Portland's Cuckoo Nest

Nobody wants to be Nurse Ratched

Oregon had reason to pat itself on the back a few days ago — the 50th anniversary of the celebrated “One Flew Over the Cuckoo’s Nest” — filmed on location at Oregon State Hospital in Salem.

Was there ever a more lovable statutory rapist than the roguish Randle P. McMurphy, portrayed by the charismatic Jack Nicholson?

If it were shot today, “One Flew Over the Cuckoo’s Nest” would probably have to give McMurphy a more politically acceptable crime, say, murdering an insurance executive.

In honor of its 50th anniversary, “One Flew Over the Cuckoo’s Nest” returned to various theaters for a special one-day screening. Seen with a general audience, the movie still packs a lot of laughs. But in 2025, it’s an inescapable fact that today many of the movie’s characters wouldn’t be in Oregon State Hospital. They would be on the streets. Instead of drugs prescribed by a doctor, they would be on fentanyl or meth.

Instead of Nurse Ratched dealing with the crazies, it would be family members, the public or police who would have to handle them — even if violence is involved. Today the mentally ill are considered “the most vulnerable.”

Now members of the public are expected to confine themselves and stay home if they don’t want to interact with the mentally ill. (I still think of them as 5150s — the code broadcast every day on police scanners when I was a reporter in California. It’s from Article 1, Section 5150 of the California Welfare and Institutions Code allowing a 72-hour hold on people who appear dangerous to themselves or others. For many Californians, “5150” has become ubiquitous for mental cases).

“One Flew Over the Cuckoo’s Nest” perpetuates some of the worst myths about the mentally ill and the institutions that house them — the patients are helpless and harmless, and the staff are vicious, cold-blooded authoritarians.

It also reveals some truths that weren’t so evident when the movie was released in 1975 but now stand out. Mental illness can be a con job for criminals who rightfully should be prison inmates — not patients. But it’s possible for mentally ill patients to find security, help and even community while confined in a facility.

As created by writer Ken Kesey, Randle P. McMurphy is a merry prankster, a free-spirited, womanizing gambler who fakes mental illness to avoid a prison work farm. The best description I ever heard of why a loony bin is better than a prison came from a convict I met in the 1990’s: “Better drugs and a shot at some pussy.” That describes McMurphy.

When he arrives at the state mental hospital, he holds out his hands as his cuffs are removed. Then he grabs the deputy’s head and plants a kiss on him.

“You’re crazy, McMurphy,” says the deputy.

“Yeah, ain’t that the truth,” says McMurphy.

A young Japanese nurse walks by.

“Hey, how ya doin’, cutie?”

McMurphy spots another nurse and tells her, “I sure am going to enjoy my stay here.”

She replies, “I’m sure you will.”

McMurphy adds, “I ain’t never been in an institution of psychology before.”

Later he tells two male attendants: “There sure is an awful lot of poontang around here.”

Like a big man on campus stepping into a class of nerds, McMurphy immediately enlivens the ward’s Day Room by doing a jig and calling out, “Hey, you, ding-a-lings, you creeps, you goons.”

He tells one of the older patients who’s complaining about the place: “Compared to where I just come from, this is a country club.”

McMurphy finds the guys playing the card game Hearts and sets about teaching them how to a play a real card game and how to gamble using cigarettes as money.

As he settles in, he’s stunned at how docile they are. Why don’t they just walk away? He inspires his fellow patients to see the possibilities of what they can do, the fun they could have.

The only one who isn’t charmed by McMurphy is Nurse Ratched, the ward’s Big Nurse.

She is committed to the daily routine and runs a tight schedule: “Time to get up! Come on now, it’s a beautiful day! Let’s not straggle! Everybody up, up, up!”

In therapy group, she lectures: “With few exceptions, time spent in the company of others is therapeutic, while every minute spent brooding alone only increases separation.”

Kesey’s book was based in part on his time participating in LSD experiments in a hospital ward in California and then later working as an aide on the same ward. The book has the advantage of digging into the inner lives of the characters he created — “what it is really like to be twisted,” as he put it.

The book is narrated by one of the characters — Chief Bromden, a large Indian— created by Kesey while he was under the influence of peyote. He later complained that the movie turned his book into a “Hogan’s Heroes.”

The character of Nurse Ratched is barely given any redeemable qualities, which is unrealistic. It’s surprising because Oregon State Hospital’s Superintendent, Dr. Dean Brooks, plays the superintendent of the fictional hospital in the movie.

Brooks agreed to let Hollywood have on-site access because he wanted to let the public see the inside of a state mental hospital and what they do. The work is worthy and challenging. He also insisted that real patients be used as extras and technical advisors as part of their rehabilitation.

In a documentary on the making of “One Flew Over the Cuckoo’s Nest,” the actors marvel that during the shooting of the movie, there reached a point where a visitor to the set couldn’t tell the actors from the crazies. The suggestion seems to be that there is little difference.

There is little discussion of any criminal behavior that may have led any of these patients to end up in the fictional mental hospital in the movie. In reality, many Oregon State Hospital patients can be GEI — guilty except for insanity. They have committed crimes.

Eventually, McMurphy and his fellow ward mates end up on an unauthorized field trip where he commandeers a school bus and takes them fishing at Depoe Bay. His final act of mischief is arranging for a prostitute to have sex with Billy, a shy, young patient, who stutters and has attempted suicide. Nurse Ratched finds out, and Billy — fearing she will tell his mother — kills himself.

McMurphy blames Ratched and tries to strangle her. After being restrained by security, he is later strapped down and given a lobotomy. When he returns to the Day Room, he is reduced to helplessness, entirely dependent on others.

During the night, as McMurphy sleeps, the character of Chief Bromden, a 6-foot-7 Native American, places a pillow over McMurphy’s face and smothers him.

“One Flew Over the Cuckoo’s Nest” cleaned up at the Oscars. Critics of state mental hospitals still sing its praises. But what alternatives do they propose for the violent mentally ill? What are the options for families with loved ones suffering from dangerous delusions? To fathers like Mathew Padrow of Scappoose, who was stabbed 13 times by his son?

Padrow survived and was one of many people who testified in April on behalf of House Bill 2467. This legislation would have made it easier to civilly commit someone for treatment of a mental disorder. Currently, in Oregon a judge can order such treatment only if a person poses an “imminent” threat to themselves or others, which is generally defined as an immediate danger.

HB 2467 would have given judges more latitude to consider whether it is “reasonably foreseeable” that a person might become a danger to themselves or others “in the near future.”

According to Padrow, in 2023 his son started showing signs of severe mental issues.

“He was extremely paranoid thinking that people were watching him and the police were after him. He would go into fits of rage screaming at my wife and I … then soon after begin crying asking us ‘what is going on with him.’”

They could find no help for their son because he was over 18. He spent one night at Unity Behavioral Health in Portland and was sent home. The parents tried an outpatient program, but he showed no progress.

Four weeks later, Padrow’s son grabbed a chef’s knife from their kitchen and stabbed his father 13 times. That’s what it took for his son to finally receive help.

He is now a patient at Oregon State Hospital.

“I visit him often. He is doing very well now that he is on medication. … This was the first violent act in his life, and it occurred after four weeks of psychosis with virtually no treatment.”

HB 2467 attracted well over 100 persons or organizations testifying for or against — slightly more in favor, including Gov. Tina Kotek’s wife.

Mental health and addiction treatment were among the governor’s priorities for the now-concluded legislative session. HB 2467 passed the House Judiciary Committee, but it was stalled in the Ways and Means Committee when the session ended and never came up for a vote of the full House.

The bill also raised the possibility of considering drug use as “serious bodily harm” to one’s self as another route to civil commitment. Currently, a person cannot be civilly committed for drug use alone, even if it is causing physical harm to the user.

The scene of Jack Nicholson undergoing a lobotomy in “One Flew Over the Cuckoo’s Nest,” can still disturb. But we have grown to accept that portions of the population lobotomize themselves with mind-altering drugs.