Out of the Cuckoo's Nest

In the 1975 film One Flew Over the Cuckoo’s Nest, the protagonist, R.P. McMurphy, enters a state asylum although his mind may be perfectly healthy. His first interaction with
 his supervising doctor reveals the complicated attitude the film takes towards mental illness: “Now they’re telling me I’m crazy over here ‘cause I don’t sit there like a goddamn vegetable. It don’t make a bit of sense to me. If that’s what crazy is, then I’m senseless: out of it, gone down the road, wacko.” Throughout the rest of the film, the state of McMurphy’s mind is in question, as he gradually escalates his war against the hospital authorities. What is never in question is the health of the other patients, who alternate between dumb passivity and violent outbursts, regardless of their actual disease. In this way, psychiatric illness is the real protagonist of the movie.
Mental illness has figured as a prominent motif in film since the beginning of the medium, but filmmakers also frequently misrepresent it. Usually, these portrayals promote stigmas that haunt sufferers as they attempt to function in society; more accurate portrayals that emphasize a person’s battles with psychiatric illness and hindered social interactions do a much better job of relaying that stigma. As UCLA law professor Elyn Saks explained in a recent TED talk, we should be aiming to portray people with mental illness “sympathetically and … in all the richness and depth of their experience as people, and not as diagnoses.” Unfortunately, films often confine people to their diagnoses, which are often medically inaccurate.
The Norman Bates Stigma
In many ways, One Flew Over the Cuckoo’s Nest challenged the notions of mental illness. McMurphy denies that his fellow patients’ ailments should be debilitating: “What do you think you are, for Christ’s sake? Crazy or something? Well you’re not!” At the same time, the film simultaneously propagated several stigmas—a 1983 study showed that university students who had viewed the film subsequently perceived psychiatric illness in a more negative light.
The stereotype that the mentally ill are violent—epitomized in films like Psycho (1960), where Norman Bates develops dissociative identity disorder (multiple personalities) and, adopting his mother’s persona, becomes a serial killer—constantly reasserts itself through the news media. “From childhood onward, the portrayal of the twisted or nutty character is either evil or funny, but it’s a negative stereotype,” said Dr. Gene Beresin, a professor of psychiatry at Harvard Medical School, in an interview with the HPR. He points out news portrayals of school shootings: psychiatric issues are nearly always mentioned as a cause of violent action. “When the media doesn’t report mental illness in other ways, but continually links it to violence, it brings the association that mental illness and violence are linked.” But, as the Secret Service’s Safe School Initiative showed, “There is no accurate or useful profile of students who engaged in targeted school violence.” In other words, there are so many people who suffer from mental illness who do not engage in violence that
it is impossible to predict that a person will be violent due to psychiatric problems.
The “funny” stereotype is also harmful, because it mischaracterizes mental illness. Furthermore, for comic characters, their problem becomes a defining trait. The psychiatric problem provides the comic drive, and as a result the film trivializes a serious illness. For example, in Me, Myself, and Irene (2000), Jim Carrey portrays a man who, despite references to schizophrenia, in fact undergoes dissociative identity disorder, and, like Norman Bates, becomes a violent killer. In reaction, the former executive director National Alliance on Mental Illness stated that the film “reinforced a total misunderstanding” of schizophrenia and contributed to stigmatization. Older films like King of Hearts (1966) and Harvey (1950) depict people with mental illness as quirky and funny, but rarely as normal people suffering from a disease. Even television shows like Monk (2002-2009), in which Tony Shalhoub portrays a detective with severe obsessive-compulsive disorder, may support a certain stigma: OCD exclusively defines Adrian Monk, and without it, none of the episodes would function. The psychiatric illness is the center of the plot, and it is permanent and untreatable, despite Monk’s continuous visits to his psychiatrist.
The Beautiful Mind in the Movies
At the same time, Monk’s OCD is a valuable asset—in some ways, it resembles a superpower that allows him to solve crimes. Certain portrayals, then, seem to work in the opposite direction: some mental illnesses may simply be amplifications of desired traits. New York University anthropology professor Emily Martin explored this phenomenon in the context of bipolar disorder in her book Bipolar Expeditions. In an interview with the HPR, she described one Los Angeles doctor who reported famous actors entering the clinic with their agents, who would ask the doctor to undertreat the actors in order to maintain their manic, and profitable, edge. “The myth or cultural narrative has arisen that you’d be lucky if you have the set of characteristics that fall under the heading of bipolar disorder,” she explains.
With the advent of treatment for bipolar disorder in the second half of the 20th century, it became less of a “violent” mental illness and transferred over to the realm of “quirkiness.” As Martin points out, though, the revelation that many successful figures—from CEOs like Steve Jobs to entertainers like Robin Williams—had the illness led to the perception that it was something to be valued. Mania was immensely productive in society, and depression, while unproductive, could be helped with drugs.
However, Hollywood can also help reverse the stigma. Advocacy groups have recently promulgated a “growing awareness of the power of the media to perpetuate but also challenge stigmatizing stereotypes”, according to Angela Woods, a researcher at the University of Durham’s School of Medicine, Pharmacy and Health. Media can also be used as a tool to help raise awareness about mental health issues, as successful public service campaigns in both England and New Zealand demonstrate. And since the 1980s, filmmakers have devoted increased attention towards depicting psychiatric problems in a more sensitive light. While many movies continue to portray negative stereotypes, others attempt to paint a portrait of a person beyond their illness. As Good as It Gets (1997) is an excellent, detailed, and complex portrayal of OCD; 2001’s A Beautiful Mind completely overturned the public’s perception of schizophrenia; and 2012’s Silver Linings Playbook artfully depicts the difficulties faced by people with bipolar disorder and depression.
And, although it may seem strange that so many movies center around mental illness, it is completely understandable why: psychiatric problems provide good stories. “Psychiatric illness by definition is about the self, and about when the self is not doing well,” explains Dr. Steven Schlozman, associate director of the Clay Center and an assistant professor of psychiatry at Harvard Medical School. “We see ourselves in these illnesses. You go into those movies and you identify—you even identify with Hannibal Lecter.” Mental illness, he points out, occurs on a spectrum, and even though the minds of healthy people may not prevent normal social function, everyone still lives in a unique psychological landscape that films can help illuminate. R.P. McMurphy is, first and foremost, an enigma—whether or not the doctor decides that he’s crazy—and, just as One Flew Over the Cuckoo’s Nest teaches us what makes him tick, so does it provide a window into ourselves.