Abnormal Psychology in the Media

In the 1975 film One Flew Over the Cuckoo’s Nest, protagonist Randle Patrick McMurphy malingers his way from the prison work farm to the cozier mental hospital. Here, he fights a spirited battle for autonomy and dignity against the despotic Nurse Ratched, but his earnest efforts earn him only a lobotomy. McMurphy’s character arc begins in a lively, hedonistic tirade and ends in a vegetative stupor. In his final condition, McMurphy’s most loyal friend on the ward takes pity and smothers him to death with a pillow.

The Oscar-winning film’s dramatic question is whether McMurphy is insane, or merely conning the system. The hospital doctors and staff could draw from all five perspectives of abnormal psychology — biological, psychodynamic, humanistic, cognitive behavioral, sociocultural — to answer this question through the assessment and treatment of McMurphy’s disorder.

McMurphy’s Abnormal Behavior

Early in the film, McMurphy foreshadows his own vegetative fate when he laments to hospital administrator Dr. Spivey, “They’re telling me I’m crazy because I don’t sit there like a vegetable. If that’s what being crazy is, then I’m senseless, out of it, gone down the road, whacko” (Forman, 1975, 12:22). Dr. Spivey remarks about the five prior assault convictions on McMurphy’s criminal record, which McMurphy deflects with a joke. He then gloats in graphic language, to a blushing Dr. Spivey, over the grounds for his current incarceration, the statutory rape of a consenting teenage girl. His cavalier and remorseless tone raises enough flags for Dr. Spivey to admit McMurphy for further psychological evaluation.

McMurphy proceeds to smuggle pornography, liquor, and prostitutes onto the ward. He bribes the night watchman, superhumanly scales the institution’s high barbed wire fence, and absconds from the facility in a stolen bus, dragging along several gullible inpatients whom he leads on a wild fishing trip on the open sea aboard a stolen boat. Back on the ward, he trades blows with the orderlies, and finally chokes Nurse Ratched half to death. McMurphy’s antisocial personality disorder (Porter, n.d.) costs the other cast of characters their safety, sobriety, livelihoods, and even their lives. Satisfying Kearney and Trull’s (2018) criteria for mental disorder, McMurphy’s behavior is statistically deviant, maladaptive, and causes McMurphy the distress of criminal prosecution, imprisonment, and forced labor. Yet while hospital staff concur that he is dangerous, they hesitate to label him insane.

How Therapists from Five Perspectives May Treat McMurphy

Pink and Jacobson (2007) describe McMurphy as “an immoral, self-centered delinquent who feigns insanity to avoid serving a custodial sentence on a work farm” (p. 641). Nonetheless, he is adjudicated to the hospital indefinitely, to be treated with the same therapies as the decidedly mentally ill men on the ward, including lobotomy, normally a last resort procedure reserved for the incurable psychotic. (Moffic, 2014). In Spivey and Ratched’s failed approach, therapy is punitively dispensed. So, where would the proper treatment for McMurphy’s even begin?

Biological

The mental institution’s readiness to administer medication, electroshock therapy, and lobotomy all stem from the biological, or medical, model’s assumption that “mental states, emotions, and behaviors arise from brain function” (Kearney & Trull, 2018, p. 23). McMurphy’s nervous system, hormones, and genetic makeup predicate all behavior, abnormal included. Neurotransmitter deficiencies and hypoactive brain regions could present opportunities for treatment.

Psychodynamic

What unconscious drives and childhood traumas motivate McMurphy’s chronic mischief? How do his free associations, interpretations, and dreams divulge the intrapsychic conflicts beneath his overcompensating bravado? With which psychosexual fixation are McMurphy’s erotic innuendo, phallic hand gestures, and sexist treatment of women consistent? A basketball game in the hospital recreation yard visibly sublimates McMurphy’s aggression, and in this state he forms a meaningful bond with Chief, his main ally on the ward.

Humanistic

McMurphy’s charisma and persistence, if expressed charitably, would surely contribute to his own self-actualization, and benefit his fellows. Maslow’s hierarchy of needs might show a fillable gap in McMurphy’s requisites as a man and a member of society. Were Nurse Ratched to apply humanistic principles in treating McMurphy, she might soften her commanding tone during therapy and daily encounters on the ward. Nondirective process variables might ease his hostility and mistrust toward her (Kearney & Trull, 2018).

Cognitive Behavioral

Behaviorist techniques like classical conditioning and operant conditioning are seen on Nurse Ratched’s ward. At medication time, peaceful music plays overhead while patients gather in ritual obeisance round the nurse’s stand for their daily meds. Nurse Ratched grants or withholds rewards based the men’s compliance with ward policy. The men exchange cigarettes and sundries on a token economy. The cognitive principles of schema and distortion may reveal a treatable incongruity between McMurphy’s beliefs and expectations, and the reality of Nurse Ratched’s ward. Functional analysis would define and ideally restructure McMurphy’s disorderly patterns of thought and behavior (Kearney & Trull, 2018).

Sociocultural

Set in 1963, One Flew Over the Cuckoo’s Nest reflects a time when mental healthcare was highly controversial in the United States. 1963 is also the year President Kennedy signed the landmark Community Mental Health Act into law, paving the way for the deinstitutionalization of state facilities like the one satirized in the film (Erickson, 2021). So the very source of refuge McMurphy seeks, the asylum itself, is under fire; this may be a source of stress for the hospital staff and patients alike, stoking existential tension within the institution’s walls. Sexism, racism, the patriarchy and war were vilified by the counterculture, protestors, rock and roll, and the budding women’s liberation movement. So the sociocultural approach might consider McMurphy’s misogyny and mutiny as an acute cultural syndrome. His demographic and his circle of friends would also factor into his sociocultural profile.

Perspective(s) of Choice for Treatment

Since McMurphy chalks his own problems in life up to fornicating and fighting too much (Forman, 1975), he might warm up to a psychodynamic approach, projecting his sexual innuendo onto inkblots at first, leading to more sincere apperceptions. Socialization and sublimation through intramural sports, if McMurphy could participate without beating anyone up, would be an ideal yearlong activity on the outside, perhaps even a condition of parole, to vent McMurphy’s brimming physical energy and hopefully open other avenues of self-actualization, such as combining his leadership and athleticism to coach baseball, given his assault record does not bar him from the profession. This ex-con stigma will inevitably taint many of his dealings in the free world, chipping away at his ego and bounding his identity to his rap sheet. A psychodynamic emphasis on rehabilitation will motivate McMurphy to innovate his environment without overturning it altogether.