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The Methods of Madness: One Flew Over the Cuckoo’s Nest and Awakenings

The Methods of Madness: One Flew Over the Cuckoo’s Nest and Awakenings

The Methods of Madness: Representations of Inmates, Authorities and the Asylum in One Flew Over the Cuckoo’s Nest and Awakenings
Tina Butler,
May 6, 2005

Perception of the mentally ill, the environments in which they are housed and those who care for them has been largely determined and influenced by filmic representation. In American cinema, representation of the asylum in film has been a recurrent theme. There were 34 feature length US productions featuring scenes of psychiatric hospitalization between 1935 and 1990 alone (Levers). The institution has traditionally been vilified in these representations, both in the space itself, as well as the inhabitants-the inmates and employees. The asylum, by its detachment from mainstream society is a place that has been otherized. Two films that offer distinct manifestations of this realm are One Flew Over the Cuckoo’s Nest and Awakenings. The first film represents the institution in the more routine negative manner. The second attempts to reveal the place as a potential site of healing, renewal and love, offering the possibility for rehabilitation if headed by the proper individuals. Cruel Nurse Ratched is juxtaposed with selfless Dr. Sayer, increasingly inflammatory inmates contrasted with catatonic patients. Regardless of these differences however, there are discriminatory elements in both films that must be addressed.

Mental illness or instability has been a traditionally mis-conceived and demonized phenomenon. Stereotypes of ‘madness’ are powerful and deeply rooted within Western culture. The mass audience has tended to view such individuals and institutions in a particularly negative manner because of representations proffered by the foremost purveyor of mass culture, Hollywood film. Due to the powerful position of film and its ability to affect audience perception and the narrow range of diversity in terms of representations of the mentally ill and the space of the asylum itself presented to audiences, widely held stereotypes abound in the public sphere.

“Based on the acclaimed book by neurologist Oliver Sacks, director Penny Marshall’s hit 1990 drama stars Robin Williams as Dr. Malcolm Sayer. Sayer is a neurologist who discovers that the drug L-Dopa can be used to “unlock” patients in a mental hospital from the mysterious sleeping sickness that has left them utterly immobilized. Leonard (Robert De Niro) is one such patient who awakens after being in a comatose state for 30 years, leaving Sayer to guide Leonard in adjusting to the world around him. Penelope Ann Miller costars as the daughter of another patient, with whom Leonard falls tenuously in love. Earning Oscar nominations for best picture, actor, and screenplay, this moving fact-based drama was a hit with critics and audiences alike.” –Jeff Shannon

Subsequently, discrimination and misunderstanding are as commonplace as ignorance and hostility. Historically, Hollywood has presented one mode of representation of the hospital and the inmate-as dangerous, incapable, burdensome, pitiable and pathetic, asexual or sexually deviant, as an object of violence or a comic character (Levers). In more recent years however, directors have attempted to topple these constructed prejudices surrounding the figures of the inmate, the medical worker and the institution. Despite some changes in representation, these stereotypes have persisted in film-substantially in One Flew Over the Cuckoo’s Nest and to a lesser, but still significant degree in Awakenings.

The film adaptation of Ken Kesey’s One Flew Over the Cuckoo’s Nest is looked to as one of the primary documents representing the asylum. The film launched hundreds of imitations and every film about a hospital seemingly contains a reference to it. In fact, since its release in 1975, there have been over thirty films that have made allusions to One Flew Over the Cuckoo’s Nest ( Every film involving mental illness or institutions has their own Nurse Ratched and Randle Patrick McMurphy. The film lay the foundation for representing all facets of the asylum. The nurse was overtly professional, so serious about her job that any semblance of compassion was replaced with mild sadism. The inmate was sexualized, rebellious, yet eventually fallible and broken by the system. The asylum was a menacing, monolithic place governed by unfeeling drones and concerned with confinement instead of rehabilitation.

With films of the late 80s and early 90s, attempts to reform perceptions and representations of the key players in the asylum gained popularity. One of the major films to do this was Penny Marshall’s Awakenings. Here, the doctor is presented as benevolent and good, sincerely concerned with the task of healing his patients. The inmates have been somewhat neutralized and emasculated. The institution has not necessarily been reformed, but the new figure of the alternative method style doctor helps the asylum begin to function as a loving, albeit sometimes misguided caretaker. In spite of these changes, the institution has remained an elusive, sinister and inaccessible place.

The asylum in both representation and reality, is a space that is always, to some degree, isolated and distanced from the ‘real’ outside world. One Flew Over the Cuckoo’s Nest emphasizes this separation in its opening sequence.

Often there is encroachment from this ‘outside’ world, but in general, this sense of removal creates separation for the inmates and distance for the viewer. When encroachment does occur, the resulting effect is typically some kind of mayhem, hi-jinks or hilarity. In One Flew Over the Cuckoo’s Nest, these intrusions include the fishing ‘field trip,’ the hookers at the illicit and eventually disastrous holiday gala and the very presence of McMurphy himself as an outsider entering the space of the inside. He trespasses in that space on all levels, through disruption of routines, relationships and existing power structures.

Its limitations and barriers, both physical and psychological characterize the institutional space. The asylum seems unable to reach and effectively treat its patients and at the same time, the space is defined by its boundaries. In One Flew Over the Cuckoo’s Nest especially, the hospital is represented as a labyrinthine prison of doors and locks and cage-like structures. With a focus on the patients strapped down in the beds, an overarching sense of repression pervades the scene. Even the music, operating under the guise of calming the patients, operates as a means of insidious domination. The sound is ever present and controlling. The music, like the staff, function as unceasing surveillance, and the inmates cannot ever escape this sense of constant regulation and confinement.

Both the opening and closing scenes of One Flew Over the Cuckoo’s Nest use naturalistic settings to contrast with the sterile, hindering nature of the institution. The audience is presented with open spaces-fields and mountains that have nothing to do with restriction and everything to do with freedom. The opening scene is unmarred by signs of a human, industrialized world until a pair of car headlights cut through the landscape. The next shot shows Jack Nicholson’s character arriving at the asylum, being escorted up the stairs by two law enforcement officers. The end of the film depicts the Chief’s figurative and literal release from the asylum. This is emphasized visually by the exaggerated space around him as he runs off into the night. He is finally free from confinement and his own demons and returns to nature and the land. The Chief forcibly breaks out of the suffocating and damaging environment of the institution.

Awakenings follow in a similar suit in terms of physical representation of the institutional hospital. Images of chain link-blocked doorways and windows and cage-like interiors abound in the film. This sense of confinement is further emphasized and conveyed by the characters’ resistance against it. There are several scenes in which Dr. Sayer literally tears open the window in what seems like a frantic attempt to just breathe and escape the overpowering feeling of restriction, if only for a moment. Leonard, as a patient, is significantly more confined and this is made clear as his desire for freedom increases and the establishment only tightens its grip on his mobility. Leonard’s simple request to go on a walk unsupervised escalates into the film’s largest battle sequence.

There are other typical asylum elements in the two films including the communal sleeping quarters, the problematic group therapy sessions and the fixed existence and non-reality of the ‘day room,’ the element of enclosed space being highlighted. The majority of One Flew Over the Cuckoo’s Nest takes place in the ‘Day Room’ of the hospital. The setting is generally static and adds to the feeling of confinement (Seger 39). The space of the mental institution is characterized by,

There is an obsession with routines, an almost rabid desire for adherence to some unspoken order, control and confinement.

“One of the key movies of the 1970s, when exciting, groundbreaking, personal films were still being made in Hollywood, Milos Forman’s
One Flew Over the Cuckoo’s Nest emphasized the humanistic story at the heart of Ken Kesey’s more hallucinogenic novel. Jack Nicholson was born to play the part of Randle Patrick McMurphy, the rebellious inmate of a psychiatric hospital who fights back against the authorities’ cold attitudes of institutional superiority, as personified by Nurse Ratched (Louise Fletcher). It’s the classic antiestablishment tale of one man asserting his individuality in the face of a repressive, conformist system–and it works on every level. Forman populates his film with memorably eccentric faces, and gets such freshly detailed and spontaneous work from his ensemble that the picture sometimes feels like a documentary. Unlike a lot of films pitched at the “youth culture” of the 1970s, One Flew Over the Cuckoo’s Nest really hasn’t dated a bit, because the qualities of human nature that Forman captures–playfulness, courage, inspiration, pride, stubbornness–are universal and timeless. The film swept the Academy Awards for 1976, winning in all the major categories (picture, director, actor, actress, screenplay) for the first time since Frank Capra’s It Happened One Night in 1931.” –Jim Emerson

Medicine time, music time, recreation time-each is strictly segmented and designated, and deviation from this structure seems sure to be the end of everything.

In this space of strict control, order and regulation, archetypal figures begin to emerge. Most prominent in Forman’s film is the rebellious and over-sexed alpha male McMurphy, played with rabid enthusiasm by Jack Nicholson and the unfeeling and diabolical medical worker Mildred Ratched, played convincingly by Louise Fletcher. In Marshall’s film, the audience is presented with the other end of the spectrum with the good doctor, Robin Williams and the docile and childlike patient, Robert DeNiro. In any case, these characters are all removed to some extent from the outside world by way of the isolationist character of the asylum. The institution operates as an exclusionary bubble, keeping out the widely accepted version of a healthy social reality.

One Flew Over the Cuckoo’s Nest offers a very dated representation of the mental institution. Despite fine performances by the actors, the film seems to function mainly as a pop-style referent for later films, the primary source for mildly clever inside jokes rather than standing on its own as a model of the system. Forman’s film, now, appears cliched at best, but perhaps this is because it came first and its subsequent imitations vulgarize and degrade the novelty of the original. Nurse Ratched has become an iconic figure, as instantly recognizable in parody as the character of McMurphy. She is the dangerously frigid medical professional and he, the rebellious alpha male everyman. “McMurphy is as uncontrolled as the Big Nurse is controlled” (Safer 133). Nurse Ratched is as insidious and sterile as McMurphy is overtly sexual and tempestuous.

McMurphy is an interesting character as the audience identifies with him as a man

Despite his inability to function, McMurphy is presented “as consistently aware and in control-never the buffoon, even while laughing” (McCreadle 125). This all changes of course, with his lobotomy, but for the majority of the film, McMurphy ‘wears the pants.’ He exercises a fair amount of power as he wages a battle, albeit ultimately futile, against the tyranny of Nurse Ratched (Seger 81). “McMurphy makes decisions and actions that allow the story to happen. If he weren’t there, the patients would continue playing cards, going to therapy meetings and taking their medication-thus, no story” (Ibid.). “As Jack Nicholson plays him, McMurphy is no longer the Laingian Paul Bunyan of the ward, but he’s still the charismatic misfit guerrilla” (Pauline Kael 53). McMurphy is the self-elected voice of dissent for the other inmates, but he is not even one of them. He is just another voice to speak for them, but for his own amusement. I will not argue that McMurphy lacks genuine affection for the majority of his ward-mates, yet he essentially makes pawns of them to suit his own needs, desires and ends. His manipulation of the inmates, while freeing for them at some level, is self-serving.

Conversely, in Awakenings, the patient protagonist, Leonard, is initially reluctant, a relative polar opposite to McMurphy. However, as Leonard becomes a sexualized being, his rebellious and delinquent tendencies begin to materialize. His burgeoning relationship with Mary Louise Parker’s character, Paula, coincides with his increasing hostility towards his confinement, the institution and authority. As an ‘awakened’ sexual being, Leonard’s quiet and docile nature is transformed and he becomes a revolutionary in the spirit of McMurphy. Granted, Leonard’s frustration and subsequent anger are understandable, yet it is significant to note that the origins of these changes link back to his sexual realization. Leonard, in the beginning, can be viewed as a foil to McMurphy-the innocent contrasted with the sexual predator-yet, in time, he begins to appear rather like his little, somewhat slower brother.

Representations of the other patients in both films are reduced to stereotypes. In Awakenings, Dr. Sayer is clearly overwhelmed by his new charges that are presented as excitable, aggressive and screaming. Playing on the comic figure stereotype, the audience encounters Juanita, who is terrified of pens. She appears calm and amiable all of the time, except upon seeing a pen, which prompts bouts of hysterical mania. Even the catatonic patients, once their medicine kicks in, begin to embody the typical characterizations. In One Flew Over the Cuckoo’s Nest, viewers meet similar individuals. In both films, there is the weird old guy who dances around the rec. room by himself, the shy guy who experiences some kind of sexual awakening and the quiet, loner type. Comedy is employed at the expense of the patients, their often glazed and dazed expressions drawing awkward peals of laughter from the audience. Despite these similarities, the films’ representations of the asylum staff could not be more divergent.

In the case of Nurse Ratched and her counterparts and Dr. Sayer and his nursing staff, the two groups stand in stark opposition. Nurse Ratched is professional and by-the-book to a fault. She is so blinded by her sense of the doing the ‘right’ thing that she loses all ability to see the appropriateness of doing the ‘human’ thing. Her unflinching stubbornness in adherence to the edicts and routines of the establishment make her a formidable and dangerous individual, ultimately incapable of mercy or compassion. Forman says of her character, “Nurse Ratched believes deeply that she is doing right and that’s where the real drama begins for me. That’s much more frightening than if you have an evil person who knows he’s doing wrong” (McCreadle 130). She manages,

She is represented in the extreme as a demonic castrator.

In contrast, Dr. Sayer, from the very first, draws ridicule from his colleagues and superiors with his utilization of unconventional techniques of treatment. The only institutional support he receives comes from those subjugated by it, the nurses and orderlies. Dr. Sayer acts on instinct and with tremendous empathy. He attempts to understand the lives of his patients when the other doctors merely ignore them. “What is it like to be them; what are they thinking,” he asks at one point? “They’re not,” a colleague answers dismissively. Dr. Sayer’s dogged commitment and absence of by-the-book professionalism warrants results in his patients. Nurse Ratched’s dogged commitment has the opposite effect.

While Nurse Ratched denies the experience and reality of the outside world to the inmates, Dr. Sayer introduces and shares it with his patients. He wants so much to return the lives of the patients to them, give them back some part of the existence they once had by promoting and nurturing their relationships with the individuals from their previous lives outside of the hospital. Whereas in One Flew Over the Cuckoo’s Nest the music was a weapon of domination, Dr. Sayer, in Awakenings, utilizes music not as a repressive force, but a link to the outside world. He plays current rock songs to bring something vital and vibrant into the lives of his patients who have been denied for so long. Dr. Sayer becomes a caring father figure that opposes the character assumed by Nurse Ratched.

The theme of the ‘bad mother’ pervades One Flew Over the Cuckoo’s Nest in the character of Nurse Ratched. Billy Bibbit becomes the victim in this scheme as Ratched takes on the mother role. She reduces him to a child with her threats to inform his real mother of his activities involving Candy. At the same time, McMurphy in a very strong sense acts like an attention-seeking child with his antics throughout the course of the film. Many of the other patients seem childlike with their neediness and tantrums. The staff members assume the position of substitute parents, Nurse Ratched, the cruel mother, and Dr. Spivey, the impotent father (Sodowsky and Sodowsky 37).

“The action revolves around the struggle between the phantasmagorical destroyer, Nurse Ratched, and the redeemer, Randle P. McMurphy. McMurphy offers the oppressed the possibility of rebirth” (Safer 134). In this vein, a rare link can be made between this character and Dr. Sayer. Both men, in a sense, ‘awaken’ the patients, only one is operating on the inside and the other, the outside. One acts because he is selfish, the other because he is selfless. With these similarities and differences in mind, there is one indisputable aspect that the two films share.

Both films are adaptations in their own right. One Flew Over the Cuckoo’s Nest originates from Kesey’s 1962 novel by the same name and Awakenings is based on a true story, memoir written by Dr. Oliver Sacks. The process and tradition of adapting literary works to film has been the topic of much writing and debate, similar to the representation of the mentally ill in film. Adaptations often draw hostile criticism from audiences, especially those that are remakes of highly regarded or loved works. One Flew Over the Cuckoo’s Nest, by critic and audience reception alike, proved to be an exception to this tradition. This film does numerous things that distinguish it from its textual model.

The filmic version of One Flew Over the Cuckoo’s Nest changes the point of view from that of Chief Bromden to a more generalized, omniscient and neutral narrator (McCreadle 128). With the third-person narrative form, the audience members are “sane observers of a ‘cuckoo’s nest;’ [they] are outside, not inside” (Safer 137). As a result, the Chief’s role is greatly reduced in the film. He appears in only about a quarter of the film and when the audience does view him, he appears at the periphery of the camera’s frame (Sodowsky and Sodowsky 34). “When he comes into focus, it is usually as an involuntary foil to McMurphy” (Ibid.). The Chief merely observes the action in the film. He no longer speaks it and only becomes an important character towards the film’s close as he is transformed by McMurphy (Fleming and Manvell 120). The point of view in either version is a notable element because regardless of the text or film, the story is essentially the story of McMurphy, yet he never speaks its voice (Seger 24).

In addition to narrative alterations, stylistically rendered, the film is far less psychedelic and hallucinatory and far more straightforward and organized than the novel. There is a marked shift from the surreal to the ‘real.’ Certain inclusions help to increase the realist sensibilities of One Flew Over the Cuckoo’s Nest. For example, a real psychiatrist, Dr. Brooks from the Oregon State Mental Hospital, was cast as Dr. Spivey, the hospital director in the film (Fleming and Manvell 20, 170).

In the case of Awakenings, I cannot claim or identify deviations from the book to the film due to a lack of familiarity with Dr. Sacks’ work. However, I imagine that relationships were made more close and profound and that characters were presented as more likable and highly romanticized for the film version. Marshall did preserve the film’s honor to some degree by retaining an ending that does not contain a particular sense of hope or happiness.

The experience and impression of the viewer surrounding the institution of the mental hospital as well as the mental patient has been largely inflected by cinematic representation. One Flew Over the Cuckoo’s Nest and Awakenings are two such films that have played a substantial role in shaping such perceptions. While the films attempt and sometimes achieve portrayals that diverge from more negative past characterizations, for the most part they rely on old stereotypes that are self-perpetuating towards discrimination against these figures. In One Flew Over the Cuckoo’s Nest, the audience is presented with “the horrors of the mental institution [translated] into a microcosm of the complex suppression exercised by society upon its dissident members” (Safer 132). In Awakenings, the viewer encounters an asylum with significant shortcomings in regard to patient treatment and care, yet the promise of something better when the right people are allowed to act. In the end however, both films fail to either emancipate their patients or the stigma attached to the institution itself in their representations.

Works Cited

Awakenings. Dir. Penny Marshall. Perf. Robert DeNiro, Julie Kavner, Penelope Ann Miller, Robin Williams. Columbia Pictures. 1990.

Fleming, Michael and Roger Manvell. Images of Madness: The Portrayal of Insanity in Feature Film. Associated University Presses: London, 1985.


Levers, Lisa Lopez. “Representations of Psychiatric Disability in Fifty Years of Hollywood Film: An Ethnographic Analysis.” Theory and Science. 2001. 20 Apr. 2002.