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Sara M. Martin
Professor Jonniann Butterfield
SOC 3700-W1
November 13, 2012
Media Analysis: One Flew Over the Cuckoos Nest
Sociological Model of Mental Illness
Mental illness is defined through subjective social judgments: judgments are based on
emotional views and/or preconceived ideas, and are usually stereotypical assumptions.
Mental illness reflects a particular social setting as well as individual behavior or biology:
an individuals unacceptable behavior derives partly from violating social norms, and not entirely
from psychological or biological reasons. What may be considered normal behavior in one
social group may be determined as abnormal in another.
Persons labeled mentally ill may experience improvement regardless of treatment, and
treatment may not help: When therapist and patient do not share the same views in what is
best, clash in treatment options may occur.
Medical treatment for mental illness sometimes can harm patients: because of the politics of
psychiatric diagnosis, mental illness may be misdiagnosed. One such reason may be the changes
in definitions for certain mental disorders in the Diagnostic and Statistical Manual of Mental
Disorders (DSM) that were once considered a mental illness, and now are not.
Looking at psychologist David Rosenhans 1973 experiment gives evidence supporting the
Sociological Model of Mental Illness where he and seven of his assistants pretended to be
mentally ill (hearing voices, etc.) and admitted themselves in twelve different mental facilities.
After being admitted, all began to behave normal, and it took 19 days for these mentally ill
patients to be released from the hospitals, but their symptoms were still recognized by the staff as
being in remission.
Medical Model of Mental Illness
Mental illness is defined by objectively measurable conditions: mental illness is like a
biological disease in the brain, creating symptoms. These symptoms need to be measured by
a licensed physician.
Mental illness stems largely or solely from something within individual psychology or
biology: mental illness derives from only from abnormalities of the brain and/or the body.
Mental illness will worsen if left untreated but may improve or disappear if treated
promptly by a medical authority: if a patient does not receive some form of medical treatment
(medication or a type of therapy), the mental illness will worsen. With medication or therapy,
patients mental illness will improve.
Medical treatment of mental illness can never harm patients: medication and/or therapy for
mental illness can not affect a person in a negative manner.
The most common evidence supporting the Medical Model of Mental Illness is through the
treatment of medication, either through over the counter medicines or via doctor-prescribed

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medications. For example, Prozac, prescribed for the treatment of depression and/or anxiety
levels out the imbalanced serotonin levels. Other examples are through the use of Monoamine
Oxidase Inhibitor (MAOI) drugs such as Nardil, Marplan, Parnate, and Manerix.
One Flew over the Cuckoos Nest
1) Who defined the main character as mentally ill (or in need of institutionalization)? The
officials from the work farm at the correctional facility that the main character, Randall P.
McMurphy, was at previously were the ones who originally wanted him evaluated to identify
whether he needed permanent institutionalization or not, as they believed he was fabricating
his insanity. (See also question #3)
2) What words were used by mental health professionals to describe the main character? After
Mr. McMurphy takes a group of his peers on a fishing trip following the hijacking of the
facilitys bus (joy ride), the physicians have a board meeting about McMurphys recent
behavior. Dr. Spivey, presumably the medical director, asks everyone if the patient is
dangerous. One physician says, I think hes dangeroushes not crazy. Dr. Sanji says, I
dont think hes overly psychotic, but I still think hes quite sick. Nurse Ratched, who is
considered as the person closest to the patient says, in my opinion, if we send him back to
Pendleton or we send him up to Disturbed, it's just one more way of passing on our problems
to somebody elseso I'd like to keep him on the ward. I think we can help him.
3) What behaviors did the main character exhibit that led to the label of mentally ill (or in
need of institutionalization)? Shortly after R.P. McMurphy arrives at the mental health
facility, he is taken to speak with Dr. Spivey as an initial interview to inform the patient of
the intended plan for his stay. After some idle chit-chat, Dr. Spivey asks Mr. McMurphy if he
knows why he is there, to which the patient denies knowing the answer. Dr. Spivey reads Mr.
McMurphys file from the penitentiary stating that he has been belligerenttalked when
unauthorizedresentful in attitude towards worklazy. He further states that Mr.
McMurphys reasons for being in the penitentiary is for five arrests for assault, statutory rape,
and they think youve been faking it [insanity] in order to get out of your work detail.
4) How was mental illness defined through subjective social judgments? For Mr. McMurphy,
because the staff knew that he had arrived from jail, there most likely was an automatic social
stigma that he was a rude and obnoxious individual. That being exposed to that type of
environment was one of many possible reasons for his behavior. Mr. McMurphys
instigating, outspoken and loud behavior and vulgarities, especially toward Nurse Ratched,
did not help his case in evaluating reasons for sanity. Nurse Ratched seemed untouchable
with a calm demeanor, and this added more negative points for Mr. McMurphy.
Also, toward the beginning of the film, after being admitted into the mental health facility,
Mr. McMurphy seemed baffled with the behaviors of the other patients, of which he probably
believed they themselves were mentally ill in the sense of the actual clinical definition as he
understood it.

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5) How did the doctors, nurses, and staff contribute to the continuance of the main character
being labeled as mentally ill? In two different group therapy sessions, there is the issue of
importance for Mr. McMurphy about viewing the World Series. In the first session, he
requested a vote of raising hands about who wants to have a field trip to Yankee Stadium to
watch the opening of the event, but no one raised their hand. In the next days session, the
World Series was brought up again by another patient, Mr. Cheswick, who requested another
vote. After much coercion by Mr. McMurphy, there were not enough raised hands, and Nurse
Ratched declared the meeting adjourned and that the voting session was closed. Her decision
disturbed Mr. McMurphy, where he became extremely loud and rude. He demanded the nurse
to turn the television on, but she refused instead, turning on a classical music record for the
patients to listen to. Frustrated, Mr. McMurphy faces the television and begins to imagine he
is watching the World Series as if he were broadcasting the events live. His actions peak the
interest of the other patients, who begin to join in his imagination, creating a group
disturbance - by Nurse Ratcheds viewpoint.
6) How did being labeled mentally ill (or being institutionalized) affect the main character? The
label did not seem to affect Mr. McMurphy at all; he even poked fun at being labeled crazy
by the penitentiary, for not being able to resist the female teenager he was accused for
statutory rape. It seemed that he viewed himself as normal compared to the other patients
in the facility, especially when he tried to enforce the rules during a poker game that another
patient, Martini, seemed unable to comprehend what Mr. McMurphy was trying to explain.
7) In what ways did being labeled mentally ill (or being institutionalized) lead the main
character to display behaviors that were considered deviant? What were those
behaviors? The day after the World Series imagination scene, Mr. McMurphy meets with Dr.
Spivey and another health official to talk about the patients progress. He explains his
frustrations about Nurse Ratched. Dr. Spivey then informs Mr. McMurphy that after four
weeks of observation, he sees no evidence of mental illness, believing he has been faking his
insane behavior. Here, the patient displays with facial gestures (drooling, crazy looking
eyes) and hand gestures (masturbation) of what he believes is considered as being mentally
ill. Mr. McMurphy also asks the doctor if that is crazy enough for him, or if he would like
him to defecate on the floor, which would also indicate an example of mental illness,
according to Mr. McMurphy.
8) Did the medical treatment provided to any of the patients cause harm to them? If so, please
describe. From a non-medical or non-health professional point of view, the electric shock
therapy given to Mr. Cheswick and McMurphy would probably seem as harmful. Also, while
it is unknown what medications the patients were receiving, one would assume the daily
medications were probably impairing their judgments.
9) Did any of the patients experience improvement during the film? If so, under what
circumstances? A few circumstances may seem controversial; however I believe that Mr.
McMurphys consistent confrontations with Nurse Ratched influenced the other patients to
gain a sort of mental strength to be able to voice their opinions. For example, when Mr.
Cheswick voiced during the second group therapy session, that he wanted a second vote to

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watch the World Series. (Granted, Mr. McMurphys influence also contributed to some group
disturbances, creating defiance among the other patients as mentioned above.)
Another example was toward the end when a patient, Chief, felt he had the inner strength to
leave the institution after seeing what happened to Mr. McMurphy (unnecessary brain
surgery). In the weeks prior, after finding out that Chief really was not deaf or dumb, Mr.
McMurphy spoke to him like a normal person, carrying normal conversations, all the
while asking Chief why he just didnt leave if he didnt need to be there.
I believe that Mr. McMurphys encouragement of Billys date with one of the young ladies
(that broke into the facility late at night) gave Billy that extra push he might have wanted, to
be able to have a sexual encounter (deviance) with a woman, like a normal, average
person. However, as the events following the next morning show, the results of his actions
along with Nurse Ratcheds comments about his mothers reaction to his behavior, created a
negative outcome for Billy.
Critical Reflection
Do you consider the main character to be mentally ill? Why or why not? I do not consider the
main character, Mr. McMurphy, to be mentally ill at all. In all honesty, I thought his deviant
behaviors - from the vulgarities, to the confrontations and instigations with Nurse Ratched, to
the disruptions with the rest of the patients - were quite comical. I say this because it was
evident his actions were created to frustrate the staff. He knew they were observing his
behavior, and he treated his stay there as a vacation from the penitentiary. His performance at
the institution indicated his time there was a game, and he was going to have as much fun
with it. However, if anyone got hurt in the process, was far beyond his expectations. Using
the words crazy and/or dangerous by the physicians earlier in the film, may imply that Mr.
McMurphy is not necessarily a danger to his overall health, but that he is disruptive in his
manner of defiance toward authority or rules and regulations. It would seem that he is not
intentionally putting others at risk, but that he is unfocused (clueless) as to the consequences
of his actions, and does not seem to be bothered much by those consequences unless
something severely drastic happens, such as the incident with Billys suicide.
Do you think that the Medical Model of Mental Illness or the Sociological Model of Mental
Illness is more useful in todays society? Provide evidence to support your claim. I believe
that both the Medical and Sociological Models of Mental Illness are useful in todays
society. They should be used together in order to assess an individuals behavior simply
because social norms and societies in different parts of the country have changed drastically
over the decades. One example could be the issue of abortion and/or sexual promiscuity.
Years ago, when abortion was illegal and unspoken of, there were countless stories of young
girls who became pregnant out of wedlock who were sent away. Years ago, this type of
behavior (sexual promiscuity) was considered deviant and abnormal. Aside from the trauma
of either losing the baby, or giving the baby up for adoption, the negative social stigma
related to pregnancy out of wedlock decades ago gave reason for parents to believe there was
something (mentally) wrong or abnormal with their daughter. This created even more deviant
behavior, the daughter believing herself that she is mentally ill as well, therefore giving more

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reason to have her medicated. Today, or in more recent years after abortion was legalized,
this is not as much considered as deviant behavior by many families across the country
because what was considered negative is now more widely accepted (abortion and sexual
promiscuity); still frowned upon, but accepted for the most part.
Please provide any reflections, observations, or critiques of the video that you would like to
add. As mentioned above, I thought it was quite comical and thoroughly enjoyed this film. I
have watched it years ago, but did not fully grasp the social and medical concepts of the film.
I mentioned in our last discussion the discovery of Oppositional Defiant Disorder (ODD)
when a teacher-friend of mine spoke of it about one of her students. I had never heard of this
term; however, in viewing this film, I am willing to bet that the main character, Mr.
McMurphy, would have been diagnosed with this disorder! He displayed almost all of the
symptoms for this disorder: persistence, disruptiveness, negativity, defiance, disobedience,
hostility, etc. While this disorder is probably more diagnosed among young children, I am
sure there are quite a few adults who also display this behaviorThe film was great, and I
really enjoyed it.

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References
One Flew Over the Cuckoos Nest. Dir. Milos Forman. Perf. Jack Nicholson, Louis Fletcher, and
Michael Berryman. Fantasy Films, 1975. Film.
Mayo Foundation for Medical Education and Research (MFMER). The Mayo Clinic, 26 Jan.
2012. Web. 13 Nov. 2012.