In very morning nurse Ratched comes to the State Mental Hospital and welcomed by Mr. Warren, Mr. Washington and nurse Pilbow. Nurse Ratched displays her authoritative and imposing nature over anything she regards as being a ‘nuisance’. Everything runs according to her plan or not at all. After some time there comes Randall Patrick McMurphy and made an introduction with some of the patients and Dr. Spivey. Dr. Spivey said to McMurphy that he is here just to be evaluated if he is mentally ill. The main reason of McMurphy’s mental evaluation that he raped a 15-year-old young girl. McMurphy said he is here because he fights and fucks too much. McMurphy’s ward run by nurse Ratched and every patient is afraid of her specially Billy Bibbit. Immediately McMurphy establishes himself as a leader and everyone started depending on him such as Billy Bibbit, a nervous stuttering young man, Charlie Cheswick, a man disposed to childish fits of temper; Martini, who is delusional; Dale Harding, a high-strung well-educated paranoid; Max Taber, who is belligerent and profane; Jim Sefelt, who is epileptic; and Chief Bromden, a schizophrenic patient at a mental hospital. Bromden sees and hears most of the activities on the ward, but he has convinced the staff members to believe he can neither hear, nor speak. They believe that he cannot reveal what he sees because he doesn't speak; ironically, he is the novel's narrator. The events in ‘One Flew Over the Cuckoo's Nest’ are filtered through Bromden, who believes that a sinister organization called the Combine is in control of everything on the ward. Nurse Ratched calls for a meeting of mental patients every morning. McMurphy entered into nurse’s station to turn of music but finally nurse Ratched managed to stop him. McMurphy begins his attack on the nurse's authority by proposing a change in the ward schedule to allow the men to watch the World Series. Nurse Ratched is opposed to change of any kind, but she finally agrees to abide by the wishes of the majority. McMurphy loses the vote, but Nurse Ratched soon realizes the obstinate nature of her opponent when McMurphy pretends to watch the game on a darkened television. McMurphy announced to go downtown by breaking the window. Sefelt and Billy said that he couldn’t go out; Taber and Harding bet some dollars against McMurphy. Finally, McMurphy couldn’t lift the hydrotherapy console and said “but I tried, didn’t I? Goddamn It! At least I did that”. Next day nurse Ratched again calls for vote on favor of watching World Series by request of Cheswick. They got 10 votes from 18 patients and nurse Ratched turned on the television for patients to see the World Series. McMurphy shirks from State Mental Institution steals hospital bus and takes Scanlan, Cheswick, Taber, Fredrickson, Harding, Bibbit, Martini and Sefelt. They moved out for fishing and McMurphy stopped for a while to pick Candy. After that incident some of the senior doctors of State Mental Institution like Dr. Songee, Dr. Spivey, and nurse Ratched made a meeting about R. P. McMurphy. McMurphy, Chief, Harding, Martini, Scanlan, Billy, Cheswick, Taber, Bancini, Fredrickson enjoyed their next basketball game against institutional supervisors. After that McMurphy heard about the Institution have power to keep him indefinitely. Cheswick, Chief and McMurphy breaks the institutional rules and taken to the ‘shock shop’ for electroconvulsive therapy. McMurphy there discovers that Chief Bromden is neither deaf nor mute. Chief thanked McMurphy for chewing gum and also said: “Ah…Juicy Fruit”. McMurphy and Chief Bromden both committed to shirk from State Mental Institution to Canada. McMurphy advised Chief to follow his suggestions. At night McMurphy calls Candy from nurse’s station to come on State Mental Institution. Candy and Rose came with some bottles of booze. McMurphy offered Turkle (Night Supervisor) $20 dollar and Rose to spend some moments. Turkle agreed and proceeded with McMurphy. Turkle got to snooze because of crapulence and Murphy collected the key from Turkle’s pocket to unlock the window. At the farewell time Murphy offered Billy to have a date with Candy. Billy and Candy ostracized by everyone of the ward to have date. At the end of the night every one of the wards get snoozed. Next morning nurse Ratched comes to the State Mental Institution. Billy got caught in a room with Candy. For the first time Billy started talking without stuttering and he said to nurse Ratched that he can explain everything. Nurse Ratched said to Washington to put Billy in Dr. Spivey’s office. Billy begged to nurse Ratched not to charge on him but in vain. Billy killed himself by glass fragments. Then McMurphy tried to kill nurse Ratched by holding down her throat. Washington biffed on McMurphy’s head and he becomes senseless. After that scene Harding, Cheswick, Taber and Martini was playing cards. Jim Sefelt comes to the ward and said to Fredrickson that McMurphy escaped. At night two supervisors came with Murphy and they placed him in his bed. Chief comes to McMurphy and said that he is ready to shirk from State Mental Hospital. Chief noticed that there are two sutures on Murphy’s forehead. Chief didn’t want to put Murphy such situation. Chief made mutual greeting with Murphy and then killed him by stopping his breathing. Finally, Chief tried to follow Murphy's escape plan by lifting the hydrotherapy console off the floor and hurling the massive fixture through a grated window, climbing through and running off into the distance. Taber wakes up and cheers as he saw Chief Bromden shirking from State Mental Institution.
There are lots of psychological disorders depicted in this film. Starting with Billy we can tell from the moment he speaks, that he stutters and is very nervous, which is said to be caused by anxiety. Recent studies show that stuttering runs in families, and suggests that people who stutter may process speech and language in a completely different area of the brain than people who don’t. But it has been found that stuttering can increase anxiety and stress. There is no one specific treatment for stuttering, but can include learning how to control anxiety and fear associated with speaking, patient listening and positive reinforcement, helping people who stutter to slow down their speech and regulate their breathing, and having the person participate in self-help support groups (Heaps). Some of these treatments are shown in the film such as when the inmates are having the group therapy sessions, Billy is asked many times by Nurse Ratched if he would like to start the session or if he would like to add a comment. He attempts to comment but still stutters. As the film goes on, Billy talks more and more and come out of his shell and is able to talk really well at the end, which may have been the cure for his stutter – to be more confident.
Group means two or more individuals interacting and interdependent who have come together to achieve particular objectives. There are numerous advantages to being in gatherings other than camaraderie and survival. Individuals who join gatherings will have both one of a kind and widespread points of view on what they gain from their experience. In addition, having a characteristic propensity to shape gatherings, a great many people discover bunches gainful. It is through gatherings that people are associated and connect with others in generative and beneficial ways. Inside solid gatherings, trust, unselfishness, harmony, and cooperative energy are cultivated. More likely than not individuals would not endure, not to mention flourish, without depending on gatherings. This reliance is seen in everything from care groups for the bereaved and those in anguish to bunch for midlife vocation change and for understudies with low inspiration (Gladding, 1994). According to me, from the movie there was a heterogeneous group which contained a mixture of individuals with different emotional problems. Members of a heterogeneous group come from a variety of backgrounds and are at different stages in their development.
When highlighting into some of the ethical issues seen in the movie and how the facilitators portrayed, could mention that Clarity of presentation in respect of the self is low. We can witness this from the scene where Dr. Spivey invites RP Murphy to sit down and says, “Let’s talk”. Dr. Spivey is not clearly defining whether it is a social or therapeutic. Moreover, attempting to decide if Murphy is malingering or not is blended in spite of the fact that Dr. Spivey presents in all respects obviously to Murphy, the rest of the staff don't. The staff defines the distance in the relationship in an extremely distant way. This is maintained by the staff displaying a lack of empathy, openness, understanding, and vulnerability as I noticed Ratched’s aloof, cold, unempathetic and intellectual behavior as the group facilitator. The staff does not exhibit empathy to the patient and this was clearly seen in the scene where nurse Ratched’s unempathetic handling of Murphy’s appeals to watch the game on TV.
The staff does not give unconditioned positive regard. This is kept up by the staff's judgmental and basic attitude towards the patient. Medical attendant Ratched's judgment of McMurphy to Dr. Spivey in spurring to keep McMurphy in the institution as somebody who has an issue or that there is some kind of problem with him and who need treatment; and Nurse Ratched's displeasure and extreme dismay and disappointment at McMurphy and the other ‘patients’ party in the ward. Therefore, there is no indication of the staff receiving unconditional positive regard.
Also, the staff typically displays a low level of congruence. Dr. Spivey smiling in an apparently friendly way whilst asking RP McMurphy whether or not he was really mentally disturbed or just malingering. High levels of congruence are considered to facilitate growth in the therapeutic relationship. However, in this setting, the communication between the staff and ‘patients’ was characterized by varying degrees of incongruence.
The staff displays poor, if not anti-ethical problem-solving. Nurse Ratched’s damaging attempt to help McMurphy’s group better understand the reason for Mr. Harding’s wife supposedly having an affair. Here Nurse Ratched apparently inadvertently asked Mr. Harding two questions in succession on two different logical levels which were “Maybe you should tell us why you suspect her”, and “Have you ever speculated, Mr. Harding, that perhaps you are impatient with your wife because she does not meet your mental requirements”, which precipitated his psychotic reaction and subsequent disruption of the group.
In the movie picture ‘One Flew over the Cuckoo's Nest’, Nurse Ratched's treatment and care of the patients was untrustworthy when contrasted with the benchmarks one would expect of a human services overseer. She utilized command over her patients to guarantee request, without respect to the emotions and worries of the patients. There are many situations in which Nurse Ratched exhibits control over her patients, by treating them as subordinates, humiliating them and de-masculinizing them without concern for their well-being. She uses control to withhold simple privileges, such as being able to watch a baseball game on the television, tub privileges and their right to have possession of cigarettes. It appears she actually gets fulfillment from this through clues of grins, which are so only occasionally observed. This just achieves outrage and threatening vibe in the patients on account of the manner in which she treats them.
The psychiatrists, with Retched present, concluded: “He's not crazy, but he's dangerous”. Retched insists on committing Mac in spite of the danger, and her superiors defer. Thus, we see Ratched's need to win trumps good judgment. She does win. Mac comes within seconds of crushing her windpipe. The ethical thing to do following the attack would have been to assign Mac to the disturbed ward or to have him released into the custody of the corrections dept. She doesn't. She arranges a lobotomy for Mac. That's how she wins. Retched destroys Mac's ability to function at all; she neutralizes him; she takes away his humanity.
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A nurse has a responsibility to reduce the amount of stress on a patient in mental facilities, not cause it. Electroshock therapy and pre-frontal lobotomy procedures are also used as a form of control in the film. These should be used in extreme cases where it is necessary or beneficial to the patient or not used at all. In any circumstance though, it should definitely not be used as punishment or as a solution to subdue a problem patient in order to control them. Instead, psychotherapy technique could have been used. This strays from the moral conduct expected of hospital personnel. One of the most disturbing scenes in the movie is when a patient, Billy, is embarrassed by the authoritarian, manipulative, patronizing, and mind games player Nurse Retched in front all the other patients. Ratched's treatment of Billy demonstrates her lack of ethics. After Billy loses his virginity with the prostitute Mac sneaks into the hospital, Ratched's demeanor is not concerned but vengeful. She threatens to tell his mother of his sexual encounter he had in the hospital the previous night. In this way, he is treated like a child and not respected of his right as an adult to withhold personal information from others. He is made to feel so ashamed of what he had done which leads to lack of confidentiality.
Moreover, there was no informed consent present, as the horrible Nurse Retched used ECT as punishment in her institution without even informing it to patients. Murphy and two others were given this treatment when they got into trouble. The medication ethics are also pretty shit. When Murphy asks what tablet he’s being given, the nurse patronizes him and then Nurse Retched threatens him. Even when compelled to receive treatment, people should be informed about what it is you want them to take. Therefore, I feel that this was an unethical act seen from the movie.
‘One Flew over the Cuckoo’s Nest’ takes place in what the sociologist Goffman termed a ‘total institution’, where a group of people are confined in a controlled setting for a prolonged period of time. Its features include all activities of daily living taking place in the same location, with a large batch of people all conforming to the same schedule and rules. There is also a marked divide between staff and community members – in this case, patients.
This heightened control becomes obvious in the film when Murphy tries to change the ward’s schedule for the baseball World Series. While there is a show of democracy in the voting, the act is rigged by the staff. The belief that orders and schedule are vital to mental health is being applied here by force and against autonomy. The other most obvious point is the institutionalization of the characters. Murphy is stunned to find out that most of his fellow patients are voluntary and not compelled to stay on the ward. Then why do they stay? So, this was one of the huge challenges faced by the patients.
The movie can be effectively utilized as a training tool. After a thorough knowledge and understanding of systems and interactional pattern analysis are obtained, the movie can be used as an exercise in analyzing the dynamics of the systems and subsystems. Furthermore, it’s beneficial to identify communicative entrapping statements and effects which will also assist the trainee to guard against falling into a similar pattern in future.
If I were the group facilitator or therapist, in order to carry out an effective session to the group, I would first make plans and decisions that will have an impact on the success or failure of the group. For instance, I must decide whether to work from a theoretical or an atheoretical approach. Then comes the job of defining the type of group that is to be established. An ideal number in most groups for adults is between 10 and 14 persons. If the group grows above 14, then members tend to form subgroups. If a group has been set up for therapeutic purposes, the number of group members should be
limited to 7 or 8 persons (Gladding, 1994). Therefore, I would like to keep my group size limited to 7 to 8 members. I will be selecting group members on the basis of their similarity or dissimilarity to each other. Third part of the planning process is to clarify the group's objectives. After these initial steps are taken, other procedures such as screening and selecting members can take place. Recruiting members and ensuring that they have adequate preparation is vital. There are individuals who are not ready or are not able to work in a group, and they should be screened out of participating in the group and instead be offered other needed services. So, I’ll give a great importance to this area too.
The planning of a group will be done with care and precision, the chances are greatly improved that the group will be productive. Care, thoughtfulness, and thoroughness are all critical in group planning. Groups are most effective if the developmental stage of the group is kept in mind during the planning process (Gladding, 1994). I will also carry out the session in a setting where the members feel more comfortable. I would rather go for a psychotherapy technique as these focus on what members can do in the here and now and help members work together to form a cohesive group in which they can freely share their victories and setbacks in a safe and supportive environment. Unlike shown in the movie and when using psychotherapy in a group setting must practice empathy in order for individual group members to communicate freely with each other. This will help those new in recovery build the interpersonal skills they need in order to effectively communicate with others in a healthy manner.
Just as it is important to consider theoretical dimensions of groups, it is equally vital to plan the criteria by which one will respond to ethical aspects of group work. Deciding how to help group members from an ethical perspective and exactly what to do in troublesome situations is a vital techniques and members about the task that group leaders and the group as a whole have to accomplish. I will follow the Code of Ethics strictly. In the movie, Nurse Retched did not bother to ask or let the member know about the procedures or techniques she uses. However, before starting the session I will be informing the procedures, I will be using throughout the session. This will make increase in congruency.
To conclude, ‘One Flew over the Cuckoo’s Nest’ is realistic in some ways, and it was a hugely important movie for the time, because it helped bring attention to some hospitals with unethical practices or unsafe living conditions. Both the book and the movie are insightful views into societal problems such as stereotypes about people who have mental disorders. But the film is largely out of date in terms of depicting hospital staff as manipulative or evil. I believe similar institution, mental hospitals should be calm, healing environments—as they should be.
References
- Gladding, S. T. (1994). Effective Group Counseling. North Carolina: Eric.
- Heaps, J. (n.d.). Psychological Disorders in Film. 1-3.
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