On ECT, Jack Nicholson and One Flew Over the Cuckoo’s Nest

By Dr David Laing Dawson

In my addendum to Marvin’s blog last week I referenced Jack Nicholson in One Flew Over the Cuckoo’s Nest. I’m sure everybody got the reference. Some of those scenes are burned into the collective imagination. And I was a fan of both Ken Kesey’s novel and the movie. I say ‘was’, because as great as Nicholson’s performance, as great as Milos Forman’s direction, and Louise Fletcher’s acting, the movie may have played a minor role in the demise of the Mental Illness treatment system of North America and a return to incarceration in jails and prisons for thousands of the mentally ill, to say nothing of an unwarranted negative public reaction to ECT.  At least unwarranted since it has become more selectively and carefully used to treat only patients with severe illness not responding to medication.

The novel rose out of Mr. Kesey’s part time work as an attendant on the night shift of a Veteran’s Hospital, while taking part in a CIA sponsored experiment with psychedelic, hallucinogenic drugs, in the late 1950’s.

Movies are magic, and they play fast and loose with the truth. In the sound and fury of them, in our vicarious pleasure of escaping our bonds, seeking revenge, getting back the man or woman of our dreams, and saving the world, we often miss a few nuances and incongruities.

Randle McMurphy does embody the free rebellious rule-breaking individual confronting oppressive institutional authority as personified by Nurse Rached. And the movie makes us root for him and hate Nurse Rached. Her ultimate weapons being ECT and Lobotomy.

Now there certainly is some truth to those big overcrowded wards of large mental hospitals being run by nurses whose prime directive was to keep everything peaceful, under control, with a modicum of care and nurturing on the side. And the doctor often was, as described by sociologists, the absent father whose power could be invoked by the nurses, as in “You just wait until your father gets home.”

But here are some of the nuances in that film that slip by us: All but a couple of the patients on that ward are voluntary and could leave any time they wanted. And McMurphy, well, he is a charming psychopath, and he has faked insanity so he could be transferred to that hospital from a prison. His most recent conviction is for statutory rape with his defense being, “She came on to me.” That would imply that McMurphy had sex with a 13 or 14 year-old child at the time the book was written.

Our attitudes have shifted a little since that film was made. Today McMurphy might be charged with “sexual assault” “rape of a minor” “sexual molestation of a minor”. He would be placed on a sexual offense registry, and the public and our courts would show him little sympathy. And, I suspect, that if I were asked to provide a psychiatric evaluation of McMurphy, I would be telling the court that he is high risk to re-offend.

On the other hand, if any actor could make us root for a pedophile it would be Jack Nicholson in his prime.