Nurse Ratched and the Therapeutic State

In the history of American cinema, few characterizations of female villains have been so artfully played as Louise Fletcher's "Nurse Ratched" from One Flew over the Cuckoo's Nest. Bloodless and detached, psychologically opaque, calculating and as serenely reserved as an adder, Randle McMurphy's more than worthy Antagonist in White is deftly portrayed as a creature of malignant control couched within starched layers of therapeutic justification. Throughout the course of the film, it will be both characters' unyielding struggle for ascendency that ultimately crescendos into its tragic finale, as the spirit of rebellious freedom crashes headlong into a system that has been designed to silently strangle that very hope.

The Good Nurse in her antiseptic fiefdom communicates the appearance of benevolent concern for her charges -- but upon piercing the outer veil we find this not to be so. From Kesey's novel we learn that Ratched has spent years acquiring the correct mix of doctors and staff that serve as pliant instrumentalities of her will -- and that her will manifests a more personal agenda. Hence, as we immerse ourselves in the tale, we find that a select group of patients, many who are voluntary admissions, are in reality the victims of Ratched's therapeutic malevolence. Her method is designed to homogenize -- to pit them against one another and themselves. By quashing bad thoughts, her project is systematically geared towards instilling an infantilizing culture of emasculation and caste-iron control. Most disturbingly, we learn that the ward's therapeutic goal, once ideally aimed at the restoration of health, has long been discarded for the Nurse's own questionable discipline: a therapy with a paper thin veneer of democracy that has nevertheless metastasized into a calculated regime of dominance.

Under color of an exaggerated maternal concern for our temporal wellbeing, the Therapeutic State arises in America with reptilian eyes as she licks her lips and sizes us up. Flowing from a technical reservoir of absolute certainty, the Great Matriarch Who Knows Best has deemed it prudent for you to assume the Procrustean dimensions of body and mind that have been lovingly prepared as an altruistic service to her wayward children. Such a project, however, cannot be instituted in one day. Indeed, much of America is like a young colt that will not be broken; and hence, how difficult it is to accustom a proud people to the overseer's yoke. Thus, any governmental strategy directed towards a policy of inordinate control must mimic the boiling frog scenario. However, if men can be convinced that the restriction or evisceration of freedoms or an unorthodox train of thought are counter to a people's own interests of health or wellbeing, then many will fasten the saddle and halter upon themselves and lovingly lick the whip master's hand. The great fantasist and theological writer C.S. Lewis crystallizes this observation:

Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their consciences.

Once the camel's nose has appeared under the tent, he cannot be kept out. For example: having long ago relinquished the reins of collective accountability to the hands of their Masters in a herded hive mentality such as New York City, should it be so surprising to a citizenry that its mayor could throw down stunningly invasive legislation concerning Big Gulps: laws that in themselves would elicit convulsive laughter in Gillette, Wyoming?

It could be that the jihad leveled against tobacco fulfilled the same opening that the camel's nose provided. Whichever way one views what is unarguably a nasty habit, it cannot be denied that the state has willingly used the practice as a wedge to cast moral aspersions on smokers by turning the population against one another, much as Nurse Ratched did in her therapy sessions that singled out and humiliated. Furthermore, it can be little denied that the American anti-smoking long march, which even the collectivized sheeple of Europe would deem beyond the pale, has taken every concession granted as a sign of weakness that only further arouses the state's thirst for more lucre. In truth, cigarette smokers are looked down upon and deemed cultural pariahs -- persona non grata who in some places fear smoking in their own residences lest the Health Gestapo make their dour appearance for crimes against children.

It is utterly amazing that a vice that never contributed to moral depravity and that some of the greatest minds of Earth's intellectual pantheon engaged in have been relegated to the status of cultural lepers -- often by the same crusaders who glowingly evangelize the benefits of brain numbing strains of marijuana. One could perhaps feel a certain respect for the therapeutic busybodies if they in their fanaticism just made the entire tobacco enterprise illegal and stood on principle. But in extracting pounds of flesh in a mercenary fashion, the state retains its moral high ground while it pummels its victims and drains an increasingly debilitating amount of blood for its own purposes in the bargain. As government taxation now dwarfs the profits made by cigarette manufacturers, it assumes the role as muscle in what is no more than an extortion racket. It is as if a father, in punishing his naughty son, not only made him go to the woodshed to pick out a stick, but ordered him to use his personal allowance to go to the father's own lumber store and purchase the means of his thrashing.

The Therapeutic State can only make its self-serving argument if health itself is viewed as a zero sum game. If the state then commands the economics of the health care industry, then a case can be made that the sphere of private action harms the public weal, therein providing the justification for turning a larger faction against a smaller one. As the private sphere becomes more diminished, this domain of personal right will also tend to vanish as the relationship between one's culinary habits and the public's interest in your Body Mass Index (BMI) become everybody's business. When things are shared in common, what one does in the privacy of one's own home, even things once viewed benign in a simpler age, are subject to the scrutiny of the nanny state -- all in the interest of an abstract homogeneity. But the dark rub is this: Having acquired political mastery over the private authority by which health care is measured and dispensed, the state then solely determines the worthiness of how those finite resources are allocated and thus becomes the ultimate arbiter of life.

The most pernicious development of the Therapeutic State is the reductionism of things moral to the physical. Under the specter of government mandated healthcare, personnel can compile into a clearinghouse almost everything about you, apparently including whether you have a firearm in your residence. Furthermore, a society that has deconstructed morality into lifestyle preferences normalizes what was once considered in traditional America as deviance. The tendency to view moral choices that manifest as cruelties, addictions, and criminal activities into biological and cultural pathologies is ultimately ethically confusing, thus dissolving conceptions of good and evil into a deterministic fog that hamstrings moral accountability. Societies that descend into the morass of therapeutic reductionism invert the moral universe and magnify relatively innocuous health matters into civil sins while reserving judgment upon or even validating immoral lifestyles and sexual proclivities that not long ago were viewed as wicked, diseased, or narcissistic at best.

In societies that come to view the temporal and material world as the totality of existence, death then becomes that greatest of all evils whom none can escape. As such, death is annihilation and the obsessions of health and the avoidance of pain and suffering are ultimately manic but futile longings pursued as so much smoke. Inevitably, youth withers and death draws its veil as we eventually roll snake-eyes despite the Herculean efforts of our medicine. So terrifying is our culture's morbid fear of death that it does what it can to submerge it in the Waters of Forgetfulness. Our advertisements and entertainments betray this vain worshipping at the Cult of Youth; but it was not always this way. In healthy societies and ages, such neurotic fear of death would be viewed with astonishment. In all wisdom, there are worse things than death -- including the loss of liberty and the obsessive anxiety to dig one's claws into survival at any cost. In bargaining for health and life in exchange for the freedoms and privileges of a free people, America has voluntarily introduced the spirit of tyranny through its back door in the guise of a cloying matriarchal nurse who has other agendas secured behind her chilling blue-eyed gaze.

In that final scene that haunts anyone who has ever viewed Cuckoo's Nest, Chief Bromden, the silent Native-American giant who McMurphy psychologically redeems by his rebellion, comes to terms with his demons and is ready to now leave that shadow-world existence of perpetual smallness where he has for years hid himself away. Even before finding and "liberating" McMurphy from his final silent hell, he had awoken to the knowledge that the slow manacled death that comes when you hold your freedom hostage to fear is far worse than any terrors that await on the outside. We would do well in considering this metaphor before America willingly barters away any more of a legacy birthed in the rebellious distrust of power -- especially that artful and cunning seduction concealed within Nurse Ratched's therapeutic hand.

Glenn Fairman writes from Southern California and blogs as The Eloquent Professor at He can be contacted at

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