Cuckoo's Nest Psychosurgery

One Flew Over the Cuckoo’s Nest – Psychosurgery and Institutionalisation

The film “One Flew Over the Cuckoo’s Nest” was made in 1975, over 10 years after the book was first sent for review. It won 5 Oscars and another 28 awards, as well as having 11 other nominations. At the end of the film, we see the main character, the rebellious Randal McMurphy, after he was forced to have a frontal lobotomy. He is in a vegetative state and there is no trace of the once fun-loving and adventurous man. This is an excellent example of psychosurgery and institutionalisation and how they were used during the 1940~50s, when the original novel that the film is based on was written.

Psychosurgery was invented in 1935 by Egas Moniz, a Portuguese neurosurgeon
at a hospital in Lisbon. It is the practice of severing or disabling areas of the brain to treat a personality disorder, behaviour disorder, or other mental illness. Lobotomy, a branch of psychosurgery, is a procedure performed on the frontal lobe of the brain and its purpose is to alleviate mental illness and chronic pain symptoms. It is classified as a functional neurosurgical procedure because it attempts to improve or restore function by altering underlying physiology.

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In a frontal lobotomy, as we see in the film, surgeons cut or drill holes in the skull and remove or destroy tissue in the frontal lobes. This is where most current evidence indicates the higher cognitive and reasoning capabilities of humans are
localized.

Lobotomies were associated with a high complication rate including intellectual impairment, personality change, seizures, paralysis and death. Early operations were performed with surgical knives, electrodes, suction, or ice picks, to cut or sweep out portions of the frontal lobe.

Between 1946 and 1949, the use of the lobotomy grew from 500 to 5,000 annual procedures in the United States. At that time, the procedure was viewed as a possible solution to the overcrowded and understaffed conditions in state-run mental hospitals and asylums. Patients are described by the nurses and the doctors, over and over, as dull, apathetic, listless, without drive or initiative, flat, lethargic, placid and unconcerned, childlike, docile, needing pushing, passive, lacking in spontaneity, without aim or purpose, preoccupied and dependent."

Another matter that arose in the film was Institutionalisation.
In clinical and abnormal psychology, institutionalization refers to deficits or disabilities in social and life skills, which develop after a person has spent a long period living in mental hospitals, prisons, or other remote institutions. Individuals in institutions may be deprived (unintentionally) of independence and of responsibility; to the point that once they return to "outside life" they are often unable to manage many of its demands. This was the case with Chief and several other characters in the film.

Institutionalisation is sometimes a deliberate process whereby a person entering the institution is reprogrammed to accept and conform to strict controls that enables the institution to manage a large number of people with a minimum of necessary staff. This is seen throughout the film, with Nurse Ratchet being the toughest rule maker/enforcer. Here, the institutionalisation is very
deliberate.

The process of institutionalisation starts as soon as a patient is admitted into an institution. Depersonalization is achieved with weighing, photographing, removal of personal possessions, dressing in undifferentiated clothing, etc . Then the institution separates the person from the external world, denies them visitors, force them to adapt to the institution rather than hanker after external contact and allowing visitors only as a reward for acceptance of institutional rules. After a visit, trained staff watch how the patients behave carefully and only allow subsequent visits if they show no signs of rejecting the institution.

In the film “One Flew over the Cuckoo’s Nest”, the institution controls the patients’ daily routines, their medication, their diet, their belongings (eg, rationing cigarettes) , and even try to mould how they think by using subtle threats and intimidation. Unquestioning obedience is forced by harsh punishment, both psychological and physical. One example of this is when Billy is caught in bed with a woman – for once in his life, he talked without stuttering, but Nurse Hatchet, instead of encouraging him to develop his speaking, threatens to tell his mother about the incident. This lead to Billy’s suicide just minutes later.
McMurphy's message to live free or die is ultimately not lost on one inmate, revealing that escape is still possible even from the most oppressive conditions. In present times, psychosurgery is much more technologically advanced, using an electric current and computer-based processes to burn a hole (usually ½ cm in size) in the limbic system (brain structures involved in automatic body functions and some emotion and behaviour). Institutionalisation, however, still goes on in a lot of prisons, asylums and monasteries even today in an attempt to cut costs and maintain order.

~by Liza Wei