Philosophy through Film: One Flew over the Cuckoo's Nest

I’m taking a class this semester called Philosophy through Film, and one of the assignments is to write a journal entry for each movie we watch.  My previous entries are on Groundhog Day,  Crimes and Misdemeanors, and the Matrix. First impressions

I don't like what this movie has to say about mental health institutions. Throughout the film, Jack Nicholson's clearly maladjusted character is treated like a breath-of-fresh-air free spirit, which is frustrating because of the damage he so obviously does to the mental health of the patients around him -- provoking them to rebel against their treatment, taking them outside the hospital without supervision, ultimately creating the circumstances that lead one to commit suicide and another to escape the institution.

I don't think that the hospital staff are angels -- I'm not sure there's ever an appropriate situation in which to lobotomize someone, and it certainly wasn't appropriate in Mac's case.  Nurse Ratched repeatedly made the mistake of keeping Mac in the hospital, in which they were ill-equipped to deal with a criminally insane patient, rather than returning him to the prison.  She also threatened to tell Billy's mother about his behavior, at a point when he was in crisis.  Even given the circumstances of her time and resources, those were clearly bad decisions.

But Mac's approach, to treat the other patients as though they're not mentally ill, doesn't work.  I mean, it obviously doesn't work.  If treating people with mental illness as though they were not mentally ill worked, then there wouldn't be mental illness because being outside an institution would solve the problem naturally.

And this is my main problem with the film:  The fact that a mental institution isn't a fun place does not substantiate the implicit claim that being outside the institution would be better.  The characters in One Flew over the Cuckoo's Nest are mentally ill.  That's a horrible state to be in, and one of the many unpleasant manifestations of the fact that we live in a world that has flaws, in which bad things happen to good people and some people are born with or develop crippling mental disorders that make it difficult or impossible for them to function.

Leaving it alone doesn't help.  And maybe the institution doesn't help cure mental illness (a claim I would contest, in most cases) but it definitely helps minimize the suffering of the patients and the damage they could otherwise do to the people and property around them.

On institutionalizing personality types

One of the major concerns I've heard raised (and, in the past, raised myself) about the mental health system is that it's less about treating illness than it is about artificially manufacturing conformity.  I would absolutely agree that there's a grey area in the broader context of that issue -- I think ritalin is massively overperscribed, for one thing -- but the people in that hospital were not in that grey area.  They all displayed symptoms that merited medical attention.  In Billy's case at least, it was probably saving his life, until Mac's interventions.

The reality is that while there are some things that can be diagnosed as mental illness which amount to descriptions of a personality, all mental illness diagnoses take into account whether the qualities diagnosed interfere with the individual's ability to function, and most mental illnesses present with an aspect of depression.

On depression

I want to take a moment to spell this out, and I'll be touching on it again in a later section of this post.  Depression is not the same thing as sadness.  It's not like feeling under the weather, it's not even like grief.  It's not like anything a person who hasn't experienced mental illness can compare it to.  Depression is a deeply crippling  and painful experience, and a person suffering from it can't just 'suck it up' and get on with life.  It's often chemical, and requires medication to treat.  In one of my favorite talks on the subject (which is not embedded because it's an hour long), JT Eberhard compares it to diabetes -- it isn't something you cure.  People with diabetes always have to take insulin, and people with primarily chemical depression always need to take medication to manage it, or develop other coping strategies that go well beyond everyday living.

On Electroshock therapy

This is one of my favorite videos on mental health.  It's about the use of electroshock therapy to treat depression.  The key message:  It works.  It's not evil, it's not dangerous, the way it's done now it doesn't even hurt.  Like many medical interventions, it has been used poorly in the past, and the value of its use in the film was arguable.  But it is not torture.  It's not comparable to waterbording, or to lobotomy, and vilifying it doesn't help anyone.  It only makes it harder to treat depression effectively.

The conflict between society and personal freedom

Many of the people in the institution in One Flew Over the Cuckoo's Nest are there voluntarily.  But Mac's presence, and the presence of other incarcerated patients, does raise the question of personal freedom.  Does a person have the right to be whatever sort of person they want to be, and retain their freedom, too?

Mac was placed both in prison and in the mental institution, and these two locations reflect two different (though not necessarily mutually exclusive or platonically distinct) views towards the treatment of disruptive persons in the context of a society.  They can be removed, indefinitely or for a period of time, as in prison, or they can be institutionalized, with the goal of rehabilitation so they can function in society.

Both of these options ignore the possibility of leaving them free, but that decision is morally questionable.  From a utilitarian perspective, it's certainly better for a dangerous person to be removed than to be left to cause more damage.  From a Kantian perspective, this could constitute treating the person merely as a means to an end, without also treating them as an end unto themselves.

I think the Kantian problem can be solved by rehabilitation, as in mental health facilities.  It's an unfortunate reality that some people are violent, destructive and self-destructive, but these tendencies would make it as difficult to function even in society as it would make it for them to function if removed -- an attempt to rehabilitate them respects their personhood and provides an opportunity for them to maximize their own happiness without infringing upon the safety of their fellow citizens.

On the glorification of mental illness, the vilification of psychiatric medicine, and the failure to imagine others complexly

Ultimately I think the reason films like this work, why people are prepared to accept a story in which mental health professionals are treated like dehumanizing monsters and the mentally ill are treated like victims of society, is because people without experience with mental illness often believe that, deep down, there's not much really wrong with being mentally ill.  They glamorize it,  characterizing schizophrenia or depression as uniquely insightful, or bipolar disorder as an example of stifled creativity.  Or, they characterize the mental illness as not all it's cracked up to be, and insinuate that the patients could basically get over it if they wanted to, and would fit in fine if they had the chance.

And I do think that understanding mental illness is one of the more difficult exercises of empathy in life, and empathy is not a highly practiced skill in our culture.  But that's exactly why we need mental health professionals to treat mental illness, and exactly why laypeople are not equipped to evaluate the effectiveness of those professionals' methods.

A final note on "Chief" Bromden

Whether Bromden was mentally ill in any significant way is debatable, as is whether it was fair to incarcerate him.  But given what we know about him, that he lives a persona of catatonic schizophrenia, the only character he sympathizes with is Mac, a violent, possibly manic convict, and his strategy for dealing with his dissatisfaction with his circumstances is to throw a marble table through a window, I am not at all confident that he was wrongly institutionalized.