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"If He's Crazy What Does That Make You?" the Negative

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"If He's Crazy What Does That Make You?" The Negative Perception of the Mentally Ill During the Twentieth Century and the Power of the Film One Flew Over the Cuckoo's Nest by Jordan Carroll Siena College Honors Thesis 2010 Reader Date "If He's Crazy What Does That Make You?"; The Negative Perception of the Mentally Ill During the Twentieth Century and the Power of the Film One Flew Over the Cuckoo's Nest. Jordan Carroll Honors Thesis Dr. Karen Mahar Dr. Karen Boswell Dr. Paul Santilli March 21, 2010 2 In 1975, Fantasy Films released the film adaptation of the popular 1962 Ken Kesey novel, One Flew Over the Cuckoo's Nest. Its tagline asked American citizens a very important question, "If he's crazy, what does that make you?" That same year, Janet Gotkin sat in front of a Senate subcommittee and gave a testimony of her ten-year stay at several mental institutions, where she was treated for a psychotic break in which she displayed suicidal tendencies during her freshman year of college. The Senate subcommittee was investigating the use of drugs known as neuroleptics in juvenile institutions, jails and homes for the mentally retarded. 1 In his opening statement, subcommittee chairman Senator Birch Bayh noted that the investigation was based on the idea that drug abuse was not limited to unauthorized use on umuly inmates or patients, but also included the "administration of mind-controlling drugs to unwilling, competent persons and the unnecessary use of these powerful medications on those institutionalized."2 In simpler terms, the employees at these institutions were charged with drugging patients, often daily, in order to control symptoms and behavior they did not want to treat tlu·ough other, therapeutic, but more difficult medical means. Janet Gotkin was just one of many mental patients who shared their experience with these powerfuldrugs. In her prepared statement, she conceded that her only claim to expertise on the subject was her "experience as a psychiatric guinea pig. "3 She described how medication "turned me into a fucking invalid, all in the name of mental health": I became alienated from myself, my thoughts, my life, a stranger in the normal world, a prisoner of drugs and psychiatric mystification, unable to survive anywhere but a psychiatric hospital ... It was so hard to think, the effortwas so great; more often than not I would fallinto a stupor of not caring or I would go to sleep. In eight years I did not read an entire book, a newspaper, or see a whole 1 Robert Whitaker, Mad in America; Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill" (New York; Perseus Books Group, 2002), 177. 2 th st U.S Senate Subcommittee to Investigate Juvenile Delinquency. 94 Congress; I session. 3 th st U.S Senate Subcommittee to Investigate Juvenile Delinquency. 94 Congress; 1 session. 3 movie. I could not focus my blurred eyes to read and I always fell asleep at a film. People's voices came through filtered,strange. They could not penetrate my Thorazine fog; and I could not escape my drug prison ...These drugs are used,not to heal or help, but to torture and control. It is that simple.4 Senator Bayh spoke of the need to eliminate the "chemical straight jacketing of thousands." Testimony at these hearings indicated that drugs were being administered to the mentally ill not for therapeutic reasons, but instead, in Bayh's words,to "make the custodial job easier." 5 That same year a grand jury investigation of Greystone Park Psychiatric Hospital in Morris County, New Jersey,found unsupervised patients living in unspeakable filth,doctors with limited English ignoring their rounds, and unscreened employees with criminal records ignoring their duties as well. It was labeled a "prison without an exit."6 Gotkin's testimony brought to light perhaps the worst abuse of the mental care system against its patients,and as a result the frequent administration of mind-altering drugs by psychiatric medical professionals,such as neuroleptics, was coming to national attention.7 Prior to the 1960s and 1970s,the treatment of the mentally ill,particularly in institutions, frequently made news. In fact,there are articles from the New York Times that report overcrowding in East Coast mental institutions as early as 1902. In one particular institution, over 250 patients were found sleeping in corridors because there were not enough dormitories to 8 accommodate them. Why the sudden spotlight on the plight of the institutionalized mental patient in 1975? This paper will find that although there was a reformmovement within the 4 Robert Whitaker,Mad in America, 176. 5 U.S Senate Subcommittee to Investigate Juvenile Delinquency. 94th Congress; l st session. 6 Joan Cook,"Grand Jury Finds Abuses of Patients at Greystone," New York Times, May 30, 1975,67. 7 See,for example, coverage of the 1975 Supreme Court ruling in O'Connor v. Donaldson, which won the right of those involuntarily committed to mental hospitals to treatment and not just custodial care, "U.S. Backs Treatment as a Right to Mental Patients," New York Time, January 16, 1975, 10. 8 "Many Insane in Bay State," New York Times, December 15, 1902. 4 fieldof psychiatry, the civil rights movement also had a positive effecton the lives of mental patients. And although the majority of reform efforts inspired by the civil rights movement had already peaked, concern over the treatment of the mentally ill was just gaining ground in 1975. However, the I 970's were a pivotal decade for the rights of the mentally ill and One Flew Over the Cuckoo's Nest was an example of this concern, but it was hardly the only manifestation of this movement. The state of institutionalized mental health care created steady headlines in that decade, mostly due to lawsuits filed on behalf of the mentally ill. Although there was a reform movement within the psychiatric field that predated the 1962 publication of Ken Kesey's novel One Flew Over the Cuckoo's Nest, and which criticized the worst abuses within institutionalized mental health care, this paper concludes that it was unlikely that the internalreform movement, by itself, would have been successful without public exposure of these practices in the form of newspaper headlines and Cuckoo's Nest. With the film and the civil rights movement occurring together and reflectingthe spirit of the times, and also the strides made as a result of the internal reform movement of the mid I 950's, the mentally ill gained rights they did not previously have. In 1971, New York Times reporter John Sibley covered a symposium in which psychiatrists argued that the fundamental right of a mental patient ought to be the "right not to be 9 a mental patient." The panelists in attendance at the symposium agreed that all too often patients are "railroaded" into state-funded hospitals against their will and usually at the request of their families. Families that had to care for mentally ill family members often felt overwhelmed and burdened and were unsure how to care fortheir loved ones. Many family caretakers viewed these institutions as the only acceptable placement forthe apparently mentally ill. Dr. Gurston D. Goldin stated that his fellowpsychiatrists would regularly diagnose a patient 9 John Sibley, "Mental Patients Held Vulnerable; Their Rights Are Demanded at Conference Here," New York Times (March 28, 1971), 29. 5 with a psychiatric abnormality when in reality the problem was "unmet social needs," that today might be called an emotional disability, treatment for which was better suited to a social worker. Furthermore, panelists pointed out the ineptitude of some professionals to correctly diagnose patients and feltthat overcrowding in mental institutions was a result. Dr. Alan D. Miller, the State Commissioner forMental Hygiene, had slightly improved the situation by mandating that patients be admitted to mental hospitals "only if they showed definite symptoms of mental illness." 10 Perhaps the most devastating effect of the placement of individuals into these institutions was the custodial care they received. The men and women treated at these facilities were rarely seen by doctors, and as the duration of their stay increased, the practices of the institutions wore down their ability to resist unwanted treatment, causing a blatant abuse of their civil rights. At the time Sibley's article was written, New York law allowed emergency commitments to a mental hospital against an individual's will forup to 30 days. The basis for this stay could be an unsworn allegation of a family member. In some instances, for example at Greystone Park Psychiatric Hospital in New Jersey, the care the mentally ill received could not even be definedas custodial; a 40 page report uncovered the deplorable conditions of the entire facility, as well as conditions that were considered to be even worse in the "closed" wards where the more disturbed and regressed patients were treated. 11 Patients were leftunsupervised with no treatment for theirillnesses , bathroom floors were covered with dirt, urine and human excrement, and in some wards only one cup was given for all patients to drink water from. The conditions were classified as "antitherapeutic" and sent the message that the patients being housed there were no better than animals - less than human. IO Ibid. 11 Joan Cook, "Grand Jury Finds Abuses of Patients at Greystone," 67. 6 Donald G. Collester, the prosecutor in Morris, New Jersey, that conducted the investigation, stated that the purpose of making the grand jury's findings public was to heighten public awareness of the conditions in the hospital. Despite all of the evidence, including over 40 separate allegations of patient abuse, no indictments were administered because the allegations were assault charges that would amount to a $500 fineor six months in jail.12 Janet Gotkin' s testimony brought to light perhaps the worst abuse of the mental care system against its patients, and as a result the frequent administration of mind-altering drugs by psychiatric medical professionals, such as neuroleptics, was coming to national attention.
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