During the 1950s, institutionalization of the mentally ill reached an all-time high in the United States, with California housing 37,500 patients in state mental hospitals in 1959. According to scholar Robert Faggen, American psychiatrists of this era were perceived as "the knights of reason and order saving damsels from proliferating dragons of the mind."
This perception changed radically during the 1960s, led by Ken Kesey's 1962 classic book, One Flew Over the Cuckoo's Nest. By the time the five Academy Awards were handed out for the 1975 movie version of Cuckoo's Nest, a cultural reversal had occurred regarding the treatment of the mentally ill: most were set free. Populations of state mental hospitals were reduced significantly and many were closed, with then-Gov. Ronald Reagan leading the way in California.
Closing mental institutions cut significant costs from state budgets. The moves were justified by increased faith in medications, namely Thorazine, to help patients function outside of an institutionalized setting. There was a shift toward "community treatment" and the non-disclosure rights of individuals receiving psychiatric care.
One related outcome was an increased rate of mass-killing events, which tripled between 1980 and 2000. Last year saw frequent, high-profile events, including the Connecticut elementary school shootings by a mentally ill Adam Lanza. Is it time to bring back state-run asylums to address the most severe mental health cases? Are there better forms of care as alternatives to institutionalization?
Kesey believed that the "therapeutic community" in general, through the mechanism of the state asylum, was a way of forcing an internal soul to fit someone else's ideal for an external environment. He demonstrated this idea in One Flew Over the Cuckoo's Nest, a fictional battle within an Oregon mental institution between two vivid characters: Nurse Ratched and Randle McMurphy.
Nurse Ratched, "the big nurse," represents the state. She is the trained, professional, certified, parental and well-intended administrator of group therapy sessions, rigid time schedules, orderliness and progress. Nurse Ratched oils and fine-tunes "the machine," so that life ticks properly both inside and outside the state asylum walls.
Yet achieving this idyllic humming proves impossible with the arrival of Randle McMurphy, a statutory rapist and hustler looking for easier jail time. McMurphy is a classic example of a "trickster," an essential character to Native American mythology and world literature. The "trickster" subverts all established hierarchy by embodying a deep primordial power, animalism, the force of legend and lies that tell the truth.
McMurphy imposes laws of nature into Nurse Ratched's machine state. When McMurphy first enters the asylum, he laughs at the other patients—not a "public relations" laugh, but the first real laugh that Chief Bromden has heard in years. McMurphy declares, "You lose your laugh, you lose your footing. You can't be really strong until you see the funny side of things." This laughter disrupts order, profoundly irritating Nurse Ratched.
For Chief Bromden, though, McMurphy is an awakening and a most effective therapy. Unlike the movie version of Cuckoo’s Nest, the novel is written completely from the chief’s point of view. The chief observes and experiences the card-playing, basketball games, a fishing trip, and a secret late-night party with McMurphy’s prostitute friends—therapies of engaging primordial life. Mac’s words and acts strongly affect the Chief, along with the inmates on the floor (Cheswick, Bibbit, Seafelt, Fredrickson, Harding).
For years, Bromden hid behind a curtain of alcohol abuse and self-imposed silence, after the government took over his native land to build a dam, imposing a capitalist structure upon an ancient indigenous community. McMurphy's vitality in the face of imposed institutionalization inspires Chief Bromden to reengage the world as he smashes through a barred asylum window and walks back to the wild.
How, then, to cure the Adam Lanzas of America? How to curb the next mass killing? As a community and a civil society, we could promote more constructive outlets for Lanza's intelligence and primordial drive; we could help his mother more with custodial care; we could remain vigilant and aware of those who suffer. If Adam Lanza had lived, he would be in jail, a place where 25-35 percent of the population receives psychiatric treatment, a hidden asylum. It appears that Lanza's local high school environment provided just enough institutional structure and support, and when that support was gone, he slipped into violence. Is it time to resurrect state mental institutions? Maybe it is a good time to read Kesey's One Flew Over the Cuckoo's Nest.
Lee Miller is the author of the Bengali novel, Kali Sunset (www.clovercreekpress.com), the story of a traditional Hindu mother, Mrs. Sona Choudhury, raising her family amidst the rapid transformation of 20th Century India.