The film ‘One Flew Over the Cuckoo's Nest’ is narrated by a paranoid schizophrenic Native American male who pretends to be deaf and dumb in order to avoid socialization or confrontation from anyone in the Oregon psychiatric hospital. Bromden along with the rest of patients in the hospital fear former army and head nurse, Nurse Ratched, who Bromden believes to be controlling the ward. Bromden is dictated by the fear of this assemblage that is ruling society and coercing others into conformity, he refers to this as the ‘Combine’. Although Bromden is cognizant of his surroundings, he has impersonated being deaf and speechless for the extent of his commitment. The ward branched its patients into categories depending on their status of being curable and those who show no indication of recovery. If anyone disobeyed Nurse Ratched, patients received shock treatment as punishment and in more severe cases, lobotomy.
Chief Bromden is a Native American who identifies as a Columbia Indian from the Pacific Northwest descent. Bromden has been experiencing debilitating hallucinations and delusions that has led to a series of events upon the admittance process in the Oregon psychiatric inpatient hospital. Bromden’s developmental history presents a complexity of features consistent with schizophrenia spectrum disorder. In the interim of his adolescence, he experiences periods during which he experienced optical hallucinations. For example, in the film he is seeing his mother grow extraordinarily tall and his father shrink. He also demonstrates having delusions as evidenced by his expression of being ‘invisible to white men’. His vivid recollection of anger and remorse at the time of his father’s alcohol abuse, emasculation by Bromden’s mother and the white establishment all appear to be underlying components of Bromden’s delusions. These episodes each lasted less than six months during Bromden’s developmental stages in late childhood and early adolescence. In his course of adulthood, Bromden was plunged by recurring delusions of the ‘Combine’ machine and its thought- and behavior-controlling power, auditory hallucinations of hearing the ‘Combine’ rhythmically chug, and visual hallucinations of a fog-creating machine. In sum, Bromden continues to demonstrate this pattern of psychotic symptoms throughout the film along with social dysfunction, persisting for more than 6 months. Subsequent to his initial episode, he experienced enduring cycles of intense delusions and hallucinations, which sometimes would dwindle or lessen in intensity, however did not dissipate. Because Bromden did not present being in an acute episode at the time of the interviewing process at the hospital; the diagnosing specifier would best be: multiple episodes, currently in partial remission. Bromden also expressed having a history of alcohol abuse, that would diagnose him with history of alcohol use disorder as well.
As a therapist, I would ensure to precisely identify personal biases and counseling presentations of Native cultural norms, specifically in regards to auditory and visual experiences, narrative delivery, use of silence and space, social confinement, and other cultural considerations in order to make an accurate diagnosis. The development of a cognitive behavioral treatment (CBT) plan to address the psychotic symptoms and the impairment caused by his symptoms would best benefit Bromden’s case. The course of CBT services will have a duration of about six to nine months due to Bromden’s high intensity of symptomatology. Long term goals would include: 1) learning how to distinguish hallucinations from real auditory and visual events, 2) learning how to distinguish delusional narratives from reality, 3) learning the importance of participating in group counseling in order to enhance social functioning, medication, and symptom management. He will participate in cognitive restructuring techniques such as ‘self-monitoring’ (for feelings of oppression and conspiracies). In regards to suicidality, he can use cognitive behavioral practices to manage effects of his symptoms and reduce negative consequences. Self-monitoring also provides Bromden with the ability to recognize cognitive distortions during situations of extreme vulnerability preventing the result of suicidality.