In this thesis I write about mental health in relation to society, shamanism and ideology. My argument focusses on schizophrenia. To exemplify my case I conducted a literary analysis of Ken Kesey’s One Flew Over The Cuckoo’s Nest. (Spoiler warning for book and film)
Thesis written by R. E. Junesworth
Ken Kesey’s One Flew Over The Cuckoo’s Nest (1962) (abbreviated One Flew) tells the story of a fictional US-American mental ward under administration of “Big Nurse” Ratched (4). The novel’s narrator is half Indian American “Chief” Bromden (Kesey 4). He inherited the nickname “Chief” from his father, and Bromden is his (white) mother’s surname. Chief has stopped talking or acting on his own will, like many other patients in the ward. However, Bromden is different, because he can see what others cannot see. Bromden is a schizophrenic, and his hallucinations epitomize the imaginative “Combine,” a machine network that connects all things and tries to make people into machines (Kesey 185). Bromden hallucinates a mythical fight between Combine-agent nurse Ratched and new involuntary patient McMurphy, who is fighting for the patients. In the novel Bromden undergoes an inward journey that reveals traumatic experiences, and the repressive effects of ideology on people trapped in the psychiatric system. Bromden has to realize that the Combine is only in his mind, but that his hallucinations were nevertheless true.
One Flew has been analyzed by scholars and critics, often revolving around the countercultural background and the stigma of mental illness. Michael Meloy has focused on the concept of masculinity and the “feminization” of the patients by nurse Ratched (4). Elaine Safer, has compared the novel and the film adaptation of the same name (director: Miloš Forman, 1975) and found that only the novel offers an insight experience of madness through the narration of Chief Bromden (134). Mettler found that the Combine “makes literal the countercultural fear that technocracy was turning postwar society into a vast impersonal machine” (178). Mettler further has analyzed in how far the novel holds the potential to change people’s attitudes toward mental illness. She concluded that One Flew “succeeded in reversing contemporary mainstream assumptions about deviance and mental illness” (Mettler 183). However, Mettler found that the book “had little positive effect on the treatment of actual mad people in the real world” (184). Kaiser and Munoz state that the novel does not break entirely with the norms of the dominant culture, which the counterculture attempted to do, and they criticize that the novel “fosters a notable misogyny”(Kaiser 203 and Munoz 668). Kaiser and Munoz are pointing at the infamous scene at the end of the novel in which McMurphy rips the clothes of “Big Nurse” Ratched (Kesey 270-271). One Flew in this light is a story of “machismo hero” McMurphy, who motivates the patients to reclaim their masculinity and autonomy (Safer 134). McMurphy makes it easy to see the novel as an anti- authoritarian story that fits the sentiments of the 1960s counterculture in which many minority groups fought for equal rights and identity. Many scholars focus mostly on McMurphy because narrator Bromden accentuates McMurphy as the central figure. Yet, it is clear in the novel that the story is Chief Bromden’s story. After all, it is Bromden’s “deluded” perspective that transforms McMurphy into a “mythical hero” (Safer 134).
With distance to the period of the counterculture, the anti-authoritarian “savior” McMurphy can step aside and make space to analyze the saved, Chief Bromden. Wilson Kaiser sees Kesey’s decision to use a Native American narrator as an outcome of the countercultural desire for “deeper spiritual connection to the environment and a greater sense of personal wholeness” (189). In Genealogies of Shamanism (2011) Jeroen W. Boekhoven explains that “hippie tribes” romanticized the Native American culture, but remained a separate group with their own practices and values, such as psychedelic drugs and sexual freedom (171-172). This might explain why Kaiser saw the use of a Native American narrator as symbolic for the counterculture’s spirituality. However, it is easy to relate the Chief to the category counterculture, but when Kesey wrote the book in 1962 such a unified cultural identity might not have existed but was forming. Therefore, it is more useful to see the countercultural influence as a background – and possible explanation for the character choices that Kesey made – and to analyze Bromden not as a countercultural figure, but as a Native American schizophrenic with insight about the ideological structure of the society that he is part of.
What the earlier mentioned scholars have not focused on is the symbolism of the “shamanic” inner journey that Kesey depicts through narrator Chief Bromden. The experience of schizophrenia has been associated by scholars, such as Mircea Eliade, Joseph Campbell, and philosopher Terence McKenna to the shamanic experience. There is evidence that Chief Bromden’s experience symbolizes a shamanic journey. For example, the retrospective narration of schizophrenic Bromden can be seen as the guidance of a healer that has overcome a sickness. Furthermore, his ability to see the oppressive Combine makes Bromden an untrained shaman. In Shamanism (1964) Eliade highlights that the “sicknesses, dreams, and ecstasies” of future shamans “constitute an initiation” (33). Campbell “argued that the ‘inward journeys of the mythological hero, the shaman, the mystic and the schizophrenic’ were in principle the same” (qtd. in Boekhoven 203). McKenna emphasized that the shaman “is someone who swims in the same ocean as the schizophrenic,” with the difference that the schizophrenic has no access to the shamanic teaching and training (AMP3083 “Terence McKenna” 04:28). In accordance with this, Eliade explained that while shaman masters train the initiate shaman, it is the “ecstatic experience that radically changes the religious status of the ‘chosen’ person” in traditional shamanic societies (33). Bromden’s insightful hallucinations and “delusional” thoughts are such ecstatic experiences, though they terrify Bromden. This nightmarish feature is another experience that Bromden shares with the shaman. Eliade assessed that “all the ecstatic experiences that determine the future shaman’s vocation involve the traditional schema of an initiation ceremony: suffering, death, resurrection” (33). Bromden has long been acting deaf in reaction to being treated with silence even before he came to the mental ward (Kesey 175). When he enters the asylum he undergoes a social death from which he resurrects as a talking and acting individual when he breaks free. In The Politics Of Experience (1967) psychiatrist Ronald D. Laing called the schizophrenic experience “an initiation ceremonial” that leads the person on a journey “into inner space” (128). Laing continued that the experience of madness “may be one that all of us need” to form a “sane society” (Politics 129). Boekhoven found that “although Laing did not offer a direct interpretation of shamanism, his work on schizophrenia was more significant for the genesis of a field of shamanism than the views of many scholars who dealt explicitly with shamanism” (181). Boekhoven points out that some shamans find their powers, while others seek them (73). Assuming that the shaman is a type of person, shamans must also exist in non-shamanic cultures. Fictional character Bromden – due to his existence in a non-shamanic society – belongs to the former category, he did not seek his powers but was overwhelmed by them in form of a sickness. It is this sickness that allows him to see the repressive ideology of society, or in his words, the Combine.
Louis Althusser’s concept of overdetermination provides a useful framework for a theoretical model of the Combine. Overdetermination refers to the dynamic relationship of the economic base and the superstructure in a society. They influence each other back and forth and in this process, the superstructural (dominant) ideology slowly evolves along in order to remain coherent to the evolving reality within the base (Eagleton 14). Terry Eagleton describes the dynamic relationship of the “economic ‘base’ or ‘infrastructure’ and the superstructure – certain forms of law and politics, a certain kind of state, whose essential function is to legitimate the power of the social class which owns the means of economic production” (5). According to Althusser the norms, values, and behaviors in a society are overdetermined to fit the historical ideas of the ruling class and are organized through “Ideological State Apparatuses” (ISAs) and “Repressive State Apparatuses” (RSAs) (Althusser 303). With the ISAs Althusser “means social institutions, the educational system, language, the media, the political system, and so on” (Fiske 307). Fiske explains that “these institutions produce in people the tendency to behave and think in socially acceptable ways” but these norms are “neither neutral nor objective; they have developed in the interests of those with social power, and they work to maintain their sites of power by naturalizing them into the commonsense” (307). Using Ken Kesey’s One Flew as an example this means that the superstructure defines sane and insane in law and medicine through which it becomes common sense. In effect, people are being confined in mental wards and treated with approved treatments. In response to this, Ken Kesey – considering his countercultural background – produced a piece of art that represents the struggle of the class of people that psychiatry calls mentally ill. Thus Kesey’s book is part of the relationship between the base and superstructure by communicating the repressive effects that ideology has on so called mentally ill people.
Althusser’s RSAs on the other hand include institutions such as the police, prisons, and psychiatric institutions which “coerce people into behaving according to the social norm” (Fiske 307). The subjects in a society mostly function “all by themselves” due to the shared ideology, however, some others do not follow the ideology, and thus require the work of the RSAs (Althusser 303). The mental ward in One Flew belongs to the category RSA, and while it claims to help the patients, its job is to ensure that the patients accept the ideological “truth” that they are sick. In Kesey’s words, patient Harding needs the nurse to be happy in his role as a “rabbit” (55). In other words, someone who is affected by the “sickness” of society must accept that it is really him who is sick. This truth represents the ideas of the ruling class, and is, as Marx has argued in “The German Ideology” (1846), not an objective truth, but a myth to “make the one class the ruling one” (253- 254). In accordance with this Bromden says that the mental ward is “a factory for the Combine” (Kesey 33). For the staff that is engulfed in the ideology that gave birth to the asylum this ideology is normality. It is an “obvious truth” that the patient is sick and needs help (Foucault 177). Thus, the treatment is justified and right. In contrast, for an outsider, such as Chief Bromden, the ideological structure of society is obvious because he literally sees it. Bromden sees the overdetermined relationship of ideology, when he mentions that the ward is “for fixing up mistakes made in the neighborhoods and in the schools and in the churches” (Kesey 33-34). Furthermore, the name Combine shows the combined power coming from the connectedness of institutions within the ISAs and RSAs. Unfortunately, Bromden’s hallucinations merge with his ordinary perception of reality and obscure it with their seeming falsity. This would not be an issue in an environment that would guide the patient through these experiences to come to an understanding of them. However, when these symptoms are repressed, and the existence of the “unreal” things denied, we stop understanding the sense of the “madman” and hear nonsense. This is what Michel Foucault meant when he criticized that “confinement did seek to suppress madness, to eliminate from the social order a figure which did not find its place within it” (115). In the confinement of the asylum “madness is acknowledged to be nothing” (Foucault 116). If a (sane) schizophrenic would, instead, be seen as a guide “helping future patients go mad” then he becomes a shaman (Laing Politics 128).
Subsequently, the cultural importance of One Flew does not lie merely in its social critique, or masculine anti-authoritarian aspects, nor does Kesey attempt to bring wide social change or improvement for the sick. Although the general focus has been on McMurphy’s anti-authoritarian struggle against the Big Nurse, in this essay I provide a psychology-infused literary analysis of One Flew Over the Cuckoo’s Nest in which I argue that the book’s relevance is in its depiction of the inward experience of narrator Bromden that demystifies schizophrenia of its psychiatric meaning and alternatively offers a journey into the realm of inner space. This quasi-shamanic experience illustrates the reality-revealing properties of schizophrenia in opposition to the historically created morality of the asylum that claims that the condition is a mental illness. Bromden’s comical hallucinations of the Combine reveal the repressive nature of psychiatry because they exaggerate the events in the mental ward and make them obvious. The hallucinations mock the treatment in the mental ward and demystify the ward as a material manifestation of Louis Althusser’s repressive state apparatus within the larger overdetermined ideology of U.S. society. Kesey, brings the illusion of the caring mental ward to a climax, and unveils that the asylum is not a treatment, but an institution to repress and correct those that do not adhere to the norms, values, and behaviors made by the ruling class. As a result, One Flew is about the class struggle of schizophrenics and other “mentally ill” people trying to find their place in social environments that create dead-end situations and are ideologically built to shield off the natural states of consciousness known as mental illnesses. Thus, One Flew becomes a western form of literary shamanism that plays an important role in representing the qualities of people considered schizophrenic, and unmasking psychiatric violence covered as love. Kesey does not attempt to lift the stigma of mental illness, so that the reader views the sick better, instead Kesey shows that sometimes there is no sickness, but only mundane human nature, and that the patient must heal him or herself.
Michel Foucault’s analysis of the history of madness reveals that mental wards are moral-correction institutions to defend the values made by the ruling authority, and to repress “everything that opposes the essential virtues of society” (Foucault 258). In Madness and Civilization (1965) Foucault offers detailed research on the history of madness in the course of western history. Foucault writes that in the Middle Ages madness was part of social life and “he talks about a dialogue between the ‘sane’ and the ‘mad’ in earlier historical periods, with the mad having a culturally significant role” (Sapouna 613). This significance came from the view that the mad, like comedians, were speaking the truth (Foucault 14). This view places the mad closer to a shaman than contemporary medical views. Foucault places madness and folly next to another to underline their proximity to “reason and truth” (14). Foucault reports that the fifteenth century gave birth to socially repressive institutions that pushed the mad out of society and in to centers of confinement (35-36). The sixteenth century introduced the so called “Madhouse,” which was the predecessor to the asylum and mental wards as seen in One Flew (Foucault 35). A wave of confinement in the seventeenth century that confined “one out of every hundred inhabitants of the city of Paris” further stigmatized the insane because they were confined in the same institutions as the poor, the unemployed, and criminals (Foucault 38-39). At this time it was common to see “mendicancy and idleness as the source of all disorders” (Foucault 47). At the heart of the confinement of the mad was not treatment, but correction of people who stopped functioning in working-life and in following the discipline and order of society. This moral correction was combined with the medical sciences, which allowed doctors to do punishment work for the authorities (Foucault 177). To cover the punishing nature of their work asylums veiled their work with scientific myths. Foucault highlights that “it is within the walls of confinement” that psychiatry was born (Foucault 39). By the eighteenth century medicine was fully entangled into the repressive apparatus. “Medicine was now content to regulate and punish” so that madness could be restored “to the world’s obvious truth” (Foucault 177). This truth is of course that of the ruling class and its goal was to suppress any other kind of truth that was deemed unacceptable with the ways life ought to be lived. The eighteenth century finalized the image of the “animal madman” as an other that could only be treated with brutal discipline (Foucault 75). This effectively demonized the mad and disarmed the (shamanic) power of madness to speak truth and stigmatized it as nothingness. Foucault concluded that “what we call psychiatric practice is a certain moral tactic contemporary with the end of the eighteenth century, preserved in the rites of asylum life, and overlaid by the myths of positivism” (Foucault 276). This development led to the creation of myths that people passively accept as scientific truths. The psychiatric view has no place for a truth in madness, or for alternative approaches, such as shamanic initiation illnesses.
In contrast, the 1960s countercultural movements created an audience for the truth in madness and started an ongoing discussion about mental illness and its treatment. The hippies – which Ken Kesey influenced – rejected the established way of culture that preached discipline, waged war, and confined the mad. Instead, the hippies focussed on personal change, community, altered states of consciousness, and love. Unsurprisingly, some hippies saw madness – which is an altered state of consciousness – positively, they favored “insanity over sanity” (Mettler 173). The hippies saw madness positively because of the usefulness of madness as a “tool to make a broader social critique” (Mettler 173). Madness’ ability to speak truths was in line with the hippie’s critical perspectives. Willingly or not, this placed some mad into roles of guidance that are comparable to the guidance of a shaman for his society. However, the “celebration of mental illness,” and “free love, communal living, and LSD were unable to revolutionize society” (Mettler 186). While this is, arguably, the case because psychedelic drugs were banned and authorities continued to endorse ideologically repressive institutions (psychiatry etc.), it is important to note that mere romanticization of a condition of deep suffering does not alleviate suffering nor does it foster moments of insight that help the sufferer. In line with this, One Flew’s Bromden explains to McMurphy that he certainly understands to see the funny side, but he does not see the other side that “parches laughter deep inside your stomach” (Kesey 201). Sickness and suffering are not a free pass to become a shamanic guide or a cultural critic – many psychiatric diagnoses, e.g. dementia, are in no relation to shamanic insight – but the initiation sickness can lead the sufferer to become a healer if the sufferer manages to overcome the sickness. Eliade “recorded no case of a shaman whose professional hysteria deteriorated into serious mental disorders” (31). After their initiation sickness shamans are “expected to be, and usually are, perfectly healthy and normal” (Eliade 31). Others, such as psychoanalyst George Devereux challenged this and instead saw in the shaman “a severe neurotic or psychotic” person (qtd. in Boekhoven 174-175). Nonetheless, Devereux highlighted that the “socially sanctioned” guiding system in shamanic societies allow the shaman to cope with the mental condition (qtd. in Boekhoven 175). Thus, madness in general should not be romanticized because each individual case differs, and romanticizing madness does not provide guidance like that in shamanic societies. To become a healing process madness’ inner journey needs to be allowed to happen so that an understanding of the underlying reasons for the sickness can lead the sufferer back to normality.
This is why it is helpful to see the shamanic journey as a framework for the journey of mad people, such as Bromden, transcending from sickness into a new healthy life. Shamanism was very attractive to the hippie’s “longing for individual freedom” and “communal life in tribes” (Boekhoven 201). Hippies and Native American shamans are both known for use of psychedelics, interest in consciousness, and closeness to nature. However, the push to see shamans as “wounded healers” that “had attained a more authentic and integrated, and less inhibited state of mind” was formulated largely by psychologists (Boekhoven 201). Boekhoven writes that the “shaman came to represent an individual who was not restricted by social structures and who was, therefore, in touch with nature, with the deepest layers of the mind, and with perennial knowledge” (200-201). These are features that schizophrenic Bromden shares, though he is restricted by social structures in form
of the mental ward. His dreams and visions of nature, past memories, and symbolic hallucinations of the ideological workings of society make Bromden a kind of shaman stuck in a system that subjects him as a schizophrenic. His mind is sick from his social environment, and hence reveals that sickness to him in vivid images. This makes the sickness a natural treatment similar to how a fever is the body’s treatment to fight infections.
Through Bromden’s narration the reader witnesses such an inner journey from the inside, and although his hallucinations are terrifying the symbolic imagery reveals the repressive morality of the ward. The novel’s first introductory chapter ends with Chief Bromden explaining: “But it’s the truth even if it didn’t happen” (Kesey 7). With this key sentence Kesey states a central point of the novel. Bromden’s hallucinations illustrate the machine-like connectedness and control of the ideological apparatus. The oppressive ideology of U.S. society affected his family, and visualizes in form of Bromden’s hallucinations. Furthermore, the hallucinations illustrate the way Chief relates to the mental ward and its staff. They reveal his ”imaginary relationship” to his “real condition[s] of existence” (Althusser 294). The hallucinations, however, do not take realism serious, they exaggerate Bromden’s experience in satirical ways. This is why Bromden sees the epileptic Mr. Sefelt melt into “a gray puddle” when the Big Nurse shames him for not taking his medication (Kesey 147-148). Bromden is aware of the imaginations, but seemingly unable to distinguish between real and fantasy. For a long time Bromden is lost in his hallucinations that enshroud him like the fog of a smoke grenade. He sees the Big Nurse as a machine of the Combine, and while others cannot see her power – but only feel it – the Chief can “see it” (Kesey 202). Bromden hears the “gears grinding” and sees the machine of the Combine work in the walls of the ward and the staff (Kesey 45). Chief Bromden speaks his “mad truths” to the reader when he speaks of the Combine. Such a truth is dangerous to the established ideology of society in which the government and its institutions ought to be taken serious and viewed positively. The staff works to silence such truths, which is why Bromden is not talking anymore. Bromden tells the reader that the Big Nurse on the one hand “adjusts” the “inside” world of the ward, and on the other hand the “outside” world (Kesey 23). Bromden sees how the overdetermined ideology of the ruling class and its myths stretch over all parts of society, inside the mental ward as well as outside. Chief Bromden realizes that nurse Ratched is a mere “high-ranking official” of a much bigger system of oppression that he calls the “nation-wide Combine” (Kesey 159). From the perspective of modern psychiatry Bromden is delusional and has hallucinations of “things that are not there” – such as machine-like humans (ICD 10 F.20). This is precisely how the Big Nurse treats patients. She is the expert, subsequently she knows what is going on, and the ignorant childish patients have to subdue to her motherly authority. However, as Henry Munn argued,“to call such transcendental experiences of light, vision and speech hallucinatory is to deny that they are revelatory of reality” (qtd. in Boekhoven 218).
R. D. Laing has expanded on the reality-revelatory journeys of schizophrenics. Laing argued that madness’ inner journey “need not be all breakdown. It may also be breakthrough” (Politics 133). Laing thought of such ‘illness’ as truth-revelatory, though possibly destructive, and he argued that “schizophrenics have more to teach psychiatrists about the inner world than psychiatrists their patients” (Politics 109). This coincides with Bromden’s schizophrenic insight. Schizophrenics are pushed into an inward journey reflecting over “one’s personal life” and “beyond into the experience of all mankind” (Laing Politics 126). Bromden’s mind wanders through personal memories, and sometimes memories of his father “communicate” with him (Kesey 6). Bromden also escapes into objects, such as paintings from which he observes the happenings in the ward “through the frame” of the painting (Kesey 107). Although painful, such an inner journey can also be “liberation and renewal,” similar to the shaman being “reborn” after overcoming sickness (Laing Politics 133). Laing wrote that the schizophrenic goes on a “voyage from outer to inner” which brings the person to a standstill (Politics 128). Chief Bromden is silent and passive in the mental ward, which indicates that he is halfway through his journey. He entered the inner world and has yet to return. This journey leads the person from “the ego to the self,” and “from life to a kind of death”
(Laing Politics 128). In the optimal case the schizophrenic returns “from death to life,” “back to a movement,” “from self to a new ego,” and finally undergoes “an existential rebirth” (Laing Politics 129). In the ending chapters Bromden goes from this passive condition to a new identity inspired by rebellious McMurphy. The turning point occurs when McMurphy brings Bromden to a conclusion of his inner journey. McMurphy sings “oh, does the spearmint lose its flavor on the bedpost overnight?” and makes Bromden laugh about his own desperate behavior to collect chewing gums under the bed (Kesey 182). In the ward Bromden has no money or agency to buy new ones. Bromden is able to look at himself from a point of laughter again. In addition, McMurphy uncovers the nurse’s breasts toward the end and this shows Bromden that she is not a powerful machine but merely a human being (Kesey 271-272). This makes Bromden reach a point of self-realization about himself and his environment that ends his suffering and initiates his rebirth.
Laing’s description of schizophrenia is similar to the process of “death” and “resurrection” that shamans undergo, either through “ecstatic dreams, sickness, unusual events, or ritual” (Eliade 64). The key factor in both cases is that the sufferer comes to a point of self-realization in which previously unconscious things become conscious. In the shamanic language those things are called spirits, and the mental journey is named the “symbolic descent to the underworld” (Eliade 64). In the language of psychology, Carl Jung explained that “the unconscious no sooner touches us than we are it” (22). This means that to solve unconscious problems one has to become aware of one’s “true self” – the self that is conscious of the entirety of body, mind, and outside world. This is perhaps what Foucault called the “animal in man,” our primal animalistic self (73). No guide or doctor can cure a person of the own primal self trying to cure itself. The “ill” person has to heal him or herself. Yet it is precisely the dogma of psychiatry that the doctor can (and has to) cure the patient of this inner journey.
In contrast to the psychiatric view of mental illness as a physical disease, Laing and Gregory Bateson saw mental distress as a reaction to an existential dead-end, either socially or personally. Laing criticized that “there is no such ‘condition’ as ‘schizophrenia,’ but the label is a social fact and the social fact is a political event” (Politics 121). One Flew illustrates the effects of this political event through Chief Bromden. Bromden got sick from traumatic experiences that the government caused to his family, and in the mental ward he gets categorized as mentally ill. Laing pointed at the relation of sociological environment and madness when he wrote that the “disturbing patterns of communication” of schizophrenics are reflective or reactive of the “disturbed and disturbing pattern characterizing his or her family of origin” (Politics 114). The family and other social institutions are conditioned to perpetuate the norms and values of the overdetermined ideology, and they are more significant in understanding the origin of madness than medical explanations. In the ward Bromden has arrived “in a position of checkmate” (Laing Politics 115). This situation is what Gregory Bateson called the “double bind,” “a situation in which no matter what a person does, he ‘can’t win’” (201). Madness, from this perspective, is “a special strategy that a person invents in order to live in a unlivable situation” (Laing Politics 115). This situation is often an outcome of political decisions that discriminate against minority groups, such as Native Americans and the so called mentally ill. In a surreal and comical manner Bromden’s hallucinations show the traumatic experiences that brought him to this checkmate. For instance, his time in the army and the practice to fog battlefields explain why he sees the ward covered in fog (Kesey 109- 110). Furthermore, his parents’ unhealthy relationship and his father’s struggle against the power of the government explain why much of Bromden’s inner journey depicts childhood memories of his father’s losing fight against government men who, ultimately, replaced his tribe’s village with a dam (Kesey 146). Bromden informs McMurphy that his white mother made his Native American father “too little to fight any more and he gave up” (Kesey 185). Bromden faces the power of the “Combine” that – through his mother – coerced his father to give up the whole reservoir of his tribe, and now Bromden projects his oppressive mother on the Big Nurse. As a child he saw his mother to be much larger than her “five feet nine” (Kesey 184). Similar to his mother, nurse Ratched blows up in size – “big as a tractor” – when she uses her authoritarian power (Kesey 5). Consequently, Bromden “turns” into his father and becomes silent and small. Bromden is stuck at a double bind which his mind tries to overcome by looping on the memories and projecting them everywhere.
Huxley’s reducing valve, as described in The Doors of Perception (1954), serves as a helpful concept to understand how such surreal experiences of reality come to be, or to be more precise, how they are prevented from happening unless they are triggered. Through our upbringing we learn how to act, talk, and think. Laing pointed out that “a child of two is already a moral mover and moral talker and moral experiencer. He already moves the ‘right’ way, makes the ‘right’ noises, and knows what he should feel and what he should not feel” (Politics 59). Normal ordinary perceived reality is, hence, dominated by conditioned behaviors that are based on memories. At all times this mass of memories is theoretically accessible to the person (Huxley 16). To prevent all this information to come to our consciousness Huxley theorized that the “brain and nervous system” function as a “reducing valve” which has the primary function to “protect us from being overwhelmed and confused by this mass of largely useless and irrelevant knowledge” stored in the brain (16). However, the brain is fully capable of creating a completely different reality. After all, our perception of “normal reality” is a “hallucination” entirely manufactured in the brain based on incoming sensual perception and memory. If one now enters a dead end situation – a checkmate in which the available information cannot lead to a solution – then the mind’s primary purpose becomes survival. The reducing valve “opens” and accesses the only source of knowledge that the mind has: Own memories and imaginations, which are tainted by the ambiguity of imagos.
In such an inward journey secondary things, such as culturally acceptable behavior, ordinary perception, or a culturally agreed external reality become irrelevant. This is why it is harmful that psychiatric wards, as described in One Flew, force patients to keep up their “scheduled duties” and “discipline and order” (Kesey 121-122). The individual reality becomes the truth of the person, just as Bromden’s hallucinations are his personal truth. In this state a person cannot function in the social-cultural system, centering around functionality in working life and conditioned behaviors. This is why the mentally ill often seem so crazy. For instance, a person in such a checkmate might imagine to be dead “as a defen[s]e against the pain of life” (Laing Divided Self 149). With the right guidance this point of false death can be useful to analyze why one died. This might not sound sensible to the doctor who sees that the person is very much alive but it does make symbolic sense to the “psyche in crisis” of a shaman or a person that has arrived at an existential checkmate (Eliade XVII). In Kesey’s words, it is “a sense of your own” (Kesey 113). By figuring out the reasons that “killed” the person – those things that appear as hallucinations, demons, or evil spirits – the person can come to a conclusion and return to ordinary reality. However, this process of self-healing is only possible if one is not misinformed that such conditions are diseases and that the hallucinations and delusions are not real. With the current notion of mental illness it is unsurprising that many who end up in such journeys can only find the confusion and fear that they were conditioned to expect.
Ideological language – defined in the superstructure (law and medicine) – creates social myths that mislead the sufferer into the care of psychiatric treatment. Psychiatry, as a repressive institution, masks its violence as treatment, and denounces other approaches as nonscientific. Psychiatry upholds the myths formulated by the ruling ideology that justify psychiatry as scientific. Due to this, psychiatry textbooks frame the lack of scientific evidence for mental illnesses not as a fundamental problem of psychiatry, but as a danger that gives rise to “competing unscientific views” (Geddes et al. 4). One such view is the shamanic view that acknowledges that the shaman is sane after his sickness and that the sufferer determines the end of the journey and not a doctor. In shamanic societies shamans take the role as “unconventional leaders of the tribe” and heal their people because they can see moral problems (Boekhoven 201). Psychiatrists too deal with these moral problems which “they cannot solve by medical methods” (Szasz 9). To counter these problems psychiatry invented medical diseases to suit symptoms of people that psychiatrists discovered by observing the patient’s behavior (Szasz 12). Modern psychiatry excludes explanations outside its own dogma and develops “mutually-exclusive, non-overlapping diagnostic boxes” to fit symptoms of patients (Miller 690). However, psychiatric diseases were not found through scientific “methods of pathology,” “but by creating a new criterion of what constitutes disease” (Szasz 12). According to nurse Ratched one such criterion is the patient’s “proven inability to adjust to society” (Kesey 140). However, nurse Ratched and psychiatric doctors are not scientific experts on madness, but “personalit[ies], whose powers borrowed from science only their disguise, or at most their justification” (Foucault 271). Psychiatry is no science, though it attempts to live up to the scientific standards of the natural sciences (Miller 689).
To cover up the ideological being of mental illness, psychiatry conditions physicians and limits the agency of the patient by subjecting the patient as a victim not of psychiatry but of an alleged illness. Szasz explained that psychiatry indoctrinates “the young physician into the theory and practice of psychiatric violence,” (qtd. in Breeding 249). Once a patient is diagnosed the psychiatric staff holds the power to decide when the patient is cured. In One Flew nurse Ratched has the “say as to who gets discharged and who doesn’t” (Kesey 161). Breeding notes that “when a psychiatrist decides that a person has a mental illness and that person disagrees, according to the psychiatrist, that disagreement just shows the person lacks ‘insight’ and is in itself proof of the mental illness” (251). Everything that the patient says from that point on can be interpreted as an expression of the alleged illness. Since the ideology of western medicine defines psychiatry not as punishment but as treatment any attempt to escape this treatment will look like resistance against a much needed therapy. In some cases this can lead to forced treatment. The lack of agency is significant in cases of involuntary commitment. A patient might be committed against his will simply because his will is considered mad because he behaved in unwanted ways. In One Flew, McMurphy is involuntarily committed, and the Big Nurse informs him that he is “under jurisdiction and control” of the staff (Kesey 121). This kind of abuse of power is masked as “benevolence of psychiatry as a more humane treatment for mentally ill criminals” (Breeding 245). However, such loss of agency is critical in a society that officially adheres to liberty and human rights. Breeding noted that “from a human rights perspective, an involuntary patient has lost his liberty, without a criminal conviction” (Breeding 245).
Also voluntary patients lose their agency. For example, it is the psychiatrist’s power to “decide whether to invoke powers of compulsory admission and or” treatment that is supposedly in the “best interest” of the patient (Geddes et al. 98) This is “violence masquerading as love” (Laing Politics 58). The psychiatrist can also change the voluntary status of a patient into an involuntary one. The patient becomes a child-like “psychological subject, to the authority and prestige of the man of reason, who assumed for him the concrete figure of an adult” (Foucault 253). In One Flew, patient Taber asks what kind of medication he is given, and nurse Ratched says that he “acts like a child” and he can leave if he insists to not “take his medication orally” (italics added) (Kesey 28- 29). This exemplifies how the nurse insinuates further violence (non oral ingestion) if the patient does as he wants. Szasz emphasized the importance to include “freedom, choice, and responsibility into the conceptual framework and vocabulary of psychiatry” (Szasz 6). Yet, psychiatry denounces this because of the expertise of the psychiatrist and the urgency to treat the alleged illness. The question is, if mental illnesses were diseases like any other disease why is psychiatry so engaged with laws and limiting the agency of the patient?
The answer to this might lie, on the one hand, in the legal sanctioning of the patient’s loss of agency, and on the other hand in mental illness’ potential to power. Kesey reveals this side when McMurphy takes Bromden and many of the other patients on a fishing trip. Outside of the mental ward the patients use the stigma of mental illness for their advantage. At a gas station the patients act mad and make many demands while Harding explains that they are “lunatics from the hospital up the highway, psycho-ceramics, the cracked pots of mankind” (Kesey 200). Patient Harding, who self-identified as a rabbit without agency in an earlier chapter, says that “never before did I realize that mental illness could have the aspect of power” (Kesey 200). Harding continues that he thinks that “perhaps the more insane a man is, the more powerful he could become” (Kesey 200-201). Madness holds a power to make us understand things in new and unexpected ways because it shows us how subjective reality is. These new ways to look at reality are powerful because they allow us to change our views and create new norms, values, and behaviors. If one analyzes the concept of mental illness historically it becomes clear that the definitions of mental illness change over time. At any time the status quo perpetuates itself with myths (e.g. scientific truths), until that truth is undone by another truth. Homosexuality, for example, was considered a mental illness until 1973 in the United States (Hyland 179). Repressive institutions, such as psychiatry, work against this progression of the social reality and silence this own sense, because their primary function is to reinforce the current norms, values, and behaviors.
Ken Kesey exemplifies the strength that such own sense has in the language of Bromden, such as Combine. The word is effective in making the reader understand the power and the danger of the ruling ideology because Bromden does not use the word US-government or the establishment. If Bromden would use already existent words his language would be under the control of the ideology that defines those words. Bromden’s own sense makes the reader understand the ills of society through use of allegories and symbolic language that are removed from the already existing and controlled words. The imaginative Combine mocks the real existing establishment of U.S. government and military industrial complex that try to cover up how machine-like these institutions are. Ideology is powerful if it is being taken serious. Bromden’s mad allegories show how one can free oneself from this power by not taking it serious. Kesey does not describe, a realistic mental ward, but one that is overly violent, overly crazy, and funny. Bromden’s mental illness mocks his experience until he finally understands the message and stops to take the ward and his own experience serious. If one takes Bromden’s words literal one might come to the conclusion that he is hallucinating. Whereas, if one takes them as expressive for his feelings and experience of reality then they are understandable and clear. The hallucinations can show Bromden only the unreal, because he has to realize what this says about reality. This outside perspective – seemingly removed from reality – is where the power of the shaman and the schizophrenic lie. When Bromden returns from his inner journey he immediately shares his knowledge of the Combine with McMurphy (Kesey 185). Thus, Bromden gives his shamanic knowledge from overcoming sickness to McMurphy who is a victim of the same discriminatory sickness, the Combine. Bromden concluded the journey, but by the norms of psychiatry he would still be considered delusional because he still speaks of machines and a machine-network. This is why Bromden realizes that he would never have found help in the ward, and that his friend McMurphy cannot save him but only show him the door. Bromden must save himself.
One Flew Over the Cuckoo’s Nest is culturally relevant because it illustrates the suppression of so called mentally ill people and offers an alternative view, one in which the patients are not ill, but relatable human beings with understandable life problems. This invites the engaged reader to question the myths manufactured by psychiatry. The fundamental view of such conditions as sickness remains widely accepted and unchanged. Extreme violent cases overshadow the many harmless people that psychiatry “treats” for abnormal behavior, thoughts, and experiences. Conditions, such as schizophrenia, are not helped with romanticization, but they are also not helped with suppressive treatments and condemnation as illnesses. Bromden’s inner journey exemplifies the clash of experienced inner world with the external social reality. Laing warned that “sanity today appears to rest largely on a capacity to adapt to the external world – the interpersonal world, and the realm of human collectivities” (Politics 141). This focus on the ideologically structured outer world, makes “any personal direct awareness of the inner world” a risk for the person experiencing it (Laing Politics 141). Mental illnesses are, on the one hand, real conditions of deep suffering. On the other hand, they are socially constructed concepts to control, correct, and suppress imaginations and fantasies and behaviors that do not coincide with the socially determined outside world. Western societies have treated the matter differently in earlier periods, and shamanic cultures continue to exemplify how guidance, ritual, and spirituality can help a person whose spirit is suffering. The idea of the inner journey is one that has yet to reach mainstream views in western societies. Unfortunately, such shamanic approaches are easily dismissed as “primitive” and unscientific in contrast to the glorified advancements of western medicine. Yet, this advanced “science” fails to provide “valid empirical evidence” that mental illness is a disease like other diseases (Breeding 249). Bromden’s schizophrenia is a fitting example for this. The schizophrenic journey is not a disease for Bromden, but a suffering that points at the things that make him ill. It is unfortunate, but unsurprising, that the mass-audience accessible film version does not make any use of the inner journey and instead transforms the novel into a story about mentally ill people and prankster McMurphy. The film wants to reach large numbers of people, which is why it adheres to the overdetermined ideology and presents a perspective of mentally ill people that fits the paradigm of the status quo. This perspective evades Bromden’s inner journey because it is easier for a cinema audience. Many people in the audience, perhaps the majority, have never heard of any other explanation for mental illness than that of genetics and other psychiatric speculations. The reasons for the condition come rather from many diverse individual risk factors and not from a particular genetic malfunction (Kendler 81). Such complicated views are replaced by simple truths that convince the masses. People that offer more complex explanations, such as Laing, Foucault, and Szasz are significant for the progress of society but often do not reach the wider public. Mental illness might be something that we should not look for in the patient – though there are predispositions to get affected by such conditions – but in the ideological power structures we have built in our society.
Non-psychiatric treatments and psychotherapy play an increasingly important role as a form of therapy for mental illness, but few look at mental illness from a sociological standpoint. The sociological perspective is lacking. This halts mental illness to reach a new status in the superstructure. The mentally ill are a class of people that is disempowered because their struggle is not recognized as a class struggle, but framed as an illness that is treated by psychiatry and psychotherapeutic methods. Other minority groups, e.g. African Americans, and homosexuals are known in the common sense as groups that fight for equality and human rights. The class struggle of mentally ill people, however, (excluding those cases that are affected by actual brain illnesses and old age related mental impairment etc.) is one that is ideologically suppressed and concealed with cultural myths of illness and treatment. This creates social environments in which many are scared of the idea to be affected by mental illness, and when one shows symptoms many people have no available information but the myths spread by the work of the ideological apparatus. From that point on it is easy to end up in psychiatric treatment – voluntarily or involuntarily – and to lose agency and liberty over mind and body. To prevent this, education about the ideological workings of society, alternative views on mental illness, and engagement with the own mind and consciousness are necessary. Artworks, such as One Flew, are seeds of knowledge that deal with these topics and they impact the slowly changing reality in base and superstructure. In recent years there has been development towards lobby groups that fight for alternative views on madness. This goes well with One Flew’s “hire the insane” idea, and the proposed lobby groups for the mentally ill (Kesey 203). For instance, in Ireland the so called Madpride holds events to discuss and review madness from critical as well as positive perspectives. Madpride Ireland hosts events to “show the world that madness is an everyday occurrence that affects us and can be dealt with openly, lovingly and without fear” (Sapouna 615). Such alternative “approaches break the silence of ‘madness’, moving it from nothingness to community engagement and visibility, often celebrating the ‘gift’ and ‘normality’ of madness” (Sapouna 615). Abnormal behavior must not always signify illness, sometimes it just points at the madness of our culturally enforced norms, values, and behaviors, and deserves to be listened to. To form a fairer and more equal society we need less politics that define and categorize experience, and more experience that makes politics.
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