Ken Kesey

About the Author  Kesey actually worked as a night warden on a ward in a mental hospital.  He was so determined to get the feel of being a patient that he underwent ECT.  While at Stanford, Kesey volunteered for medical studies on the effects of psychoactive drugs (often hallucinogens).  He used these experiences to inform how Chief would see the world.

Narration  Be patient with your narrator, Chief Bromden.  He has had too much electroshock therapy and too many drugs.  Keep in mind that our narrator is not the same as our protagonist.  Essential Question: What is the significance of Chief’s narration? How would the novel be different without it?

Symbols  Symbols are really anything that stands for something else. Obvious examples are flags, which symbolize a nation; the cross is a symbol for Christianity; Uncle Sam a symbol for the United States. In literature, a symbol is expected to have significance.  Symbols in Cuckoo’s Nest: The fog Ratched’s window McMurphy The Combine Outside

Check out some images that McMurphy would have seen in his ward.

Mental Hospitals 1930s-1960s

Conditions at These Hospitals Could Be Atrocious  Over crowded  Dirty  Not nurturing  No privacy  Similar to—or in some cases worse than—prison

Inside the Institutions  Patients were provided with “adequate care” (and segregated) which often times led to inadequate care, poor facilities, and loss of dignity.  They were usually given uniforms and daily “chores.” In fact it wasn’t until 1973 that New York state banned public hospitals from requiring patients to work in exchange for their room and board.  Families were often ashamed of the patients and would deny their existence.  Ultimately, some of these hospitals became holding areas for a person’s entire life.

Medical Care in Mental Hospitals  Deaths and injuries sometimes resulted from both appropriate and inappropriate treatments.  Patients were treated with medically approved procedures like: being put in tanks of ice-cold water, spun in chairs for hours, and forced "medications" (powerful psychoactive drugs).  Patients were also “treated” with non-medically approved procedures which were simply designed to control them. For example, patients could be shackled to walls, placed in seclusion (most often without clothing) or placed in restraints (being strapped to a bed with leather restraints, often in a spread-eagle position).

Treatments for the Mentally Ill: Drug Therapy  Thorazine: the first psychotropic drug, was a milestone in treatment therapy, making it possible to calm unruly behavior, anxiety, agitation, and confusion without using physical restraints. "chemical restraint"  Chlorpromazine: schizophrenic psychosis or manic depressive disorder

Treatments for the Mentally Ill: Electroshock Therapy  Became very popular 1930’s- 40’s.  Originated to control negative behaviors in animals  A doctor had noticed that schizophrenic epileptics who had a seizure often were more “normal” after the seizure— which led to chemical convulsives and ultimately electroconvulsive treatment  Used to alter the chemistry in the brain to produce desired behaviors.  Cruelly, it was used as a control

Electroshock Therapy Today  Used to treat some forms of severe depression  Used to “control” the elderly  Used on children in an attempt to correct their wild and/or unwanted behaviors

Treatments for the Mentally Ill: Lobotomy  Surgical procedure for cutting nerve pathways in the frontal lobes of the brain.  The operation has been performed on mentally ill patients whose behavioral patterns were not improved by other forms of treatment; it was supposed to be a last resort.  The procedure was pioneered by Nobel laureate Egas Moniz in the 1930s  Between over 100,000 lobotomies were performed in the United States.  If performed correctly, disconnecting the frontal lobes there caused no loss of intellect, no impairment

How a Lobotomy Was Performed  Leucotomy The goal was to cut the nerves that run from front of the brain to the rear. A technique was devised that involved drilling two holes on either side of the forehead, insert a surgical knife, and sever the prefrontal cortex from the rest of the brain.  Ice Pick Lobotomy Invented in Walter Freeman Insert an ordinary ice pick above each eye of a patient with only local anesthetic, drive it through the thin bone with a light tap of a mallet, swish the pick back and forth, then remove. A formerly difficult patient is now passive.

Abuse of Lobotomy  "Every patient probably loses something by this operation, some spontaneity, some sparkle, some flavor of the personality”  The aim was that "the patient might be transformed from a disturbed to a quiet clement [insane person]." There was no intention to "help" the patient. The goal was only to eradicate the behavior which others found undesirable.  The frontal lobe is the seat of the higher functions such as love, concern for others, empathy, self- insight, creativity, initiative, autonomy, rationality, abstract reasoning, judgment, future planning, foresight, will-power, determination and concentration

Discipline is absolutely necessary in most situations.

All people are “crazy” to some extent.

Our society forces men to act like stereotypical men.

Hatred is inherent to human nature.

One person can change an established, stable environment

The best place for those with mental illness in an institution and/or hospital.

Rules are necessary to maintain order

War is a terrible thing for all involved— and should be avoided whenever possible.

Some people simply can/will never change.