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One Flew Over the Cuckoo's Nest

Set in 1963, this landmark film took viewers into the heart of a typical psychiatric ward and exposed the realities therein. Based on the 1962 novel by Ken Kesey, it tells the story of Randle P McMurphy—an immoral, self centred delinquent who feigns insanity to avoid serving a custodial sentence on a work farm. Not realising that his release from the hospital is dependent on a sound psychiatric report, he decides to instigate his own brand of mayhem to pass the time and “show them who's nuts!” 
 
His antics backfire when his doctors classify him as dangerous, but not necessarily mad, and he is subsequently detained on the ward for further management. During this period, McMurphy continues to taunt the orderly, maternal, authoritarian Nurse Ratched, who seeks to maintain the ward routine that he so desperately tries to disrupt. When a fight breaks out on the ward and McMurphy assaults a staff member, he is sent for electroconvulsive therapy—a scene as graphic as it is disturbing. 
 
The central conflict in the drama is between McMurphy and his nemesis Nurse Ratched. Initially she seems caring and sensitive but is shown ultimately to be just as manipulative as McMurphy, especially in the searing penultimate scene after a drunken impromptu ward party. The supporting characters are equally intriguing and include the vulnerable, stuttering Billy Bibbit; the elective mute native American Indian chief Bromden; the misunderstood, suspicious intellectual Harding; and Cheswick, a middle aged man unable to face the real world. 
 
Thoughtfully filmed in Oregon State Hospital, where the superintendent not only allowed filming on an empty ward but also played the role of the consultant psychiatrist, this film is littered with themes of power, autonomy, and consent. It is therefore an ideal film to study with our medical students as it serves as an accessible template for the discussion of these important issues. 
 
We debate whether Nurse Ratched is a “personification of evil” (she was named the fifth greatest villain in film history by an American Film Institute poll in 2003) and whether McMurphy is mad. We discuss whether such a character, with features of antisocial personality disorder (irresponsible, impulsive, difficulty maintaining relationships) and who is deemed dangerous (by a panel of psychiatrists), could be detained against his will if the proposed new mental health laws were passed in the UK. 
 
However, this film didn't win academy awards for best actor, best actress, best screenplay, best director, and best film because of the breadth of ethical issues it covered—it was successful because it is both thought provoking and entertaining. This is a film that can make you laugh, cry, and shout at the screen. It is regarded by many (including us) to be a true classic.