Psychiatrists were knights of reason and order saving damsels from the proliferating dragons of the mind. But by 1960, the dragons had become the psychiatrists and the institutions of psychiatric care themselves. Budapest-trained psychoanalyst Thomas Szasz, in The Myth of Mental Illness (1960), turned on his own training and called the idea of psychiatric illness "scientifically worthless and socially harmful". In The Divided Self: A Study of Sanity and Madness (1960), R. D. Laing argued that the schizophrenic patient was often playing at being mad, making a fool of himself and the doctor as a way of keeping dangerous people at bay. Michel Foucault's Folie et deraison: histoire de la folie a l'age classique (1961), later published as Madness and Civilization, provided an account of the birth of the asylum and suggested that the modern concept of madness was a cultural invention of control; the mad who had once been an accepted part of society and life's folly became seen as threats, separated into asylums, and silenced. Sociologist Erving Goffman's Asylums described mental hospitals, particularly Washington's St. Elizabeth's, as built on a power dynamic in which patients were abased as a way not of curing mental illness but of asserting the power and authority of the psychiatric and mental health professionals. Goffman concluded that "mental patients find themselves in a special bind. To get out of the hospital, or to ease their life within it, they must show acceptance of the place accorded them, and the place accorded them is to support the occupational role of those who appear to force this bargain... Mental patients can find themselves crushed by the weight of a service ideal that eases life for the rest of us."These books looked at psychiatry and mental illness as instruments of social purification masquerading as science with little diagnostic or therapeutic value. Therapy meant learning to internalize the moral codes of a particular society, not treatment of an illness. Despite the prestige and influence of these books in intellectual circles, none of them had the widespread impact of a novel that was begun in 1960 by a twenty-four-year-old writing student who was working the graveyard shift at a mental hospital and participating in government-sponsored drug experiments. Ken Kesey was not out to write a treatise on psychiatric practice (the merits of electroshock therapy are still debated) or to right any particular political wrongs. His temperament was too anarchic and mischievous to recommend a sociological or political agenda. As he worked on the mental ward in the Menlo Park Veterans Hospital near Stanford University, he became sympathetic to the patients and began to question the boundaries that had been created between the sane and insane. He began to consider whether madness really meant the common practice conforming to a mindless system or the attempt to escape from such a system altogether. In One Flew Over the Cuckoo's Nest, Scanlon, a psychiatric patient, utters what could be a gloss either on Goffman's thesis or modern definition of tragedy: "Hell of a life. Damned if you do and damned if you don't. Puts a man in one confounded bind, I'd say." Either conform and be released or maintain your integrity and be kept in the ward.Kesey envisioned the-then widespread practice of "Therapeutic Community" as a way of forcing the internal soul to fit someone else's idea of the ideal external environment. According to the practice, patients confessed their secrets to each other in an effort to make the ward "as much like... democratic, free neighborhoods as possible – a little world Inside that is a made-to-scale prototype of the big world Outside that you will one day be taking your place in again." Therapeutic Community became a trick of coercion that pretended to help people by and for the democratic common good but served only the tyranny of the mediocre majority and the management of the institutions that supported the practice for its own purposes. In One Flew Over the Cuckoo's Nest, Kesey turned the mental ward into a symbol of the tricks of control afoot in postwar American society.
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