The mind is regarded as the most complex aspect of the human being. Long after the secrets of the body had been discovered, analyzed, and mastered, the enigma of the psyche remained. Eventually, facilities to deal with illnesses of the mind were founded. However, the barbaric manner in which the patients were treated damaged them more often than it helped. As these institutions gained experience, their approach to the therapy of the patients improved and the institutions became more successful at rehabilitating the mentally disturbed.
The improvements can largely be classified within two categories; the approach to leisure and discipline by the staff. This transition, from jailhouse to hospital, is clearly illustrated through the analysis of the mental institutions portrayed in the novel One Flew Over The Cuckoo's Nest, written by Ken Kesey, and the film The Dream Team (1989), directed by Howard Zieff. The novel, set in the early 1960s, depicts the attitude of the main caregiver, Nurse Ratched, as a sadistic tyrant more interested in the efficiency of her ward than the state of those in her care.
The movie, set in the late 1980s, illustrates Doctor Jeff Weitzman, as an idealistic, kind man who is prepared to stand up for what he believes is best for his patients. These two approaches, while seeming opposite, share many of the same concepts, and differ only in how those concepts are best applied. The concept of leisure is important to both approaches. It is recognized that the patients must learn to interact in an unstructured manner if they are to successfully reintegrate into society. The Nurses' approach, however, believes that this interaction should be strictly monitored and controlled.
As such, the schedules in the establishment are rigid, and seeking a conditional pass to the outside world is not encouraged. The Doctor's approach involves slowly reintroducing the patients to society. This means that, as the therapy progresses, the patient experiences more freedom in their recreation period, and small excursions into the general public are encouraged. The Nurse and Doctor both encounter a similar request for a small sporting oriented trip. They differ, however, in the manner in which they respond to the request. The Nurse is asked about a day of deep-sea fishing.
The Nurse denies the two applications for an accompanied pass. The first is refused, because the patient, Randle McMurphy, is too new on the ward. The second, attempted a month later by the same individual, is "turned down on the grounds that this Miss Starr didn't seem like the most wholesome person for a patient to go pass with. " (Kesey, p 176) When McMurphy applies for a third time, this time being accompanied by "two sweet old aunts from a little place outside of Oregon City" (Kesey, p 177) the Nurse cannot find a valid reason to deny the pass.
However, immediately after approving the accompanied pass, the nurse takes out a newspaper article warning about the dangers of fishing off the coast of Oregon. In the following days she pins up several of these articles, all depicting the waters as being rough and treacherous, telling the men to "give that some thought" (Kesey, p 177). This demonstrates how the Nurse does not want the men to be able to leave her sphere of influence. She is uncomfortable with anything she cannot control, and is made uneasy when her patients seek to leave her control, even for a few hours.
The Doctor, when inquired about the possibility of seeing a New York Yankees game, is enthused and immediately presents the notion to his superiors. He finds himself the object of much ridicule. "I am not sure about the therapeutic effects of a hot dog," (Zieff, The Dream Team, 1989) he is told. Despite the scorn of his superiors, Dr. Weitzman argues that the patients have not been out of the asylum in years, and it is important that they begin to be part of the public. He honestly believes that the patients are best served by an excursion of this nature.
The fact that he is willing to take personal risk for the benefit of his patients by being accountable for their actions in public shows a level of trust that he has created with the patients. This is shown when Henry, who is lost in New York City, asks, "Can you recommend a good clinical psychiatrist in the area? We seem to have lost ours. " (Zieff, The Dream Team, 1989) The patients recognize that the therapy they receive is genuinely in their best interests. They trust in the rehabilitation process, and actively seek out help when they find themselves without the Doctor.
Although the Doctor and Nurse are both put in similar circumstances, the way they deal with the requests greatly affect the ensuing events. The Doctor's benevolent attitude creates a bond of trust between himself and his patients. The Nurse's oppressive and restrictive policies create feelings of resentment in the patients towards her. The trust and goodwill that the Doctor creates will end up saving his life, when his patients rescue him from would-be assassins. The resentment that the Nurse creates ends up threatening her life, when a patient snaps and tries to strangle her.
The differing approaches to leisure have far ranging effects on the patients. The way they are taught to interact in the artificial environment of the mental institute is how they will interact of their own accord later on. To successfully reintegrate into society, the patients must also be aware of society's norms and sanctions. They must understand their role within the population, and realize that for every action there is a consequence. To this end, disciplining a patient may be necessary. While the Nurse and Doctor both discipline their patients, they polarize on their methods.
The Nurse employs a near sadistic approach designed to humiliate the misbehaving patient into submission. The Doctor disarms the anger felt by the patient by finding the humor in the situation. He then takes advantage of the natural human urge to conform to rationally reason with the patient to obtain the desired results. While both approaches provide discipline and obedience, they have wildly different effects. The Nurse's form of discipline is demonstrated many times. She utilizes terror to obtain obedience within her ward.
This approach begins the moment a new arrival enters the institution. They are subjected to what is termed an "admission shower. " (Kesey, p 27) This ritualistic rite of initiation comprises of the new admission being stripped, cleaned, and sodomized by the Nurse's three aides. ... watch him stand scared till the black boys come sign for him and take him into the shower room, where they strip him and leave him shivering with the door open while they all three run grinning up and down the halls looking for the Vaseline. "We need that Vaseline," they'll tell the big Nurse, "for the thermometer. She looks from one to the other: "I'm sure you do," and hands them a jar holds at least a gallon, "but mind you boys don't group up in there. " Then I see two, maybe all three of them in there, in that shower room with the Admission, running that thermometer around in the grease till it's coated the size of your finger, crooning, "Tha's right, muthah, that's right," and then shut the door and turn all the showers up to where u can't hear anything but the vicious hiss of water on the green tile. (Kesey, p15) This initial rite of passage is usually enough to instill sufficient fear in the patients to deter them from further disruptions.
However, when challenged, the Nurse is sure to make an example of the defiant patient. "How do I [Mr Taber] know this isn't one of those funny pills that makes me something I'm not? " "Don't get upset Mr. Taber-"... "That's all right Miss Flinn, she [The Nurse] says. "If Mr. Taber chooses to act like a child, he may have to be treated as such. We've tried to be kind and considerate with him. Obviously that's not the answer. Hostility, hostility, that's the thanks we get. You can go, Mr. Taber, if you don't wish to take your medication orally. (Kesey, p 35)... They [the three aides] push him [Mr.
Taber] face down on the mattress. One sits on his head and the other rips his pants open in back and peels the cloth until Taber's peach-colored rear is framed by the ragged lettuce-green... They're in there a long time before the door opens up again and they come out, carrying him across the hall to the lab. His greens are ripped clear off now and he's wrapped up in a damp sheet. (Kesey, pp 36-37) The result is a ward full of patients who fear the Nurse, and will do anything she wants. The ward is run efficiently, as there are no disruptions, but the success rate for rehabilitated patients is staggeringly low.
While technically effective, the Nurse's manner of disciplining the patients is cruel, and serves little purpose other than to humiliate and dehumanize those in her care. The Doctor brings an entirely different approach to the concept of discipline. He does not ever mentally or physically harm his patients. Instead, he seeks through a mutual friendship the ability to reason with any one causing a disruption. When he enters a room to find chairs thrown about, including one thrown through a window and caught on the mesh reinforcement, he slyly remarks "Looks like one of our chairs tried to make a break for it, eh? (Zieff, The Dream Team, 1989) He does not accuse any of his patients. By creating humor, he effectively disarms the defensive psychological stance that the troublemaker, a patient of his named Billy Caufield, had initially adopted. Then, he simply asks in a calm voice if Billy would sit down. Billy has no reason not to, everybody else is sitting, and nobody has given him a reason to continue feeling angry. The social norms have been reinforced without giving Billy a motive to rebel against them. This effectively and expediously ends the problem.
The different approaches to two fundamental concepts regarding human psychology offer insight into the changes in how those with mental illnesses are viewed. In the early 1960's, those with authority, like Nurse Ratched, wielded it mercilessly, and their power could not be questioned. By the late 1980's the authoritarian ideal had been replaced with a trust system, similar to Doctor Weitzman's approach, that encouraged the patients to develop their own moral ideals and use them. The Nurses' approach left her with three patients dead, one escaped, and each voluntary patient withdrawing himself from the ward.
The Doctor's patients, however, all demonstrated significant improvement. One of those patients, Billy Caufield, was even released. The rest voluntarily returned to the mental hospital, confident that they would also be released when they were ready. Those who were oppressed, regressed; those who were cared for, were cured. The patients treated like animals acted as such, and those treated humanely became balanced individuals. As the mysteries of the psyche are slowly understood, the care for those with mental health issues will evolve. It is merely a matter of time, before we can glimpse at what lies behind the mind.