One Flew over the Cuckoo’s Nest

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One Flew over the Cuckoo’s Nest

by Ken Kesey

THE LITERARY WORK

A novel set in a mental hospital in Oregon during the late 1950s; published in 1962.

SYNOPSIS

An energetic con man seeks institutionalization as a means of escaping the rigors of a prison work farm. Before long, he begins to challenge the dictatorial Nurse Ratched, irrevocably altering the destiny of those in the ward.

Events in History at the Time the Novel Takes Place

The Novel in Focus

Events in History at the Time the Novel Was Written

For More Information

After earning his bachelor’s degree from the University of Oregon in 1957, Ken Kesey went on to study creative writing at Stanford University under some of America’s most famous authors. In the course of his second year, he met a young graduate student named Vik Lovell, who introduced him to experiments involving the use of mind-altering drugs that were being conducted locally at the Veterans’ Hospital in Menlo Park. After serving as a paid subject for the duration of the experiments, Kesey accepted a job as a night attendant on the hospital’s psychiatric ward. During the long hours from dusk until dawn, often aided by drugs such as LSD, he began writing One Flew over the Cuckoo’s Nest, his most renowned work.

Events in History at the Time the Novel Takes Place

A brief history of the American mental institution

For generations one of the most perturbing questions plaguing American society has been the matter of caring for its mentally ill. From the arrival of the nation’s first settlers and continuing well into the middle of the nineteenth century, early attempts at treating such disorders often bordered on the grounds of cruel and unusual punishment; it was not uncommon to find those persons afflicted with the illness to be chained to a wall or locked up in a cellar or attic.

During the mid-1800s, attitudes regarding the mentally ill slowly began to change. Thanks to the efforts of humanitarian reformers such as Dorothea Dix, millions of dollars were raised to establish state mental institutions capable of caring for large numbers of patients. As a result, the number admitted soared tremendously, causing overcrowding in many of the institutions. A century later, when the United States entered World War II, the plight of the mentally ill was once more cast into the spotlight. More than 1.75 million people were rejected for military service in World War II because of mental and emotional problems. Additionally, more soldiers were medically discharged because of neuropsychiatric disorders than for any other reason. Thereafter the medical community began to more closely evaluate the conditions that existed in the mental health care system.

In 1946 the federal government became involved with the passage of the National Mental Health Act, a piece of legislation that provided for the creation of the National Institute of Mental Health in 1949 as well as funding of more advanced research and treatment. The number of the institutionalized continued to rise steadily; by 1955, half of all the hospital beds in America were occupied by the mentally ill.

While advances in pharmaceutical research made during the 1950s may have moved physicians one step closer to their goal of helping the mentally ill, the attitudes and ideas that pervaded American society in the 1960s seemed to force the problem two steps backward. In an ironic twist of events, many psychiatrists, led by Dr. Ronald Laing in England and Dr. Thomas Szasz in the United States, began to question whether mental illness was indeed purely physiological in origin, looking at the problem as having social or environmental causes. Laing, for example, viewed schizophrenia as a strategy of escapism invented by a person so the person could live in an unbearable situation; he blamed stressful family environments as a primary cause. (This view has been widely discarded today.) Szasz similarly believed that mental illness was not an illness at all, but a set of unusual behaviors directly linked to an individual’s inability to interact properly with his family, surroundings, and society.

The concept that mental illness was not really an illness quickly found support in another movement of the decade: the counterculture—young rebels critical of mainstream society. The idea of mental illness as an invention of the psychiatric “establishment” seemed highly plausible to these rebels. After all, they argued, what were mental hospitals other than large warehouses designed to contain those social nonconformists whom specialists had labeled as “insane”? Secondly, with the rise of consciousness-expanding drugs like LSD, many now looked toward those afflicted with mental disorders as the paradigm for what they were trying to achieve: the escape from rationality.

The end result of the humanistic approaches to psychology by men like Laing and Szasz was a movement demanding more humane treatment of the mentally ill and opposing involuntary confinement of such individuals. Several acts of legislation were passed, ostensibly intended to protect the rights of the mentally ill. In reality, however, these acts provided for more selective requirements in admitting patients as well as the premature release of thousands of individuals still in need of treatment. Over the next two decades, this mass exodus would lead to a reduction of 65 percent of the total hospital population, many of whom resorted to living on the streets as their last—but sometimes only—alternative.

Methods of treatment

One of the recurring elements found in Kesey’s novel is the treatment of mental illness through a wide array of medical aids and procedures. Of these, the use of drugs, electroshock therapy, and psychosurgery are the most prevalent.

DR. BENJAMIN RUSH: “THE FATHER OF AMERICAN PSYCHIATRY”

As a physician at Pennsylvania Hospital in the late 1700s, Dr. Benjamin Rush thought the cause of insanity to be located in the blood vessels of the brain. He believed the key to treatment lay in the curing of both the body and the soul together. At the time, both of these theories seemed revolutionary, and the forms of treatment he advocated seemed cruel and unjust. One form of treatment, designed to increase blood supply to the brain, consisted of strapping a patient into a gyrating chair and then shaking the chair vigorously. Another exercise sought to restrain excited or manic patients by harnessing their arms, legs, and chest to a chair while their head was constrained in a structure resembling a vise. Dr. Rush’s ideas were enormously popular; in fact, his public lectures were Philadelphia’s leading cultural attraction in the 1790s. Since Dr. Rush’s textbook on psychiatry was the only one of its kind prior to 1883, many regarded him as a respected authority, no matter how startling his procedures seemed.

In the era following World War II, psychologists began experimenting with drugs as a means of curing the mentally ill. One of the first of their discoveries concerned the drug chlorpromazine. Synthesized in France in 1950, chlorpromazine was originally produced during work with antihistamines and was subsequently used in anesthesia. Two years later, however, doctors discovered that the same drug could be used as a tranquilizer to assuage worry or control hallucinations and delusions. At the same time alternative uses for other drugs were also being uncovered. In 1956, more patients were being discharged from U.S. mental institutions than admitted for the first time in over a century, many aided by prescribed drugs to manage irrational behavior.

Another form of treatment used to combat psychiatric disorders is the use of electroconvulsive (or electroshock) therapy, or ECT. In the 1930s many psychiatrists began experimenting with more physical approaches to cure mental illness, including the inducement of convulsions by injections of camphor. In 1937 two Italian psychiatrists thought to apply an electrical charge directly to the brain, a procedure that would later be known as electroshock therapy. Despite the harsh stigma that has been unfairly associated with this type of treatment—in Kesey’s novel it is seen as a means of punishment rather than a cure—the use of electroconvulsive therapy has sometimes proven successful in cases involving moderate to severe bouts of depression. Yet the stigma remains. ECT continues to be regarded by some as one of the more barbaric forms of legal medical procedures in the modern age.

A third mode of treatment, and by far the most controversial, is the destruction of certain cells or fibers in the brain through surgical measures. At the onset, this technique was labeled a “lobotomy” because it required the removal of the frontal lobe of the brain. Later, with modern, more precise means of locating desired tissues, it is more commonly referred to as psychosurgery.

The first lobotomy on record was performed in the United States in 1936 by Dr. Walter Freeman. Although original results proved successful in calming down patients with highly energetic or exceedingly violent personalities, soon physicians began noticing undesirable effects on the patient’s mental and physical health. These effects are epitomized by Kesey’s character Mc-Murphy after his experience in undergoing such surgery.

The Novel in Focus

The plot

When One Flew over the Cuckoo’s Nest opens, the reader is introduced to a wild and engaging character named Rändle P. McMurphy. This introduction comes through Chief Bromden, a Native American and psychiatric hospital patient who is the narrator. From the moment McMurphy is admitted to the hospital, he begins to stir up trouble. Based on information garnered during one of the group’s weekly therapy sessions, the reader discovers that after several years at a prison work farm, McMurphy has decided to feign mental illness in order to escape further rigors. The same attributes that originally landed him in jail—a history of street brawls, arrests for drunkenness, and repeated offenses for gambling—now make him a hero among the other patients. Soon, he is challenging many of the policies of Nurse Ratched, an ex-army nurse in charge of the ward—and he of course has the support of his wardmates to back him.

Over the next several months, McMurphy gains perks for all the inmates, including the privilege of watching the World Series telecast and using the Day Room, which he utilizes as his own gambling arena. With each new conquest, the patients begin to feel more liberated, evidenced by their renewed interest in the weekly therapy sessions. Unfortunately, just as events in the ward seem to be improving, McMurphy learns from the lifeguard at the swimming pool the terms regarding his confinement: only Nurse Ratched may approve his release.

Stricken by this news, McMurphy returns to the ward intent on obeying her policies. But when he relinquishes his de facto leadership of the group, it is not long before things begin to revert back to the way they were prior to his arrival. Privileges that had been recently granted are now revoked, and the weekly therapy, once a vibrant forum for ideas, regresses to silent sessions.

As the mood of the men continues to worsen, McMurphy begins to reevaluate his decision. He realizes that by succumbing to Nurse Ratched, he is denying hope to the others who need it. So in a conscious display against her authority, he smashes his hand through the glass window of the Nurse’s Station, ostensibly to retrieve his cigarettes.

In the weeks following this outburst, Mc-Murphy seems bent on making up time lost to complacency. As the days go by, McMurphy decides that it is time to organize a fishing trip. After contacting some old acquaintances to serve as guides, he rushes around the ward, frantically searching for volunteers. Ten patients agree to go, in addition to Dr. Spivey, a physician on the ward, and McMurphy’s “acquaintance” from before his incarceration, a woman named Candy Starr. Like Jesus at the head of his twelve disciples, McMurphy leads the motley crew of patients out of the institution and back into the real world.

Upon returning to the asylum after their trip, it becomes evident to those who accompanied McMurphy that life on the “outside” was not as difficult as they imagined. Before they can relish their newfound discovery, however, they are whisked away for a “special shower” to remove any vermin they might have acquired on the trip. While in the shower, the orderlies take particular delight in harassing George, a delusional patient constantly worried about his cleanliness. When they fail to cease their heckling, McMurphy and Chief Bromden step in to defend him, causing a fight.

Because of their involvement in the altercation, McMurphy and the Chief are sent to the Disturbed Ward, where they are to be administered electroshock therapy. Once there, they are befriended by a kind Japanese nurse who assures them sanctuary at least until the treatments are completed. For the Chief, this amounts to only one dosage; for McMurphy, it is to be four. Despite the continuous shocks, McMurphy manages to maintain his high spirits. “When I get out of here,” he declares proudly, “the first woman that takes on ol’ Red McMurphy the ten-thousand-watt psychopath, she’s gonna light up like a pinball machine and pay off in silver dollars” (Kesey, One Flew over the Cuckoo’s Nest, p. 276).

When the two agitators reemerge from the Disturbed Ward following their treatments, they are met with a hero’s welcome. In honor of their return, a clandestine party is planned with Candy, the girl from the fishing excursion, and her friend, Sandy Gilfilliam, as invited guests. When the night comes for the celebration, they bribe the nighttime orderly, Mr. Turkle, into allowing the two women to climb through a window of the ward. Besides the wine and vodka the women bring, Mr. Turkle produces some marijuana, and soon the entire party gets out of hand.

When the group finally awakens in the morning, it is to the sound of Nurse Ratched and the three daytime orderlies attempting to discern what has happened. In the midst of their assessment, it is discovered that Billy Bibbit, a thirty-one-year-old patient with the mind of a child, has fallen asleep in the Seclusion Room in the company of Candy. Upon seeing this, Nurse Ratched begins to express outright shock, threatening to inform Billy’s mother of his “crime.” The nurse tells him, reprovingly, that she is very ashamed of him.

As Nurse Ratched begins to scold the remaining miscreants, her rebuke is interrupted by the frantic voice of the doctor. Apparently, unable to deal with the guilt of his actions, Billy has slit his own throat. Staring straight at McMurphy, Nurse Ratched accuses him of nearly holding the sharp instrument himself. “I hope you’re finally satisfied,” she says sternly. “Playing with human lives—gambling with human lives—as if you thought yourself to be a God” (One Flew over the Cuckoo’s Nest, p. 304).

Unable to contain himself any longer, Mc-Murphy lunges after her, wrapping his fingers around her throat. It takes the efforts of all three orderlies to remove him.

After three weeks, a gurney appears with a chart at the bottom reading: “MC MURPHY, RANDLE P. POST-OPERATIVE. And below this... written in ink, LOBOTOMY” (One Flew over the Cuckoo’s Nest, p. 307).

At first, the remaining patients find it difficult to believe that the lifeless vegetable in front of them is actually the remains of their heroic leader. But after further confirmation, Chief Bromden takes it upon himself to remove Mc-Murphy, or what is left of him, from his misery by suffocating him with a pillow.

Conformity in the Cuckoo’s Nest

As the novel’s main protagonist, Randle P. McMurphy wages a tireless campaign against symbols of conformity. Whether they be in the form of seemingly nonsensical ward policies or in the personification of the dictatorial Nurse Ratched, McMurphy does not discriminate; in his mind, he is a free spirit unwilling to adapt to the rules and orders set forth by others.

A perfect example of McMurphy’s propensity to question authority occurs when he decides to brush his teeth one morning before the designated time. After learning from one of the orderlies that the cabinet containing the toothpaste will not be unlocked until 6:45 a.m., McMurphy politely inquires as to the reason why. Upon hearing that it is simply ward policy, McMurphy thinks it over. When the orderly asks him if he understands this mode of reasoning, he replies sarcastically:

Yes, now, I do. You’re saying people’d be brushin’ their teeth whenever the spirit moved them.... And, lordy, can you imagine? Teeth bein’ brushed at six-thirty, six-twenty—and who can tell? maybe even six o’clock. Yeah, I can see your point.
(One Flew over the Cuckoo’s Nest, p. 90)

In addition to serving as a mechanism for rebellion in the mental institution, McMurphy’s antics may also be seen as an allegory for the time in which the novel was written. During the latter half of the 1950s, many of the nation’s younger generation began to challenge symbols of conformity. In their eyes, the ward policies that confined McMurphy seemed remarkably similar to the ubiquitous presence of the American legal system, while the authoritarian Nurse Ratched personified the power and control exhibited by large agencies, both in government and in business.

Sources

Probably of most influence on Kesey during his writing of One Flew over the Cuckoo’s Nest was his continuous use of mind-altering substances. During his tenure at Stanford, he had completed a novel about life in San Francisco’s North Beach entitled Zoo. However, after experiencing the hallucinogenic effects of drugs such as LSD as part of an experiment at the local Veterans’ Administration Hospital, he decided to forego fine-tuning the book in favor of his new project, a story about the allegorical struggle of patients in a mental institution. At the conclusion of the experiments, Kesey began working the graveyard shift as an aide in the psychiatric ward of the hospital. Every evening, from midnight until eight the following morning, he would complete a few more pages of his manuscript, often aided by drugs “borrowed” from the hospital’s storage room. He would later admit: “I was taking mescaline and LSD. It gave me a different perspective on the people in the mental hospital, a sense that maybe they were not so crazy or as bad as the sterile environment they were living in” (Kesey in Faggen, p. 71). In order to describe more accurately what it would be like to experience electroshock therapy, Kesey subjected himself to a real-life shock treatment. Kesey would later admit that the insight he accrued from the experience aided him immensely in describing his characters’ own trips to the “shock shop.”

Nearly all of the novel’s secondary characters were based on real-life individuals whom Kesey met while on his watch at the hospital. The inspiration for George originated with a man named Maternick. In a letter to his friend Ken Babbs, Kesey defined Maternick as an individual consumed by his tidiness. “No one can touch him. He won’t touch an object another has touched. He rubbed the hide off the end of his nose after running it up against a patient who had stopped too quickly” (Kesey in Pratt, p. 340). Another of Kesey’s characters, the retired Colonel Matterson, was also based on a real-life patient, a man named Mellanson. In the same letter to Ken Babbs, Kesey described him as “tall, bony with bones that you know were once straight and useful. He sits in his wheelchair at attention, with his hands on the balls of his calcified knees. Under his black brows his eyes have appearance of calm authority, kindness that is kind because it is right” (Kesey in Pratt, p. 342).

Whereas most of the characters in Kesey’s novel were inspired by real persons he had come in contact with while working on the psychiatric ward, the novel’s main protagonist, Randle Patrick McMurphy, was actually born out of the desire to create the ideal American hero. Having already decided on much of the supporting cast, Kesey turned to figures from his childhood—comic books heroes like Superman, the Human Torch, and television heroes such as the Lone Ranger—to come up with a classic outside agitator whose desire to do good rivaled his ability to cause trouble. The end result was R. P. Mc-Murphy, a roustabout who, in the words of the book’s narrator, embodied “the swaggering gambler, the big redheaded brawling Irishman, the cowboy out of the T.V. set walking down the middle of the street to meet a dare” (One Flew over the Cuckoo’s Nest, p. 189).

Events in History at the Time the Novel Was Written

The counterculture

At the time Kesey began working on his novel, the mood of the country was becoming more tense. Controversial issues such as civil rights came to the forefront, inspiring more and more young Americans to question those in power. Expressing themselves through discussion, art, and nonviolent action, they formed a subgroup in American society that historians would term the counterculture.

What began as a band of political protesters eventually gave rise to the hippies, a collection of mostly young people dedicated to peace, love, and the search for “the glorious, indescribable beauty of life” through the use of mind-expanding drugs such as LSD (Wolfe in Stevens, p. 300). Both factions sought revolution in a country they felt had usurped their rights as individuals, but their paths of rebellion differed. While the former preached activism in the way of protests, the latter chose to rally behind the slogan “turn on, tune in, drop out.”

LSD

From the time Kesey experienced his first dosage of LSD while a volunteer at the Menlo Park Veterans’ Hospital, the young man from Oregon—who had seldom drunk even beer—was hooked. LSD, or lysergic acid diethylamide-25, is one of the most potent mind-altering chemicals known. It was discovered in 1938 by Dr. Albert Hofmann, a brilliant young chemist working at Sandoz Pharmaceuticals in Switzerland. While conducting a routine synthesis, a small portion of the drug soaked through his fingers, causing him to feel a little woozy. Sensing the onset of a cold, he decided to go home, where he soon began to experience hallucinations. He would later describe his condition as “an uninterrupted stream of fantastic images of extraordinary plasticity and vividness and accompanied by an intense kaleidoscopic play of colors” (Hofmann in Stevens, p. 4).

Not long after this discovery, vast experiments were conducted first on animals and then on humans to determine the overall effects of the drug. Based on the findings, it was discovered that when carefully regulated, LSD was non-fatal and could even be used in the treatment of such psychological disorders as schizophrenia.

When the U.S. government received the news that a new mind-altering drug known as LSD-25 had been successfully synthesized in Switzerland, its interest was piqued. Since the World War II era, when Nazi experiments told of a supposed “truth drug” consisting of mescaline and other compounds, members of America’s Central Intelligence Agency had been interested in acquiring such a device for their own brand of intelligence. On April 13, 1953, the CIA formally approved MK-ULTRA, a federally funded operation designed to conduct experiments involving biological and chemical materials. One of their first priorities was to purchase the entire stash of LSD from Sandoz Pharmaceuticals. Over the years, experiments were held on both willing and unwilling participants until the CIA’s Inspector General closed down portions of the operation in the late 1950s. It is partially because of the cancellation of this project that Dr. Leo Hollister, head of the psychedelic experiments in Menlo Park, was called upon to enlist volunteers such as Kesey to aid in his research.

LSD became both a blessing and a curse for American society. To the psychologists who sought to use it as an elixir for mental disorders like schizophrenia and depression, successful results were often marred by the sometimes dramatic and unpleasant reactions—usually manifested in visual and/or audible hallucinations—that would accompany them. To the rising counterculture of the 1960s, LSD served as the unifying vehicle that would later define an entire generation. Some even went so far as to call it “a gift from God, given to mankind in order to save the planet from nuclear finale” (Stevens, p. xiv).

Reviews

When One Flew over the Cuckoo’s Nest was originally published in 1962, it was hailed as a major literary success by an overwhelming majority of reviewers. After reading a rough draft, critic Malcolm Cowley, one of Kesey’s teachers at Stanford, remarked that it contained “some of the most brilliant scenes I have ever read” and “passion like I’ve not seen in you young writers before” (Cowley in Stine, p. 231).

Though the critics acknowledged that the novel was Kesey’s masterpiece, they failed to agree as to just why. In the Chicago Sunday Tribune Magazine of Books, R. A. Jelliffe praised the novel for its brilliant mixture of realism and myth. Time magazine lauded its author for both his power and humor, describing the book as “a strong, warm story about the nature of human good and evil, despite the macabre setting” (Porter, p. 16). In addition to the rave reviews that abounded in periodicals everywhere, Kesey’s novel also earned mention in several academic journals as well. It was later made into a 1975 film, starring Jack Nicholson as McMurphy, that won the Academy Award for Best Picture.