Either conform and be released, or maintain your integrity and be kept in the ward. During his time working at the Menlo Park Veteran’s Hospital, this is the harsh reality that Ken Kesey learned. Through endless observations and short discussions with patients in the mental ward, he also began to wonder, were these people really so different that they needed to be treated in a special manner? Or, were they only different in the fact that society did not feel like dealing with them, and therefore took the easy way out by placing them in an institute and forgetting about them? (Wilson 288). These thoughts served as one of the many motivations for writing one his best pieces, One Flew Over the Cuckoo’s Nest. Taking place in the 1950’s, this novel, when published in 1962, served as an inspiration to many, and continues to have people questioning authority, and more importantly, questioning insanity to this very day.
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Ken Kesey shows that the line which is drawn between sanity (health) and insanity (illness) is based entirely on individual perception, and as such it is difficult to determine exactly where that line should be drawn. Minds may be altered through ingestion of prescribed medication, or be substance-free and shaped solely by social norms and values, but in all cases reality is shown to be an entirely subjective experience. The apparently sane reader will be aware at the start that they are reading the narration of someone who is paranoid and delusional, but at some point during the story this conscious awareness disappears and the difference is no longer questioned. This no doubt mirrors Ken Kesey’s own interaction with those termed “mentally ill.” By the end of the story the reader may find that a lot of their preconceived ideas about what constitutes health or illness have been shattered. The mad person here is more insightful than the caregiver. In fact, it is the forms of therapy which are considered curative that often keep the person locked in their illness with little or no hope of recovery. Health and illness suddenly become grey areas rather than black or white certainties.
The novel is set in a mental health institution and is narrated by Chief Bromden who has been institutionalised for many years. He is striking in stature and in looks, being over six and a half feet tall and a half-Columbian Indian. From a psychiatric point of view his illness is undoubtedly real. He sees society as a huge, mechanical, controlling device called “The Combine”. In his perception the hospital is somewhere that those who do not conform are sent to be fixed and Nurse Ratched is the Combine’s agent. She can control time by means of a mechanical device in the nurse’s station. The Chief exists much of the time inside a fog. This fog appears to have two purposes. It can be induced by the staff when they want to hide something from the patients, or it can be a source of psychological comfort to the Chief when he feels uncomfortable with what is going on around him. The Chief pretends to be deaf and dumb and does not communicate with others on the ward in any way. He reveals his reasons for doing so:
I lay in bed . . . and thought it over, about my being deaf, about the years of not letting on I heard what was said, and I wondered if I could ever act any other way again. But I remembered one thing: it wasn’t me that started acting deaf; it was people that first started acting like I was too dumb to hear or see or say anything at all. (Kesey 179)
Chief Bromden’s decline into what society would define as illness has at its foundation the negative attitudes of society towards him. He has become what people have wrongly perceived him to be.
Those in charge of the Chief’s care are not aware of these facts. No attempt has been made on their part to link events in his early life with the symptoms he is now experiencing. They cannot see past the text book presentation of schizophrenia. Kesey is telling us that mental illness isn’t strictly an illness at all. It is simply a form of individual expression that makes the majority of society feel uncomfortable. Therefore the best way of dealing with it is to remove that individual. People such as Chief Bromden would be locked up in asylums for many years with no attempts at finding causative factors for their illness until psychiatry began to undergo paradigm shifts in this regard in the 1980’s. By then the effects of decades of institutionalisation meant some had no hope of ever rejoining society. There is a premonitory quality in One Flew Over the Cuckoo’s Nest given that it was written some 20 years before psychiatry woke up to their mistakes and began their programmes of rehabilitation.
We are introduced to sanity in the form of Randle P McMurphy, the protagonist of the story. Just transferred from a prison work farm for being someone who “fights too much and fucks too much” (Kesey 11), he has been given the label psychopath. It is clear from the beginning that McMurphy is not suffering from mental illness in the way that the other patients are. He laughs freely and refuses to be controlled by Nurse Ratched. Chief Bromden “realize[s] all of a sudden it’s the first laugh [he’s] heard in years”. McMurpy’s laugh is “free and loud” (Kesey 11). It is McMurphy, not the hospital, who provides the therapeutic environment in which recovery can begin.
The Combine’s answer to mental illness is to lock people up, tranquilise them, use group therapy in which the patients attack each other in order to gain rewards, and in the cases of problem patients who refuse to conform to the rules, the use of Electric Shock Therapy and lobotomy is commonplace. As the patient Sefelt explains “What a life â€¦ give some of us pills to stop a fit, give the rest shock to start one” (Kesey 132). In stark contrast McMurphy offers his own form of treatment. Rather than locking people up he believes they should be set free. Instead of tranquilisers he favours recreational drugs such as alcohol and marijuana which can be taken through choice rather than imposed and which will enhance perception rather than deaden it. His form of group therapy involves a fishing trip where the men learn to co-operate with each other for the purposes of group harmony. He has no alternative to EST as a treatment but after receiving it himself he becomes eerily calm. His way of beating the system is to deliberately use the effect which they desire to his own advantage. As for lobotomy, that defeats him in the end. The system has its most powerful tool – they remove individuality and with it the rebellion disappears.
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The forms of therapy used in the hospital are completely ineffective in achieving anything other than a sterile, automatic and highly controlled environment. The antagonist Nurse Ratched rules with fear. She destroys the patients’ self-esteem. As Tony Tanner says, “In a crude way she embodies the principles of Behaviourism, believing that people can a must be adjusted to social norms . . . [She] has reduced the men to puppets, mechanically obeying her rules” (Tanner 373). Nurse Ratched’s goal is to remove any traces of the individual psyche and she is largely successful before McMurphy arrives. Chief Bromden’s delusions of the mechanistic workings of the hospital may be a result of his insanity, but there is also a metaphorical quality to how he sees things.
McMurphy offers the only hope of defeating Nurse Ratched and therefore defeating the Combine. McMurphy’s therapy is largely successful. He teaches the men to be more outward looking. He encourages their self-esteem. He recognises that they have all been dominated in various ways by women in their lives and realises that this lies at the heart of their problems. To McMurphy these men are not ill. They are simply in need of a means of expressing their sexuality. He has particular success in the case of the stuttering, infantile Billy Bibbit. He arranges for him to have sex with Candy Starr. The therapy works well. Billy is a more relaxed and happy individual but Nurse Ratched soon gains back her domination. By threatening to tell his mother, she reduces Billy to the unconfident wreck he was previously. Unable to cope with the prospect of his mother being told details of his sex life he commits suicide. This leads directly to McMurphy’s downfall. He brutally attacks Nurse Ratched and viciously attempts to strangle her. At last she has the excuse she has been looking for. She is able to have McMurphy lobotomised.
Mental illness and mental health are now defined and treated in different ways than they were in the 1960’s. Like many others at the time, Kesey did not see what made the “insane” different from everybody else. Ken Kesey has given his readers different ways of defining what is health and what is illness and shows us that while our perceptions are what makes us individual, it is by other people’s perceptions that we are labelled. The two states of being can only be distinguished by the assumption or belief of the majority, which will always leave a minority who don’t fit.
We are given no answers. The conclusion is negative. “It’s a hell of a life. Damned if you do. Damned if you don’t” (Kesey 154). Even the McMurphy whom we consider to be sane in the end fulfils the “psychopath” label which the Combine has placed on him by attempting to murder Nurse Ratched. However justified he may be, society cannot condone his actions. McMurphy has grown through the story from a self-interested con man to an altruistic messiah-like figure that is sacrificed in the end for the greater good. McMurphy, unwilling to conform to any rules or standards however does not symbolize a present day tyrant, or radical, but rather the typical hero archetype. The hero complex, which consists of bravery, intelligence, and drive, does not fit McMurphy manifestly, but throughout the novel as he lowers his shield and more is exposed, it is clear that he is looked up to by the other men of the ward. He is the guy that most of the men in the ward wish they could be, and the guy that the people working in the ward fear.
But even altruism cannot overcome illness. To use the famously coined phrase of Kesey’s, the only way of coping with life is to “go with the flow”. The only problem is, just who’s flow do we choose to go with? Our own? Society’s? Is there a difference? Is there such a thing as health? Is there such a thing as illness? The novel gives us no conclusive answers.
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