Cuckoo's Nest 10-15 (pages 117-148; Finish Part 1)

At the time “One Flew Over the Cuckoo’s Nest” was written mental health was still fairly new. According to the US Mental Health Timeline, mental health institutions were more to get these people out of the public. The people in these institutions were not well cared for, E. Fuller Tory stated “People who have “diseases of the brain” should be treated” much more compassionately". I agree with this, the people in the story don’t have much of an idea of what's going on, at least this is true for Chief… he believes that everyone is out to get him. If the nurses were more compassionate towards him maybe he wouldn’t feel this way.

In the book, Cheif says “I’d wander for days in the fog, scared I’d never see another thing, then there'd be that door, opening to show me the mattress padding on the other side to stop out the sounds, the men standing in a line like zombies among shiny copper wires and tubes pulsing light, and the bright scrape of arcing electricity. (132)”. I believe that when Cheif is “in the fog” his mental illness, specifically schizophrenia,  is acting up, which nurses take notice of and send him to get electroshock therapy. The way he talks about the therapy makes it sound like they are killing people, basically chaining people down and torturing them, but electroshock therapy has actually been proven to help people. According to R. Douglas Feilds, electroshock therapy is “used on over 100,000 people a year in the US” and “is highly effective in treating severe depression, bipolar disorder, and other mental illnesses.”. As I mentioned earlier Cheif doesn’t comprehend what a lot of things mean making him think everyone is out to get him, them using electroshock therapy is their way of trying to cure him.

In the time frame that One Flew Over the Cuckoo’s nest takes place, mental illness was a disease that was not very well known in the medical industry. In 1934, a scientist, Ladislaus Meduna, experimented with inducing seizures to increase Gila cells in the brain. They hypothesized that the lack of Gila cells was the problem with these disabilities. On the fifth electrocution of his first experiment, the once vegetable of a man woke up, dressed himself, and addressed Meduna as if nothing had happened. This helped people with schizophrenia and depression, as their brains lacked Gila cells (Fields). 

In Chief’s story, he seems to have schizophrenia and when he goes through spells of insanity, he goes into the “fog.” I believe this fog is induced because of the electrical treatments that he might be undergoing at the hospital and it’s affecting his brain, “So I used to try not to get in too deep, for fear I’d get lost and turn up at the Shock Shop door” (132). Chief was scared of getting shocked so it prevented him from acting out. This implies that he has been shocked in the past. The doctors are trying to cure him by shocking him but it’s just making things worse. Chief doesn’t realize the doctors are trying to help him get better, so he is scared of them.

Insane asylums during the 1820s and beyond were extremely neglected and the mental health of people was not properly being accounted for. Mentally ill patients were placed into prisons and hospitals where they were not properly cared for and the conditions were not acceptable for mentalally ill patients or even prisoners. Advocates helped create new insane asylums to house patients and were supposed to be a peaceful place made for recovery and full of compassion.

Electroshock, lobotomies, and other out of date forms of treatments were used before medicine became an option to treat patients with a mental illness. The new form of treatment through medicine was supposed to help rehabilitate patients. 

The amount of patients in mental hospitals decreased drastically after Kennedy funded to open more smaller mental institutions and train professionals in order to allow patients to live in smaller and more community based facilities. 

From the perspective of the Chief, the mental institution he has been placed in does not fit the ideal community and hospital that were being promoted by advocates and by Kennedy for years. The mental institution he is in does not hold any compassion for the patients. Nurse Ratched and her employees do not have the intention of trying to help the patients. Ratched forces the patients to express wrong doings or past traumas in front of the whole ward so they can judge them. She tries turning the patients against one another. Her patience seems to grow very fast which leads to her resorting to sending away patients or finding an alternative solution in order to quiet them. Her intent does not seem to be to help the patients leave the hospital. The patients are constantly told that they are being shaped into good citizens for society but they are not receiving any sort of treatment that would help them progress towards the goal of being released. The patients are just given drugs to quiet them or when they try to advocate for themselves they are threatened with old forms of treatment such as electroshock therapy. Electroshock therapy can be successful for some patients but the hospital is using the treatment as a way to scare the patients instead of as a way to help treat them.. There are also barely any staff members who are properly trained for the job, hence why there are only about three of the workers which the Chief talks about frequently. The workers are not patient or considerate of the patients. The hospital building itself is nice and updated but it is only that way to hide the neglect that the patients are suffering from. 

The History of Mental Institutions helped me learn about the lack of mental health support during that time. To be honest I’ve struggled to understand and follow this book, and had never heard of electroconvulsive therapy. Now the “shock shop”(Kesey, 69) that is mentioned earlier in the book makes sense. I wasn’t aware of the enormous number of people that dealt with mental health issues during this era of time, and how they didn’t receive effective help. Until Psychiatric Drugs were developed and John F. Kennedy pushed the issue with the increase of institutions and research, over half a million people suffered from mental illnesses. Electroconvulsive therapy and other, “treatments often left patients severely damaged.”(Event 1954. https://www.tiki-toki.com/timeline/entry/37146/A-History-of-Mental-Institutions-in-the-United-States ) This helps me understand why some of the patients on the ward have become chronics. Their brain and bodies are already altered from the shock therapy and there’s no reverting it. When McMurphy is entering the ward and, “He shakes the hands of Wheelers and Walkers and Vegetables,”(Kesey 23) he has to pick up some of their hands because their minds and bodies aren’t capable anymore. 

The Scientific American article affects the way that I view the Novel’s representation of ECT because I understand that it’s not an entirely bad form of therapy. The Novel is presented to us through the lens of a patient in the ward, who is made to give us a negative perception of ECT. This is because, like many people during that time, Chief doesn’t all understand the efficacy of ECT. The findings in the article go against my inference that shock therapy makes all the acutes in the ward chronic because, “ECT is highly effective in treating severe depression, bipolar disorder and other mental illnesses.”(Fields, https://www.scientificamerican.com/article/beyond-the-cuckoos-nest-the-quest-for-why-shock-therapy-can-work/ ) But early in the novel, Chief talks about Ellis and how they, “overloaded him in that filthy brain-murdering room.”(Kesey 16) So the book and article agree on the idea that researchers need to learn how to properly administer the therapy to individual patients. There are variables like, “The power, the frequency, the electrode placement,”(Fields, https://www.scientificamerican.com/article/beyond-the-cuckoos-nest-the-quest-for-why-shock-therapy-can-work/ ) that can all altar the success of ECT. Institutions lacked knowledge of these details around the time of the novel, which is why I believe the novel gives us this representation of ECT.

In the past, mental institutions were very prison-like. They were very cold, dull, undesirable, and were seen as a punishment. There was a switch in 1825 where the legislature fought for “...better prison and jail conditions and hospitals for the mentally ill”(Dix and the Growth of Institutions). They wanted to create “...very peaceful locations where people could go to recover and not be subjected to those terrible conditions”(Dix and the Growth of Institutions). Many patients see these newly renovated asylums, even if they still use harmful tactics, as a home. As the place they eat, sleep, and will eventually pass. This is painfully true when considering the ‘Chronics’ in ‘One Flew Over the Cuckoo’s Nest’. 

 Throughout the novel, I was wondering why these patients weren’t revolting against these things that McMurphy deems unfair, because he has quite a few reasonable concerns. He feels as if the patients should be allowed to vote on concerns, believing he has a right to fight for democracy. I was trying to understand, I agreed and was wondering why others don’t stand up for themselves when treated wrongfully, or being a bystander to mistreatment. But now it is easy to understand why.  Public Relations stated that “A man that would want to run away from a place as nice as this…why there’d be something wrong with him”(Kesey 127).The patients couldn’t even imagine escaping or not living there, and will do their best to not speed up the death process or make their situations worse. 

The article seemed pretty accurate as how it was described in the book. It does give some insight on how outside of the ward would've been like. How it was clear patients were being mistreated in most places, but in the book many don’t seem to know. How medicine changed a lot of things within the system, and in a little over a decade or so, less patients were being admitted because of the help of medication. 

Everything contradicts, but with sense. It makes sense that some patients might be happy and better after a procedure, while others may not, or that wellness will only happen for a certain amount of time. In the book it only looks like this procedure would be a bad thing. And to the patients in the ward it most likely is. “Sometimes I got lost in it anyway, got in too deep, trying to hide, and everytime I did, it seemed like I always turned up at that same place…” (131) In this quote Chief is talking about electroshock. And it seems every time he gets too deep into a “fog” that is where he ends up. This could be seen as a representation of his mental illness, which is basically the reason for this procedure in the first place. Chief portrays the room horridly, based on his experiences. ‘“The procedure has been so horrifically portrayed in media...showing it being used in mental facilities as punishment, not for its tremendous therapeutic effects,” Ingram says” ( https://www.scientificamerican.com/article/beyond-the-cuckoos-nest-the-quest-for-why-shock-therapy-can-work/ )  Because clearly, Chief hadn’t had good experiences with it. Compared to some of the good outcomes in the real world.