It is suggested that Ken Kesey”s One Flew over the Cuckoo”s Nest contains examples of behaviour and attitudes displayed by characters within the clinical environment of the psychiatric ward which can be compared to behaviour found within contemporary American society. These include examples of leadership and hierarchy within a class or caste system, sexism and crime and punishment.
In the text, the theme of leadership is very prominent and important to the story. Arguably it is more important theme of the book, than the issue of mental illness, which forms the setting and the core of the novel.
The leader figure in the ward is Big Nurse, who has complete control over the ward. Any decisions that are made over a patient or with regards the running of the ward must go through Big Nurse first. She is seen by the Chief as being almost mechanical in her approach to her running of the ward:
She”s got that bag full of a thousand parts she aims to use in her duties today-wheels and gears, cogs polished to a hard glitter…(10)
The ward is run by her to a very strict daily routine, which is almost fanatically neurotic in it”s precision and dedication. Chief describes Big Nurse”s devotion to her daily routine:
‘The slightest thing messy or out of kilter in any way ties her into a little white knot of tight-smiled fury” (27)
When McMurphy enters the ward, the delicate equilibrium which the nurse has created is upset. This is because, like the nurse, McMurphy is a natural leader-figure. He takes over the control of the ward by manipulating the patients; seemingly for their own good, but it may be argued that he gets a feeling a control from being a leader over a large group of people.
This may be a feeling of control and power which has previously been absent in his life for some reason.
We are told, early in the book, of McMurphy”s admission to the ward doctor about his conviction for raping a fifteen year old girl, and his unwillingness to acknowledge that he had committed a crime:
‘Said she was seventeen, Doc, and she was plenty willin”… so willin”, in fact, I took to sowing my pants up” (40)
This could also be argued for Big Nurse; What is her motive for her total dedication to the job? It is possible that she also relishes the feeling of control over the patients in her care which her job allows.
She knows that she has absolute power over every patient in her ‘care”; The power to change any of her patient”s lives immediately wherever she might see fit.
Such behaviour can also be seen in contemporary society in an environment such as a school;
The school is a good example because it has a central leader in the position of the head teacher. The head teacher has full responsibility over every person within the school, and also sets the rules and regulations which everyone in that particular school must obey.
If a member of the school breaks any of the rules, the head teacher will decide an appropriate punishment. While the head teacher is answerable to the Governing Board of the school, they still have the most ‘power” and authority over the school.
It can also be shown within a large corporation with the position of a Managing Director. All other staff in the company are directly answerable to him. The Managing Director has the power to hire new staff, and also to make staff redundant. But, again, he is answerable to the owner of the company and perhaps the shareholders; so he can never have total power in his position
This can be contrasted with Big Nurse; She is, in theory, answerable to the Management Board of the hospital, and even to the doctors who work on the ward. But she appears to have the most control over the daily running of the ward, as if she were senior to the doctors, even though, in fact, she is only a nurse. She seems to have total and complete authority over every person in the ward.
The theme of leadership does not mirror the outside world very accurately, as in contemporary society a leader of a society or an organisation is almost always accountable to a person senior to him. This is not seen in the novel, as Big Nurse seems to be answerable to no one, in fact, it is arguable that everyone answers to her.
A hierarchy or class system operates inside the ward which can be clearly seen throughout the course of the novel. Patients living within the ward are ‘classed” according to the state of their mental health or to the condition of which they suffer from. Chief describes the method of discriminating patients from one another:
‘Across the room from the Acutes are the Chronics… Not in the hospital, these, to get fixed, but to keep them walking the streets…” (17)
Patients are divided into two categories of Acutes & Chronics:
Chronics are those patients who have a condition which is untreatable, “machines with flaws which cannot be repaired” (17) and can only be controlled with medical methods. They will spend the rest of their lives inside the ward of the hospital. Patients who are seen as being likely to recover from their illness, and will return to society.
Acutes are those patients e.g. Harding, who are seen as being likely to recover from their illness, and will return to society.
Chronics can either have full use of their bodies or can be again sub-categorised into Wheelers and Vegetables; Those whose movement is impaired to such an extent, they can only move by being pushed around in wheelchairs. Vegetables are patients who, through excessive ECT ‘Shock Shop” (18) or through the overperscription of tranquillising medications:
‘Ellis is a chronic came in an Acute and got fouled up bad when they overloaded him in the Shock Shop…” (18)
When McMurphy enters the ward, he assumes the role of a leader over all of his fellow patients in the ward. McMurphy has a strong, intelligent character and so he is able to manipulate others who are more vulnerable than he is. An example of his manipulation is when he shows some playing cards with pornographic photographs on them to Cheswick:
‘I brought along my own deck…Fifty-two positions”. Cheswick is pop-eyed already…those cards don”t help his condition. (16)
Personality types which can be seen in contemporary society can also be seen very clearly with regard to the characters in the ward setting:
McMurphy”s character is a rebel character who hates authority and authoritative figures. This is, perhaps, why he clashes so fiercely with Big Nurse.
Chief is the veteran of the ward. He has been there the longest, since the start of World War II, with the exception of Big Nurse. He has the mutual respect of everyone in the ward.
Billy Bibbit is insecure and has a stutter. His name is ironic in that it resembles a stutter when said. His problems have probably been caused by his overbearing mother, who was very protective and spoke for him whenever possible.
In a large group of individuals, these personalities are often seen; A rebel character who goes against the system is almost always present in a class inside a school; A veteran who has gained the respect of everyone in that particular grouping; A person who is lacking in confidence, often reluctant to speak out.
Today, in contemporary society, a class system is still very much a part of everyday life. People are classed on wealth, status and employment. Discrimination can also exist between classes; lower classes finding higher classes snobbish and elitist; higher classes perhaps seeing lower classes as ‘common” and uneducated.
The book mirrors hierarchy in contemporary society very well, as it shows different personality types and differentiates between the different classes of people within it very clearly and accurately. However, it does not show discrimination between the different classes which exists today in contemporary society and is quite important to the structure of modern societies.
The issues of Sexism and Sexuality are also raised within the book. Although they do not feature so prominently as the themes of Leadership and Hierarchy, they are nevertheless very important to the behaviour of the characters.
Taking the theme of sexism in the text, women are placed into two distinct stereotypical types. They are portrayed as either whores, sluts or nymphomaniac wives; or the book goes to the other extreme where women are held as asexual ‘machines”. This view is very important when referring to Big Nurse.
The prostitutes that appear during McMurphy”s fishing trip are a good example of the first way the book describes women. They are shown as amoral, trivialising sex so that it is seen only as a meaningless business transaction. It is also made clear of the loss of McMurphy”s at the age of nine:
‘The first girl ever drug me to bed wore that same dress. I was about ten…Taught me how to love, bless her sweet ass (201)”
Ruckly”s wife is another example of this such view of women as adulteresses. Ruckly has had an unsuccessful lobotomy, making him rather mentally unstable. The text portrays him very sympathetically, so the reader empathises with his character from the outset:
‘They brought him back to the ward two weeks later…you can see by his eyes how they burned him up in there” (18)
Ruckly had found out that his wife had been seeing other men; Every time she is mentioned he remembers what she did to him:
‘Memory whispers someplace in that jumbled machinery…He turns red and veins clog up…Fffffffuck da wife! Ffffffuck da wife!” (19)
This is not the only unfavourable way women are portrayed in the novel. Big Nurse is shown as a hardened and rather sterile asexual character. ‘
‘A mistake was made in manufacturing, putting those big, womanly breasts on her…and you can she how bitter she is for it” (11)
Whenever she is described by Chief, her attributes are likened to a piece of machinery which is cold and unfeeling. It appears that she is so dedicated to the ward that she is ‘married” to the job and sexual relationships have no place in her ‘plan”. It is arguable that this is why she becomes so enraged when she discovers McMurphy”s relations with the prostitutes towards the end of the book.
Today, in contemporary society, the view sometimes is still held that women inferior to men. They can be seen as incapable of carrying out work, and should stay at home to look after the children. Although the advent of feminism has almost vanquished these ‘male chauvinist” attitudes, women can still be stereotyped as above; as whores or nymphomaniacs or, like Big Nurse; ‘frigid”, asexual and cold. It can be seen, thus, the text of One Flew over the Cuckoo”s Nest shows sexism in contemporary society accurately.
Finally, the issues of crime and punishment are raised throughout the book and are very important from the outset and ultimately to the ending of the story. The ward, like the society outside, is run on a system of sanctions and rewards which are allocated according to a patient”s behaviour.
Punishments may be issued, by Big Nurse, for unwillingness to co-operate with the daily routine or with the staff. Punishments included ECT , the removal of privileges such as cigarettes or more serious, repeat offenders as a last resort, a lobotomy. A patient could also be sent to Disturbed, in effect a ‘hospital within a hospital” where a patient could be sent to recover from an outburst and they will return to the ward when Big Nurse sees fit.
A lobotomy is a surgical procedure in which the pre-frontal lobes of the brain are either removed or destroyed. This was thought to pacify aggressive patients, but in practise, it transformed them into inactive individuals:
“The installations they do these days are usually successful…a success they say…like Ruckly fumbling and drooling all over his picture” (18-19)
Rewards were also issued to by the establishment of the ward; Patients were give a ‘ration” of cigarettes every week, but this was stopped when McMurphy arrived in the ward as he used to win the others” cigarettes from them in gambling card games.
It is arguable that the security of the hospital could be seen as a reward. Patients, who through the result of their ‘mental illness ” could not cope in the outside world and require the constant daily routine to feel secure and safe.
Contemporary society has a system of rules, laws and legislations which must be followed to be a member of that society. Society also has the power, like the ward to issue sanctions for those who break the rules.
Although many countries have abolished the use of corporal or capital punishment for serious crimes, North America is one such a country where, depending on the state, a person may face capital punishment by lethal injection, electric chair or gas chamber. The ward applies corporal punishment in the form of the ECT and it may be argued that a lobotomy is a form of capital punishment because the patient has little or no quality of life left after the procedure, so they might as well have been killed.
Ken Kesey”s One Flew Over The Cuckoo”s Nest mirrors, in the behaviour of it”s characters, contemporary society very accurately and can still be relied on, as a contemporary text, an accurate display of the treatment of patients within a mental hospital today.
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