Review: One Flew Over The Cuckoo’s Nest (Ken Kesey)

After the success of my first book review
I’ve decided now’s time for number two.
This time it’s something on a quasi-medical theme
one which comments on the nature of conformity and power as seen
throught the lense of psychiatric care and remnants of the asylum system
an area which most doctors try to avoid based on conventional wisdom.

First a little about the author – Ken Kesey-
he graduated UO in 1957 then says he
became an orderly at a veterans hospital in Menlo Park
which along with MKULTRA gave him the creative spark
to complete the manuscript for a novel which would go on to drive
the creation of a succesful play in ’63 and a movie in ’75.

The story’s set on a psych ward run like a Stalinist state
where the head nurse uses her authority to insistently manipulate
her powerless patients and cowed staff to create a
culture which serves to magnify and inflate her
claims of beneficience to suppress patient rights
while maintaining ward-wide obedience at cult-like heights.

Into this mix comes the protagonist, McMurphy.
Upon entering the nurse’s tightly controlled turf he
starts encouraging inmates to take their lives into their own hands,
become empowered, address the future and make plans.
This modus operandi puts him in direct defiance
of the nurse’s strategy of tearing patients down to ensure their compliance.

The passive-aggressive conflict which subsequently results
sees the two threatening and charming each others allies and trading insults.
The battle of wills escalates as the book goes on,
with every freedom won by the patients receiving increasingly strong
retaliation and counter-measures until finally both reap the whirlwind they sowed
the nurse is choked ‘til she loses her larynx and costs McMurphy his frontal lobe.

There’s two main readings (though really they’re one and the same).
The monolithic institution vs the individual portrayed again and again
Indians and the government, mentally ill vs the asylum, man against society, but all across this range
the process never really alters, it’s only the names that change.
Because even if the individual wins a while it never lasts too long
they always slip, always lose, for the collective is just too strong.

The second reading’s just a more superficial version of the first:
the gross imbalance of power with which psychiatry is inherently cursed.
The implication is that the head nurse with her oppressive punitive measures
is just the natural consequence of attitudes that the system treasures.
The outlook of psychiatry in the ‘50s and society as a whole
meant they would always need someone like her to step into such a role.

Obviously this story paints a pretty grim portrait.
In the last 50 years have we improved this poor state?
Having worked in a psych hospital here for a year
I can only answer yes, but still I fear
modern medicine’s left psychiatry far behind
with a different paradigm being applied to the theory of mind.

There are various other themes to be seen
but I take the fact I’ve reached 500 words to mean
it’s time to wrap this up and get back to reading medical stuff
so it looks like this review’ll just have to pass as good enough.

They banned these the year before I started work (though drugs made them obsolete long before then).

One component of an old-school ECT machine at our hospital's museum.