Compare the ways in which psychiatric institutions and mental illness are presented in Barker's 'Regeneration' and Kesey's 'One Flew Over The Cuckoo's Nest'.
Compare the ways in which psychiatric institutions and mental illness are presented in Barker's 'Regeneration' and Kesey's 'One Flew Over The Cuckoo's Nest'
The novels 'Regeneration' by Pat Barker and 'One Flew Over The Cuckoo's Nest' by Ken Kesey are both centred on events that take place within psychiatric institutions. The protagonist of 'Regeneration' is Siegfried Sassoon, a soldier protesting against war who is sent to Craiglockhart psychiatric institution for assessment because of his views. In comparison, 'One Flew Over The Cuckoo's Nest' focuses predominantly on Randle McMurphy, a character who seems to have contrived to get himself admitted to a mental hospital in Oregon to escape the rigours and hardships of prison life.
An immediate similarity between both these characters is that neither Sassoon nor McMurphy appears to be truly insane, and consequently one might say that they do not belong in a mental hospital. In 'Regeneration' Sassoon presents the British government with his Soldier's Declaration, an act of 'wilful defiance' signalling his refusal to fight. The Soldier's Declaration is a document that proclaims that it is wrong for soldiers to keep fighting when the war could be ended on diplomatic terms. This poses a problem for the government. One course of action for them would be to shoot Sassoon for desertion. However, this would be unwise, since shooting a high profile poet who had previously fought in the war would not earn them good publicity. That leaves the option of declaring that Sassoon must be suffering because of psychological strain, and sending him to Craiglockhart institution where further analysis can take place. Interestingly McMurphy is also sent to a psychiatric institution for assessment of his mental state since it suspected that he might be feigning mental illness. McMurphy seems to have entered the mental hospital in order to make easy money by gambling with the other patients of the hospital who truly belong there. McMurphy seems to suppose that the staff in a mental institution will be a soft touch when set against those whom he encountered in his former prison regime, and he also supposes that they hospital ward will be more to his liking. This assumption drives McMurphy to rebel against the figurehead of power in the novel, Nurse Ratched, for the sheer enjoyment acquired from belittling a feared authoritarian. 'Sometimes he slept till eight o'clock. She would reprimand him without heat at all, and he would stand and listen until she was finished and then destroy her whole effect by asking something like did she wear a B cup, he wondered, or a C cup, of any ol' cup at all.' McMurphy's behaviour can be compared with that of a schoolchild who seeks the attention of his classmates by provoking the teacher. In this case, the authority figure exists in the form of nurse Ratched, seen as a formidable disciplinarian on the ward.
A fundamental difference between the setting of the two novels is that Barker's 'Regeneration' is set in Craiglockhart, which is a Psychiatric institution that really existed, so Barker tries to recreate through fiction, actual conversations that may have taken place between real personages. 'One Flew Over The Cuckoo's Nest' on the other hand is a fictionalized account of a 'mental institution' in Oregon, although Kesey may have been partially inspired by his own experiences of working in psychiatric institutions. Indeed prior to writing 'One Flew Over The Cuckoo's Nest' Kesey had submitted himself to electro shock therapy and took psycho active drugs such as LSD as he was interested in altered states of consciousness.
In 'Regeneration' Dr Rivers is a well-respected psychiatrist at Craiglockhart castle, and it is precisely for this reason as a man at the pinnacle of his profession, that he is chosen to assess Sassoon. When interacting with his patients he displays patience and will power holistically by drawing patients out of themselves through a careful and painstaking process and listens to what the patients tell him, rather than telling the patients what their problem is and neglecting their opinions. His form of treatment is to cure the problem, rather than merely address the symptoms. Rivers allows patients to decide the way the therapy sessions are run, which is an effective approach as he usually gets the information he needs to make a diagnosis without putting much pressure on the patient. Nurse Ratched, the head nurse on the psychiatric ward In 'One Flew Over The Cuckoo's Nest' has a very different method to Dr Rivers when it comes to handling patients. She occasionally resorts to Electro Shock Therapy to treat patients who fall out of line, claiming that it has therapeutic value, as patients seem to calm down after the treatment. This is evident from a quotation from Chief Bromden after he had received his last administration of Electro Shock Therapy. 'There had been times when I'd wandered around in a daze for as long as two weeks after a shock treatment...for two weeks'
In 'One Flew Over The Cuckoo's Nest' we see the patients take part in group therapy, which involves all the patients sitting together and discussing and problems they would like to share or any progress they have made. Nurse Ratched claims that this has therapeutic value, however early on in the book we can see that it is a means of control for the nurse, as she has the chance to humiliate patients in front of each other. For example, in the first group meeting we witness the nurse is able to make each patient reveal a secret ...
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In 'One Flew Over The Cuckoo's Nest' we see the patients take part in group therapy, which involves all the patients sitting together and discussing and problems they would like to share or any progress they have made. Nurse Ratched claims that this has therapeutic value, however early on in the book we can see that it is a means of control for the nurse, as she has the chance to humiliate patients in front of each other. For example, in the first group meeting we witness the nurse is able to make each patient reveal a secret about himself in front of the entire group, whom he can no longer face because of the shame of his revelation. 'I tried to take my sister to bed' 'I - one time - wanted to take my brother to bed' 'I lied about trying, I did take my sister! So did I! So did I! And me! And me!'. The patients successively admit to the disgraceful acts they had committed, each trying to outdo the other, in an attempt to satisfy the Nurse. This is the result of the group therapy sessions, which are simply used as another means of control by the nurse. Conversely, Dr Rivers in Regeneration tends towards using individual therapy, where he sees one patient at a time and is therefore able to concentrate his attention of that individual. His therapy sessions are different to those of nurse Ratched in that Rivers does not need total control over the session and of his patients, he allows the patients to talk about what they wish at their own pace. 'If you feel you can't talk about France, would it help to talk about the nightmares?' Rivers allows the patient to express themselves, to make a more accurate and informed diagnosis and be able to treat and cure the problem more efficiently. Nurse Ratched creates the illusion of freedom of speech by allowing her patients to express themselves in the group therapy sessions. However, Nurse Ratched uses manipulative techniques and the patients' psychological weaknesses to pin them down and force them into behaving as she wishes 'He [Cheswick] looked at McMurphy and got no look back, and went down the line of Acutes looking for help. Each time a man looked away and refused to back him up, his panic doubled' This is an example of the way the nurse can exert her control over the patients once their ring leader, McMurphy, abandons them in their struggle against her. Nurse Ratched, often referred to as 'The Big Nurse', is seen as a formidable force by the patients on the ward, until the arrival of McMurphy, who presents the nurse with a challenge to her authority. As the plot progresses, we see McMurphy defeat the nurse's influence on the inmates by undermining her authority, and the other patients seem to follow suit. One example is with regard to a vote taken during one of the group therapy sessions where McMurphy requests to have the television schedule changed so that he can watch the World Series. When the Nurse refuses, McMurphy suggests that the patients take a vote. 'All twenty of them, raising their hand not just for watching TV, but against the Big Nurse, against her trying to send McMurphy to Disturbed, against the way she's talked and acted and beat them down for years.' In this incident, the patients follow McMurphy's lead, as he provides a protection for them, as if only he will be punished for the act of defiance, while the other patients will remain safe. However, the Big Nurse manages to deny the request, using the ploy that the 20 chronic patients also count as voters, and they did not for the proposition of McMurphy's idea. The nurse abuses the chronic patients' inability to understand the situation to control the rest of the group. Frustrated by the nurse's victory, McMurphy decides to spite her by sitting in the lounge and staring at a blank television screen when he was supposed to be doing menial chores on the ward. The other acute patients saw this as an opportunity to rebel, and join McMurphy in his defiance, Chief Bromden included. 'And we're all sitting there, lined up in front of that blanked out TV set, watching the grey screen as if we could see the baseball game as clear as day, and she's ranting and screaming behind us.' The irony here is that the patients are actually being led by a supposedly sane man, yet they are acting in a completely irrational manner by watching the blank screen. The patients then refuse to do their chores and rebel against the Nurse, without a thought for the consequences of their action. Such is the effect of McMurphy on a group of people who once lived in constant fear of the Big Nurse. However, the nurse is later able to use this incident to enforce punishment upon the patients because of their behaviour. This makes the ward seem more like a prison than an institute where the mentally ill are regenerated into rational members of society
At the beginning of 'One Flew Over The Cuckoo's Nest', we are introduced to Chief Bromden, who is the narrator of the book. The Chief is a mentally ill patient on the ward and suffers from delusions and exaggerates things he sees. This makes it difficult for the reader to judge whether his perceptions can always be trusted or not. He also deceives patients and ward staff into believing he is a deaf mute, whereas we later find out that the Chief does have the ability to hear and speak. This deception has arisen from the Chief's paranoia and serves as a means of protection for him from the supposedly hostile external forces of society to which he refers as the 'Combine'. The Chief views the world as one mechanical system which is out to 'get' any individuals who fail to conform to society's rules, i.e. mentally ill patients. His psychology may have arisen from his experiences as a child on the plain where he lived as a Native American. People from the government went to visit the plain to speak to the Chief's father to negotiate the repossession of the land on which the tribe lives to build a hydroelectric dam. The Chief recollects how angry he became when the people ignored what he said 'what he said makes me madder the more I think about it'. This experience could account for the development of the Chief's hatred towards the government, and consequently the whole 'Combine'. However, through this experience the Chief learns that he is not the subject of attention, even when he tries to acquire it. 'And I'm just about to go on and tell them, how, if they'll come on in, I'll go get Papa off the scaffolds of the falls, when I see that they don't look like they heard me talk at all.' From this realisation, the Chief's deaf and dumb act is born, in order to withdraw attention from himself. A side effect of his conduct however is that it allows him access to all conversations and events to which other patients on the ward are not privy. For example, at one point in the novel, the chief is cleaning the room during one of the board meetings about McMurphy and he is able to absorb much information about the staff's thoughts and opinions of the newest arrival on the ward. The Chief's delusions are mirrored with Siegfried Sassoon's hallucinations in Regeneration; however, the Chief tends to exaggerate size and sound, while Sassoon hallucinates about mutilated corpses walking around him. Sassoon hallucinations originated from his wartime experiences and seeing so many dying soldiers, in both action and in the hospitals while he was injured. The Chief's paranoia may have originated from him having to live in fear of the government who had driven him out of his home, constantly thinking that the 'Combine' is out to get him. His paranoia is a symptom of his mental illness
The patients of nurse Ratched's ward, particularly the acute patients, form a close bond against nurse Ratched after McMurphy's arrival. He challenges the nurse's authority and shows the other patients that she can be defeated, for example, the incident in which McMurphy gained access for the patients into the Tub Room to play cards. The idea was backed by the resident Dr Spivey 'so how would the group like to have the tub room as a sort of second day room, as game room shall we say?'. Because it was presented to the nurse by Dr Spivey, it carried a certain weight, which she could not easily dismiss, so the idea was carried. However, McMurphy was only able to defeat the nurse from what he learned when she defeated him in his bid to change the television schedule. 'Cheswick shows his hand higher and glares around. Scanlon shakes his head, and then raises his hand, keeping his elbow on the arm of the chair. And nobody else. McMurphy can't say a word.' In this defeat, McMurphy learns that he must convince the patients of an idea before being faced with the nurse; otherwise, the patients become frightened of her and lose their nerve. Once again, McMurphy attempted to change the TV schedule, but failed again due to technicalities such as the vote of the chronic patients, and the fact that the meeting had ended before McMurphy was able to get the majority vote so the motion was not carried.
This incident formed a bond between the patients against the hospital staff, and they had gained an important ally in Dr Spivey, an unwary double agent. However, In Regeneration the patients of Craiglockhart do not treat staff as if they were afraid of them. The doctors and nurses of Craiglockhart are less authoritative and are lenient with the rules of conduct. 'One of the VAD's tugged at it. "There's room for two in there," she said, smiling, coaxing. "Have I to get in with you?"'. The patients treat doctors with respect and are friendly towards other patients, however at times the patients appear to fear treatment. '"There's no area of analgesia," Rivers said to Sister Rogers. Prior snatched up the pad. "IF THAT MEANS IT HURT YES IT DID"'. On the other hand, in 'One Flew Over The Cuckoo's Nest' the patients treat nurse Ratched with minimal respect and some of the patients are very unprofessional in what they say and do to her and the other student nurses. It can be said that Craiglockhart is more civilised as a hospital, and nurse Ratched's ward can be compared to a high school classroom where the patients are conspiring as to how they can defeat the nurse, similar to the way students may act together to outwit a teacher. Nurse Ratched constantly undermines her patients in front of one another to make them feel inadequate; almost emasculating them. 'Right at your balls. No, that nurse aint some kinda monster chicken, buddy, what she is, is a ball-cutter.' On the other hand, Rivers sees his patients as his equals and treats them with high regard, even though Rivers himself is more intelligent and qualified than almost all of the patients that he treats. Patients in Ratched's ward also resent the ward itself and its confines, and wish they could escape the dreariness of it all. The irony of this is that most of the patients who complain are not committed and are only in the hospital voluntarily, so they could walk out of the door at a moment's notice; however, the patients are unable to do this due to nurse Ratched making them feel inadequate and therefore unfit for society. When McMurphy discovers that it is the Nurse who decides how long a patient spends on the ward, he is beside himself with anger, directed mainly at the other acute patients for egging him along against the nurse, when all the while they knew that it would only get him committed for a longer period. Conversely, we are given the impression that all the patients at Craiglockhart are committed, however they all have the freedom to roam most of the institution and the outdoor facilities such as the golf course 'Prior watched the amber lights winking in his beer. He was sitting in the shadowy corner of a pub in some sleazy district of Edinburgh.' The patients are allowed to leave the hospital premises and are trusted to be responsible enough to return. In 'One Flew Over The Cuckoo's Nest', patients are not even allowed to leave the premises without an accompanied pass. This is needed in order for McMurphy to take a group of the patients and Dr Spivey, one of the resident doctors of the hospital, on a fishing trip later in the novel.
The fishing trip was organised by McMurphy for a number of reasons that could only possibly be contrived by a person of sound mind. The first of these reasons is to deliver a blow to the nurse's control over the patients and to show them that they are in fact free to do what they wish. His other incentives were money, which he acquired from the remainder of the funds from patients used hire the boat, and also the chance to spend some time alone with a woman who would be accompanying the men on the boat, something that we can presume McMurphy has not been able to do for a while now. During the fishing trip, we are able to see the effect of nurse Ratched's enfeeblement of the patients when they enter the garage to buy fuel. The mechanics at the garage are taken aback by the sight of patients from a psychiatric institution, and the awkward exchanges between the doctor and the mechanics only make things worse. It is at this moment when McMurphy comes to the rescue of the patients and confronts the workers at the garage. 'we're every bloody one of us hot of the criminal-insane ward, on our way to San Quentin where they got better facilities to handle us.' McMurphy lies and uses bravado to frighten the mechanics and empower the patients, who no longer feel as if they are the laughing stock of town and begin to order the workers around. This is an example of how mental illness is perceived in society at the time the book was set, and how the patients were able to overcome its stigma, if only for a short period. Their personal triumph was over once the patients had reached the fishing port and were confronted by sailors who took the opportunity to make suggestive jokes about the patients' female companion, as they stood there helplessly, unable to defend her without the presence of McMurphy.
In 'Regeneration', the reader encounters a similar stigma attached to mental illness. One particular case involves the character Prior, who is questioned about why he was not wearing his blue hospital badge. Prior retorts to Rivers' question, stating that 'I wasn't wearing the badge because I was looking for a girl. Which - as you may or may not know - is not made easier by going around with a badge stuck on your chest saying I AM A LOONY.' Prior assumes, perhaps from experience, that wearing his hospital badge would be a deterrent for women as nobody seems to jump at the opportunity to be involved with a mentally ill person. Another incident in involving the badge occurred with Sassoon when he went to the Conservative Club to meet Rivers. 'looking at the young man in uniform evoked, and then - or perhaps he was being oversensitive? - with a slight ambivalence, a growing doubt, as they worked out what the blue badge on his tunic meant.' Once again, the reader is presented with a situation in which people change their opinions when faced with an 'outcast' from society, someone who is irrational and is therefore supposed to be unacceptable to the general public.
Near the end of 'Regeneration' Barker introduces another psychiatrist called Dr Lewis Yealland. He is similar to Rivers in that Yealland is also highly respected and acclaimed on his work; however, the underlying difference between the two characters is in the way they treat their patients. Where Rivers would tend towards having a conversation with the patient to solve the problem, Yealland prefers to cast a dominating presence to the patient, neglecting their views and suggestions. '"No", Yealland said. "The time for more electrical treatment has not yet come; if it had I should give it to you. Suggestions are not wanted from you, they are not needed."' Yealland does not allow patients to express themselves as he feels that any self-diagnosis by a patient is a threat to his judgement, and this is intolerable in his treatment. Yealland can be compared to nurse Ratched, in that both the characters require dominance in a situation and superiority over those under their jurisdiction. Another difference between Rivers and Yealland would be that Rivers, as mentioned before, endeavours to resolve the problem that the patient is suffering from, thus curing the patient of his illness, whereas Yealland merely addresses the symptom arising from the illness and treats the patient to rid them of this. He eradicates the symptom, while this is only the tip of the figurative iceberg, and neglects the patient's psychological problem, which caused the symptom in the first place. In the novel, Yealland serves a larger purpose as a metaphor for the control that the government exerts over citizens, indifferent towards the voices of individuals, for example, the voice of Siegfried Sassoon, which was ignored and discredited by the government in the same way Yealland ignores and discredits his patients' views. Yealland provides the reader with a clear, yet cleverly concealed allegorical view of the novel where the same concept is repeated for a greater effect on the reader's opinion of both the presentation of mental illness and the way it is treated, and also the government's approach to dealing with soldiers who cry out against the unjustness of war.
Nearer the end of 'One Flew Over The Cuckoos Nest', McMurphy throws a party one night for his farewell as he plans to break out of the ward and make his escape that night. The party is not sanctioned by the nurse who has no idea of its taking place, so McMurphy knows that he must leave otherwise he will be punished severely for his actions. On the night of the party McMurphy organises for a girl to come onto the ward and make love to Billy Bibbit, making him lose his virginity. McMurphy's plan of escape fails and the nurse returns in the morning to find the atrocities that have taken place on her ward. She confronts Billy Bibbit about his actions, and he seems confident, however once the nurse threatens to informs Billy's mother of his wrong doing Billy breaks down and pleads with her not to do so. '"Nuh! Nuh!" His mouth was working. He shook his head, begging her. "You d-don't n-n-need!"' Billy is so disturbed by the prospect of his mother finding out about his actions, that he takes his own life shortly after the nurse confirms that she will inform his mother. After this event, the ward changes dramatically. Patients who were not committed begin to leave; Sefelt, Frederickson, even Harding. McMurphy was taken away for a lobotomy, which succeeded in calming him down, but it did so to the point where he would not fit the description of a mentally ill patient, but more of a breathing corpse. The Chief cannot stand to look at this change in McMurphy so he resorts to suffocating him in order to put out his suffering once and for all. On doing so, the Chief escapes the ward by picking up the control panel in the tub room and throwing it through the window. This mirrors the event where McMurphy attempted to lift the control panel, the difference being that the Chief succeeded where McMurphy failed by learning from him. This event is a representation of the book as a whole, where one man's titanic struggle and failure managed to stimulate another man's will to live, and as one circle of life draws to a close, a new one begins.
Emile Khan
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