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The Cost of Quality Care in one Flew over the Cuckoo’s Nest by Ken Kesey

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The Cost of Quality Care in One Flew Over the Cuckoo’s Nest by Ken Kesey.

The setting of Ken Kesey’s One Flew over the Cuckoo’s Nest takes primarily takes place in the Oregon Psychiatric Facility in the late 1950’s to early 1960’s. The narrator of the novel is Chief Bromden who has been a patient at the Oregon Psychiatric Facility for about ten years for his hallucinations and delusions. It is through his point of view that we learn about the abuse Nurse Ratched and the other nurses inflict on the patients in the ward. Nurse Ratched, a former army nurse, now runs the ward. She controls everything in the ward and is the major antagonist in the novel. She insists on using practices such as electroshock treatments and lobotomies as a mean of punishment for the patients that rebel against her. I believe that a lot of the reason for the abuse that goes unreported in the novel stems from the fact that the patients simply cannot afford good quality of care so they often get “stuck” with people who either control or abuse them in state funded psychiatric hospitals. In this paper I will discuss how mentally challenged patients such as the ones in Ken Kesey’s One Flew over the Cuckoo’s Nest are often abused when being treated at a State funded facility rather than a privately owned facility.

Bromden’s description of Oregon Psychiatric Facility presents a setting that is similar to a typical psychiatric hospital, monotonous and rigidly regulated by none other than Nurse Ratched. Nurse Ratched’s character basically runs the facility, all of the staff is under her command as well as her patients. She hold the ability to determine patient's medication, their type of treatments they receive, and any disciplinary actions patients may receive if they misbehave. She prides herself on being seen as an authoritative figure who doesn't freight from using techniques such as bullying or blackmail in order to get her staff and her patients to do what she says.

In an article titled Top 10 Forms of Psychiatric Institution Abuse we get a clear understanding of just the top ten reasons as to why patients in state funded psychiatric facilities are often abused. In this essay I will address only the top three; manipulation, segregation, and ineptitude and how they relate to One Flew over the Cuckoo’s Nest.

According to Texas State Historical Association (TSHA) psychiatric Facilities were initially established with a “Persistent emphasis on segregating the mentally ill state in eleemosynary institutions” (TSHA 2010). In One Flew over the Cuckoo's Nest we see that Nurse Ratched constantly trying to keep the patients from knowing the real world. When McMurphy is committed to the facility he is the closest thing that the patients in the ward will ever see to the outside world. With him he brings new knowledge and excitement, something no one but the staff knows about. He also tries to bring change to the ward which Nurse Ratched absolutely cannot stand because she has taught the patients to depend on the routine she has set for them. One form of abuse that was depicted in the novel was how Nurse Ratched forced already mentally unstable patient into codependency. Mentally ill patients tend to be more susceptible to codependency as opposed to being



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