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One Flew Over the Cuckoo's Nest (1975)

Starring Jack Nicholson, Louise Fletcher, Will Sampson, Brad Dourif, Christopher Lloyd, Danny DeVito

Directed by Milos Forman

Screenplay by Laurence Hauben and Bo Goldman

Based on the book by Ken Kesey

United Artists

Rated R

Nursing rating 1/2 star

Rating guide:
excellent = 4 stars; good = 3 stars;
fair = 2 stars, poor = 1 star

Artistic rating 3 1/2 stars

Milos Forman's 1975 adaptation of Ken Kesey's One Flew Over the Cuckoo's Nest, which won five major Oscars, shows just how much subversive brilliance and serious misogyny can inhabit the same film. Released the year after President Nixon resigned, it captures the anti-authoritarian spirit of the Sixties counterculture, but seems to suggest that the revolution had little to offer its sisters. The film has since become a classic, with its timeless themes, dark wit, and excellent performances, especially by Oscar winners Jack Nicholson and Louise Fletcher. Today, Fletcher's portrayal of the insidious Nurse Ratched stands as a nursing image whose negative power may never be surpassed.

Randle McMurphy (Nicholson) is a charismatic roughneck who engineers a transfer from the work farm where he has been serving his latest sentence for assault to a state mental health facility, despite concerns that he is faking illness in order to do his time in a more comfortable place. McMurphy joins a unit of men with various psychiatric problems, including the mute American Indian Chief Bromden (Will Sampson) and the fearful young Billy (Brad Dourif). The unit is dominated by Nurse Mildred Ratched. Ratched leads the patients in daily discussions which at first seem like actual group therapy, and she offers calm, rational explanations for the array of rules with which she controls their lives. But McMurphy gradually realizes that Ratched is in fact a cunning sociopath who terrifies and psychologically tortures those she is ostensibly helping, aided by the meek Nurse Pilbow (Mimi Sarkisian) and a crew of thuggish and/or irresponsible African-American attendants (the movie is no friend of African-Americans either). Ratched's therapy is, to say the least, non-therapeutic. Yet the film emphasizes that--as in a company or a democracy--most of the patients are there voluntarily. While the absentee male physicians debate whether McMurphy is really ill, he sets out to undermine Ratched's authority, leading the patients on forbidden adventures involving wine, women and song that he knows will infuriate Ratched. McMurphy is not exactly a diligent chaperone, but miraculously no serious harm results, and these escapades clearly promote more healing than Ratched's rigid, joyless regime. As McMurphy's refusal to conform starts to instill a sense of independence in the other patients, he and Ratched become locked in an escalating battle for the unit, and Ratched resorts to increasingly harsh measures to maintain control.

Nurse Ratched has become an American archetype, a soul killer who masterfully abuses her professional and institutional power over her patients. Even her name evokes words like "rat" and "wretched." And the film offers no positive counterexample or explanation for her behavior (e.g., burnout after years of caring for difficult patients in a harsh state facility). Beyond the obvious political and social symbolism, Ratched could be viewed as a warning about the potential for abuse in the nursing profession. But she can't easily be separated from the film's reactionary view of women generally: they are either emasculating, anti-sex mother figures like her, spineless mice like Nurse Pilbow, or--in the best case scenario--easy, giggling facilitators like McMurphy's girlfriend (Marya Small) whose name is Candy (really). The movie is a withering indictment of establishment power structures, but it seems to place the blame mostly on Mom, who just won't let boys be boys. While Mom's status as a nurse is probably incidental, the presence of such a destructive nursing image at the core of this important film is distressing.

Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, RN, MSN, MPH
Reviewed January 10, 2003

The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.

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