One of the more remarkable pairings of movies is that of One Flew Over the Cuckoo’s Nest vs. Girl, Interrupted: remarkable in that they have essentially the same settings and set-ups, and yet arrived at diametrically opposed conclusions.
Both movies are set at mental institutions in the 1960s, and both institutions are obviously meant to represent society as a whole. Both have confused and lost protagonists. Both institutions are invaded by a rebel who plays by their own rules, giving new hope and wonder to the repressed patients. Both have stern, female, authoritarian, nurse antagonists trying to keep the rebel in line. Both films’ confused protagonists have their horizons expanded by the freewheeling rebel, who introduces them to forbidden pleasures and who sneaks them outside. And in the end, both films’ rebels are eventually defeated and broken, although for very different reasons.
The endings are different because the two films (and books they are based on) are making opposite assumptions about the world we live in. In Cuckoo’s Nest, Nurse Ratched is a fundamentally evil person — because society/government/etc is fundamentally a cruel and heartless place. She seeks mainly to beat down and suppress any humanity in the patients. Jack Nicholson’s character’s cause is just, and he is seen as the ultimate victim of Ratched, punished simply because he had humanity and individuality that she could not control. The message is clear: if you do not allow yourself to be repressed and controlled by society/government/employer, you too will be destroyed.
But in Girl, Interrupted, Whoopi Goldberg’s nurse Valerie Owens, the counterpart to Ratched and therefore this film’s representation of society, was actually benevolent all along. Angelina Jolie’s character was self-destructive, and her final breakdown was due to her own tragic problems and out-of-control nature rather than through any evil actions of the mental institution. Her main problem was that she was unable to trust Valerie Owens and see the good and the order that she offered. Her fun-loving wild-child schtick was just a mask to cover the pain inside, and that is what defeated her — not any action on the part of Owens. Her final surrender was what allowed her to get help.
Cuckoo’s Nest’s rebel was the healthiest and sanest person in the film. He was destroyed because he refused to be bent or corrupted by Ratched’s soulless, bureaucratic institution. Girl, Interrupted’s rebel, on the other hand, was one of the craziest and most depressed people in the institution. She was destroyed only by herself, but the institution could make her whole again.
The genders of these two films are also appropriate. Cuckoo’s Nest celebrates rugged individualism, traditionally seen as a masculine trait. The collectivism and empathy of Girl, Interrupted, of course, are viewed as feminine.
Either way, I used to have a more positive view of the world as in the latter film, until my own experience with a Nurse Ratched-level dystopia moved me irrevocably into the camp of the former. I see now that the elites who run most institutions really are corrupt, cynical, uncaring, and only wanting to keep their boot on your neck for life. Our Big Nurses come not offering warmth or compassion. They come offering lobotomies.
My own mental institution was the pediatrics department of the University of Nevada in Las Vegas (not to be confused with UNLV — two completely separate schools). As a first-year resident in that program, I got to find out what really happens when you cross paths with one of these elites who tells everyone around him how he just wants to help people. After all, what elite doesn’t say that? Obama? Any of the Bushes or Clintons? Google executives? University presidents? Even the president of BP Oil? They all say they are there to help, and they are all equally lying. Perhaps that is why I respect the men who run firms like Goldman Sachs… they never pretend to be anything but what they are. Perhaps that is the ultimate sin of Nurse Ratched: pretending to care.
Here was the cast: My own Nurse Ratched was an elderly pediatric hematologist named Jack Lazerson, program director and probably the most legendary pediatric-side doctor in the state of Nevada, with everyone respecting him and none willing to cross him. And above him was Dr. Miriam Bar-on, Dean of the Vegas campus and his titular superior, comparable to the largely unseen doctors and administrators of the films’ mental institutions. Underneath Lazerson was an army of various flunkies and bootlicks not worth naming, representing the orderlies of the nuthouse. I was the clueless protagonist, turned rebel by necessity.
For what happen was that Nurse Ratch — er I mean, Jack Lazerson decided one day that he would destroy me because I have Asperger’s. He told me this to my face in September of that year that he felt that anyone on the autism spectrum should not be in medicine, and that was that. He was going to use the institution and his vast powers to grind me to dust. He was completely without pity or remorse no matter how much I pleaded. In fact, come to think of it he rarely showed any higher-order emotions at all, tending more to the base emotions of fear and rage.
Now what laypeople need to understand: this is more than a problem of just one asshole boss. Everyone’s had those. The problem was that this one asshole boss was, for all of his residents, the face of the entire system. This is the same as every other program director. Medical residency is unlike any other employment or educational system in the country in that your program director is the absolute, totalitarian dictator of the careers of each of his residents, so you better pray you get someone not from the evil list. This will take a bit of explanation for anyone who’s not a physician, so bear with me.
In med school or any other educational program, no one person has the power of a residency program director. Each professor or instructor gives you their grade, and the average of your grades is your GPA. Even if one teacher hates you, that’s just one grade out of many. If there is a thesis or dissertation involved, multiple different professors evaluate it. Almost no dean can run a 3.5 GPA student with no conduct problems out of his school simply because he or she doesn’t like them… or if they do, there is nothing to prevent the student from simply transferring.
Similarly, no other paying employer or profession is like this, including the near-doctor careers of nurse practitioner or PA. If a law-school grad gets a nightmare law firm, he or she can always quit and find new employment. Sure, a short run with your first firm can damage your resume, but it is not a killer. Or if I’m a teacher and my principal is out to get me, I can quit and find a new school or district. Or if I’m a freaking McDonald’s employee and this happens, well, there’s always Burger King down the block. It’s not like every single prospective employer for the rest of your life will not hire you if that one asshole boss tells them not to.
In medical residency, though, that is precisely the case. While the Program Director cannot fire you outright without cause, they can make your life hell on earth while trying to deviously find any excuse or loophole in your contract to terminate you — and since PDs generally don’t get overruled, they will find some excuse sooner or later. And this is the most important part: if your Program Director does not want you to get hired by any other residency program, you will never complete a residency program again in your lifetime. This is because every other Program Director of every other residency program in the country will not consider you without a good recommendation from your prior PD. It literally does not matter how many other letters from how many other people you have — the only one that matters is the one from the PD. And if he’s a person with the sort of morality to where he has told you to your face that he wants to end your career through any means possible because he does not believe that people with Asperger’s should be in medicine… well, you see the problem. Even if you passed all your rotations with good “grades,” as I did, that is irrelevant. You cannot complete residency if your initial PD does not want you to, period, end of discussion. You cannot even get licensed in many states if your PD does not want you to be licensed.
So this is why he has the power of Nurse Ratched, in case you are wondering.
Anyway, during this residency from hell, I would be regularly assured by Lazerson or his minions that they were “just trying to help.” When I was pulled out of rounds so that he could scream at me on the phone, he was just trying to help. When I was brought before the entire panel of attendings so he could lecture me for a half-hour how unprofessional I was because of my Asperger’s, he was just trying to help. When he would scream and berate, he was just trying to help. When he singled me out for verbal abuse in front of all the other residents, he was just trying to help. When he (unsuccessfully) reached out to an attending to try and have me unfairly flunked on a rotation, he was just trying to help. When he (unsuccessfully) tried to have my medical license revoked because he honestly felt that the Nevada board of medicine would agree with him that Asperger’s should preclude anyone from medicine… yes, he was just trying to help.
When Nurse Ratched gave Jack Nicholson’s character a lobotomy, she was just trying to help.
So? I rebelled. He refused to let me transfer to another program, no matter how much I begged and pleaded with him. (I did try anyway but the few PDs who responded told me flat-out they could not consider me without a letter from my PD. Many others called Jack on the phone to ask about me… I overheard what he said about me.) So I quit after a year was done and went to work at an urgent care. It was quite literally my only option. And remember how I said that many states will not license you without your PD’s say-so? Fortunately, though, many of them do.
Lest you thing my fate was an aberration: while I was there he held back at least 3 other residents that I know of; fired at least 3 others; and had a third of the program on academic probation. I am not making that up: Jack had literally a third of his residents on formal academic probation.
Later on, the same thing that happened to me happened to a colleague of mine, another resident. It seems Jack felt that this colleague had accused him of having dementia, when this resident did no such thing. But Jack could not bring this charge up with the university — that a resident accused him of having dementia. The reason is because Jack Lazerson… well, I won’t say that he has dementia… but I will say he practices excellent hematology for the year 1975.
So instead, he had to devise other ways to get this resident fired, and the cycle repeated itself. When my colleague was held back and made to repeat his third year, it was Lazerson “just trying to help.” When he was brought before the same grave councils of frowning attendings as me, he was just trying to help. When he recommended that my colleague be terminated from the program, he was just trying to help. And my colleague did get many attendings to testify on his behalf, but what difference did that make against a Program Director? So when my colleague was actually terminated, it was Lazerson just trying to help. And when Lazerson tried to prevent my colleague from getting a license in another state, it was Lazerson just trying to help.
Neither he nor I may ever enter nor complete a residency program again for the rest of our lives. Practice medicine, yes. Get further training in medicine, no. Someone please tell me how this is just. (Also, PAs and NPs do not need any residency whatsoever. Their schools are easier and shorter and far less expensive. Why did I not consider going that route?)
That was my defining experience with the awesome malevolance of the system. Not that Lazerson was just an old, embittered asshole who had other attendings literally covering for his own medical mistakes in the hospital — where he practices on children, no less. The world is full of assholes and would-be Ratched’s. The problems are the systems that allows such vile, despicable people to prosper and thrive while punishing the plebians and the commoners undernearth them.
For Dr. Bar-on did nothing and would do nothing. Like Ratched’s unnamed employers, she allowed Lazerson to have this level of unsupervised power. She told me to my face that she knew his program was malignant (as did other residents and attendings in other programs), but that she would do nothing. She did write me a letter of rec, but again, without Jack allowing me to join another residency program, it wasn’t worth the paper it was printed on as she well knew. She just could not countenance any scenario that involved any sort of punishment or dismissal of Lazerson, no matter what he did, no matter how many children he put at risk, and no matter how many careers he ruined. Her own dean — Jack’s boss’s boss — told me using these exact words, “Lazerson’s actions are not up for review.”
The elites of the University of Nevada’s medical education system fell all over each other to defend one of their own, no matter how evil and incompetent he was, no matter what a threat he was to his own pediatric patients. Just as the elites of the nation protected another evil incompetent named Jeff Zucker. Or Jon Corzine. Or countless others. It is why a disgraced ex-general named David Petraeus was hired as an executive of an investment firm. It is not because of the extensive knowledge of the financial markets he gathered while in Iraq.
There is a silver lining to my story, besides the fact that I am not unemployed despite Jack’s most vigorous efforts. Because of that firing of my colleague, on top of the endless years of malignancy and poor reviews and general incompetence only partly masked by Jack’s bluster and ego, the chairman of the program finally roused himself to give him a taste of his own medicine — and terminated him. The news quickly circulated among us outcasts and victims of his particular brand of management, and it was said that Jack was in tears as he cleaned out his desk. As satisfying as that was, though, Jack’s getting the pink slip did not help his many victims. (and disclaimer: I don’t know anything of the new regime of the program. I only hope that they are reforming it.)
So I have seen how the system work up close. I know how these people are. And I know that Girl, Interrupted paints a rosy yet utterly false picture of how the vast majority of Establishments work. They don’t work to help us. They don’t want us to surrender to them so they can finally heal us. They want to lobotomize us partly so we no longer give them any trouble, and partly because they just want us to hurt. It is why real wages stagnate while the 1% prosper. It is why youth unemployment never improves. It is why Wal-Mart and Amazon treat their workers the way they do. It is why tuitions skyrocket and post-grad employment tanks. It is why the same sort of people get nominated for president on both sides, every four years. They want us powerless and hurting and nothing will stop them.