Nursing on the silver screen: How can the hit film One Flew Over the Cuckoo’s Nest help inform good caring professional practice?

by Matthew Meegan

[This piece was written for the King’s Experience Award’s ‘A Beautiful Mind: Art, Science and Mental Health’ module.]

In 1975, the hit film One Flew Over the Cuckoo’s Nest won five major Academy Awards. It stars Jack Nicholson as the maverick Randle Patrick McMurphy; an offender looking for an easier alternative to prison, thereby falsifying his insanity, entering psychiatric hospital as an inpatient instead. McMurphy brings disruption and relief to the oppressive and institutionalized environment of the hospital ward overseen by the domineering Nurse Ratchet.

Through looking at selected scenes in this movie, I show McMurphy’s character as a force for good who helps his fellow patients. I also want to convey how this film, although maybe a bit dated, has modern-day value in helping the mental health and other caring professionals of today to challenge oppressive status quos (where they exist), to be truly patient-led (wherever possible) and to consider the real worth of positive risk-taking (within legal parameters!).

Throughout the film, we see McMurphy as a conduit for positive change where the wellbeing of his fellow patients is concerned. We can also see how he generally uplifts the oppressive status quo of the institutionalised inpatient ward. Institutionalization or institutional abuse, in reference to the film, occurs through the authoritarian and controlling management of the nursing staff, including the rigid regimes they set and the lack of personal choice the inpatients are given (in, for example, not being able to watch the opening of the World Series baseball game on TV, which many of the patients were keen to watch). You can find out more about how institutional abuse can appear here.

In selected and often pivotal scenes within the film, we see McMurphy supporting his fellow inpatients in such a way as to empower them to take positive risks, which in turn has a positive effect on their wellbeing. The first scene where we can really notice McMurphy bringing about changes within the patient community is early on when McMurphy has just recently been admitted to the hospital. As part of his stay he enters a ‘therapeutic’ group with some of his fellow patients, although the group itself is dysfunctional in how it is managed by the outrageous Nurse Ratchet.

The main example of McMurphy’s support to his fellow patients comes when he sneaks out of the hospital, taking some of the group on a fishing trip, cunningly hijacking the travel bus and yacht, without staff presence. In this scene we see how Mr. Cheswick (a fellow patient with a very nervous yet sensitive and kind disposition) is given the responsibility of steering the yacht. This appears, albeit unbeknown to Mr. Cheswick, to be a crude form of exposure therapy, in which he is exposed to an event that makes him nervous but allows him to confront his previous negative feelings and thoughts – based on maybe hurtful or traumatic experiences – and, as a result, to ground himself in a more realistic and healthier reality. In this scene, Mr. Cheswick is left to man the yacht single-handedly, which initially makes him very nervous, but he quickly takes pride in, and gains a sense of ownership over, his new role. We can particularly notice this when he argues with another patient trying to take over the controls that it is actually his responsibility to steer the yacht.

In social work theory, the theme of empowerment is a fundamental one. Empowerment itself refers to helping marginalized groups and individuals gain greater control over their lives, particularly in relation to discrimination and oppression. We see through the (somewhat irresponsible and criminal) fishing trip how the patients not only learn the skills to fish, but also develop self-confidence, supporting one another and projecting this confidence into future situations within the film. Alongside this, the patients gain an increased sense of agency in making decisions and in finding meaning in their lives, which is certainly something that lasts long after the boat trip.

Within Danish social pedagogy (a form of ‘social teaching’ that involves social work, therapy and community/youth work), the ‘common third’ is often applied. The ‘common third’ is simply a shared activity such as building a kite, cooking or playing sports, which allows for a shared power relationship between the partners of a task (often including a social pedagogue and young person/people). It is both social and therapeutic, in that it involves a variety of skills, such as negotiation and communication, and requires their development in order to complete the activity. Moreover, it can also help build trust in relationships and teach people how to be in the world.

In the film, we see how McMurphy brings people together through such shared tasks, which enable positive change in patient wellbeing and recovery. Not only are some of the patients’ symptoms reduced, but it is also possible to see how their holistic needs are met through McMurphy’s intervention. For example, McMurphy supports the other patients to learn to play basketball, which encourages them to trust and work together, and which further helps one patient, nick-named ‘Chief’, to become confident enough to leave the institution and move forward with his life.

In this article, I hope not only to have conveyed my reasons for why I think One Flew Over the Cuckoo’s Nest is still a great film, but also to have highlighted some of the forward-thinking lessons we can learn from Randle Patrick McMurphy’s character as practicing and trainee mental health professionals. Examining this film certainly made me think about how, if we notice institutional practices, one way we can choose to challenge them is in how we ourselves practice and role model good care. This in itself can bring about cultural changes. As a post-graduate nursing student, I was also really moved by how McMurphy’s belief and trust in his fellow patients was able to bring about better mental health and a happier community. I really hope that sense of staying true to the people we serve and bringing an air of creativity and hope to people’s lives is something I can bring into my own caring practice.

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