Antisocial Personality disorder

McMurphy is admitted to the hospital with what the DSM IV would refer to as an Antisocial Personality disorder. During his time in the hospital he is given a number of different treatments, the first being group therapy. A number of other patients who have various other psychiatric disorders take part in this group counseling session, where they sit together with Nurse Ratchet and one patient discusses their problems whilst the group listens and then gives them feedback. The goal of these sessions is to get the patient to share their feelings with others and to get them to communicate with the group.

This is an important factor in treating people with any type of anti-social behavioural disorder as it gets them to interact with other people in the presence of a nurse who makes sure they are behaving appropriately. However this treatment doesn’t always work out so well in the hospital as there are often outbursts of anger and the patients act like children would in a classroom, fighting and shouting. Group therapy is based mainly on the Psychodynamic model of development, and is usually used in conjunction with drugs to help cure a patient’s illness and treat their symptoms.

The goal of the treatment is to help the patients recognize the difference between what is anti-social behaviour and what isn’t; this is done through the authority of Nurse Ratched who tells the patients when they are not behaving as is socially desired. All the patients in the hospital are given some form of medication, and soothing classical music is played during this time to help make the patients feel relaxed and at ease. Through the film we find no reason to suggest that the drugs aren’t working properly.

The patients know they have to take them and don’t kick up a fuss, and every time we see them take it they retain their calmness and function adequately enough not to be surpassed as psychotic. However, if the drugs did work as well as they should, the patients symptoms should not be recurring as frequently as we see they do in the hospital. This could be happening due to the side effects of the drugs, eg; we see that Billy is suffering from depression so the type of antipsychotic drugs he would most probably be taking in the hospital are anti depressants.

It would depend on the specific drug he was taking for us to know the exact side effects, but we do know, according to controlled studies (NIMH 1987) that their effectiveness is no greater than those in Psychosurgery and Cognitive therapy. Martini is most likely to be given a drug such as Ritalin which is prescribed for people with an attention deficit disorder. Martini displays childlike behaviours, like hyperactivity and imagining things on the Monopoly board which aren’t really there, some would describe his actions as very childlike- these are symptoms of schizophrenia.

Ritalin has controversially been given to children who are hyperactive and are unable to concentrate on things. Another example of treatments used in the medical model is Electro Convulsive Therapy, which is carried out on McMurphy after he is shown to be behaving in a way that is uncontrollable and he breaks the rules of the hospital. The hospital has a very rigid routine, this is interrupted when McMurphy enters the hospital and tries to persuade Nurse Ratched to let the patients watch the game during the day. Nurse Ratched holds a very strong authoritative role and the patients know that they have to obey her.

I see the relationship between the patients and the doctors very much similar to that between a teacher and a child. This signifies that the patients are being treated like children; they do not hold power over their own lives, this may be unbeneficial to them in the long run as they will not know how to have any responsibility or how to cope with the consequences of their actions after they have been discharged from the hospital, so whilst the nurse may be helping them try to confront their issues at present, she isn’t letting them have any control over their own lives.

McMurphy is given ECT as a result of his unwillingness to be controlled by the ‘authority figures’ in the hospital. From observing the conditions in which the ECT is taking place we can see that the patient is being held down by the hospital staff so that they can carry out the procedure, I would say ECT is shown in a very negative light and the patient seems to be undergoing a sever amount of stress which also indicates factors of ethical issues, such as the patients loss of control over their body and the amount of stress they undergo.

It has been criticized on ethical grounds by Heather (1976) who described the therapy as ‘about as scientific as kicking a television set because it is not working’. From studying how ECT is supposed to be performed, the patient should undergo the least amount of stress possible, and are given a form of drugs to numb the pain. In the hospital we see the opposite of this correct procedure, therefore making ECT look like a barbaric act being carried out on a human being.

McMurphy is diagnosed with hebephrenic schizophrenia in the hospital, and after various attempts to help calm his symptoms; the nurse thinks the best option is to give him a Lobotomy. This is a form of Psychosurgery, where part of the brain is removed, leaving the patient in a state which could be described alike to a vegetable. A lobotomy is the most severe type of therapy anyone in the hospital would receive; the nurse chose to do this as McMurphy tried to escape from the hospital and broke several rules of the hospital on different occasions.

We notice that it is up to the nurse in the hospital to decide which therapy the patient undergoes, this would never happen under normal circumstances as it is always a certified Psychiatrists job to plan a course of treatment for the patient. The surgery itself concerns itself with many ethical issues due to the amount of pain and stress the patient will undergo and the resulting side effects, many of which are permanent.

Rappaport (1992) found that Psychosurgery was performed on people who weren’t fully able to give their consent to the operation, this being a major ethical issue as we know that McMurphy did not consent to surgery. Before entering the hospital McMurphy talks to a doctor about why he is being admitted there. From first impressions and the way he is shown in contrast to the other characters with mental illness it seems like there is nothing wrong with him.

Through the film we see he shows no real symptoms of any mental disorder, and tries to make the other patients feel like there is nothing wrong with them mentally because it’s just the way society is. This shows how he is representing some views on ‘anti-psychiatry’, as he states that just because the patients have been diagnosed with a disorder doesn’t mean that the rest of society aren’t the same as them. Sszaz (1962) believed that mental illness was an issue concerned with society and the law, rather than medical.

McMurphy would have been assessed mentally before he entered the hospital, and it seems likely that he was ‘faking’ symptoms to try to decrease the length of his prison sentence. This puts Doctors in a very difficult position because it is a high risk strategy for Doctors to choose not to diagnose somebody who is displaying symptoms. Rosenhan (1973) studied patients who weren’t really ill but had acted out symptoms to a doctor who then had them admitted to a hospital on the basis of them being schizophrenic.

Whilst in the hospital the patients did not display any of these symptoms and acted as normal, however the staff at the hospital did not realise what was happening, and interpreted all of their behaviours as being linked to their illness. This study shows that Doctors can sometimes wrongly diagnose people, as seems to be the case with McMurphy. The patients seem to be portrayed in a mainly negative light, giving connotations of a Psychiatric ward being similar to that of a prison where the patients are shown as typically ‘mad’.

It is as if the patients are being labelled as ‘insane’, as we only really see them acting bizarrely in the hospital, the effect that labeling has is that it makes the patient more aware of their specific behaviours, eg; Billy is continuously nervous around people, maybe as a result of him being labelled, which might in turn result in his frequent stutter. To conclude, in my opinion, the best form of therapy being given at the hospital is probably drugs and group therapy, as these seem to be the most beneficial therapies for the majority of the patients.

However, I think the regime at the hospital is far too strict and confined; the patients need to be given more responsibility for themselves and more freedom. The majority of treatments used in the hospital are based upon the Medical Model, Lobotomy and ECT being the most severe and I do not think these are beneficial for the patient. Issues regarding ethics needs to be addressed thoroughly as the patients aren’t being given their full rights and we never see them being briefed about any of the therapies being carried out on them.

I think the quality of care could be a lot better at the hospital; other types of therapies that could be taken into consideration are different types of ‘one to one/group’ therapies based on the Psychodynamic Model, and treatments based on the Cognitive-Behavioural Model. The major treatments used for schizophrenic patients are anti-psychotic drugs and therapies, both of which are in use in the hospital; however the strict routine in the institution is not helping the patients.

It is a well known fact that many schizophrenic patients, like Martini, go through cycles of hospital admission, known as the ‘revolving door syndrome’ where the individual isn’t given enough care within the community to maintain their psychological health, so they are re-admitted into hospital. In the film we do not see much of the world outside the hospital, so cannot fully comment on how the patients would be treated by the community.

We do see how the patients are treated by the staff in the hospital though, and this type or treatment does not prepare the patients for the way they will have to interact with people outside the hospital, eg; the nurse holds strong authority over the ward and the patients have to obey her no matter what. This type of relationship can be negative as when the patients are discharged from the hospital they may feel they need to maintain the role of being held in authority by people around them, as this is what they are used to.

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