1. One Flew over the Cuckoo’s Nest Ken Kesey

2. Why did Kesey Write in this Way? 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

3. Adaptations Cuckoo’s nest was adapted for both stage and screen. The 1975 film won the “big five” Oscars: Best film, best adapted screenplay, best actress, best actor, and best director. Kesey unsuccessfully sued film producers in 1975 because they changed the point of view from the original story.

4. Narration Be patient with your narrator, Chief Bromden. He has had too much electroshock therapy and too many drugs.  Kesey probably did too! Keep in mind that our narrator is not the same as our protagonist.

5. What is this?

6. Combine Harvester A combine harvester is an agricultural machine that harvests all types of cereals, oil seeds, and legumes through four main steps: The crop is cut and directed into a rotating chamber with a series of beaters going the opposite direction. The grain is dislodged, falls to the bottom, separated from debris by sieves and wind. The grain is transferred to a hopper for transfer and the debris falls out the rear

7. Motifs to keep an eye on: Fog Hands Nature/purity Machine/combine Christ/savior Sanity/insanity Laughter

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

12. Similarities to “Cuckoo’s Nest” Guests had to check in Most were admitted by family members Many patients had the power to leave on their own but were “controlled” by staff and manipulated to believe that they needed to stay.

13. Mental Hospitals in the 1930-1960s

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

15. 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.

20. 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).

21. Types of Treatments for the Mentally Ill: Group therapy Drug Therapy Electroshock Therapy Lobotomy

22. Drug Therapy Chlorpromazine: Schizophrenic psychosis or manic depressive disorder 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.

23. Electroshock/Electroconvulsive Therapy Became very popular 1930’s- 40’s. Originated to control negative behaviors in animals (electroshock) 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 human brain to produce desired behaviors. Cruelly, it was used as a control device within most wards.

24. Electroshock Therapy is Very Controversial but is Still Used 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

25. 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 1939-1955 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 of memory, and no problems with speech or gait.

26. Abuses of Lobotomy: Freeman developed what others called assembly line lobotomies, going from one patient to the next with his gold-plated ice pick, even having his assistants time him to see if he could break the lobotomy speed record. It is said that even some seasoned surgeons fainted at the sight. Doctors would recommend the procedure for everything from psychosis to depression to neurosis to criminality.

27. 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. “Mercy killing of the psyche” 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

28. “deinstitutionalization revolution” mid – 1960’s A radical "deinstitutionalization revolution" began It was supposed to end the cruel and inadequate care of institutions Individuals would live in their communities and have a "normalized" life Group homes, residential care facilities, and rooming houses were developed The movement helped to break up the control that was happening in the hospitals.