Chapters 10-15 (Finish Part 1)

I knew that treatment for people struggling with mental health was very bad in the past. The world viewed them as lunatics because they didn't understand the science. However, I learned that in 1954, an anti-psychotic drug called Thorazine was introduced and was then mass-prescribed to many patients to calm some of their disorders and help institutions maintain order and control. The book takes place in the 1960s, so conditions for mental health patients in institutions were starting to get better, especially because of new drugs that could be used as treatments. (We see that, for example, with the pills given to each patient before bed). However, there was still a lot of misunderstanding and society in the outside world still judged people as being insane or a lunatic in many cases. Even though Chief says things in the ward were better than they used to be, the patients are still being manipulated and treated poorly.

The article discusses how ECT has improved significantly since it was first used in the 1930s. It is much safer and kinder now, and often can save lives. However, ECT is still inconsistent in who it works on and to what degree it is applied. There is a lot that we still don't know about ECT and how it works. In the book, ECT is carried out in the Shock Shop in a violent way, as can be expected due to the time period. The only thing the article really changed my perspective on is that fact that shock therapy can actually be beneficial, especially when carried out in a humane way. I guess that would work against the inference that everything they do in the Ward (in the book) is not necessarily for the benefit of the patients. For example, Chief mentions the installations done by the ward staff and how patients sometimes come out a completely changed person much nicer and better behaved, so  "improved." But Chief doesn't necessarily view these procedures as positive. He says, "A success, they say, but I say he's just another robot for the Combine and might be better off as a failure..." (Kesey 17). If ECT is effective, then I suppose it would be helpful to some patients, which goes against the previously mentioned inference.

The article supports my inference of the inhumane methods of treatment that the ward sometimes uses. The way the article starts out is by explaining the origin of shock therapy and how brutal it was at the time. Only a few decades later, they're still using ECT on the patients in the book. Chief provides some supporting evidence when describing what is on the other side of the Shock Shop door: "...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...the table shaped like a cross, with shadows of a thousand murdered men printed on it, silhouette wrists and ankles running under leather straps sweated green with use..." (Kesey 131-132). This type of treatment is what was typical for the time period. 

The first article showed me that every ward was like that in that time period. They were throwing anyone who showed any sign of mental illness in a ward because they did not know what to do with them. The world was not that advanced yet with psychiatric knowledge like we are now. It was just in 1954 when they developed Thorazine which basically sedates the patients. Then millions of people were prescribed it when they probably did not even need it but the ward thought they did. It sounds very similar to what goes on in The Cuckoo’s Nest and shows me that in their time period, they were doing what everyone else was, but that still does not make it right. Mental health facilities have come so far today and have definitely grown from how they were in the past.

The article talks about how ECT can be used today to treat certain patients. It has improved a lot since how it was used in The Cuckoo’s Nest and there are many success stories. But, it is still inconsistent and hard to figure out which case should use ECT or not. I thought that today this kind of treatment was not happening because of all the past awful occurrences, but the article showed me it is still going on, just more improved. The article works against the Novel when it talks about, “the horrifying scenes dramatizing shock therapy in movies like One Flew Over the Cuckoo’s Nest, violent seizures did not wrack the patient’s body when the high-voltage switch was thrown”. It is talking about how ECT in real life is not as bad as the Novel makes it look. But, both the article and Novel support each other when the article mentions what ECT is used for, “ECT is highly effective in treating severe depression, bipolar disorder, and other mental illnesses”. Most, if not everyone, in the ward has some type of mental illness and that is why they are in there. So, ECT today is still being used to treat the same types of illnesses it was in the novel.

Obviously, the care for mental illnesses has come a very long way over the years and it is for the better. It was not that long ago, certain drugs that people use every day now, were just developed. When they were first made, not many knew who they should be prescribed to or the right dosage for each patient. Now, with modern technology and more time to experiment, our medical healthcare has become quite advanced. So, back when the Novel takes place, having those scary treatments were common but people today look at it like it’s crazy. Those scary treatments could look like this, “But they kept making the fog thicker and thicker, and it seemed to me that, no matter how hard I tried, two or three times a month I found myself with that door opening in front of me to the acid smell of sparks and ozone” (Kesey 132). Like the article said, the Novel is dramatized, but I am sure treatments did look somewhat like this back then, which is scary to think that people had to be put through that.

I think that it was very interesting to read about Dix in the middle of the 1800s. She advocated for those that lived in psychiatric facilities and fought for more rights. She also advocated for more humane and nice conditions for them, which I think would be helpful for those in the book. The Chief, in the book, talks about how there were times when he, or others, would be subjected to shock therapy and other therapies that did not seem to help them, such as isolation. These therapies were just some of the problems that Dix was trying to help solve. During the time when the book was set, society as a whole did not believe that those were things that needed to be fixed. 

In the article, it talks about how they used shock therapy to help cure and rehabilitate those in psychiatric facilities. These morals were also brought up in the book, however, they were not talked about in such good/ moral terms. In the article, as well as the book they talk about “running under leather straps” (132) This imagery shows just how badly they were treated. They were strapped down, against their will, and used to show how therapy could be used in institutions.

ECT as a whole, when done correctly, is not a bad thing. Now adays, when ECT is used, it is given to mentally ill patients at a very low dose. This little shock of electricity, less than a second, is proven to help those with specific mental illnesses, such as schizophrenia. These therapies, although not correctly used in the book or the article, can be helpful/ needed for many mental illnesses.  

Looking at the history it truly disgusts me who mistreated mental health patients. Before the discovery of phytrichairt drug therapy mental health patients were treated as if they had no hope. Electroconvulsive therapy was done to them and this left a serious amount of damage. This reminds me of how the Chronics are treated in the novel. Everyone was treated as chronic for this time period even if they were fixable IE Acutes. 

 Reading the article provided discusses the experimental therapy done on a man who had not been able to speak or move and the shocking results. The first seizure did not do anything to the man and in fact just made the doctor feel guilty to the point of collapsing. By the time the fifth seizure was induced however, it gave very different results. “By the fifth seizure he induced on February 10, 1934, the man awoke, dressed himself, requested breakfast and greeted Meduna cheerfully by name.” Someone who was viewed as a vegetable for the rest of their life miraculously recovered to the point of being able to fend for himself. This case went well and many others aspired to do the same to their hopeless patients. However the results were not always positive. In some cases, patients who underwent these primitive procedures experienced improved mental states noticeably. But they could also induce violent, whole-body contractions that sometimes dislocated joints and broke bones.” As you can see this method was not and end all be all. This sparked the debate of this being a good idea or not. What if this was done to the Chronics of the ward? Yes it may provide the chance to walk and eat alone again. However, it could also cost them their lives. Chronics are used to life the way they are and some may not see the benefit to the risk of losing their lives or breaking bones. It truly depends on the individual. This article reminds me of the incident with the Chronic who had an experiment go wrong when he was acute. “Ruckly is another Chronic came in a few years back as an Acute, but him they overloaded in a different way: they made a mistake in one of their head installations. He was being a holy nuisance all over the place, kicking the black boys and biting the student nurses on the legs, so they took him away to be fixed. (13)” Just like the article, the electric shock therapy instead of helping others really harmed them. Against their will patients in the ward were strapped down to tables and experimented on. The fact is this happens in real life. Not being able to defend yourself both literally and through speech is a terrible thing. Mental health patient recovers and ways of helping have come a long way however. Every patient now has there emotions and reasonings taken care of individually and are not all given the same treatment no matter the cause of the mental health issue. 

I didn’t realize just how many people were in mental health institutions. I also didn’t know that a new drug came out called Thorazine, which was used to calm down large groups of patients so that they could be controlled. This drug came out just before the novel takes place, which could mean that the idea of controlling drugs is still new and it could be being abused by those in power. In terms of outside the ward, I think that most people just view everyone in the ward as being crazy because they’re very segregated from the rest of society and no one outside really gets a look into what it’s like inside the ward. 

The article talks about how ECT has improved a lot since it was first introduced, and how now it can even be used to treat people with mental illnesses like depression. These treatments definitely used to be very violent and they still can be, but when used correctly and on the right people, they can do a lot of good. This idea goes against the inference that everyone is mistreated in the ward since these ECT treatments could have potential benefits linked with them. The article talks about how these treatments are now a lot different than the “horrifying scenes dramatizing shock therapy in movies like One Flew Over the Cuckoo’s Nest.” They specifically called out that ECT treatments have come a long way and they often aren’t as harmful as they are portrayed to be.

However, this article also does some to support how treatments are only good when they’re used the right way. In the novel, Chief describes that, “Now he’s nailed against the wall in the same condition they lifted him off the table for the last time, in the same shape, arms out, palms cupped, with the same horror on his face. He’s nailed like that on the wall, like a stuffed trophy (16). This shows how Chief sees how patients are being treated in the ward and how it doesn’t seem like the nurses are going to full lengths to ensure comfort or safety.

Mental health is something that a lot of people struggle with. When dealing with something as serious as mental health, it is so broad and everyone deals with it differently. I know that some cases are more severe than others and some people may need more help than others. With that being said, reading about how they use “prison” to describe a mental health hospital rubs me the wrong way. Just because someone looks or acts differently than you, or may need more help than you necessarily would, does not make them any less of a human than you are. It made me think back to the novel and how people are basically treated just as badly as people on the ward in the novel were. A lot has changed over time, but that doesn’t mean we should forget about the way people were treated because, at the time, they thought it was the right thing to do. 

When I read the first article, it talked about how much time and effort Dix put into making it an overall better environment, “They were supposed to be very peaceful locations where people could go to recover or at least have a chance to recover and not be subjected to those terrible conditions” (Dix 1825). When Dix is explaining what mental hospitals were supposed to look like, you could tell she was really passionate about it as she’s out in quite a lot of time trying to change the way the mental hospital was perceived. It made me think back to the book and it’s very clear that they aren’t in there for the best interest.

In both the article and the timeline, it talked about a specific therapy called electroconvulsive therapy, “these treatments often left patients severely damaged” (1954). Even though every time they used electroconvulsive therapy, it had gone wrong, you would think they would have stopped it soon.

In the novel, it stated, “I’ve heard the Cheif, years ago, receiver more than two hundred shock treatments when they were really the vogue” (41). As stated earlier, when treatments wouldn’t work the first couple of times, you would think they would stop it altogether rather than continue to do so. 

Before reading the additional information about the history of mental institutions, I knew that in the past they were not as developed. The information they had was limited and so they resorted to electroconvulsive therapy, insulin coma therapy, and lobotomies as treatments, many of which are discussed in the book. Something I did not know was that mental institutions at that time were created to be a more comfortable place for mentally ill people where they wouldn’t be subjected to terrible conditions as they would in prison. To me, it seems as though they were trying to find a place for mentally ill people where they wouldn’t bother the rest of society and where they would be safe from society. This is also mentioned in the book when Chief says, “Nobody complains about the fog. I know why, now: as bad as it is, you can slip back in it and feel safe. That’s what McMurphy can’t understand, us wanting to be safe” (Kesey 128). Since McMurphy is accustomed to the outside world and never experienced the problems and stigmas surrounding the other patients, he believes everyone should be treated the way he was used to outside the ward; he doesn't understand why all the patients are more or less content with where they are and the ward's policies. In addition to this, the new information I learned about mental institutions housing mentally ill people rather than jails also supports the idea that McMurphy is pretending to be mentally ill in order to stay in a place that’s better than a prison sentence. As the public relations guy said, “A man that would want to run away from a place as nice as this… why, there would be something wrong with him” (127 Kesey).

The article gives a new perspective on what is happening within the ward. Although Nurse Ratched and the other people working in the ward are made out to be the bad guys, they most likely are genuinely trying to help their patients. Since this was a time where there was little knowledge on mental disorders, they are trying to help as best they can with the information they do have. For example, the usage of electroconvulsive therapy (ECT), although risky due to minimal information/research, could really help some people. This goes against the inferences the readers make from the book because of the unique perspective we get from Chief. Since he’s been through ECT and has been in the ward for a long time, our view of what is actually happening is distorted to think the staff is out to them because he was a victim of ECT going poorly and because of how McMurphy responds to how the ward is run. Looking back, I find myself realizing that even though Nurse Ratched is manipulative and can go too far, she also can show how she cares for the patients’ well-being in instances where she explains how the ward’s “...schedule has been set up for a delicately balanced reason that would be thrown into turmoil by the switch of routines” (118 Kesey) when McMurphy wants to watch the World Series. Although it’s easy to recognize that the way mental institutions were run in the past was not good and that we’ve come a long way with more humane and effective treatments, they were doing the best they had at the time.

Prior to reading what happened in the year 1825, I knew that there was a decision made at some point in history to create psychiatric wards for those who are mentally ill rather than sending them to prison. What I was not aware of was how early they were created. The text from, ‘Tiki Toki’, explains the purpose of these buildings were, “... peaceful locations where people go to recover or at least have a chance to recover and not be subjected to those terrible conditions’ in the prisons” (Ron Honburg). The novel does not seem to be creating this ideal plan that was made in 1825. In 1954, there was a drug discovered that calmed people with schizophrenia which was not used in the book because it had not been discovered yet at the time the book was set in. Before this drug was used in psychiatric wards, they used, “electroconvulsive therapy, insulin coma therapy and lobotomies” (Kaydence Jackson). The book has blatantly come out and said that this is what was done to the patients, but the way chief describes one situation makes us believe this is how they were treated, “You are strapped to a table, shaped, ironically, like a cross, with a crown of electric sparks in place of thorns. You are touched on each side of the head with wires. Zap!” (Kesey 69). The book makes this treatment out to be some sort of punishment which is how society views it when in reality it actually can do wonders according to Wendy Marie Ingram from Scientific American Article, “The procedure has been horrifically portrayed in the media… showing it to be used in mental facilities as punishment, not for its tremendous therapeutic effect” (Ingram). This makes the reader wonder if Chief has been treated by the staff in such a way that makes him believe they are the enemy when they may actually be trying to help him. 

During the time that time article focuses on, mental health and the effects it has on a person was quite a taboo subject. Even to this day, there is still a stigma around mental health issues that many are trying to correct. Mental illness was seen as a weakness and even incompetence. People who sought help for their personal issues were outcasts and it was something they were told to keep quiet about. This article puts poor treatment of patients in mental health and psychiatric facilities into perspective. Often when we think 'electroshock therapy' we think of the overdramatized version of the procedure that we see in movies and TV shows where they "turn their brains to mush" and such. While this procedure is not the safest approach and not particularly recommended, we should also think back to the observations the doctors made. I'm sure these physicians were not evil doctors that wanted to harm their patients, they believed that something would work and made post-op observations that supported their claims. In the long run, we know that it was not entirely effective, but at the time it was quite the breakthrough. In the book, this procedure is almost made out to be a form of punishment, somewhat dreaded by patients. 

In the first link, I made a connection from the 1825 historic section where research was being done on the conditions of the mental illness institutions. Ron Henburg, director of policy and legal affairs for the National Alliance on Mental Illness, once stated in the early 18th century, "...they were, at the time, very nice buildings. They were supposed to be very peaceful locations where people could go to recover or at least have a chance to recover and not be subjected to those terrible conditions in the prisons". During the growth of mental illness institutions, most of them began looking more like prisons than recovery facilities for those in need. Relating to the novel which takes place in the 1960s, Chief and McMurphy make it sound like the reformation of mental facilities was never established.  

The following article, explains in-depth what electroconvulsive therapy (ECT) did for patients. As a reader, Chief made the treatment given by the ward sound directed by malicious intentions. The article references that idea within the novel and explains that "...in contrast to the horrifying scenes dramatizing shock therapy in movies like One Flew Over the Cuckoo’s Nest, violent seizures did not wrack the patient’s body when the high-voltage switch was thrown" (Ingram). 

“You see the body tense for a period of time and then it relaxes—that’s it,” Ingram says. “It’s amazing,” she adds, “patients who are severely depressed, suicidal or catatonic are given ECT, and two weeks later they are up, happy, chatting with the physicians and nurses", Ingram states in the article. This information was new to me and surprised me as a reader since electroconvulsive therapy (ECT) was given created to benefit the patients' condition entirely. Though the risk of safety still stands due to the minimal amount of information/research at the time. 

I learned a lot in the first article with the timeline, I find it crazy that they had been doing those types of treatments even though there was not a pill treatment those other treatments had a great chance of causing serve damage to the people who had it. Knowing that the treatments may not even work just seems like it was practically torture. It is also crazy that when the pill came out they gave it to tons of people just so they could keep people calm, it seems like it was more for the people taking care of the patients rather than benefiting the patients themselves. This seems to be what is happening in the ward and it is something that Chief and McMurphy notice in the book. Chief especially realizes how none of them really go insane but all of them have been taking their pills.

The article about ECT's explains that there is a lot more research done on it today rather than just giving people an electric shock it is used at a lower level as well. Most of the time an ECT is a last resort option, I would have thought that the ECT was no longer a thing at all. The article talks about how it is no longer a thing that is as horrible as some movies may present it, the article says, "In contrast to the horrifying scenes dramatizing shock therapy in movies like One Flew Over the Cuckoo’s Nest, violent seizures did not wrack the patient’s body when the high-voltage switch was thrown. " (Ingram) The book represents the ECT as a horrible thing that is almost used to punish the people in the ward, "“You are strapped to a table, shaped, ironically, like a cross, with a crown of electric sparks in place of thorns. You are touched on each side of the head with wires. Zap! Five cents’ worth of electricity through the brain and you are jointly administered therapy and a punishment for your hostile go-to-hell behavior, on top of being put out of everyone’s way for six hours to three days, depending on the individual." (Kesey 69) The article goes against this because things have changed and they still are doing research on how this affects people as individuals. 

I was very well aware of the stigma society had on mental institutions. Mostly because they haven't changed a ton since the 1900's. People one the outside still view psych wards as a scary place to be. Where insane and unstable people go to get help that they cant imagine needing. I was also aware of the shock therapy transition to psychiatric drug therapy. I wasn't aware this was all in an effort through Dix's work in 1825. She said that "people with mental illness should be treated 'much more compassionately'", according to the History of Mental Institutions. However during McMurphey's and Chief's time at the ward, they had to experience both drug therapy and shock therapy which leads me to believe it was still during that transition period. 

I wasn't aware that shock therapy had any benefits. I thought it was purely used a punishment, as it was made out to be in the book. This isn't the only source that has lead me to believe that shock therapy was a punishment. Shows like American Horror Story, have dramatized and exaggerated some of the many horrors the staff at wards did. The way they abused the shock therapy and used it as a power move. “You are strapped to a table, shaped, ironically, like a cross, with a crown of electric sparks in place of thorns. You are touched on each side of the head with wires. Zap!” (Kesey 69). This description of the procedure from the patients point of view instills fear. However, the article "Beyond the Cuckoos Nest: The quest fr why Shock Therapy Can Work", explains the great results from this extreme procedure. Someone who would've been referred to as a "vegetable" was now dressing themselves and requesting breakfast. I found that rather interesting. Today it is used as a last resort to patients. It will never be used to the extent books and movies and past wards abused it.