11Chapter 9. One Flew Over the Cuckoo’s Nest: Two Sides of the Same Story

In Rome, in April 1938, at the psychiatric clinic of La Sapienza University, two doctors were preparing for an experiment that was destined to go down in the history of medicine.

Their names were Ugo Cerletti (1877–1963) and Lucio Bini (1908–1964). But the idea that guided them through the darkness of psychiatric wards was not their own. Several years earlier, the Hungarian psychiatrist Ladislas von Meduna (1896–1964) had observed a curious clinical fact. In patients who suffered from both epilepsy and schizophrenia, delusions would subside. Psychotic symptoms weakened after each epileptic seizure. Could madness truly be halted by a seizure? Meduna decided to put this theory to the test. Seizures, it seemed, could be therapeutic for schizophrenia. He began inducing them artificially—first through crude injections of camphor, then with the more controlled substance, Cardiazol. The method worked. But at what cost? A primal terror gripped the patient from within. Before the convulsive tremor wracked their body, they experienced a suffocating sensation. Acute fear tightened their throat. And yet, the clinical effect was undeniable.

Cerletti and Bini pondered: could seizures be induced in a different manner—more controlled and less traumatic? Perhaps with electricity?

They observed how pigs in Roman slaughterhouses were given a stunning electric shock before slaughter. The shock caused the pigs to briefly convulse. Cerletti requested permission to study the optimal parameters, conducted experiments, and determined: a voltage of about 80–120 volts, exposure lasting a fraction of a second, with electrodes applied to the temples.

First patient. A man around forty years old. Diagnosis—severe paranoid psychosis. He was brought to the clinic and became the first to test the method. First shock—minimal voltage. The body showed no reaction. No convulsions, no seizures. Cerletti increased the intensity. Second shock. A brief muscle spasm. Still, no full-blown seizure followed. The assistant suggested stopping. The patient regained consciousness after two electric shocks and clearly said in Latin: “Non iterum!” “Not again!

Cerletti remembered this phrase. In his later memoirs, he admitted: it had sounded like a philosophical protest. But at the time, he didn’t stop. He increased the voltage. The third shock. This time—a full epileptic convulsion. After a few minutes, the patient regained consciousness. According to Cerletti and Bini’s reports, an improvement in psychotic symptoms was observed.

The method was named electroconvulsive therapy (ECT). It spread rapidly across the world.

In its original form, EST was administered without anesthesia, without muscle relaxants, without monitoring. The patient was laid on a couch, held down by hands. Living flesh—violently subdued by brute force. Electrodes were placed on the temples, a shock was delivered, and the body convulsed violently. A generalized seizure seized the entire body, twisting muscles with such crushing force that tissue tore and bones cracked. Fractured vertebrae, broken femurs. Dislocated shoulder joints. Torn muscles. Jaws clenched so tightly that teeth cut into the tongue until it bled—bruises so severe that every breath was agony. The seizure would subside. But what remained afterward? A scorched void. Confusion. Disorientation. Temporary amnesia and speech impairment—a mind abruptly unmoored.

Despite all this, the method continued to be used. And not just used—it became one of the primary treatments in psychiatric hospitals during the 1940s and 1950s. Why? Because unlike sulfosin or lobotomy, it actually worked. Not for schizophrenia, as Cerletti and Bini had believed, but for severe depression, catatonia, and certain forms of psychosis with pronounced affective symptoms. Patients who had spent weeks in deep depression or lay motionless in catatonic stupors would return to life after a few ECT sessions. The difference was striking. It was clinically convincing.

But the way it looked — physically, visually, on a human level — was terrifying.

1959. Menlo Park, California. Night. A young writer named Ken Kesey steps into a veterans’ hospital. He is twenty-four. Fresh out of Stanford, he has honed his craft in the writing program under Wallace Stegner himself. But now, his tool will no longer be ink. His place is the psychiatric ward. Night shifts in pitch darkness. What does he see? Bodies convulsing under the merciless surge of electroshock therapy. Minds flattened by heavy doses of chlorpromazine—quiet, obedient, erased to nothing. Who rules here? Orderlies. Head nurses. Their power is absolute, unchecked. They are the wardens; the patients, eternal prisoners in monotonous wards. Year after year. No hope. No way out. Kesey watches. Kesey remembers. This darkness will be his fuel. This system will explode from within.

In keeping with the fashion of that era, Kesey participated in psychiatric studies on the effects of LSD—back when it was not yet banned and was being researched by serious scientists as a potential therapeutic tool. He took the drug as part of the program and wrote about his experiences. These impressions merged with his observations from the psychiatric ward.

In 1962, he published his first novel, One Flew Over the Cuckoo’s Nest. The book became a bestseller. Its protagonist, an Irish rogue named Randle Patrick McMurphy, fakes mental illness to avoid prison and ends up in a psychiatric ward run by the merciless Nurse Ratched. In the climax, McMurphy undergoes electroshock therapy as punishment for breaking the rules. In the end, he is lobotomized, stripping him of all free will.

The novel was adapted for the screen in 1975 by Czech director Miloš Forman, with Jack Nicholson in the lead role. The film won five major Academy Awards — Best Picture, Best Director, Best Actor, Best Actress (Louise Fletcher as Ratched), and Best Adapted Screenplay. It became one of the most striking works in the history of antipsychiatry.

And it shaped an entire generation’s idea of what psychiatry is.

One Flew Over the Cuckoo’s Nest is a gut-punch to its era. A book that ripped away the scalpel of truth. What hid behind the doors of mid-20th century psychiatric wards? The scarce voices of patients. The unchecked tyranny of staff. Practices shielded by the guise of “treatment,” but in reality, crude restraint. Electroshock. Without anesthesia. The current scorches the body, seizing muscles in convulsions, while consciousness writhes in a silent scream. Lobotomy as the ultimate measure. A steel blade invades the brain, severing forever the invisible threads of personality. The person still breathes, but they are gone—reduced to a “vegetative state,” flesh without a spark. This portrayal is no caricature. It is a historically precise reflection of reality. Kesey saw it with his own eyes. 1959. He stood there, inhaled the hospital ether, gazed into hollow eyes—and documented what for everyone else was an uncontested, unspoken reality.

Forman’s 1975 film was released at a pivotal moment. It coincided with the peak of the antipsychiatry movement launched by Thomas Szasz, Ronald Laing, and Franco Basaglia. That same year in Italy, Basaglia’s Law 180 initiated the closure of large psychiatric hospitals. Across the Western world, reforms in psychiatric services were hotly debated. Public opinion had turned sharply against traditional methods.

And “One Flew Over the Cuckoo’s Nest” played a huge role in this turn of events. It instilled in millions of viewers a deep, emotional perception of psychiatry as a system of oppression. Electroshock therapy became synonymous with torture in the eyes of the average person. Lobotomy—a synonym for turning a human being into a vegetable. Psychiatrists—synonymous with Nurse Ratched, cold, mechanical, and cruel.

There’s just one problem. This image truly reflects the middle of the 20th century. But it doesn’t align with modern psychiatric practice. And that’s the tragedy.

Let’s be honest. Let’s separate two different issues.

First question: Were there systemic abuses in 20th-century psychiatry, including the use of outdated methods, dehumanization of patients, and punitive practices?

Answer: yes. Yes, they did exist. In Soviet special psychiatric hospitals under Snezhnevsky. In American institutions under Freimuth. In Chelmsford Deep Sleep Therapy in Australia, where between 1963 and 1979, 24 patients died as a result of a practice devised by a single psychiatrist and left unchecked for fifteen years until a Royal Commission investigation was launched. In American reform schools for troubled teens. In the clinics of the 1940s and 1950s where electroshock therapy was administered without anesthesia. This list could go on and on. The world described by Kesey and Forman is real.

Second question: are these methods still used today in the same form? Does modern psychiatry operate as a Ratched-style system?

Answer: No. Overwhelmingly, no. And we need to speak about it just as loudly as we do about past abuses.

Consider a specific example: electroconvulsive therapy.

Modern ECT is not like the procedures of the 1940s and 1950s. Back then, bodies convulsed violently. Bones broke. Muscles tore. The screams still echo in one’s ears. Today, everything is different. The patient is given general anesthesia. Consciousness fades. They are unaware of the procedure. They experience no discomfort. Muscle relaxants are administered, paralyzing spasms. Fractures? Tears? They no longer happen. The electrical current is strictly controlled. EEG monitoring tracks every brain impulse. The procedure takes place in a specially equipped room with emergency support on standby. The patient is conscious only until the anesthetic takes effect. One breath. Darkness. The next memory is waking up in the recovery room. The entire procedure lasts about thirty minutes. Side effects? Only mild confusion in the first few hours. Sometimes, temporary short-term memory loss—but only for events related to the procedure. The shadows of the past are defeated.

This is nothing like what was portrayed in Forman’s film.

But the main point is hidden in plain sight. Modern ECT is a method proven to be effective—one of the most extensively studied in the history of medicine. How is this possible? It’s a mystery that demands solving. Yet the facts are undeniable. Systematic reviews in the Cochrane Library, guidelines from the American Psychiatric Association (APA), protocols from the UK’s National Institute for Health and Clinical Excellence (NICE), and documents from the World Health Organization (WHO) all acknowledge ECT. They recognize it as an effective treatment for certain conditions. Primarily, for severe depression that resists medication. When chemistry fails, electricity pierces the darkness. The same holds true for severe depression with psychotic features. For catatonia—especially life-threatening, fatal cases where the body stiffens and breathing fades. In some instances, it’s used for bipolar disorder with severe mania. For certain forms of psychosis in the elderly.

Approximately 100,000 ECT sessions are performed annually in the United States. In the UK—around 11,000. Across the EU—hundreds of thousands. The overwhelming majority are conducted with informed consent, under anesthesia, and with documented clinical justification.

Here my position as a psychiatrist must be absolutely straightforward.

I am not a defender of everything psychiatry did in the 20th century. I have written the eight preceding chapters of this book about how psychiatry erred, maimed, and killed. I witnessed outdated methods firsthand in clinics in Baku and St. Petersburg in the early 2000s. I am not here to uphold professional solidarity.

This is precisely why I can confidently say: modern ECT is not torture. It is an evidence-based treatment that saves the lives of patients with severe depression.

When a woman with debilitating depression experiences ••••••••••e thoughts, when she stops eating, sleeping, caring for herself, when antidepressants fail for weeks on end while despair and the risk of ••••• grow—ECT may be the only intervention that brings her back to life. And it does. Every day. In hundreds of clinics worldwide.

Yet here’s the strange part: the myth born from Kesey’s novel and Forman’s film persists and continues to exert pressure. On every patient. On everyone offered ECT. The psychiatrist making the referral knows in advance—this conversation is inevitable. Thirty minutes at least. First, anesthesia. Yes, it’s used. No bone-breaking convulsions. No one becomes a vegetable. Memory returns. It’s a standard medical procedure. In an operating theater. Like any other.

This work of persuasion drains resources. Reinforces stigma. Delays critical decisions. In some cases, it leads patients who could benefit from ECT to refuse it and continue suffering—sometimes fatally.

Thus a myth born in response to the real abuses of the 1950s now works against patients in the twenty-first century.

And here we confront a complex truth that cannot be evaded.

The antipsychiatry movements that gained momentum in the 1960s-70s did something necessary and right. They exposed real abuses. Forced the closure of dozens of “snake pits” — massive hospital facilities where patients languished for decades. They gave patients a voice and established the ethical foundation for modern psychiatric reform.

But they did something else as well. They created a lasting image of psychiatry as an inherently repressive discipline. And that image, once formed, proved resistant to revision. Even when psychiatry genuinely changed, the image remained.

And it is on this image, on this long-entrenched shadow, that an entire industry now thrives. An industry that exploits real tragedies of the past to discredit modern evidence-based psychiatry—and to promote its own alternatives, often far more delusional than anything that existed in the 1950s.

Picture this: 1969. L. Ron Hubbard, former naval officer, sci-fi writer, and founder of Scientology, signs documents creating an organization with a deceptively innocuous name — Citizens Commission on Human Rights (CCHR). It sounds like a human rights initiative. But behind this façade operates one of the world’s most aggressive antipsychiatry campaigns. They don’t debate. They don’t discuss. They strike at the heart. Here’s their method: documentaries. On screen — footage of lobotomies. Actual torture evidence. Clips from “One Flew Over the Cuckoo’s Nest.” Three images spliced into one narrative. Editing that leaves no choice. Watch. Here’s the doctor. Here’s the patient. Here’s the instrument. And the conclusion they hammer into viewers’ minds: modern psychiatry is an industry of death. Psychotropic drugs are poison. Psychiatrists are murderers. Three theses. Three strikes. Remember them. Because next, we’ll examine exactly how this machine operates.

Meanwhile, the Church of Scientology peddles its own “alternative treatment,” built on Hubbard’s delusional concept of “engrams.” Engrams—traces of pain imprinted in cells. Does it sound scientific? In 1950, Erich Fromm coolly dismantled this theory, calling it “a poorly understood, inverted Freudianism dressed in new vocabulary.” This isn’t science. It’s a commercial cult. Yet it maintains its grip. Its propaganda exploits the real tragedies of 20th-century psychiatry. It parasitizes pain—raw, agonizing, irreversible pain, the suffering of Freeman’s lobotomized patients and Rosemary Kennedy. On their broken lives, it builds a business, selling its own “purification courses.”

Here’s how I’ll draw the line in this book. Criticizing outdated methods—that’s one thing. Denying evidence-based psychiatry—that’s another. The first is necessary. The second? Dangerous for patients—and, regrettably, the go-to move for too many modern peddlers of alternatives.

The film “One Flew Over the Cuckoo’s Nest” is a great work. I don’t want to diminish its artistic value. It rightly remains one of the most powerful dystopian films in cinematic history.

But it is a work of fiction, grounded in the psychiatric reality of 1959. Not 2026.

When we psychiatrists hear a patient say, “I’m afraid of ECT—I saw in a movie that it turns people into vegetables,” we must patiently explain that the film showed the truth of 1959, that 1959 was long ago, that modern procedure is entirely different, that we live in another era, and that evidence-based medicine has advanced far beyond.

“Psychiatry is a fraud. Drugs are poison. Go to a family constellation therapist—no chemicals, no shock treatment, and everything will be fine.” These words drop like stones. Whispered by a friend. Repeated by a relative. Declared by an acquaintance. We must respond. Calmly. Firmly. Psychiatry is a science. Seventy years. Seven decades of relentless self-correction. Not perfect. Not finished. But undeniably real. And what is a “family constellation therapist”? Someone selling you ideology. It’s barely thirty years old. Thirty—against seventy. And the critical blow: this ideology has not passed a single placebo-controlled trial. Not one. Zero evidence. Just hot air.

I’m not asking you to blindly trust psychiatrists. What I am asking is this: distinguish between a scientific discipline and commercial mysticism. These are two different things, and the difference is fundamental—however unfamiliar or frightening either side may seem.

Modern psychiatry makes mistakes. It will keep making them. But it has built-in mechanisms—research, meta-analyses, classification revisions—to correct those errors. The “auditor” lacks such mechanisms because his system isn’t subject to scientific scrutiny; it offers unfalsifiable, unscientific hypotheses.

That is the whole difference. The reader of this book already knows its name: the correction mechanism. Science has one. The formula of madness does not—and cannot.

When I first saw Forman’s film, I was a medical student. I was young then and full of admiration. I thought: here it is, the truth about psychiatry. This is the profession I’ve chosen.

Later, I began my internship and encountered something entirely different. Not Nurse Ratched — though such figures did exist in the post-Soviet system — but patients who were genuinely suffering and whom modern medicine could help. Colleagues who often sincerely tried their best. Methods that worked and methods that didn’t. Truths that turned out to be far more complex than a cinematic portrayal.

I haven’t betrayed the ideals I brought into this profession after watching Forman’s film. I’ve deepened them. I’ve realized that fighting against bad psychiatry is crucial, but fighting for good psychiatry is even more important.

And here’s the trap. Invisible. Dev•••••••••ing. The inability to distinguish one thing from another — a snare that ensnares good, compassionate people with astonishing regularity. Fearful of becoming Nurse Ratched, they recoil in horror. They refuse ECT — even as their own mother sinks into the depths of severe depression. They despise Freeman — but it is precisely this rage that blinds them. They take their schizophrenic sibling to a facilitator of systemic constellations, clinging to the illusion: “At least it’s not chemotherapy.” They consider themselves critics of psychiatry. They challenge the system. But who do they truly become? A••••••••••rs. Or accomplices in the pseudomedicine industry — far worse.

The false choice — between bad psychiatry and unscientific alternatives — doesn’t exist. The real choice is between sound, evidence-based psychiatry and everything else. Including bad psychiatry and commercial mysticism.

We will also turn to the other side of this equation—the modern industry of “alternative mind care” that feeds on psychiatry’s shortcomings in order to peddle its own far more dubious methods. To Hellinger. To Stibal. To Hubbard. Their time in this book will come.

But first — the third part of our investigation. Before judging those who reject the rules, we must honestly show how those rules came to be: how 20th-century science learned to understand schizophrenia and — more importantly — learned to distinguish itself from its own shadow. Let’s begin with the man who first led psychiatry into its depths — Sigmund Freud.