This question was recently addressed by American Icons Studio 360 on National Public Radio in a review of the American classic film One Flew Over the Cuckoo’s Nest starring Jack Nicholson.
The film begins with Randall Patrick McMurphy (Nicholson) in transit from a work farm where he’d been imprisoned for assaulting someone in a bar room brawl. His previous history of violent behavior along with his weird, erratic conduct on the work farm have caused the authorities to refer him to a hospital for psychiatric assessment. In his first meeting with Dr. Spivey, the hospital’s chief psychiatrist, we get a strong impression that McMurphy is playing a game of cat and mouse and Spivey is clearly aware of it. Does McMurphy have a serious psychiatric disorder or is he hoping for a leisurely gig in the hospital’s psychiatric ward?
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McMurphy’s brief stay in the psychiatric ward supervised by Nurse Ratched is a disaster, both for McMurphy and another young man, Billy Bibbit. Ratched is not only responsible for managing the ward which requires her to supervise the nursing staff, the orderlies and the dispensing of medication to patients, she also leads a daily therapy group of the men in the ward who are able to participate, including McMurphy. Although she’s a qualified registered nurse, Ratched has virtually no formal training or experience in family therapy, group therapy or in leading a therapy group. The role she performs as group leader lies outside the boundaries of her competence, education, training, and supervised experience.
“Nurse Ratched is totally well intentioned. That’s what so scary. She doesn’t see her behavior as it really is. Who sees that they’re really evil?” -Louise Fletcher who plays Nurse Ratched.
In working with McMurphy and the other ward patients Ratched commits six ethical violations that slowly build upon each other in a crescendo of empathic breaches and sadistic interventions that have tragic results.
First, she refuses to discuss letting the men watch the World Series, telling them brusquely that “The business of this meeting is therapy!”
Second, when McMurphy is on the verge of getting a majority vote from the men in favor of changing the ward schedule to watch the Series, Ratched arbitrarily nullifies the vote by counting other members of the ward who are in a vegetative state and unable to vote let alone participate in group therapy.
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Third, she blames McMurphy for the loss of the men’s recreation room privileges and cigarette rationing because he encouraged them to gamble. This causes them to rebel, she loses control of the group and the orderlies are required to restrain the men and restore order.
Fourth, in a review of McMurphy’s case with the Dr. Spivey and the members of his psychiatric staff – after McMurphy smashes the widow of the nurse’s station to retrieve the men’s cigarettes – Ratched tells the others in a bone chilling tone of voice, “If we send him back to the work farm, we’ll just be passing on our problems. I’d like to keep him on the ward. I think we can help him.”