the none-too-subtle sexism that shapes the film’s critique [End Page 298] of authoritarian structures. Many are troubled by the film’s conflation of racial and gendered politics, with female nurses and employees of color pitted against McMurphy’s band of male misfits. Some of these critiques have a longer history in shaping popular reception of the film. Above all, however, my students wonder if the psychiatric moment the film speaks to is analogous to their own.
Even so, they continue to watch, expectantly. I assign One Flew as one of three films that the students evaluate as a primary source in the history of psychiatry. Every year, the vast majority choose to focus on One Flew, with smaller numbers opting for the classic psychiatry pictures Spellbound (dir. Alfred Hitchcock, 1945) and The Snake Pit (dir. Anatole Litvak, 1948). For the most part, students engage uncomplicatedly with both Spellbound and Snake Pit: they read them in straightforward and largely historical terms. Yet, when it comes to One Flew, that distance does not come easily. Even as students are troubled by the film’s politics, they are pulled in by its reputation. However problematically, One Flew continues to be a film that they feel they must watch.
The assignment invites students to consider the fertile symbiosis between film and psychiatry in the United States. Hollywood, for example, has long been credited as a popularizer of psychoanalysis; in a broader sense, filmmaking has drawn on the narrative techniques, wonders, and (at times) horrors of psychiatry.2 Across vast geographical and ideological differences, film has often been conceptualized as a therapeutic agent with the capacity to ameliorate mental distress and rescript emotional patterns. It has also been used to train mental health practitioners, evoking longstanding debates about the relationship between psychiatric pathology and performance, while also alerting psychiatric professionals to past controversies and abuses. Indeed, the most prevalent function that movies have played within the history of psychiatry has been a galvanizing one, provoking critical reflection about the discipline in the public sphere. Paradoxically, the same film can and has been drafted to tap into all of these functions: curative, prescriptive, cautionary, and inciting.
One Flew has maintained a uniquely prominent position in professional and popular conversations for several decades now. It is for this reason that I initially assigned it: the film seemed to offer a paradigmatic lens onto the cultural and professional roots and reverberations of the anti-psychiatry movement and dehospitalization.3 My students thus approach One Flew expecting to find in it the same denunciation of institutional psychiatry that their parents and grandparents once [End Page 299] thrilled to. To their surprise, however, they often come away feeling ambivalent about, and even alienated from, the film’s central message.
It is a paradigmatic tenet of historical work that cultural objects must be understood contextually, with respect to the social and political conditions from which they sprang. We bemoan in turn our students’ proclivity to consume historical media with present-day concerns in mind. But what might come of turning diachronic ways of reading into the text, rather than the subtext, of our engagement with them? How might we parse interpretive differences across time as a window onto psychiatry’s past and present, as well as the ways in which we process both?
Many have argued that the history of psychiatry follows a cyclical course: from promise to disappointment, and back again. So, too, have popular and professional efforts to chronicle its trajectory, with celebration and hagiography succeeded by critical denunciation and demands for reform.4 The ghosts of psychiatry’s past have also colored its living present, with past offenses always at the disposal of those seeking to evaluate its future prospects. Where psychiatric reformers turned to history to highlight their humanitarian difference, inevitably the next generation of reformers subjected them to the same treatment.5 The discipline’s skeletons have thus provided fodder for multiple declarations of historical rupture, from Philippe Pinel, legendary liberator of the insane in France, all the way through the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Yet they have served equally the needs of psychiatry’s detractors.
On this basis, psychiatry’s value has often been measured by its relationship to its past—either its distance from or proximity to earlier sins. Critics in turn tend to characterize the discipline as itself something of an anachronism, a vestigial branch of medicine doomed to obsolescence. Hence, the rhetoric of psychiatry constantly lagging behind its disciplinary counterparts, and the concerted efforts of psychiatrists to locate themselves in a vanguard position. But if psychiatry is a discipline haunted by its past, historical consciousness may offer a useful tool to those who, like some of my students, hope to form part of its future. As more than one undergraduate, confronted with evidence of former horrors, has come to articulate over the course of the class, psychiatry’s history puts a pointed question to its present: “what are we doing now that we will regret in fifty years?”
Of particular concern to observers of the discipline’s history has been its tendency to reflect rather than redress a given culture’s mores and prejudices. From the pathologization of runaway slaves in [End Page 300] the antebellum American South to the overrepresentation of women among psychopharmaceutical consumers in the present, psychiatry has often served to shore up existing power hierarchies along the lines of gender, race, ethnicity, and class. Yet the extraordinary sensitivity of psychiatric practice to contextual factors has also endowed cultural products with heightened power to shape its cycles of critique and reform. As a result, psychiatric conversations have been embedded in the broader zeitgeist—and vice versa—in deeply consequential ways.
In response to the question of psychiatric futures raised by my students, then, One Flew allows me to pose a question back to them about the discipline’s representational history. Since the film’s release, it has been read as a symptom of popular attitudes toward psychiatry, as well as an agent for changing them. Yet it has also persistently raised questions about which psychiatry—namely, the discipline’s past or its present—it reflects. Unsurprisingly, these are the same questions my students put to the film in raising concerns about the content thereof and, reciprocally, their own psychiatric context. In reading changing reactions to the film as an imperfect but evocative synecdoche for broader cultural shifts, we thus find a point of entry onto this problem of pastness: the haunting presence of psychiatry’s history in conversations about its present and future.
From the vantage point of the 1960s and 1970s, the fanfare that attended One Flew’s release was perhaps overdetermined. Several decades of mobilization both within and beyond the psychiatric discipline had left the field and its signal institution in a precarious position. Film also played a supporting role in solidifying this critique. In the 1940s, for example, The Snake Pit (1948) provided a language of denunciation—the term “snake pit” skyrocketed in popularity following the film’s release and has remained an important part of public discourse ever since—and the redemptive hero, in the form of psychoanalysis.6 Several decades later, One Flew Over the Cuckoo’s Nest would dramatize this broad-based rejection of psychiatric facilities. In doing so, it forced psychiatric professionals to answer to an increasingly suspicious zeitgeist, even as they insisted that the film, with its terrifying scenes of electroshock and lobotomy, was anachronistic. This interplay between psychiatric pasts, presents, and futures would be central to the film’s evolving reception. [End Page 301]
In this, the film encapsulated a variety of reformist forces. In the middle decades of the twentieth century, following significant wartime experimentation and innovation, psychiatric professionals would cultivate a sensibility of therapeutic progress, from new biological remedies (lobotomy and the shock therapies, for example) to refined psychological approaches (psychotherapy, psychoanalysis, and more). The hope was that these advances would light a path out of the discipline’s historic, widely censured seat: the mental asylum. This extra-institutional shift would also be spurred by the first major breakthroughs in psychopharmacology, with the synthesis of chlorpromazine and other first-generation antipsychotics in the early 1950s, soon followed by tricyclic antidepressants, monoamine oxidase inhibitors, and tranquilizers. Chlorpromazine, approved by the United States Food and Drug Administration in 1954 and marketed as Thorazine, raised hopes that those suffering from chronic mental illness might be able to live outside of institutional care.7
Therapeutic optimism also prompted federal intervention in mental health care, beginning with the creation of the National Institute of Mental Health (NIMH) under President Truman. The 1955 Mental Health Study Act led to the creation of a Joint Commission on Mental Illness and Health (JCMIH), tasked with carrying out a nationwide analysis of mental health conditions. The committee’s ten-volume report was sent to Congress in late 1960, and President Kennedy set up an inter-agency committee to inform the government’s response. In 1963, Kennedy became the first president to deliver a special message to Congress about mental health, which led to the passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act (1963). The bill established an ambitious goal for psychiatric reform: to reduce by fifty per cent or more the number of patients under custodial care within ten to twenty years.8
This enthusiasm for psychiatry’s advancement beyond the walls of the asylum also reflects the revival of institutional critique as practiced by academics and researchers in the 1950s and countercultural and anti-psychiatry partisans of the 1960s. Sociologist Erving Goffman’s 1961 book Asylums brought together his work on the human toll of “total institutions,” much of it grounded in participant observation.9 Required reading for a generation of college students, Asylums was soon joined by other seminal texts of institutional critique, including Michel Foucault’s Folie et Déraison: Histoire de la folie à l’âge classique (1961), published in an abridged English edition as Madness and Civilization in 1964. Like Goffman, Foucault downplayed the medical function [End Page 302] of psychiatric institutions, arguing that there were other forces of reciprocal definition and hierarchization at work within their walls. In the coming years, their work would be vividly brought to life in the accounts of former patients and psychiatric survivors.10
If Goffman, Foucault, and other (proto)-anti-psychiatry voices (Thomas Szasz, R. D. Laing, David Cooper, and Herbert Marcuse, among others) were enthusiastically imbibed by the counterculture, One Flew Over the Cuckoo’s Nest would help to connect both spheres of critical activity.11 Ken Kesey’s book and Milos Forman’s film would make the philosophical basis for this link explicit: psychiatry and, in particular, the psychiatric hospital was depicted as a microcosm of societal pressures and authoritarianism. Kesey had elaborated this equivalence while working as a night aide at the Menlo Park Veterans’ Hospital (Palo Alto, California) while simultaneously participating in secret CIA-funded experiments with LSD and other hallucinogenic drugs. The film’s complicated relationship with an actual institution—the Oregon State Hospital, where it was filmed—would also inform debates over the abuses purportedly inherent to the discipline. Though fans of the book often attempt to disentangle the film’s overblown take from the book’s presumed subtlety on this question, it is striking that both texts depart from this connection to psychiatric “reality.”
The context they spoke to was the growing consensus that the psychiatric institution was less a clinic for medical cures than a laboratory of social power. A series of sociological studies documented this in dramatic ways. Researchers faked mental illness to get themselves admitted to mental hospitals and quickly discovered how difficult it was to get out, even when they showed their cards to doctors and administrators.12 Mental illness was increasingly painted as a slippery object, a convenient “myth” for the enforcement of social norms.13
One Flew stages this confrontation between the medical model and its manipulation by authority structures. A loud and boisterous man by the name of McMurphy (Nicholson) arrives onto the scene of a prototypical institution presided over by Nurse Ratched. McMurphy’s past is opaque but ostensibly ignoble: he seems to have found in a manufactured psychiatric diagnosis a pretext to flee his confinement on a work farm. The very ambiguity of his mental state quickly becomes a weapon with which to challenge the nurse’s rule. McMurphy riles up his fellow patients, snapping them out of their resignation to her castrating order. Though the book and the film differ on multiple points (some discussed below), both are framed around the escalating battle between McMurphy and Nurse Ratched. His challenges to [End Page 303] her authority are punished with a trip to the “shock shop,” but even this exposure to electroconvulsive therapy does not dim his rebellious enthusiasm. Finally, an argument between them devolves into McMurphy attempting to choke Ratched (in the book, this takes a more extreme form). His “final” penalty is soon meted out in the form of a lobotomy. McMurphy’s Native American friend, Chief Bromden (narrator of Kesey’s book), smothers him to death with a pillow and proceeds to carry out the escape plan they had previously hatched.
The story, then, stages a rebellion against structures of authority, and this was a primary and enduring source of its appeal. Many young people who made their way to Kesey’s 1963 novel found in it a model for their own disquiet with 1950s America; in the words of one reviewer, “I consumed it—and it me—in a single sitting . . . [. T]he real appeal was in the crazy premise that not only was it possible to buck authority successfully, but you were darn well obliged to if you wanted a piece of freedom. This was heady stuff for a kid out of the ’50s.”14 The book quickly became a “cult” hit within the counterculture, and Kesey one of their preeminent gurus.15 Drawing on its popularity, preparations began for a theater adaptation, written by playwright Dale Wasserman and starring veteran actor Kirk Douglas. Unfortunately, the 1963 run of the play was a critical and a commercial “flop.”16 Nonetheless, Douglas presciently purchased the film rights for $20,000, hoping that his son Michael might someday direct it.17 But, for nearly the rest of the decade, Kesey’s book would be the only version of One Flew informing countercultural protest against social mores.
That changed in 1969. In that year the play, drawing on the same Wasserman adaptation, reopened off Broadway and, improbably, became a runaway success.18 Critics speculated that the war in Vietnam and the sharpening of youthful rebellion in the late 1960s accounted for the newly warm reception, making One Flew’s message more appealing than ever. Unsurprisingly, it was a largely young audience that turned out in droves in major cities on the West and East Coasts, and then finally all over the country. According to the play’s general manager in Boston, Bill Craver, it had “become the kids’ cry of outrage in a mad world, and madness, specific or not, is something they understand. I mean the war in Vietnam is a prime example of insanity, right? And most kids have that burned clear through their conscience. They get the play’s meaning, they understand it in their bones, they know life is like that or can be like that and it frightens them and they respond to that fright.”19 A critic present for the North Beach debut in San [End Page 304] Francisco similarly cast the young and disaffected as the play’s natural audience: “They were the jean-clad young people who, on another night, might be at the Fillmore getting off on the Grateful Dead or Jefferson Airplane. At the rock hall, many would be stoned—following in the path Kesey had travelled years before. . . . Here in the theatre, they were attuned, seemingly without pharmaceutical aid. They were tracking on Kesey’s ideas.”20
If both the book and the play were enormously successful as countercultural objects, their relationship to psychiatry was less clear. Throughout the early 1970s, reviewers largely honed in on the allegorical use of institutionality, more rarely targeting psychiatry itself. The metaphorical register in which One Flew operated was awkwardly on view in a 1973 staging of the play at the Manteno State Hospital in Kankakee, Illinois. The actors, some of whom “looked scared,” performed in a hospital gym-auditorium for 1200 patients and employees.21 Initial reactions were mixed. Gradually, however, some of the patients warmed to the play, per critic Linda Winer: “Someone yelled ‘bravo’ nine times in the middle of a scene. ‘Do I look insane?’ got much applause. And when the Indian expressed the play’s final declaration of independence, a strong serene voice from the rear said ‘A-men.’”22 Did the play encourage a sense of patient identification? By some standards, it did: “During ‘group therapy,’ another woman calmly strode onto the stage to drink from the water fountain and then walked back to her seat. Someone else found so much reality in the situation, she came up to get her pills, too.”23 But the play’s dramatic electroshock scene, performed used a “genuine ‘shock box’ lent by the hospital,” produced surprising “little response,” in Winer’s estimation, perhaps “because, depending on which staff member you ask, shock treatments virtually disappeared between 2 and 10 years ago.”24
Hospital staff had conceived of the performance as a therapeutic exercise in “reality confrontation therapy,” designed to awaken patients from their “zombie dormitory life.”25 According to psychiatrist Dusan Gojkovich, they would have measured success by the insinuation of doubt: “What I’d hope most of all is somebody to ask what he’s doing here.”26 The question of verisimilitude was a complicated one for many in the audience. For some patients, consternation over the degree of likeness led them to leave, but others were transfixed by it. Most convinced, however, were the “young staffers” themselves, who “found it ‘so real it’s unreal.’”27
Nevertheless, the reproduction of psychiatric reality was a distant objective in both the novel and in the play that hewed closely [End Page 305] to its spirit. It was rather the film version that would be associated with a seemingly documentarian emphasis, provoking criticism from Kesey diehards and broader debates about its staging of psychiatry.28 To some degree, the conversation about filmic verité was shaped by the artistic choices of its director, celebrated Czech émigré Milos Forman. In constructing the film, Forman dispensed with the framing narration of Chief Bromden and instead arranged the story around what critics described as “concrete detailed scenes” as opposed to the novel’s hallucinogenic feel.29 Fans of the book alleged that a picture of “psychological growth” was thus “forfeited for the one-dimensional level of slapstick humor.”30 Most gallingly, for Kesey, this meant that the underlying anti-authoritarian “morality” of his book was excised: “they took out the Combine—the conspiracy that is America.”31 Ultimately, Kesey would publicly denounce Michael Douglas and Saul Zaentz, the film’s producers, as “immoral,” and sue them for some of the film’s profits.32
Yet Kesey’s imprint was not entirely absent from the film. Surprisingly, it was perhaps most felt in the presence of Dr. Dean K. Brooks, superintendent of the Oregon State Hospital, where the film was shot. Brooks had become friends with Kesey, who helped him to reconceive of the book as an allegory. In dialogue with that interpretation, Brooks had decided to welcome filmmakers into his institution and would subsequently be forced to navigate the question of representational truth. His complicated role in the film’s production in turn echoed the controversy that greeted an earlier participant in the cinematic psychiatry wars: Frederick Wiseman’s Titicut Follies (1967), whose unsparing portrayal of the notorious Bridgewater State Hospital in Massachusetts emerged out of a collaboration with the facility’s reformist director but ultimately prompted significant backlash and a total ban on its distribution.33
In the case of One Flew, Brooks began as a technical advisor on the film but would end up playing the fictional director of the hospital, Dr. Spivey. In interviews, he insisted that this did not signify his acquiescence to the film’s literal depiction of psychiatry but rather its figurative message about “repression.”34 The electroshock scene again figured centrally here as a test of these seemingly incompatible commitments. According to Brooks, “Jack’s convulsion on the table was like it was 30 years ago—not like it is today or was in 1963, when muscle relaxants and anesthesia made the convulsions barely noticeable. . . . From a technical point of view, shock was not like that in 1962. But from a dramatic point of view the scene was correct. The patient was resisting the treatment with everything that was in him.”35 [End Page 306]
The allegorical imperative, however, was inherently at odds with the film’s realistic aesthetic. Louise Fletcher, the celebrated actress who took on the role of Nurse Ratched, had “[observed] group therapy sessions at Oregon State Hospital” in preparation for her role.36 Jack Nicholson had also “studied” the hospital and its patients, “playing pinball machines with them, eating in their mess halls and studying their speech and behavior patterns.”37 He even decided to attend an electroshock therapy session at which he felt, reportedly, “personal horror”38: “These patients suffer through shock treatments which I thought hospitals didn’t give anymore. If you’d asked me before about shock treatments, I’d say it’s barbaric but they are using them and they reach people who can’t be reached any other way. Anyway, as an outsider I felt it wasn’t my place to second-guess the hospital’s methodology. But it is depressing!”39
Unsurprisingly, the film provoked frequent criticism of and from within the psychiatric community, perhaps no more so than in its depiction of electroshock. While some psychiatrists distanced themselves from the film’s anachronistic portrait—Brooks’s position, for example—others defended ECT’s therapeutic potential. As Jonathan Sadowsky argues, the period between the release of Kesey’s novel and Forman’s film saw the waning of ECT use among psychiatrists due to anti-psychiatry mobilization and the development of effective psychopharmaceutical treatments.40 Yet this decline was far from total; some accounts chart the continued deployment of ECT in this period, as well as its subsequent revival as a treatment for severe depression.41 A similar dynamic shaped debates over the film’s invocation of lobotomy. Though by the 1970s psychosurgery no longer played an integral role in asylum psychiatry, One Flew’s critical portrayal coincided with an ostensible revival in the practice as an instrument of racialized behavioral control, which in turn prompted Senate hearings and new guidelines for biomedical research and ethics.42
Meanwhile, the dramatic qualities to which Brooks had referred in praising the scene’s “correctness” offered potent ammunition to critics of psychiatry. According to one former psychiatric “inmate” and member of the Network Against Psychiatric Assault, One Flew “[made] some very good points. . . . It shows treatment used as a punishment instead of therapy. The thrust is to keep the patient pacified and compliant instead of dealing with their needs.”43 The critical interpellation of both ECT and lobotomy put psychiatrists on the defensive. Brooks was forced to field some of their angst himself. After a 1976 American Psychiatric Association (APA) conference in Miami, he reported peer [End Page 307] feedback that “ranged from ‘it’s set psychiatry back 25 years’ to ‘it’s the finest thing ever.’”44
The film itself contributed to and in many ways symbolized a broader crisis in the psychiatric profession. The 1975 conference of the APA had witnessed anguished debates over the challenges facing psychiatrists, including the rising costs of care, changes to legal standards for institutionalization, popular pressure to justify their costs, and competition from other professionals for their patients. A continued source of friction, however, were the “charges of drug and electro shock therapy abuses, past and present,” to which One Flew of course contributed.45 Celebrated anthropologist Margaret Mead, a keynote speaker at the event, goaded psychiatrists to confront these criticisms head on. The “majority of psychiatrists,” she insisted, were “more interested in curing the individual patient than they are in combating the social ills that lead to mental disorders.”46 Greeted by enthusiastic applause, she exhorted her audience to “convince people that psychiatry is a viable and valuable institution,” and not, as the title of one APA panel would have it, an “endangered species.”47
Mead’s centering of social problematics returns us to the controversy over One Flew. The film of course became a major popular and critical success, sweeping the Oscars and largely drowning out frustrated Kesey fans. Yet audiences were often unsure how to “read” it, precisely because of its conflation of psychiatric realities and authoritarian allegories. Indeed, it was precisely this spirit of social questioning that would make One Flew enduringly popular, if politically suspect, in the Soviet bloc and other authoritarian contexts.48 Nonetheless, if the depiction of psychiatry was realistic enough to provoke the aforementioned debates over its professional future, some viewers were troubled by the conflation. New York Times critic Vincent Canby panned the film’s handling of this problematic: “Even granting the artist his license, America is much too big and various to be satisfactorily reduced to the dimensions of one mental ward in a movie like this.”49
The filmmakers would get some pushback on this front, as in the production of a 1977 documentary about Oregon State juxtaposing footage from One Flew with actual scenes from the hospital. It did so with the explicit goal of clarifying the “distinction between reality and fiction” that had purportedly been “blurred” in Forman’s version, “with patients, staff, and doctors [assuming] each others’ roles.”50 The documentary depicted a significant difference “between the bizarre and erratic frenzy depicted in the Hollywood film version” and the “actual day to day routine characterized as restrained and solemn.”51 [End Page 308] Yet Brooks and his staff continued to maintain that realism had never been the film’s goal, pointing out that they “would [never] have played host to Hollywood if anyone had feared the film contained a whiff of autobiography. It didn’t.”52
Despite their objections, however, One Flew would retain precisely this function, sparking conversations about psychiatry’s past and present for decades to come. In these debates, the film would serve not only as a reflection of a particular moment in the discipline’s history, but also a catalyst in changing views thereof. That is, despite the controversy that greeted One Flew’s depiction of institutional psychiatry at the moment of its release, generation after generation would return to the film to relive a signal episode in the anti-psychiatry wars. Some would do so with historicist ends, envisioning the film as a window onto a specific disciplinary and cultural context. In other settings, however, the film would be read as a picture of psychiatry’s timeless present, along with its perpetually proximate sins.
Soon after One Flew’s release, George Domino, a psychologist at the University of Arizona, would seek to quantify its social effects. How, he asked, would viewing the film impact the public’s attitudes toward the mentally ill? He decided to test this proposition on 146 college students after first administering a “108-item attitude questionnaire” probing “five attitudinal areas: towards (a) mental health professionals, (b) mental hospitals and facilities, (c) mentally ill patients, (d) mental illness as a medical-hereditary phenomenon, and (3) mental illness as a psycho-social entity.”53 He then asked 124 of those students to take the test again after the film’s release, reporting that 85 had seen the film and 39 had not. Eight months later, he screened the aforementioned documentary about Oregon State to about half of that original group (the other half saw a different documentary) and again administered his questionnaire. His study yielded suggestive results: “There were no significant attitudinal differences prior to the film between those who subsequently saw Cuckoo’s Nest and those who did not. Presumably, then, those who saw the film were not primed to develop negative attitudes towards mental illness. However, students who saw Cuckoo’s Nest subsequently exhibited less positive attitudes on four of the five attitudinal areas [excluding that related to the hereditary roots of mental illness]. . . . The impact of the television documentary, which was [End Page 309] in part designed to balance the film, was nil.”54 In short, watching One Flew had decisively altered students’ attitudes about both mental health professionals and their patients—for the worse.
How would that effect hold up over time, and in very different social and psychiatric circumstances? A 2009 “dual review” of the film by one young (~30) and one older (~60) psychiatric nurse establishes some suggestive contrasts. Both nurses had misgivings about the film’s “antipsychiatry message.” Both were also relatively unsympathetic to the character of McMurphy and dismayed by the filmic depiction (young nurse) and popular interpretation (older nurse) of Nurse Ratched. The older nurse, however, was much less likely to see it as an accurate depiction of the discipline, past or present. Her critique of the film’s authenticity focused in particular on its construction of ECT as punishment. The young nurse, in contrast, argued that the film “accurately portrays a flawed system inhabited by complicated individuals,” albeit too “subtly” for the lay viewer.55
Evidently, something had changed since the 1970s, when a generation of mental health professionals mobilized to distance their field from its most polarizing cultural representation. What should we make of these divergent reactions not only to the film but also to its presumed relationship to psychiatric practice? This anecdotal evidence of change in the zeitgeist maps closely onto the reactions I have witnessed within my own classroom. Decades ago, Domino and others turned to One Flew for lessons about psychiatry and the public’s relationship to it. In asking my students to revisit this exercise, I aimed to put historical distance itself—or the lack thereof—at the center of our analytical lens.
In addition to their papers about One Flew as a primary source in the history of psychiatry, I asked students to carry out a parallel generational exercise (for which they received bonus credit), interviewing an adult from the baby boomer generation. Students were encouraged to ask their interviewees to identify heroes and villains in the film, to think about their own first impressions of it, and to reflect on whether their reactions to the film had changed since the 1970s. Students were then invited to put interview results in conversation with their own responses to the film.56 The results provide powerful evidence of important changes, both to our sociocultural mores and the psychiatric field more broadly, with depictions of gender and race an especially salient point of departure from boomer enthusiasm for the film. Even so, for both generations, One Flew continued to provoke inherently historicist musings: just how closely, interviewees in both [End Page 310] generations wondered, did the psychiatric past as depicted in the film map onto our psychiatric present?
Over and again, boomer viewers pressed one particular message on their millennial interviewers: One Flew was a film one could not forget. Decades later, they quickly brought to mind the film’s most infamous images, which many described as “visceral” in their intensity. In spite of these terrifying scenes of psychiatric abuse, however, boomer viewers largely adhered to the countercultural script in their interpretation of One Flew. The film, like the book, offers up the mental health field as a “metaphor and a way to express the overall oppression of ideas and people who didn’t fit the accepted norms,” according to one interviewee.57 Another respondent suggested that the film “did not shape how she felt about mental institutions as much as any institution and the psychology of power.”58
The battles lines in this power struggle were, for most of them, accordingly clear. Nearly all members of the boomer generation coincided in understanding the heroes of the film as McMurphy and perhaps Chief, with Ratched the obvious villain, or the “system as personified by” her.59 Many celebrated the catalytic effect McMurphy exercised in encouraging his fellow patients to rise up against the hospital’s authority structures. In this, Jack Nicholson the individual blended seamlessly with McMurphy the character; per film critic Jason Horsley, he “became an archetype, a symbol” of “freedom, revolt, the undying will to prevail no matter the obstacles.”60
Perhaps because of the framing of the exercise, my students, in contrast, are more likely to understand One Flew as a statement about psychiatry. Yet their responses do not uniformly point to whose psychiatry they see depicted there. Some students, for example, find the film to be unbearably difficult to watch, evocative of their disquiet with the discipline in its contemporary manifestation. In other cases, often in accordance with their boomer interviewees, they tend to understand the film’s depiction as unrepresentative of psychiatry’s present. In the words of one student, “The film felt like a relic of the past—a moment in history that we have moved on from.”61 Some students experience less unease at the depiction of ECT and lobotomy, for example, precisely because of their historical knowledge of the discipline. One student points out that her awareness of the “pastness” of such therapies “reduced the shock value.” So, too, did her personal distance from those conditions: “To my generation, this film holds a higher entertainment value than it does an anti-psychiatry message.”62 [End Page 311]
In spite of their heterogeneous reactions to the film’s depiction of psychiatry, almost uniformly, students distanced themselves from the packaging thereof. They expressed a great deal of skepticism about McMurphy and some identification with Ratched in their rejection of the film’s gender politics. Admittedly, this is not a new conversation: feminist critics of both Kesey’s book and the film have long pointed to their troubling villainization of female authority, with Ratched’s “castrating” regime conflated with authoritarian structures in general.63 So legendary was Kesey’s misogyny, in fact, that several leading actresses—Anne Bancroft, Angela Lansbury, Geraldine Page, Colleen Dewhurst, and Ellen Burstyn—turned down the role of Nurse Ratched, “because they thought the character was too grotesque a monster.”64 Instead, the role would ultimately re-launch Louise Fletcher’s career, and she was widely renowned for making Ratched a more complex character than her counterpart in Kesey’s book.65 Forman reportedly claimed this achievement for himself, telling a reporter that “if you read the book, you must admit that I like women much more than Ken Kesey.”66
My students are not wholly convinced. Their more ambivalent attitude toward Nurse Ratched tends to align with their suspicion of McMurphy, a judgment that differentiates them from their older interlocutors. The near unanimity of their interviewees on Ratched’s evil is a testament to how the film continued to rely on misogynist tropes in depicting her, to such an extreme that, according to one student, Ratched’s “name was used within the family as an insult for difficult women.”67 Yet this is not the sentiment with which many students leave the film. A female viewer notes, “While we all felt the film was disturbing, I felt that both the role of women in the film and the dynamics of the psychiatric ward were disturbing while my interviewees felt that only the psychiatric aspects were a point of discussion. For example, I felt McMurphy’s request that his girlfriend have sex with Billy was exploitative, coercive, and inappropriate, while my interviewees found it to be heroic and therapeutic.”68 One student captures this counterpoint in an interview with his interlocutor, a practicing psychiatrist:
For me a positive thing in the film was that it did deal in pretty nuanced terms with the patients as not just crazy and the people running the asylum as not just evil. Didn’t you think?
Wasn’t Nurse Ratchet incredibly mean? [End Page 312]
Yes, she’s mean. But in my opinion you don’t get the sense she’s evil. You feel that she’s tough but not necessarily mean-spirited, and that she actually may want to do what’s best for the patients, even if she doesn’t know exactly how to accomplish that.69
This student concludes that Ratched “doesn’t seem evil, she just seems institutional.”70
Yet the significance ascribed to Ratched’s characterization is also contextually specific. After her interview, the grandmother of one student decided to re-watch the film to assess her original response and found herself reacting with new understanding to Nurse Ratched: “While my grandmother still finds it hard to sympathize with her and her manipulation, now, more knowledgeable about the danger of dominant power structures, she also is able to see that in many ways Nurse Ratched is a victim of the system as well.”71 Another boomer interviewee (male) had the same reaction upon re-watching the film: “I found . . . the second time around that Nurse Ratched was not the villain but rather a product of the institution. The institution as a whole is the issue and the villain.”72
The operation of race within the institution similarly shapes the film’s message, namely in its alignment of black hospital attendants with Nurse Ratched’s reign of terror over white male patients. This matter is largely absent from historical conversations, yet it has provoked dramatic reactions on the part of some students, who wonder whether it is an accurate depiction of hospital staff pools at the time. There is no mistaking the meaning attached to this alignment in the novel, however, as Kesey’s black attendants enact symbolic revenge through their treatment of the patients. The film is less overbearing on this score, but a similar message is delivered: women and African Americans are inherently antagonistic to the freedom pursued by McMurphy, even if they have intelligible reasons (sexism, racism) for playing this role.
As Gene Siskel mused in one review, the movie may have had self-interested reasons for softening the book’s approach: “In the book, the hospital attendants are presented as ‘black boys’ who bug and humiliate patients at will, all under the tacit approval of the Big Nurse. All that is missing in the film. The black attendants are presented as contemporary, hip dudes, probably to appease the young black film-goers.”73 Siskel clearly overestimated how successfully the film had stripped itself of offensive racial implications. [End Page 313]
If its racial optics were rarely questioned at the time, they were implicitly reimagined in a staging of the Wasserman play that cast a black actor as McMurphy. One reviewer was mostly dismissive of the implications of this choice: “His color is, surprisingly, not a factor. McMurphy, the rascal, probably would have chosen to be black if he’d had that option, and as the ward has integrated help, there’s no reason it shouldn’t have integrated patients. One image, in fact, is enhanced—McMurphy temporarily defeated by Miss R., going in to scrub the ward toilet, brush in hand. She doesn’t have to call him ‘boy’ to make the point.”74
Defenders of Kesey’s depiction of race in the novel tend to point to the prominent place occupied by the Chief as narrator—a position denied to him in the film. The novel both mobilizes and complicates stereotypes associated with Native Americans but undeniably constructs Chief as its narrative and, to some degree, moral center.75 Though the film did not afford this space to its Native American character, it did launch the career of one of the first celebrity Native American actors, Will Sampson. To create a less stereotypical effect, Sampson had been forced to push back on Forman’s vision, which adhered to the “ugh-Tonto type Indian”: “He told me what he wanted, and I told him that wasn’t the way it was. It was 1963—Chief Bromden had gone through high school as a football athlete, had served in the Korean war, had perfect diction.”76 Despite Sampson’s lobbying, however, Kesey ultimately bemoaned that much had been lost in filmic translation. The overarching story of the Chief’s “struggle for manhood,” as Kesey described it, was supplanted by a focus on McMurphy, the “roustabout” (again, Kesey’s word) “who helps trigger the Indian’s recovery.”77
Perhaps in dialogue with their memory of the book, boomer interviewees tended to center the Chief in their recollections, some regarding him as the film’s hero on par with McMurphy and others conflating the two characters. They thus remember racism as one of the film’s moral targets. According to one interviewee, “Chief” was emblematic of the “problems of the ‘establishment’ with regard to race relations,” whose narrative revealed the contradictions in dominant racial thinking.78 Others regard him as the sole hero of the film, focusing on his decision to mercifully kill McMurphy after he is subjected to a lobotomy. Another interviewee was personally impacted by this centering of Chief’s experience, noting that the film “was one of the first places she saw a Native American character portrayed positively in a film. It was also surprising to her that Chief escaped at the end because she was not used to seeing happy outcomes for Native [End Page 314] American characters. She said that this impacted her a lot because she associated her brothers with some of the characters in the film.”79 To some extent, this interpretation renders more complex the messaging of both the book and the film, which depict McMurphy as a martyr (the book quite explicitly) who sacrifices his life to free his ward mates.
The shift from a celebration of the book’s racial politics vis-àvis Chief Bromden to a critique of its depiction of African American attendants may reflect broader political currents. Yet I suspect that the two questions—psychiatric and racial politics—are not so disparate. Students’ instinctive rejection of a story in which white men are psychiatric victims and women and black men the villains speaks volumes about their reading of the past, and their informed distrust of this version of events. It is also, however, a statement about their present. In the aftermath of dehospitalization, race has risen to the fore in media representations of mass incarceration and the mental health crisis therein. My students understand racial politics as central, not incidental, to psychiatric crises of the present. This conclusion, moreover, undergirds their broader reinterpretation of the film and the institution at its core. For some, the hospital is not the agent of psychiatric crimes, but merely their setting.
Overall, a few predominant motifs emerge out of this generational juxtaposition, all of which speak to our contemporary psychiatric moment. On one hand, students are less likely to interpret One Flew Over the Cuckoo’s Nest as a statement about abstract values like freedom or anti-institutional critique and more likely to see it as a representation of psychiatric conditions. For some, the psychiatric conditions portrayed there properly belong to the realm of the past; for others, they are troublingly visible in the present. Second, students’ experience of watching One Flew is often threaded with ambivalence. They come to the film expecting to sympathize with its message and instead find themselves uncomfortable with both its argument and its framing. They tend to note the distance between their instinctive disquiet and their parents’ and grandparents’ passionate attachment to the film, so much so that a few interviewees were inspired to re-watch the film, often to revisionist ends. Here, the politics of race and gender align with institutional politics, particularly in contemporary readings of McMurphy, Nurse Ratched, Chief, and hospital staff. The result is an upside-down reading of the original cultural script, with the villains turned into objects of some sympathy and the iconic anti-hero no longer the principal source of the film’s appeal. [End Page 315]
In their analysis, students often returned to something they heard from many of their interviewees: that One Flew had been the film that first alerted them to psychiatry’s horrors, shattering their faith in structures of authority more broadly. In its moment, the film seemed timeless, unambiguous in the moral and ethical messages it put forward. Yet the very fact that my students can and do find something else in it is instead powerful evidence in favor of historicism.
Beyond the clear importance of historical context, however, I believe that there is a more suggestive lesson conveyed by these results. Overall, there are areas where generational responses were monolithic—most clearly, those built around the gendered and racial scripts the film puts forth. Boomer viewers viewed McMurphy as a hero, and Ratched as a villain. In 2019, that characterization seems almost backwards to the student interviewers. Across and within generations, however, there are also clear notes of divergence. I am struck that both my students and their interviewees express a wide range of opinions as to the accuracy or, more precisely, the “presentness” of the film’s depiction of psychiatry. This uncertainty in turn represents a significant point of continuity with the original debates around the film, in which mental health professionals sought to carve out distance while also, like Brooks, courting proximity.
Herein, perhaps, we find the most powerful lesson in the film’s shifting fates. Neither in 1975, when the film first appeared, nor four decades later, when my students returned to it, were viewers entirely sure whether they were witnessing psychiatry’s past or present. The very fact that such questions could be posed of a work of fiction is suggestive of how intertwined cultural production and psychiatric history have become. The persistence of One Flew points to the remarkable durability of our psychiatric battles but also—and more destabilizingly, I think—to the heterogeneity of the (present) history it dramatizes. That we still cannot agree whether the film is a relic, a mirror, or a harbinger reminds us that our psychiatric battles in the present have their counterpart in the past; indeed, that there may be no static or singular past to which we can refer.
It can be comforting to cling to the assumption that the advantage of retrospect is also one of moral and scientific superiority. But on careful scrutiny the overwhelming evidence of repetition renders this position untenable. Studying the history of psychiatry reveals as much evidence of continuity as of dramatic change. That conclusion can be challenging for future practitioners and patients—among whom many of us figure—to accept. [End Page 316]
Like many of its peer institutions, Oregon State Hospital now contains a museum. Asylum museums tend to stage a dialogic relationship with the hospitals in which they are located, many of which are still actively functioning. On the surface, this compulsion to memorialize evokes pastness through contrast. Often, the overarching message is one of distance: we have moved on, we have progressed, we are not that anymore. Yet the juxtaposition can, in its very being, undermine this presumption. Our emotional, political, and cultural ownership of these spaces—and, more broadly, psychiatry’s past—is undeniably conditioned by “strategic forgetting and selective remembrance.”80
Asylum museums (and museums in general) can draw on shared sentiments of loss. Yet there is a melancholic quality to this insinuation of past-in-present, a sense that psychiatry’s history has not been fully exorcised.81 Unsurprisingly, the most dominant motif in our contemporary asylum imaginary is that of haunting. Empty asylums are often cast as theaters of paranormal activity, where past abuses impinge on our contemporary aloofness from them.82 In the case of Oregon State, this spectral staging comes to fruition in an exhibit dedicated to One Flew Over the Cuckoo’s Nest, which recalls, in the words of its official website, “the blurred lines between film crew and hospital community and the controversies it dredged up.”83
In the 1960s and 70s, One Flew Over the Cuckoo’s Nest helped to crystallize a pervasive belief within and beyond the discipline that psychiatric hospitals were fundamentally backwards. Both the book and especially the film also provided the vivid imagery with which to critique the field. For decades thereafter, supporters and critics would engage One Flew in incommensurable ways, arguing on one side that electroshock was safely consigned to the past and on the other that it was actively practiced in the present. The film provided not only fodder but ostensible evidence in the unfolding of these debates, breaching, like many cultural products before it, the nebulous line between representation and reality. Over and again, One Flew would be drafted to evaluate the most enduring problematic in the discipline’s history: whether psychiatry had finally left its past behind. Even in its moment, however, there was no clear agreement as to the contemporaneity of its portrayal.
Psychoanalysis, one of the most consequential psychiatric innovations of the last century, is premised on the understanding that the past never truly recedes, but rather is woven into our living present. [End Page 317] Fight as we may to repress its memory, history has a way of reasserting itself in the interstices of everyday life. This is also a strikingly appropriate encapsulation of psychiatry’s long arc: in and out of institutions, “forward” and inevitably “back” again. And no silver bullet has yet appeared to rescue the discipline from its Sisyphean inevitability, however eagerly it continues to be forecast and awaited.84
Learning history does not prevent us from repeating it, contrary to the truism that sometimes brings students to our classrooms. In fact, we are already repeating history by looking to psychiatry’s past with instrumentalist eyes, perhaps to apply a critical lens to its present or to imagine a less ambivalent future. Knowing that our work inevitably speaks to our present as much as it does the past does not absolve us from practicing careful empiricism in our efforts to bring the discipline’s history to life. Yet it should provoke some circumspection about assertions of epistemological certainty, deliverance, and catharsis. In this regard, the history of psychiatry undoubtedly reflects the problematics and doubts that shape historical inquiry more broadly. Even so, there is perhaps something unique about a science that has recurrently asserted mastery over the most slippery material of all: the human psyche in distress.
The shifting fates of One Flew Over the Cuckoo’s Nest provide a window onto the disciplinary and historical contexts that converted the film into both a blockbuster success and an enduring point of reference in psychiatric battles. Yet this trajectory also reminds us that, even in psychiatry’s seemingly proximate past—as represented by our very parents and grandparents—there is much that remains uncertain, undigested, irreconcilable. For students and scholars alike, this story thus presents cause for historicist modesty. We may someday be able to determine just how prevalent electroshock was in 1975, how tortuous asylum conditions were, or how abusive psychiatrists may have been. Even then, however, we may not agree on the significance of these facts, not only for our understanding of psychiatry’s past, but, perhaps more consequentially, for its present and future.
Jennifer Lambe is an associate professor of History at Brown University. She is the author of Madhouse: Psychiatry and Politics in Cuban History (University of North Carolina, 2017) and co-editor, with Michael Bustamante, of The Revolution from Within: Cuba, 1959–1980 (Duke University, 2019). Her work on the history of medicine and psychiatry in Cuba has also appeared in Cuban Studies, Bulletin of the History of Medicine, History of Psychology, Asclepio, Journal of Latin American Studies, and more.
1. All student essays that appear here are cited with the express permission of their authors.
3. I use the term “dehospitalization” rather than the more common “deinstitutionalization” to reflect the concerns of scholars and observers who argue that what has taken place is rather a process of transinstitutionalization, with new institutions—carceral facilities, emergency psychiatric wards, halfway houses, and more—replacing public psychiatric facilities as the principal providers of (notably diminished) psychiatric care.
4. For a full discussion of these trends as they influence the historiography, see Porter and Micale, “Introduction: Reflections on Psychiatry and Its Histories,” 3–39. For synoptic takes on the post-revisionist (anti-anti-psychiatry) school, see Tomes, Generous Confidence; Brown, “Dance of the Dialectic?”; Terbenche, “‘Curative’ and ‘Custodial.’”
40. Sadowsky, Electroconvulsive Therapy in America, 107–20. I am grateful to Jonathan for sharing his thoughts on this question.
41. The scene from One Flew would still be invoked in conversations on the validity of ECT into the 1990s; see Goleman, “Quiet Comeback of Electroshock Therapy,” B5; and Sadowsky, Electroconvulsive Therapy in America, 119–20.
52. Smith, “Oregon Attempts to Re-Program Convicts’ Minds,” A1. The shifting fates of Oregon State over the next two decades would ultimately raise some doubts about this assertion. Though the hospital often hosted innovative therapeutic experiments in rehabilitation for sex offenders and others, it would also face a lawsuit brought by the ACLU on behalf of seven patients alleging the forced administration of psychopharmaceuticals and electroshock. See “ACLU Files Suit,” 7.
56. This sample is small and I make no claims for its representativeness, given that these are students at an elite higher educational institution. Nonetheless, I believe that their findings do have broader significance beyond the immediate experiences represented therein.