A critical analysis of the portrayal of psychopathology through a film or television character

One Flew Over the Cuckoo’s Nest was released in 1975. This famous American movie was the adoption of the 1965 novel by the same name of Ken Kesey. In this movie Jack Nicholson performs the role of Randle Patrick McMurphy who teaches the men on the  ward how to break free from the Combine, which is a “made-to-scale prototype of  the big world Outside” the Combine is  he mechanism that  drives an increasingly technological society. Kesey’s choice of Chief Bromden (Will Sampson) who  has a white mother and a Native American father, allows for the play on and reversal of a couple of stereotypes. The Native American has been stereotyped by positioning McMurphy in the role of father-figure to Bromden. In a quasi-totemistic appropriation of Native American symbols,  Kesey locates McMurphy as the nearest thing to the Vanishing American. In the end, the Chief is left to restore both Native American masculinities and the blue-collar masculinities that  his new ‘father’ McMurphy represents.

In Cuckoo’s Nest, Kesey challenges contemporary codes of masculinity and presents his own ideological viewpoint regarding masculine codes. In providing his alternative model of masculinity, Kesey draws upon a well-know historical model – the independent, heroic wanderer.

In the following sections, I will analyse the character of McMurphy which was performed by Jack Nicholson. McMurphy has a definite appeal that revolves around hi independent, swaggering bravado, but Kesey makes it clear that the Combine threatens the existence of masculine men like McMurphy. The masculinity embodied by McMurphy stands in stark contrast to the debilitating and feminizing effects of the Combine.

In One Flew Over the Cukcoo’s Nest, McMurphy’s vitality serves two purposes. First, he describes his dominance over women, suggesting that they cannot resist him. Secondly, and more importantly in the context of the mental ward, McMurphy shows these other men, who think of themselves as rabbits, how much more masculine he is in comparison to them. In his study of masculinity, Kimmel suggests that this is a natural means for men to establish their manhood. Kimmel argues, “American men define their masculinity, not as much in relation to women, but in relation to each other. Masculinity is largely a homosocial enactment” (Kimmel 5). In Cuckoo’s Nest, the homosocial enactment of masculinity takes place in the way McCurphy brags about his sexual prowess. For McMurpy, being a man means acting like a man. Kesey’s novel, however, points the finger at women for the emasculation of men. McMurphy serves as the model of the unwavering masculine spirit largely because women have been unable to control him. John A. Barsness, in “Ken Kesey: The Hero in Modern Dress,” (1969) argues that McMurphy, as hero, is “intuitive in action, non-intellectual in habit, anti-social, anti-urban, and full of the freedom and strength inherent in nature. The enemy he fights is society, artificial, complex, institutionalized – civilization, if you will…” (433). McMurphy is the perfect protagonist to arise because he fights against a formidable foe – the inauspiciously named Combine – despite insurmountable odds. McMurphy, like any great hero, willingly lays down his life for the salvation of others.

The mental health facility in Cuckoo’s Nest symbolically depicts how technology – the Combine – sedates men and robs them of their masculinity. In the movie, treatments such as prescribed medication, electro-shock therapy, and lobotomies are symbols for the pacification of men that is taking place as the gray suites multiply. by gray suits, I mean that individuality is at stake as men become a collection of nondescript ants marching to the beat of the same drum. This is most clearly demonstrated in the Chief’s description of the world outside the mental ward. When McMurphy takes the men on an unauthorized fishing trip, Chief Bromden ventures out of the asylum for the first time in over twenty years. The Chief can finally see what the Combine has produced and what McMurphy is fighting against. The Chief also represents the threat men face if they remain blind to the changes that are occurring.

The DSM-IV-TR

The DSM-IV-TR (APA, 2000) continues to use the term mental retardation and it is defined as follows:

This disorder is characterized by significantly subaverage intellectual functioning (an IQ of approximately 70 or below) with onset before age 18 years and concurrent deficits or impairments in [at least two areas of] adaptive functioning [communication, self-care, home living, social interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety]. Separate codes are provided for Mild [IQ of 50-55 to approximately 70], Moderate [IQ of 35-40 to 50-55], Severe [IQ of 20-25 to 35-40], and Profound Mental Retardation [IQ below 20 or 25] and for Mental Retardation, severity Unspecified. (p. 39)

The DSM-IV-TR definition of intellectual disability is similar to that within other classification systems; however, there are certain distinctions. Although the AAMR definition has the same diagnostic criteria as the DSM-IVTR, it does not utilize specific codes, and it emphasizes levels of support needs as opposed to severity levels based on IQ. While the ICD-10 definition utilizes codes and levels of severity that are comparable to the DSM-IV-TR, it differs in terms of specified diagnostic criteria.

Despite the prominent usage of the above-mentioned classification system, the DSM-IV-TR (APA, 2000) definition of intellectual disability will be used in this study. This is due to the DSM-IV-TR (and earlier editions) having greater specificity in relation to psychopathology and also the increased frequency it was found to be referenced throughout the literature review.

Intellectual disability was defined using the definition of mental retardation in accordance with the DSMIV-TR (APA, 2000). Other than mental retardation, no other Axis II disorders were included under their definition of psychopathology. When a study excludes or includes certain mental disorders, there is a potential that the prevalence rate may be affected (Moss, Emerson, et al., 1997). Clay and Thomas (2005) found an overall 31% prevalence rate of psychopathology in their intellectually disabled sample. Thus, if Clay and Thomas had included other Axis I and Axis II disorders within their study, the prevalence rate may have been higher. Grouping their subjects according to levels of severity also revealed different prevalence rates.

Mildly and moderately intellectually disabled clients were diagnosed with psychopathology at similar prevalence rates of 29.0% and 30.4%, respectively, while severely and profoundly intellectually disabled clients had rates of 23.5% and 45.8%, respectively.

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In comparison, the study by Borthwick-Duffy and Eyman (1990) found a much lower overall prevalence rate of psychopathology within the intellectually disabled population. However, the size and type of sample within this study differed considerably from that of Clay and Thomas (2005). Borthwick-Duffy and Eyman (1990) had data on 78,603 clients who were diagnosed with an intellectual disability, receiving services from the state, and living in a variety of settings. While Clay and Thomas (2005) focused primarily upon community settings, Borthwick-Duffy and Eyman (1990) had also incorporated state institutions and health facilities within their sample. Data were collected through the Client Development Evaluation Report (CDER). The CDER is the standard assessment used to collect comprehensive data on the intellectually disabled individuals who receive.

Differences in the presentation of psychopathology and increased difficulties in diagnosis may also account for the lower prevalence rates found in the severely and profoundly intellectually disabled individuals. Individuals at these levels of intellectual disability may lack the ability to adequately communicate their mental state, thus they would be unable to meet certain criteria used for standard diagnostic assessment (Marston et al., 1997; Meins, 1995; Rush, Bowman, Eidman, Toole, & Mortenson, 2004; Sequeira & Hollins, 2003; Sturmey, 1998). When the ability to communicate is severely impaired, there is a greater need to rely on behavioral observations and third party informants in order to make a diagnosis (Marston et al., 1997; Moss et al., 1997; Sturmey, 1998). However, the accuracy of third party information can be questionable due to possible subjective interpretations on the part of the informants (Sturmey, 2007). Individuals in the severe and profound range of intellectual disability may also present in a manner that is highly individualized and ambiguous, making diagnosis much more difficult (Reiss, 1982). Thus, the lower prevalence rates found in the severely and profoundly intellectually disabled groups may be a greater indication of problems associated with diagnosis, as opposed to actual lower incidences of psychopathology. Severity levels of intellectual disability are just one of several factors concerning the difficulty of diagnosing psychopathology within this population.

The case of McMurphy offers a great challenge for determining whether this character meets the criteria of the DSM-IV-TR or not. Apparently, McMurphy is a modern-day cowboy, a sexual superhero who brags about his many conquests: “Now they tell me a psychpaht’s guy who fights and fucks too much, but ain’t wholly right, do you think? I mean, whoever heard tell of a man getting’ too much poozle” these sentences uttered by McMurphy show that the character has an exaggerated feelings of his manliness and masculinity.

However, diagnosis of The DSM-IV-TR is not so easy. There are certain difficulties that may hinder the true judgment. Certain individuals may deliberately attempt to conceal or deny their intellectual disability in order to cope with the stigma associated with their disorder (Edgerton, 1967). In an in-depth study, Edgerton examined the lives of former patients from an institution who were now living within the community. This sample was predominantly comprised of individuals within the mildly intellectually disabled range. Edgerton reported that the overwhelming majority of his sample found the idea of their intellectual disability as unacceptable. They fervently attempted to live their lives in a manner that presented with normalcy while internally and externally denying that they even had an intellectual disability. The same case we find in the character of McMurphy who lives a heroic life and exhibits extra sexual prowess even though some of his acts demonstrate that he has some sort of mental disorder. This denial appears to serve as a powerful coping mechanism that dealt with the harsh stigmatization associated with their disorder. Such concealment and denial, if applicable, may further hinder or obscure the diagnostic process. Sovner (1986) also described four additional factors that can impede the diagnostic process within the intellectually disabled population: intellectual distortion, psychosocial masking, cognitive disintegration, and baseline exaggeration. Intellectual distortion describes how the intellectually disabled individuals may be unable to communicate adequately or think abstractly, thus hindering their ability to report their mental state. Psychological masking refers to how a lack of social skills and life experiences can lead to a clinical presentation that is simple and generic in comparison to the non-intellectually disabled population. Cognitive disintegration describes how stress can lead to a disorganized state that can be incorrectly viewed as psychotic behavior. Lastly, baseline exaggeration refers to how preexisting psychopathology may increase during stressful periods, and it may be difficult to distinguish new symptoms from previous ones.

The difficulties associated with diagnosing this population can present a significant challenge for a clinician (Vitiello & Behar, 1992). Although proper diagnosis is best likely accomplished by those with long-term experience working with the intellectually disabled population (Gillberg et al., 1986), the majority of psychologists appear to have minimal experience or training when it comes to working with this population, thus, they may be reluctant to treat this population (Matson & Sevin, 1994).

A recommended approach to address some of these diagnostic concerns is to utilize multiple techniques and sources of information, such as reviewing the individual’s records, interviews with the individual and third parties who are well familiar with the client, and using rating scales that are capable of assessing psychopathology within the intellectually disabled (O’Connor & Rose, 1998; Rush et al., 2004; Sturmey, Reed, & Corbett, 1991).

Conclusion

The above debate shows that the character of McMurphy exhibits DSM-IV-TR criteria in some ways even though as an excited audience we tend to attribute such mental disorders as heroic deeds. For example, the exaggeration of sexual prowess is also a symptom of mental disorder, but in the movies, audience call such character a hero who is able to do miraculous deeds with superman like powers. So, clinically the character of McMurphy demonstrates the presence of mental disorder and fulfils the criteria of DSM-IV-TR.