Billy Murphy Case Summary

1. Billy is a voluntary patient and can leave the ward at any time. He has attempted to commit suicide more than once. He is deathly afraid of his mother and authority figures. I think that Billy has Anxiety disorder as well as social phobia. I do not think that Billy should be in the ward, he would do better at a rehabilitation facility. The ward is for insane or criminally insane and Billy does not belong there.

2. I do not think that McMurphy (Mac) was voluntarily committed. Someone who is voluntarily committed is a person who seeks help on their own. They check themselves into an institution and may leave whenever they want. Civil commitment is when a person is committed against their will. This happens when it is found by the court
that a criminal is judged to be mentally ill and are a threat to others and they can be institutionalized against their will in place of prison.
Criminal commitment is when and individual has been acquitted of a crime by reason of insanity and are placed in a psychiatric facility for treatment. I feel that Mac was institutionalized by civil commitment. If he had not gone to the ward he would have been in prison. He was not acquitted for his crimes, he was sentenced to a work farm and they thought he may be faking that he was insane.

3.
McMurphy's (Mac) behaviors do not seem to be symptoms of insanity. The case of Durham vs. United States held that "the accused is not criminally responsible if his unlawful act was the product of mental disease or mental defect". Mac was trying to get out of the work farm by acting out and convincing the staff that he was insane. Once he was brought to the ward it was determined by the doctors and Nurse Ratched that he was not insane, but could be dangerous. In 1972 the Durham rule was replaced because of confusion in the courts about the definition of "disease". It was replaced by legal guidelines formulated by the American Law Institute and was combined with the M'Naughten principle. Basically it states that a person is not responsible for a criminal wrongdoing if at the time they do not understand the difference between right and wrong and they have not repeated the criminal offence because of their mental disease. Mac knows the difference between right and wrong and he tells the other patients that they are not insane. At the beginning of the movie when Mac is talking to Dr. Spivey, it is mentioned that Mac has had at least 5 arrests for assault. This shows that he knows that he is wrong, but continues to do
so.

4. The patient's rights were violated right from the beginning of the movie. Some of the patients were in restraints and they use excessive force (heard, not seen) when putting Bancini in his room after his outburst during the therapy session. Bancini was not harming anyone, just yelling and they grabbed him right away and took him off. Right #5 states Patients shall not be kept in restraints or isolation except in emergency conditions. They also are made to take medications when things start to get out of hand and right #4 states they have the right to refuse excessive or unnecessary medications. Right #12 states that no more than 6 patients shall be housed in one room. In the movie all 18 patients spend the day together in the same room. Right #15 states that the patients shall not be made to do any work that is for the sake of maintaining the facility. The patients in the movie are made to do work detail, cleaning. Mac wants to change the work detail to watch the World Series and Nurse Ratched would not let them change it. Right #10 states that patients have the right to interact with the opposite gender. When Billy gets caught in bed with Candy, Nurse Ratched belittles him and makes him feel so ashamed that he commits suicide.

5.
▪Harding is a paranoid schizophrenic. He should be treated with individual therapy, focusing on his wife. He should not be hospitalized and should be on medication. Using the drugs would be a biological perspective in Harding's treatment. ▪Billy has an anxiety disorder. Cognitive behavioral therapy is used along with drug therapy. The cognitive therapists combine training in relaxation skills and learning skills of avoiding tendencies to think the worst. I think this would work well with Billy because after he was caught with Candy and all the other patients were applauding him, he stood up to Nurse Ratched for a moment and was not stuttering. He showed that when he has support he can stand up for himself and has more self esteem. This is the cognitive perspective. ▪Taber is a trouble making Sadist who is not a voluntary patient. Psychoanalysts attempt to bring childhood sexual conflicts into awareness so that they can be resolved. Although Tabor would probably not benefit from this type of treatment since there are not many cases where a psychodynamic perspective on treatment has been successful. ▪Cheswick is a paranoid neurotic who lacks self confidence. A neurotic is a person who constructs an ideal self-concept and wants to become that person. He presents his ideal self concept to society for approval. He is afraid of being his real self, particularly if it is not good enough, as defined by society. Afraid of social rejection, he pretends to
be the ideal self he invented to avoid that rejection. I would say that person centered therapy would be good for Cheswick. This type of therapy focuses on reaching self actualization and overcoming the criticized parts of the self. Humanistic therapy focuses on what the patient is experiencing in the present.