Clinical Analysis: One Flew over the Cuckoos Nest

This is strongly exhibited in the film, through nurse Ratchet's cold, dominating manner of inning of the ward. In the film Chiefs character is written off as deaf & dumb by both the staff and other patients, he often appears catatonic. Broaden does not participate In the therapy circle and appears to be only treated regularly through drugs. He Is presented In the story as a patient with the longest tenure at the institution. The film also alludes to him having had large numbers of shock treatments during his stay.

In the novel his character is described as having paranoid hallucinations of dense overwhelming fog generated by The Combine, a massive piece of machinery that intros people. The Chief isolates himself through his facade of being deaf and dumb. Eventually when Macarthur is able to get him to speak, the Chief reveals a story about his father being "worked on" by society. When he opens up, the Chief also lets on that he appears to see people as either big or small, he views people of confidence and strong spirit as large.

The Chief describes himself as a small man, his perception of himself speaks of feelings of weakness or low self efficacy and depression. To properly diagnose Broaden today, a Callahan Is likely to conduct preliminary ABA work & tests to rule out other possible causes for the schizophrenia like symptoms. A clinician would test him for commonly abused drugs that cause schizophrenia like symptoms for example, & conduct a basic physical to rule out medical illnesses that may be causing these symptoms as well as review medical history.

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A clinician would take note of Broadens very apparent symptoms of Psychosis: marked by hallucinations & delusions (The Combine), disturbances in sensory perception (the fog strongly held personal beliefs (The Combine controls people, reception of people as either being small or big) as well as emotional expression (his blunted flat affect, even when speaking to Macarthur ( speech Is flat, monotone & lacking in signs of typical emotion).

A clinician would also pickup on less obvious thinking behavior problems (in this case voluntary lack of speech). They would also need to determine whether Bromide's prolonged depressed mood is a symptom of schizophrenia or one of major depressive disorder or bipolar disorder. Psychosocial treatments would include: rehabilitation, individual psychotherapy, Emily education, self help & support groups and antispasmodic drugs. Social and vocational training would be administered early on after the antispasmodic medication has been administered.

As it deals with the immediate issues of isolation and helps teach the individual how to readjust to life outside of the sheltered/ controlled environment of a hospital setting, rehabilitation would be an integral step in eventually returning to life in the outside world. In the film Broaden appears to benefit greatly from forced social interaction with Macarthur. Macrographs character takes on the role of therapist with The Chief. He treats Broaden with respect and speaks to him instead of at him, which creates a bond of trust.

Macarthur also takes the time to involve Broaden in social activities like conversations and group activities (basketball games). The scene where Broaden successfully dunks the ball in the game against the orderlies exhibits the great effect of these simple therapeutic exercises. At the end of this scene Broaden no longer moves at a slow & sluggish pace, appears to come out of his catatonic state and even wows a change in affect with appropriate smiling after scoring in the game.

Receiving personal social attention, as well as being involved in the basketball game seems to do wonders for Broaden' isolation & self efficacy issues. Individual psychotherapy would involve regularly scheduled talks between the patient and therapist, to focus on current or past feelings, problems and experiences. Regular interaction with an empathetic person could guide the patient into a more grounded state and put them in touch with the outside world/reality. Problem solving ND coping skills could be learned from reality based therapeutic exercises.

As patients are often released and into the care of family members, it is important that they are educated on schizophrenia, relapse prevention & troubleshooting. Learned coping problem solving skills could result in a more successful outcome of care and readjustment of their family member. Self help and support groups would be used to provide mutual support and continued safe & empathetic social outlet for the patient. Patient support groups allow the patient to develop a sense of community with other patients as well as a resource of growth and learning from the sense that they are not alone in their condition.

In a way Macarthur follows the psychosocial treatment pattern with The Chief, who at the end of the movie describes the way he perceives himself as "big as a damn mountain" and has developed problem solving skills, clearly resolved his self able to make the decision to and accomplish escaping the ward. This comes in stark contrast to the methods exhibited by Nurse Ratchet that focused on maintaining control of the patients, & order of the institution, with a disregard for support/care of the progress of the individual patient.

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