Diagnosis of R.P.McMurphy from "One Flew Over the Cuckoo's Nest"

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McMurphy has always appeared to be charming; after all, he shook every patient's hand when he first arrived. But underneath all that faux charm lay an individual in need of serious psychological help (Kesey 22).

McMurphy shows many signs and symptoms of antisocial personality disorder. The first and most noticeable trait of antisocial personality disorder is a charming and friendly personality (Blair 9). But upon delving into the true emotions, a person with antisocial personality disorder suffers from constant internal turmoil.

One of the dominating social signs of antisocial personality disorder is irritability, often followed by violent behavior (InteliHealth). Several times throughout One Flew Over the Cuckoo's Nest, McMurphy showed such characteristics. For example, twice McMurphy broke the glass in the nurses' station window when he didn't agree with Nurse Ratched's decisions (Kesey 172, 176).

Antisocial personality disorder patients often worry about being considered weak or victimized. With an additional fear that others will "get the better of them," antisocial personality disorder patients will often push others around to get their way. A result from these fears is the heckling of authority (InteliHealth). McMurphy showed this the most when he tried to get a revote on watching the World Series on TV. Nurse Ratched didn't like the idea so McMurphy pestered her (Kesey 125).

Several concepts are hard for antisocial personality disorder sufferers to grasp. Societal expectations, which may lead to criminal behavior (Kahn 50), can cause repeated punishment, which is technically ineffectual (Blair 9). The reader discovers with the review of McMurphy's history. McMurphy was repeatedly arrested for infringing the rights of others (Kesey 45), which is another concept (WebMD). McMurphy showed this when he didn't get written consent for the boating trip and yet he still carried out the excursion (Kesey 206). Also when discussing McMurphy's past during the community meeting, Big Nurse revealed McMurphy's charge for rape and McMurphy completely denied that it was, in fact, rape (Kesey 45). The major concept that McMurphy simply didn't seem to comprehend was remorse. Lying, deception, and lack of guilt are major traits of antisocial personality disorder (Kime 106) and seem to play a large role in McMurphy's life, shown by the repeated criminal offences in the past (Kesey 45). Responsibility is another troublesome factor to comprehend with antisocial personality disorder (DSM-IV). McMurphy displayed this when he did a poor job cleaning the toilets and stuck dirty notes inside the toilet instead (Kesey 139).

So far in the novel, McMurphy received much "treatment." He was arrested several times and then committed to the Work Farm (Kesey 45). Then he was sent to the hospital (Kesey 15). There he received electroshock therapy for disobedience (Kesey 242) and ultimately was lobotomized after attempting to kill Nurse Ratched (Kesey 269).
The treatment McMurphy received was flawed. First off, punishment, such as arrest and EST, have been proven ineffectual to treat misconduct; the patient simply repeats the behavior for which he was punished (Blair 9). Secondly, strict hospitalization was required for such an extreme situation as McMurphy's case, but in order to effectively treat extreme apd, a system of levels of privileges is required. If and when McMurphy were admitted to a modern hospital, such as the program at the Patuxent Institution in Jessup, Maryland, McMurphy would be treated with the strictest of policies: very, if any, privileges and little, if any, freedoms. He would have to work up a hierarchy of privileges. At each level he would attain more freedoms and privileges until he worked up to the level of normal society, lessening the need for antisocial personality behavior and stabilizing emotions (Long). Group therapy can also be helpful to stabilize emotions and behavior. Individual therapy may also be helpful but only if trust can be established between the therapist and the patient (WebMD).

McMurphy's lobotomy (Kesey 269) may have caused more problems than it was worth. Recent studies have shown that violent people, mostly men, diagnosed with apd lack some of the gray brain matter in the forehead opposed to alcoholics, men with other disorders, and men with no disorders who appeared to have no missing gray matter. This may be causing apd or it may be caused by antisocial personality disorder (Bower 141). Most likely, if the missing gray matter causes antisocial personality disorder, removing the remaining frontal lobe matter with a lobotomy probably would actually worsen the patient's conditions. In both probable solutions to the missing brain matter, removing it would do absolutely no good. As seen in One Flew Over the Cuckoo's Nest, McMurphy wound up being a swollen vegetable (Kesey 269).

Works Cited Page

Blair, Jane et al (eds). Macmillan Health Encyclopedia. (1993) New York: Macmillan Publishing Company. (vol. 5: Emotional and Mental Health. p9).

Bower, Bruce. "Anatomy of Antisocial Personality." Science News. Vol. 157, February 2000. (p141). [reprinted at bigchalk.com (2000)]
DSM-IV. (4th ed.) (1994). Washington, D.C.: American Psychiatric Association.

InteliHealth. "Antisocial Personality Disorder." [on-line] Available: http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9469.html. November 16, 2000.

Kahn, Ada and Jan Fawcett. Encyclopedia of Mental Health. (1993). New York City, NY: Facts on File. (pp50-51).

Kime, Robert E. Grolier Wellness Encyclopedia. (1992). Guilford, CT: Dushkin Publishing Group, Inc. (vol. 9: Mental Health. p106)

Long, Phillip W., M.D. "Antisocial Personality Disorder: Treatment." [on-line] Available: http://www.mentalhealth.com/rx/p23-pe04.html. November 16, 2000.

WebMD. "Antisocial Personality Disorder." [on-line] Available: http://webmd.lycos.com/content/asset/adam_disease_sociopatic_personality. November 16, 2000.

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