Trisch Analysis

Out of all of the works of literature we have studied in this class, I feel that this one is the one that I am the most interested in. I felt particularly connected to this book because of the experience that I have had with mental health facilities in my lifetime.

While I have never been admitted to a mental health facility myself, I have family members and friends who have, and I have seen first hand what occurs inside them and the effects that they can have on people due to their experiences there.

In One Flew Over the Cuckoo’s Nest, we are introduced to the character Miz Ratched, who is the head nurse in this particular facility. It is apparent to the readers that she is not a very warm caregiver, nor is she particularly invested in her patients. Near the beginning of chapter one, there is a scene, which I felt captured the essence of how Miz Ratched felt about her patients and the type of care they received. In this passage, she has an interaction with some of her patients which the narrator describes as, “She stops and nods at some of the patients which come to stand around and stare out of eyes all red and puffy with sleep. She nods once to each. Precise, automatic gesture” (Kesey 6).

This passage demonstrates the cold, mechanical approach that Miz Ratched took to running the facility. Rather than embrace each person as a human being and treat them as such, she treated the patients with a cold and mechanical demeanor. This was also demonstrated on page 25, where the narrator states, “The big nurse tends to get real put out if something keeps her outfit from running like a smooth, accurate, precision-made machine” (Kesey 25).

This description was actually quite similar to the experience I have had with mental health facilities. On the occasions I have gone in to visit my friends and family who were admitted to them, I was shocked at how bleak and depressing they seemed. Many of the staff seemed to be “checked out”, and focused on staying on schedule and meeting quotas at the loss of forming relationships with the patients.

An article published by the BMC health services analyzes this exact situation. In the study conducted by the BMC, patients who had spent time in a psychiatric hospital were interviewed. They were asked questions about their experiences in the hospital, if their stay had been beneficial, and their relationships with the staff in the hospital. The study found that, “Relationships with an individual which comprised effective communication, cultural sensitivity, and the absence of coercion resulted in that person being attributed with a sense of trust. This resulted in the patient experiencing the hospital as a place of safety in terms of risk from other patients and staff” (Gilburt, Rose & Slade 1).

It is apparent that an icy approach to patients with no relational bonds whatsoever is not beneficial to these patients, as demonstrated in both fiction and non-fiction. When we stop looking at these facilities as machines to be maintained, maybe we will be able to move forward into providing the best care possible in all psychiatric hospitals.


Gilburt, H., Rose, D., & Slade, M. (2008, April 25). The importance of relationships in mental health care: A qualitative study of service users’ experiences of psychiatric hospital admission in the UK. In BMC Health Services Research. Retrieved from

Kesey, K. (1962). One Flew Over the Cuckoo’s Nest. N.p.: Penguin Books.


4 thoughts on “Trisch Analysis

  1. katieebuugg

    Like you, I found myself interested more by this reading than some of the others. I think I found myself interested in this reading because it is a longer piece narrated by a neurodiverse individual and it was written at a later date than some of the other pieces we have covered. Another thing I found interesting about your post was the personal connections you could make with your own experiences and the content in the book. I think I was particularly intrigued because I do not have any personal connections with anyone who has experienced an institution first hand, nor have I ever been in one myself. Like you also, I was bothered by Nurse Ratched and the way she treats her patients throughout the book. Nurses as I recall are supposed to help people, not give them cold, demeaning comments and looks all the time. I think there would have been more positive results that were present in some patients at the ward if Ratched cared more about her patients and went about caring for them in a more positive, warm way. I was also intrigued by your connections and how institutions have affected people you know. Not having any experience with institutions, I was shocked to see how negatively the people you know were affected by the institution they were a patient at. You would think with the new ideas in treatments, and knowledge of those who are neurodiverse that institutions would be warm, positive places to be instead of cold, depressing ones. My hope is that in the future of treatment and care for those who are neurodverse, modern day institutions can become places that solely focus on helping the individuals who are admitted and that they also care for them in ways that are positive, welcoming, and warm instead of demeaning.


  2. sgrit96

    I too have friends and family members who have been in mental health facilities and they have expressed their discomfort with the facilities and the approaches taken to their treatment. Two of my friends sought help for anxiety and depression in a local mental health facility around the same time in high school, and they both suffered a lack of emotional connection to the people working at the facility. One of my friends who was in the facility had severe social anxiety and they would force her into a group setting to talk about her discomfort. I don’t fully understand the benefits of forcing someone into a situation which would cause them extreme distress and discomfort, but I’m sure that if the staff had made any effort to understand her situation they would have been more sympathetic. When I was reading through One Flew Over the Cuckoo’s Nest, one line made me think of this detachment and cold machine-like approach, “What she dreams of there in the center of those wires is a world of precision efficiency and tidiness like a pocket watch with a glass back, a place where the schedule is unbreakable” (26). This struck me because I realized that perhaps the system in which my friends received treatment was similar, they wanted results in her treatment with speed and efficiency by forcing her to deal with her anxiety rather than working through it with her.
    It appears that the strict schedule that is apparent in One Flew Over the Cuckoo’s Nest is also a reality in modern mental health care facilities as my friend described her schedule as being strictly regimented. Such a strict adherence to schedules could be detrimental to patients as they are reintegrated into society after their treatment because they will no longer have each detail so closely monitored. My friend had difficulty coming back from her treatment due to the disconnect between the regimented schedule of the facility and her school schedule which caused her further anxiety.
    The bleak description of the facility provided by my other friend who suffers from severe depression was also perplexing to me because I don’t understand why a facility which is meant to help my friend deal with his depression would be so depressing. He described his room as lacking light and personality, his description seemed similar to what I would expect of a prison. I cannot see the benefit of such a cold environment for patients, and your article about the importance of relationships in the treatment of mental illness made it clear to me that such an environment was detrimental to my friend’s treatment. Connecting with staff and having a welcoming environment could have made my friends much more comfortable with seeking treatment, but unfortunately, they were in an environment which only pushed for fast results rather than lasting ones. Hopefully, literature like One Flew Over the Cuckoo’s Nest, will provide a platform for discussion about the need to improve the treatment of mental illness and help to bring an end to the stigma surrounding mental illness.
    Kesey, K. (1962). One Flew Over the Cuckoo’s Nest. N.p.: Penguin Books.


  3. ashleighnfowler


    Your post was very insightful and it made me think a lot. I have never been to a mental hospital but I would be very curious to see what happens inside the walls. We know that “One Flew Over the Cuckoo’s Nest” is an accurate portrayal of mental asylums but since the book has been published, have mental asylums changed?

    As someone who suffers with generalized anxiety, it always shocks me to see how people react to others who are neurodivergent or have mental health problems. For me, I hate it when people say, “What are you soanxious about?” or “you have nothing to worry about”. To me, these remarks are cold and unloving and they do more harm than good. In fact, I get more mad and upset than I already am. I can’t even imagine someone who suffers with paranoia and hallucinations, such as Chief Bromden being supervised by someone like Nurse Ratched. By her methods, Nurse Ratched dehumanizes the patients. Mental illnesses are already dehumanizing enough without cold and mechanical nurses. From what I have heard, from you and others , “One Flew Over the Cuckoo’s Nest” is an accurate portrayal of what goes on inside the walls.

    I was wondering if the book changed anything. The book is a well-known book and many people have read it. In fact, both my Uncle and my Mom were required to read the text and I am currently using their copy (It’s at least thirty years old). Since so many people have read the book, did it change anything? Books have changed society before and they’ll continue to change society. For example, Upton Sinclair’s “The Jungle” helped in creating the FDA. “Uncle Tom’s Cabin” by Harriet Beecher Stowe is claimed to “help lay the groundwork for the Civil War”. We know that words are power and that books can change society but did “One Flew Over the Cuckoo’s Nest” change psychiatry? In an article by the Telegraph, Psychiatrist, Doctor Frank Pittman states that the book has had a lasting impact on psychiatry both for the good and the bad. When Doctor Pittman was training in the 1960s, institutions did use shock treatment. As he states, shock treatment acted more quickly than the drugs they had back then and it works more quickly than the drugs that we have today. The book led to a backlash from the general public. Due to this backlash, mental hospitals began to reduce their numbers and give their patients more rights. On top of this, “One Flew Over the Cuckoo’s Nest”, also led to the acceleration of developing more effective anti-psychotic drugs. These drugs led to more patients being able to be treated at home and living a more normal life. So, instead of using group therapy to prepare the patients to live outside the hospital, patients actually lived outside the hospital walls. The book made positive impacts on psychiatry but it also created a major negative impact as well. According to the Telegraph article, a 1983 study shows that people who have seen the film (and probably have read the book too) compared to the people who haven’t seen the movie or read the book have more negative attitudes towards people with mental health problems.

    Swaine, Jon. “How ‘One Flew Over the Cuckoo’s Nest’ changed psychiatry.” The Telegraph , The Telegraph , 1 Feb. 2011, Accessed 24 Oct. 2016.


  4. emimarr

    I agree with your analysis of the lack of specialised care provided in mental health facilities. Though I’ve never had personal experience with such facilities, our readings thus far in the semester have shown the damage that these institutions can do. From Silberman’s recount about Bill Sackter, to the fictional characters of Raymond Babbitt and Bartleby; the struggle of neurodivergent people against neurotypical institutions has been highlighted. One Flew Over the Cuckoo’s Nest continues in this vein, as we see the characters’ conflicts against the authority of Nurse Ratched.

    While reading, I noticed many parallels between the overall plot of this novel and that of Rain Man. The characters in both texts enjoy a brief reprieve from the restrictions imposed by institutions, but must ultimately return to conformity. The texts detail different modes of resistance: in Rain Man, Raymond is physically removed from an institution, while in One Flew Over the Cuckoo’s Nest the patients undermine Nurse Ratched’s authority from within the institution itself. The men are emboldened by Randle McMurphy’s actions, and follow his example in breaking the oppressive rules that are enforced within the mental facility. However, their rebellion causes severe repercussions, and Randle grows increasingly desperate in his attempts to break the rules. His frustration at the institution’s lack of response causes him to act out, resulting in his eventual lobotomy. Both Raymond and Randle have their agency taken from them – though in vastly different ways – and are forced to submit to being institutionalised. This is a disturbing reminder of the hopelessness of their situation in an uncaring system.

    Nurse Ratched’s harsh rule also has drastic consequences for the other characters. This is most shockingly evidenced when her threats cause Billy Bibbit to commit suicide. Billy’s feelings of shame and alienation are commonly experienced by many patients in mental health facilities (Knoll 2012). Though figures such as Nurse Ratched may no longer exist in these facilities, the rates of suicide within institutions are still overwhelmingly high. I conducted some further research into the matter and found that 6% of all suicides in the U.S. – roughly 1800 – take place within mental health facilities. A major factor contributing to this statistic may be due to how ‘checked out’ the carers are, as you mentioned. The article I looked at listed inadequate risk assessment as one of the root causes of inpatient suicides (Knoll 2012). This evidences the consequences of the lack of personal attention within such facilities. A system that operates under a ‘one-size-fits-all’ mentality rather than accounting for individual differences can only cause harm to those it claims to help.

    One Flew Over the Cuckoo’s Nest extends upon the knowledge of institutionalisation that we have gained thus far in class. The efforts of McMurphy and the other patients to skirt authority highlight their desire to be have a voice and be treated with decency. Like many neurodivergent individuals in real life and fiction, they are mistreated by neurotypical systems. Texts such as this one emphasise the importance of reform in the way neurodivergency is addressed.

    Kesey, K 1962, One Flew Over the Cuckoo’s Nest, Viking Press, New York.
    Knoll, J 2012, Inpatient Suicide: Identifying Vulnerability in the Hospital Setting. Available from: [22 October 2016].



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