Before entering the field of psychology in the 1970s, I worked as a psychiatric nurse, gravitating to the community mental health movement, and then to anti-psychiatry politics. As a nurse at a psychiatric hospital in Santa Monica, also involved in union organizing and direct action politics with a feminist health collective, I was drawn to the radical wing of community mental health. Decades later, in producing a documentary film on the stories of people who entered the state psychiatric hospital in Oregon under the insanity plea, I had the chance to look back on that era through the lens of a fiction film that had made this hospital so famous.
My documentary, titled Guilty Except for Insanity, begins with a return to the same institution — the Oregon State Hospital — where One Flew Over the Cuckoo’s Nest was shot. The documentary opens with footage of that film and a narration explaining that our story is as much about the need for connection and care as it is about human struggles for freedom from confinement. As a project that began with a class that I teach on Gender and Madness, the documentary looks at the history of the asylum through a decidedly feminist lens — an approach that challenges some of the masculinist assumptions of the radical psychiatry movement.
The radical movement has deep roots in Eugene, Oregon, hometown of Ken Kesey and organizational base of MindFreedom — a dynamic organization that has played in important role in mental health activism in the Pacific Northwest. An anthem to the Merry Pranksters and road rebels of the 1960s, part of the West Coast counter-culture scene, One Flew Over the Cuckoo’s Nest celebrates the romantic impulses of the period. Published in 1962 and made into a film in 1975, Ken Kesey’s tale of the asylum secured a lasting place in the social imaginary. His vision of institutional confinement registered the anti-authoritarian ethos of the era, but Kesey was particularly attuned to psychological currents in American manhood.
The crisis of the story unfolds as McMurphy, who maneuvered to get into the state hospital to escape jail time, discovers that most of his fellow patients entered the facility voluntarily. Under the control of the repressed and repressive Nurse Ratched, the men on the ward choose to stay even when given the chance to leave. Chief, a Native American hospitalized for catatonia who emerges as the sentient ally of the rebellious McMurphy, emancipates himself from the control of Nurse Ratched at the film’s conclusion. After the lobotomized McMurphy is wheeled onto the ward, mentally castrated for orchestrating a rebellion, Chief performs a mercy killing by smothering the tragic hero. Gathering up the strength within his massive frame, he then extracts a hydrotherapy machine from its plumbing fixtures and hurls it through a barred window of the day room. In the final scene, Chief jumps through the window casing and runs toward the Oregon hills, with a glorious sunrise over the Cascades signaling the dawn of a new era.
This allegorical tale concludes with the liberation of the one Good Man (the silently watchful Native American) from the pernicious control of the (maternal) asylum. The onus of social control falls on the lap of nurse Ratched, the spoiler to the merry prankster hit-the-road philosophy. With this ethos of freedom as liberation from domestic constraints, the film forecloses the question of where those who escape institutional confinement, including indigenous people who end up on the streets, go when they escape the powerful institutional mother.
Throughout the history of patriarchal societies, care for dependent members of society falls largely to women. Throughout this same history, rebellious women were often spirited away to asylums, often by men disciplining their defiant daughters or wives. But women also suffer the burden of caring for family members whose needs fall below the register of the social “safety net.” Even the concept of the safety net suggests a norm of erect citizens who may periodically stumble and fall, requiring provisional holding until they get back on their feet. An element of the 1960s and ’70s anti-psychiatry critique, which we take up in Guilty Except for Insanity, centered on how the safety net readily transmogrified into a steel trap through the controlling interventions of the state.
The anti-psychiatry movement of the 1960s and ’70s flourished as part of broader resistances to authority and the state. David Cooper coined the term antipsychiatry in orienting radical politics and revolutionary change in his critique of institutional psychiatry, and in calling for therapeutic communities run as collectives. Many psychiatrists were part of radical politics and protest movements of this era, as were mental health workers from allied fields. Building community mental health centers grew from a radical vision that went beyond paternalistic care of the mentally ill or liberal tolerance. Rather, it was based on genuine appreciation for odd behavior, and for the insights that accompany delusional thinking. The conception of the schizophrenic as a folk hero, a rebel in open revolt against the reality principle, certainly contained romantic blindspots. The actual mental torment and social alienation of people who suffer symptoms of psychosis could easily be downplayed in this heroic casting of their positions as misfit.
In undertaking Guilty Except for Insanity, we were particularly interested in working with this subtext of Cuckoo’s Nest — the representation of the state hospital as both sanctuary from a threatening external world and as site of coercive confinement. Unlike the prison, the “psychiatric gaze” of the asylum penetrates the internal world of the inmate, operating up close. Our film project began from the premise that the social control models that inform much of the antipsychiatry movement overlook a range of needs related to care, as well as progressive currents in the changing terrain of Western psychiatry. The power of psychiatry may be in its license to dispense opiate to the masses. But this dispensing is a response to real human distress.
Through the documentary, we wanted to create an antidote to the steady stream of highly sensationalized horror stories about crime and madness. Reality TV programs like America’s Most Wanted focus on stereotypes of deranged psychopaths and serial killers. News stories, in both print and visual media, offer lurid tales of those who escape mental institutions. Film depictions are no less sensationalized. Mainstream films such as American Psycho, Taxi Driver, Natural Born Killers and Silence of the Lambs perpetuate public anxieties over psychopathic killers stalking the country. More progressive accounts focus on the wretched conditions of institutions housing the criminally insane, but veer toward the gothic and stereotypical. The classic Fredrick Weisman film, Titicut Follies, remains the only feature-length documentary on an institution for the criminally insane, and an important historical reference point for Guilty Except for Insanity. But the relentless bleakness of the film evokes the sadism of the institution, with staff portrayed as willing accomplices. Recent specials by Frontline on criminal insanity and the treatment of the mentally ill in the criminal justice system similarly offer limited portraits of both inmates and the staff who work in these institutions.
We wanted to subvert these conventional images of madness, with their alternating portraits of monsters and folk heroes, bringing the humanity and hopes of forensic patients into view, and focusing on the “criminally insane” manner in which American society treats those who suffer a mental health crisis. Guilty Except for Insanity counters sensationalized accounts of the “criminally insane,” showing how patients who enter the hospital through the insanity plea are not so different from everyday people. Woven through the interview segments and shots of key junctures in patients’ journeys in and out of the hospital are songs produced by patients and staff, as well as art, text, and graphics that bring a vibrant ethnographic feel to the documentary.
The documentary also offers a unique glimpse into the lives of OSH patients and staff caught in a system that reflects larger national trends toward incarceration of people suffering mental health crises. Over a period of eighteen months, the film follows individuals from diverse cultural backgrounds who enlist the insanity plea after being charged with serious crimes. Their tales recount the tragic yet often inspiring sagas of men and women whose lives had spun out of control, and of the consequences of their encounters with the criminal justice system. Through the insanity defense, the state steps in with a heavy boot, offering deliverance from criminal responsibility but exacting a terrible price.
Most patients serve far longer terms in the OSH than they would have served had they gone to prison. And the stigma they bear remains far longer than the terms of their incarceration. The documentary portrays the deeply human dilemmas behind public stereotypes of the criminally insane, and exposes the complex and varied sources of the insanity that overtakes their lives. Through the documentary, my team seeks to unravel what has gone wrong since the 1970s de-institutionalization movement, understand why the criminal justice system has devoured the community mental health system, and probe the basis of anxieties concerning reintegration of incarcerated patients.
Some subjects in Guilty Except for Insanity have described the documentary as therapeutic. For people who have been extremely marginalized or approached as a bundle of clinical symptoms, the experience of seeing themselves positioned as thoughtful, as carrying important insights on the human condition, can be a powerful experience. Yet to the extent that a picture “tells a thousand words,” documentaries can be seductive in seeming to offer a window onto a hidden world. The accessibility of the images, seeing real people in real places, can seem to bypass the need for analysis of the stories that unfold. But documentaries depend on the critical engagement of audiences and activists, not simply to pan or applaud the production but to think through critical questions in transforming the world, in imagining that a better world is indeed possible.
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Trailer for “Guilty Except for Insanity: Maddening Journeys Through an Asylum“
Interview with Dean Brooks, Superintendent of Oregon State Hospital, where
“One Flew Over the Cuckoo’s Nest” was filmed, with his eager cooperation.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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