Shocking!

One Flew Over The Cuckoo’s Nest (1975)

I recently watched One Flew Over The Cuckoo’s Nest, a classic drama film from the 70s starring Jack Nicholson who plays a patient hospitalized at a locked psychiatric facility. The film is an adaptation of the novel written by Ken Kesey. Interestingly, Kesey gained inspiration for the story from talking to psychiatric patients while high on LSD at the Menlo Park Veterans Hospital in the early 1960s. Coincidentally, I have also worked with patients at the MPVA, sans LSD however. He scored his LSD free of charge from the government, when he volunteered as a Stanford student to be a subject in the covert CIA-financed study of the effects of psychoactive drugs on human behavior.

I don’t usually rent old movies, but I wanted to watch this film because of the infamous “electroshock” therapy scene. Euphemistically referred to as electroconvulsive therapy (ECT) in the medical profession, most people seem to always react with horror and repulse whenever ECT is mentioned. The reason, not surprisingly, is the atrocious image instilled in people’s minds from the movie. After viewing the clip myself of Jack being forcefully “shocked”, I can definitely understand why people are so horrified of ECT  (Check it out for yourself).

I don’t know for sure if ECT was administered in that inhumane fashion back in the spooky days of the asylums, but Jack was definitely wronged¹. Contrary to Jack’s experience, modern day ECT requires informed consent and is done in a controlled environment under general anesthesia and with a muscle relaxant. He shouldn’t have been conscious, convulsing, and writhing in pain. There was no need for the forced insertion of the mouthpiece or the multiple guys pinning him down. More importantly, he shouldn’t have received ECT in the first place- he was not depressed, manic, or psychotic. It was solely given as a form of punishment for his unruly behavior.

ECT is a very effective treatment for severe depression, especially for patients who have not responded to multiple trials of antidepressant medications. It should be legitimately considered by patients for antidepressant treatment, and not reflexively rejected because of the unfavorable depiction from the film.

Hollywood definitely likes to portray ECT as something scary and disturbing, as also featured in Requiem for a Dream.  The entertainment industry will probably never show ECT in its true form, because that would be just too boring and not shocking enough.

Addendum

1. In response to questions about the history of ECT- The procedure was invented in the 1930s. Anesthesia, and later muscular blockade, was not introduced until the 1940s, and took more than a decade to gain widespread use. Thus, many patients suffered from broken bones and ruptured tendons.  Informed consent was also not strictly practiced, if at all, during those days. I guess Jack did receive the standard ECT of the early era.

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10 Comments

Filed under Film, History

10 responses to “Shocking!

  1. Becca

    Very interesting!

  2. Vicky

    Interesting background info to a great book and movie. Was ECT performed in a controlled environment under general anesthesia and with a muscle relaxant back in the 60s as well?

  3. Mamie

    Insightful. I look forward to future posts.

  4. Mitesh

    Funny you should mention this movie because I just watched Shutter Island about 20 minutes ago and it reminded me of One Flew over the Cukoo’s Nest. I would love to hear your take on Shutter Island. I hope you get a chance to see it.

    Thanks for the writing inspiration. I’ll keep doing so.

    M

  5. Matt

    Great insight Dr. C, write more articles.

  6. Lauren

    Great post, Dr. C. Ever seen Stanley Kubrick’s A Clockwork Orange? Not exactly ECT, but there is a similar idea in the movie using classical music behavioral therapy. I’m sure you’ll like the movie! Keep up the good work.

  7. Pingback: Blog Review: Psychiatry in the Mainstream « The Amazing World of Psychiatry: A Psychiatry Blog

  8. BR

    Great movie! Though, yes, it was quite bad for the pscyh profession. As was the prevalence of lobotomies! (check out the video & info at http://health.howstuffworks.com/lobotomy.htm.)

  9. Pingback: Science 2.0. Harnessing Collective Intelligence by Curating the Blogosphere « The Amazing World of Psychiatry: A Psychiatry Blog

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