Psychology Report: One Flew over the Cuckoo’s Nest

Ken Keasey, the author of One Flew over the Cuckoo’s Nest, got inspired to write the novel from his experience while working as a volunteer in a veteran’s hospital. He was introduced to a drug, which he experimented before he became an addict. He also experimented with other drugs as he observed their effect on his body. The novel/movie setting is in a psychiatric ward in a mental hospital situated in Oregon. The nurse head is a strict and brutal ex-army nurse who runs the affairs of the ward through manipulation and fear. However, the arrival of a new patient (Randle McMurphy) destabilizes the norm as he wreaks havoc on the existing fear and manipulative system established by Nurse Ratched (Dobbert, 2010).
Identifying Information
Randle Patrick McMurphy is a 37 years old male patient who has been brought to the mental hospital from prison to be tested for mental illness. He is a Caucasian of Irish origin and is a heterosexual since his girlfriend appears once in the movie. He is a resident of Salem, Oregon State located in the west coast of the United States. He had served in the U.S. military and fought during the Korean War earning a cross for his heroics but was later dismissed dishonorably for insubordination. After leaving the military, he engaged in criminal activities.
Chief Complaint/Presenting Problem
Randle is confident, dirty, big, and loud as compared to other patients such as Bromden who is quiet and repressed as well as the nurse in charge who is mechanical and sterile. The patients in the ward are used to suppressing emotions and they are stunned by his free loud laughter when he enters the ward. As he introduces himself, no single patient utters a single word or opposition to his loud nature. He has served time in prison charged with assault and he has never even once taken responsibility for his actions.
Medical Conditions and Substance Abuse
McMurphy exhibits a medical/psychological condition known as antisocial personality disorder. Antisocial personality disorder is a condition in which affected persons have little or no regard for the established ethical and moral rules in the society or the rights of other people (Jakeline et al, 2013). No history is available to show that Randle has abused drugs and substances in his life.
Symptoms
The society is able to maintain a cohesive and peaceful co-existence through sets of rules that are observed by all members of the society. If people fail to adhere, respect the set rules, or fail to hold high regard for the society’s morals and ethics, they tend to show signs of anti-social personality disorder. The affected persons disregard their feelings and the feelings of other people. The main characteristics exhibited by people suffering from anti-social personality disorder include impulsivity, promiscuous sexual behavior, poor control of behaviors, superficial charm, and manipulation. The disorder can affect a person due to a number of factors including the incapability to experience emotions properly to family and relationship problems. Socio-cultural factors such as poverty and racial discrimination contribute to people developing the disorder. To cope with the disorder, affected persons will engage in illicit sex, drug abuse and excessive consumption of alcohol in their adolescence. In adulthood, they rarely keep a job and will always be on the wrong side of the law as they find it hard to obey the laws of the land. Since they do not stay in employment for long, they tend to be financially unstable, and will often engage in gambling and betting (Jakeline et al, 2013).
The anti-social personality disorder is classified into five major sub-types – risk-taking, covetous, malevolent, nomadic, and reputation defending. Risk-taking refers to patients who are brave and courageous, spontaneous, and valiant. Covetous individuals tend to be extremely greedy and they take great pleasure in forcefully taking things than having them. In many cases, they never get satisfied feeling that people have deliberately denied or dispossessed them of things they believe belong to them. Malevolent are aggressive and easily offended. They yearn for revenge and are often daring and spiritless in their actions. Reputation defending patients always think they are resilient and that nobody can hurt or touch them. They are also dependable. Lastly, nomadic have a feeling that they were cursed from the beginning and it was designed from the start that they would suffer from the disorder. Social misfits and dropouts fall in this category (Dobbert, 2010).
Randle McMurphy shows numerous anti-social personality disorder symptoms. In the whole movie, he is depicted as a character that has no respect for the society moral and ethical rules as well as a disregard for the rights of other people. Though he is portrayed as a caring and thoughtful figure towards fellow patients in the psychiatric ward, other events in the movie clearly show that his heart does not mean well for them. He enjoys making fun of ailments that his fellow patients are suffering from; to him, the ailments are a joke. Impulsivity, manipulation and superficial charm are the biggest symptoms of anti-social personality disorder showed by Randle (Dobbert, 2010).
From the time he was admitted to the mental hospital his charming nature is evident. Upon entering the ward, he shook the hands of all patients. Furthermore, he extends his charming nature to the doctor’s office immediately he walks in by pretending that he was fascinated by a fish’s picture on the Doctor’s desk. He engages in small talk and all the time he keeps on smiling since he wanted to win the Doctor’s affection. When in the Doctor’s office, he makes a few jokes that he thought would appeal to the doctor though Randle is never serious about the whole situation. When the doctor asked him the reason why he was brought to the hospital from the state prison, he recklessly answered that he fought and fucked too much in the prison. In his mind, he thinks he has provided a prudent and ingenious answer. He presents a smooth and serene personality and the doctor smiles numerously as Randle makes hilarious though unsuitable jokes. His superficial charm is also evident when he is about to be taken to get a shock therapy; he is making light of the whole situation that surprises everyone around him. Many people would be anxious and would fiercely fight back if they were informed that they would have to undergo shock therapy, which is painful and terrifying. The shock therapy turns him into a vegetative state and a shadow of his former self; indeed, a fellow patient kills Randle to reduce his (Randle) suffering (Yakeley & Williams, 2014).
Impulsivity is also evident in Randle’s actions; it is clear that he does not think critically before he executes his thought. In other words, he acts on impulse. In the psychiatric ward when the patients are having a group session, Randle utters whatever issue or idea that crosses his mind without critically thinking about it. In many instances, he initiates chats among patients in the ward but quickly changes the topic in a few minutes to the utter disgust of his fellow patients. Impulse thinking is also evident when he takes boys on a fishing trip with no regard for the existing rules; the boys were surprised. Moreover, when an opportunity to take the bus presented itself, he embraced it. Randle was very angry when one of his friends died and almost strangled Nurse Ratched to death when she suggested that the boys should go on with their normal activities. He had planned to escape from the hospital but the plan backfired, thus, he resorted to strangling the nurse. It is clear that he had not planned the escape but it was an impulse thought. He becomes irritated and violent when his ideas fail; for instance, he broke windows in Nurse Ratched’s station twice when he disagreed with her decisions (Clarkin, 2010).
He effectively exercises his manipulative character in the ward. He easily persuades other patients to do things including influencing them into what he thinks they should do. Using his wit, he is able to learn the way his fellow patients think and uses the knowledge to direct the patients to execute his desires. For example, his manipulative nature is evident during the vote for the right to watch the big game. Though his manipulation failed to capture a number of patients, he was able to convince a few to his side of the argument. Indeed, he demanded a revote when he failed to convince a sufficient number of patients to support watching the big game. He constantly harassed the nurse to have his way. He was excellent in playing mind games and creating illusions so that people could fall for his ideas. For instance, he was able to manipulate the boys into believing that they were going for a field trip that had been approved by the nurse. However, when they got on the bus they realized that Randle had lied to them and they were angry (Yakeley & Williams, 2014).
Patient’s Personal Background and History of Abnormal Behaviors
For the entire of his adulthood, Randle was always in trouble with lawmakers and had been held in correctional facilities for a number of times. He was admitted in the psychiatric ward because he was ill-mannered, aggressive, did not like working hard in the prison farm; he was also a poor listener, accused of rape, and had been arrested 5 times for assault. The farm operators felt that it was good to have Randle undergo a mental evaluation. Nonetheless, even in the ward, he acted contrary to the rules and standards. There was a feeling that he was feigning his psychotic behaviors to escape labor in the farm. The condition landed him into troubles and adversities since he had not learned how to pay attention or reverence to other people (Clarkin, 2010).

Personal and Family History
The movie does not offer an insight into his childhood but his present actions can reveal that it was turbulent and unstable. Before he was admitted to the mental hospital, it is clear he was a social being. When he took the boys out fishing, his girlfriend appears. This is the only time that we have a hint of his life in the society. Due to the disorder, he has a very hard life in the ward as he is upset by actions of the nurses leading to endless quarrels and disagreements. He has a hard life to comprehend the character of fellow patients though he tries a lot. He had to undergo shock therapy and the lobotomy that severely affected his life leading to his killing. His life is largely unsatisfactory. Throughout the movie, Randle proves to be a very intelligent person but in many instances, his thoughts and deeds land him into trouble after trouble (Retz, Klein & Karger, 2010).
Randle finds it hard to comprehend a number of concepts. Contravening societal orders is regarded as criminal behavior in which an offending person is liable for punishment but punishment may actually be ineffective. Randle often interfered with the rights of other people like when he took the boys into fishing without written authority. He refused to accept that he had previously been charged for rape when the nurse revealed he had been charged for the offense in a community meeting. He had no regret or sense of guilt.
Result of Evaluation
Evaluation reveals that Randle suffered from APD. Dishonesty, deceit, and absence of remorse are key behaviors in a person suffering from APD, which are traits prominent in Randle’s life evident through frequent felonies committed in the past. The disorder had even affected his responsibility. He did a shoddy job when cleaning toilets where he smashed dirty notes inside the toilets (Clarkin, 2010).
Therapy History
Various forms of treatment have been recommended to deal with Randle’s errant behavior. He has been arrested numerously and sent to the work farm to contain his behavior. Later, he is sent to the mental hospital where his behavior worsened. He is given electroshock therapy for defiance and eventually lobotomy to tame his behavior after his failed attempt to strangle Nurse Ratched. The above forms of treatment on Randle were defective. Research has established that arrests and incarceration, as well as electroshock therapy, have failed to treat misbehavior. Offenders easily repeat the same offense once they are back into the society. A more stringent hospital environment would have suited Randle’s behavior. He would have been admitted to a hospital where freedom was restricted and a patient had to earn privileges. As his behavior improved, he would earn more privileges up to where his conduct would improve to a level he could easily integrate into the society. This way he would not be subjected to destabilizing treatments options such as electroshock therapy (Yakeley & Williams, 2014).
Collateral Information
Upon arrival at the mental hospital, Randle goes through an interview. He has been brought in from a prison for being lazy and engaging in too many sexual activities. The prison department decided to take him to the mental hospital after his failure to maintain a consistent work behavior in the farm. The farm management believed Randle was lazy and he pretended to be mentally unstable to be taken to the mental hospital so that he can stop working in the farm. He has been convicted for engaging in physical fights and assaults. Police reports must have aided in his conviction; there is no record on personality testing or intelligence reporting.
Recommendations
A more stringent hospital environment would have suited Randle’s behavior. He would have been admitted in a hospital where freedom was restricted and a patient had to earn privileges. As his behavior improved, he would earn more privileges up to where his conduct would improve to a level he could easily integrate into the society. This way he would not be subjected to destabilizing treatments options such as electroshock therapy (Yakeley & Williams, 2014).
Group therapy would also be an effective treatment method to calm down conduct and emotions of the affected persons. Use of individual therapy would also deliver positive results but this form of treatment works best in situations where the therapist and the patient have established mutual trust. Use of lobotomy is discouraged for treating APD as evident on the disastrous effect of lobotomy on Randle. He turns into a vegetative state and a fellow patient had to kill him to end his unending anguish. Research has shown that violent people especially men tend to have an insufficient gray matter in the brain compared to people who abuse alcohol and normal people. The missing part may be the cause of the anti-social personality disorder or it may have vanished due to the disorder. Lobotomy entails removing the remaining part of the brain in the forehead thought to be contributing to APD; this effectively aggravates the condition of the patient. As evident in the movie/novel One Flew over the Cuckoos Net, lobotomy performed on Randle practically ended his active life. It was a terrible and desperate action by the medical personnel in the mental hospital, which resulted into a devastating effect on the patient (Yakeley & Williams, 2014).

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References
Clarkin, J. F. (2010). Psychodynamic Psychotherapy for Personality Disorders. London: American Psychiatric Publishing.
Dobbert, D. L. (2010). Understanding personality disorders – an introduction. Florida: Rowman & Littlefield.
Jakeline, M. S. et al (2013). “The Antisocial Personality Disorder and its characteristics, changes, and advances: a challenge.” International Journal of Collaborative Research on Internal Medicine and Public Health, 5(1), 95-102.
Retz, W., Klein, R. G., & S. Karger (Firm). (2010). Attention deficit hyperactivity disorder (ADHD) in adults. Basel: Karger.
Yakeley, J & Williams, A. (2014). “Antisocial personality disorder: new directions.” Journal of Advances in Psychiatric Treatment, 20(2), 132-143.

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