How 'One Flew Over the Cuckoo's Nest' changed psychiatry
As well as being regarded as a classic novel and film, 'One Flew Over the Cuckoo's Nest' is generally considered to have left a lasting impact on the field of psychiatry.
Ken Kesey's 1962 book, and the film version released 13 years later, are both credited with irreparably tarnishing the image of electroconvulsive therapy, or ECT, and quickening its departure from mainstream mental health care.
In the story, R.P. McMurphy – played by Jack Nicholson in the film – is a misbehaved convict who ends up in an asylum after faking insanity to escape hard labour while in prison. Like other patients in the facility, he finds himself subjected to ECT.
In the famous words of Nurse Ratched, the treatment "might be said to do the work of the sleeping pill, the electric chair and the torture rack. It's a clever little procedure, simple, quick, nearly painless it happens so fast, but no one ever wants another one. Ever."
Dr Frank Pittman, the renowned American psychiatrist, has said the publication of the book "had an enormous effect" on his field.
"It gave voice, gave life, to a basic distrust of the way in which psychiatry was being used for scoiety's purposes, rather than the purposes of the people who had mental illness," Dr Pittman told The Discovery Channel.
"Back in my training in the early 60s, we gave shock treatment, particularly at that time as a treatment for agitated depression. It worked more quickly than the drugs we had then – more quickly than the drugs we have now – but it left me squeamish. The brain is much too delicate, much too mysterious, for us to mess with."
The book's publication contributed to a backlash against the entire psychiatric treatment system in the US in the 1960s. Huge, spirit-crushing state institutions – like the Oregon facility later depicted in the film – began reducing their excessive resident numbers and granting patients more rights.
It also catalysed the development of more effective anti-psychotic drugs that allowed more patients to be treated at home and live more normal lives.
Amid a minor revival in ECT in the early 1990s, The New York Times noted that thanks to the film's memorable images, "in the public mind 'shock therapy' has retained the tarnished image given it by Ken Kesey's novel: dangerous, inhumane and over-used".
Yet for many mental health professionals the book and film also had a negative effect. A 1983 study involving 146 university students found "considerable negative changes in attitude" towards people with mental health problems among those who had seen the film.