In Session with “One Flew Over the Cuckoo’s Nest”

This session we transfer you from Ratched’s Lucia State Hospital to Oregon State Hospital as we discuss a classic, One Flew Over the Cuckoo’s Nest.

Join Dr. Sam & Dr. Fran as they discuss inpatient psychiatric hospitalization as portrayed in the 1975 film and take a dive into the history of psychiatric hospitals in the US. What’s the difference between voluntary and involuntary commitments? What does treatment look like? And is ECT still a thing? The answer might SHOCK you.

Plus, we also try to sort out whether R.P McMurphy is feigning symptoms to escape prison labor or if he truly has symptoms of mental illness. How does Nurse Ratched play into all of this? And is she still a fan of the lobotomy?

Unfortunately, it doesn’t seem like Mildred is one to learn from her mistakes. Line up and take your medicine. And by medicine, we mean this session.  

Glossary of Terms

Involuntary commitment – a legal intervention by which a judge, or someone acting in a judicial capacity, may order that a person with symptoms of a serious mental disorder, and meeting other specified criteria be admitted to a psychiatric facility

Moral treatment  a therapeutic approach that emphasized character and spiritual development, and called for kindness on the part of all who came in contact with the patient

Acute hospitalization – short-term hospital stay focused on stabilization

Deinstitutionalization – a government policy focused on shifting mental health patients out of state-run psychiatric hospitals into federally funded community mental health centers

Community mental health centers locally-based centers offering outpatient mental health services, often offer free or sliding-scale care

Least restrictive environment – standard of providing patients with psychiatric treatment which is least restrictive while still encouraging recovery and promoting independence

Informed consent – a legal and ethical term defined as the process of a client agreeing to a proposed intervention after understanding of the relevant facts, risks and benefits, and available alternatives involved

Electroconvulsive therapy (ECT) – psychiatric treatment in which small electrical currents are passed through the brain to induce small seizures with the goal of causing changes to brain chemistry than can alleviate symptoms of certain mental conditions

Malingering exaggerating or faking illness to achieve an external reward or escape an undesired outcome (e.g., faking an illness to get out of work)

Secondary gain any positive advantage that accompanies physical or psychological symptoms

Oppositional defiant disorder a diagnosis in a child characterized by defiant and disobedient behavior to authority figures



Learn more about the unique filming of One Flew Over the Cuckoo’s Nest here

Don’t forget to check out the Oregon State Hospital Museum of Mental Healthlocated in the former state hospital where the movie was filmed!

What is the difference between voluntary and involuntary hospital commitment? And what are some of the stipulations around involuntary commitment?  Get answers to these questions and more here.

Read more about one of the United States’ first mental hospital, Pennsylvania Hospital

Take a deep dive into the history of involuntary commitment along with current guidelines in the United States

Patient rights are extremely important and were a big topic in today’s sessions, learn more here and here

We also discuss electroconvulsive therapy (ECT) in this episode- learn the facts about this treatment

The doctor’s think Mr. McMurphy might be malingering, read more about what malingering is and how to spot it here and here