One Flew Over the Cuckoo\'s Nest

Psycho Therapeutic Encounter

In the world of psychology, therapy is an important part in helping patients to accept the different issues they are dealing with. Over the years, various techniques and tactics have been used with numerous degrees of success. The film One Flew over the Cuckoo's Nest is the classic example of this. It is focused on how a mental institution is run during the 1960s and the way various forms of therapy are having an effect on patients. To fully understand what is happening requires describing / analyzing the therapeutic process, important skills used by mental health professionals and their impact. Together, these different elements will show the way certain disciplines will influence the quality of care provided to patients. (Douglas & Foreman, 1975)

Background One Flew over the Cuckoo's Nest

One Flew over the Cuckoo's Nest is focusing on the experiences Randal McMurphy goes through. He is sent to a mental hospital from the state work farm (i.e. prison). They felt that he was unstable and needed to have further evaluation. McMurphy is using this as a way to avoid any kind of hard work until he is released (later on). During his time in the mental hospital, he experiences different forms of therapy and continues to rebel against the staff. The result is that he throws a wild party at the end. Yet, he fails to escape. This is when his plot is discovered and McMurphy lashes out by trying to kill the head nurse (Ratcheted). The staff subsequently, conducts a frontal lobotomy on him. This is to prevent McMurphy from becoming a danger to himself or others. (Neubauer, 2011) (Douglas & Foreman, 1975)

Describe and Analyze the Therapeutic Process

These different events are illustrating the various forms therapy, available in mental health during this time. The most notable include: group therapy, the use of prescription drugs, electro shock therapy and other radical forms of treatment. The combination of these factors is illustrating how there are varying degrees utilized based upon following a number of different levels. (Neubauer, 2011) (Douglas & Foreman, 1975)

Group therapy is the most common. This takes place when the nurse will listen to what the patient's issues are and then everyone will comment about them. The basic idea is to bring the problems to the surface and show the individual how they are responsible for them. This is supposed to open a channel of communication with others. In this case, the process has very limited results. This is from other members of the group using this as a way to belittle the person. The result is that the nurses do not have control over what happens. (Neubauer, 2011) (Douglas & Foreman, 1975)

After these meetings and throughout the day, everyone is provided with a combination of anti-depressants. The basic idea is to change their underlying state of mind by having them feel more balanced and in control. In the short-term, this shifts everybody's moods. However, the problem is that they are not becoming more stable. Instead, the drugs are creating tremendous amounts of highs and lows. This causes someone to feel greater swings in their attitudes between states of joy and sadness. At the same time, their addictive properties have created a codependence on these drugs. The result is that patients will see a short-term change in the behavior. Then, they will become more psychotic and unstable once the medication wears off. (Neubauer, 2011) (Douglas & Foreman, 1975)

Electro shock therapy is used in situations where the person is acting out against authority. This serves as a form of punishment by letting the individual experience greater amounts of pain. The basic idea is to use this to shape how they reacting through forcing them to change through facing the consequences of their actions. This has limited effects, with many people experiencing mild forms of brain damage. At the same time, it can harden the resolve of someone to not succumb to the authority of mental health professionals. There is also the possibility of them falling into even greater staff of depression. As a result, these practices are cruel and do nothing to help improve the underlying mental state of the patient. Instead, they make them feel greater amounts of anti-social or depressive behavior. (Neubauer, 2011) (Douglas & Foreman, 1975)

Other radical forms of treatment are when the patient will receive a frontal lobotomy. This is because they are becoming a danger to others and the facility must take radical steps to rectify the situation. In the film, this occurs when McMurphy tries to strangle nurse Ratcheted. In the next scene, he returns as a vegetable (after a frontal lobotomy). (Melo, 2007) (Douglas & Foreman, 1975)

The result is that this form of treatment is considered to be cruel and inhuman. This is because the damage can destroy the ability of the person to think for themselves. Currently, this practice is banned based upon the U.S. Supreme Court declaring it unconstitutional. This is illustrating how these techniques are considered to be very barbaric. (Melo, 2007) (Douglas & Foreman, 1975)

These different techniques are showing how mental health professionals are not treating the root causes of these patients' problems. Instead, they are using prescription drugs to control their mood. While their group therapy sessions, are not built on understanding and learning how to confront different challenges. Instead, they are emphasizing regression and humiliation to make the person want to change. The problem is that these issues do not become better. This is because these two techniques only cover up the problem or they make the person feel bad. Over the course of time, this means that the staff will be ineffective in helping to treat patients. (Neubauer, 2011) (Douglas & Foreman, 1975)

To make matters worse, anyone who does not follow the rules or lashes out about their treatment is given electro shock therapy. This is very cruel and it is inflicting undue amounts of damage on the individual for questioning authority. In extreme situations, these twisted views are taken to another level when frontal lobotomies are conducted. This is problematic, as it does not help the patient to become any better. Instead, the entire system is designed to control the activities of a person. (Neubauer, 2011) (Douglas & Foreman, 1975)

As a result, there are very little forms of effective therapy taking place at this hospital. This is because mental health professionals do not want to understand what is happening and are more concerned about control. To achieve these objectives, they will engage in practices to belittle a person, control their mind and punish them by taking their sense of who they are. In many ways, once could argue that these practices they are using are considered to be sadistic. (Neubauer, 2011) (Douglas & Foreman, 1975)

The Skills used by the Therapist / Counselor

The basic skills that are used by the therapist include: listening, questioning, repeating and offering insights. These concepts are designed to show the patient where they are having challenges and the best approaches for addressing them. It is at this point, when the staff wants to help the individual to make a change by seeing how they are the problem. This will encourage them to change their lives over the longer term. (Domino, 1983) (Douglas & Foreman, 1975)

Listening is when the mental health professional will pay attention to what the patient is saying. In many cases, they will take notes and respond by shaking their heads. This is demonstrating how they understand the patient's viewpoints. When this is utilized, it makes the individual feel a sense of ease and comfort. This occurs once they had a chance to express their emotions to others. In the movie, this is used by both the doctors and nurses to comprehend the feelings of patients. They will then, make some kind of notation about what is happening. (Domino, 1983) (Douglas & Foreman, 1975)

Questioning is when the therapist will ask the person how they felt and wonder if they handled the situation properly. In many of their group therapy sessions, Nurse Ratcheted will often inquire about why someone decided to behave a particular way. This occurs by looking at their past lives and the way this contributed to their situation. The basic objective is to utilize questions, to force the person to reevaluate themselves and their lives over the long-term. In the film, this has devastating consequence with different people embraced about what they shared. This is used a as form of humiliation, to force the person to change. (Domino, 1983) (Douglas & Foreman, 1975)

Repeating is another way of humiliating the individual. This takes place with staff at the hospital constantly talking about negative events and poor behavior. These incidents make the patient's feel as if they have no control of their lives. This creates a scene, where someone lashes out over having the nurses take away their cigarettes during a group therapy session. (Domino, 1983) (Douglas & Foreman, 1975)

In this situation, the staff is ineffective at connecting with the person. This is because they make them feel and continue to believe like they are inferior. When this happens, they individual has no control over their lives or what is happening to them. (Domino, 1983) (Douglas & Foreman, 1975)

Offering insights is when the staff will sit and form judgments about the person. This is because they believe that they are trying to help them. Yet, in reality, they are making the situation worse by not dealing with the root causes of the problem. A good example of this can be seen with the doctors believing that McMurphy is not mentally ill. Instead, he is considered to be a social deviant who rebels at authority. Nurse Ratcheted feels that he is sick and wants to keep him under her control so she can help him. (Domino, 1983) (Douglas & Foreman, 1975)

This is showing how staff members will offer advice, based upon if the individual is moving towards their larger goals. In situations where they are not, there is the possibility they will be exposed to added amounts of therapy in order to help them. The problem is that their opinions could be misdiagnosing them problem. (Domino, 1983) (Douglas & Foreman, 1975)

These different ideas are used as a way to offer greater amounts of control to the therapist. This is because they feel that this person can more objectively understand what is happening. However, there problem is that they do not realize the long-term damage they are doing to the patient. This leaves them under their control and incapable of addressing situations independently on their own. (Domino, 1983) (Douglas & Foreman, 1975)

For example, in the film, Nurse Ratcheted believes that the character Billy is a child who never grew up. She feels that he needs to face reality in order to grow as a person. Throughout the movie, she will second guess what he did in the past and how this shaped who he is now. The result is that Billy is afraid and unsure about the best way to deal with these situations. In one of the final scenes, this comes full circle when she learns that he had a sexual encounter with a prostitute brought in by McMurphy. Once he learns that she is going to tell his mother, he immediately falls into a state of depression and commits suicide. This is illustrating how the therapist is creating a negative and controlling atmosphere for the patients. The result is they will often lash out against what is happening. (Domino, 1983) (Douglas & Foreman, 1975)

The main tool they are using to achieve these objectives; is to demonstrate how they care about the person. This is when they will open up to them and share their feelings with everyone. After this takes place, is the point the staff members will use the techniques of: listening, questioning, repeating and offering insights to challenge them. Over the course of time, this makes the individual easier to control by destroying their sense of self-worth. (Domino, 1983) (Douglas & Foreman, 1975)

Discuss their Effectiveness or Lack of Control

The various techniques are effective in controlling the situation up to a certain extent. This is taking place, with staff members using a combination of tactics to make it appear as if they care. However, beneath the surface, they are more concerned about controlling the person, their thoughts and behavior. This takes place throughout the film, by demonstrating the way they are able to determine what kinds of behavior is acceptable. (Domino, 1983) (Douglas & Foreman, 1975)

At first this occurs, is when the patients cannot watch the World Series. Then, they lose their privileges to smoke cigarettes. Once McMurphy lashes out, is the point more extreme measures are used to enforce this behavior. This occurs with him and anyone who is contributing to the situation receiving electro shock therapy. (Domino, 1983) (Douglas & Foreman, 1975)

If nothing changes after this or the individual becomes worse, there is the possibility they will be subject to a front lobotomy. In this case, the procedure is considered to be the ultimate form of control by limiting how the person will think or respond. Instead, they will have to be taken care of for the rest of their lives. (Domino, 1983) (Douglas & Foreman, 1975)

In this aspect, one could argue that these techniques are successful to a certain extent by showing who is in charge of the hospital. Anyone who does not want to follow the appropriate rules will have their privileges revoked and become exposed to more brutal forms of therapy. The basic idea is to prevent these individuals from creating a poisonous environment for everyone else. (Domino, 1983) (Douglas & Foreman, 1975)