According to the American psychological association, the mental illness is a clinical psychological or behavioral syndrome that refers to a mental disorder with definable diagnoses. These disorders may affect thinking process, mood or behaviors and some patients may have a mixture of all these three manifestations. This definition stipulates that mental disorders are multidimensional issues. Additionally, whenever a mentally ill patient’s behaviors are affected means that he or she is at risk to make other’s life in danger and make them suffering. Which constitute the origins of the social stigma and leads directly the family or the patient himself to seek care (Knaak, Mantler, & Szeto, 2017)
A competent health care team should provide their treatments in a specialized ward and respect a variety of rules well defined. For instance, separating patients with different illnesses from each other and respecting rules of therapeutic relationship. Especially, because breaking these laws can aggravate the situation of patients, threaten their lives and makes the role of care providers much more difficult.
In order to treat these patients effectively, arising people’s awareness about these conditions has a major importance. Eminently, it is not only a matter of health care providers but also all the components of the society. Since the last century, Cinema Production have been treating these issues with an artistic way that can touch all the constituents of the society. One flew over cuckoo’s nest is a movie that dealed with a group of mentally ill patients with different diagnoses treated in the same ward. The admission of a patient for observation ruined the workflow. This essay will be discussing some generalities about patients diagnoses basing on their symptoms ,comparing the way they was treated and the available treatment .finally, providing some recommendations or alternatives basing on mistaken behaviors made by health care providers and patients.
Short synopsis
The main character of the movie is called McMurphy and he was transferred from the prison to the ward for observation. Because of his out of control behaviors. Therefore, the authorities of the prison suspected that he was faking insanity just to get rid of the prison. Then they asked help from the hospital to make sure about his illness. After his admission, he realizes quickly that the head nurse Mrs. Ratched uses these therapies to manipulate all the patients to do whatever she is asking. As a result, he tries to contradict Mrs. Ratched’s orders whenever he can, he busts the patients to break hospital’s rules and enjoy the external life. He is a confident rebellious and his behaviors are very difficult to change even with electroshock therapy. He kept his attitude and decided to escape from the hospital by seeking help of his friend Candy who provided a favor for one of schizophrenic patient called Billy bibit by offering a sexual rapport but the nurse Ratched ashamed him because of his unacceptable behavior. So, he choosed to suicide.
Mr. McMurphy’s self-esteem is inflated. As a result, he start to challenge patients, the health care team and hospital policies. He always feels energized and spend the whole day talking, playing actively with all the patients and intimidating them from time to time. While manipulating and breaking rules is his main objective. According to DSM 5, the presence of the impairment of self-functioning and the interpersonal functioning not related to the ones development or culture, being manipulative, irresponsibility and risk taking are the specific criteria of the antisocial personality disorder. Therefore, the actual nursing diagnoses to Mr. McMurphy is Risk of injury or violence related to anti-social personality disorder as evidenced by hyperactivity. For Mr. Billy bibit, he has palilalia, his mood is always depressed, he lost interest in anything and he is always asleep, lethargic and fells worthless. As a result, he suicided at the end and that is enough to judge that he has been suffering from depressive disorder related to shyness and social interaction impairment as evidenced by suicidal thoughts.
Depression is a widespread mood disorder affecting nearly 16.2% of the population worldwide. The lowest prevalence of depression worldwide exist in the western pacific region followed by Asian regions by Less than 6% of the general population.(WHO,2017) while in Morocco, a national survey conducted in 2015 showed 26.5% of Moroccan people suffer from depression at some point in life.(Oneib, Sabir, Abda, ; Ouanass, 2015) .The efficacy of the available treatments still insufficient since rates of suicide and reoccurrence are elevated. Therefore, the identification of its causes is the best way to find therapeutic and prevention strategies. These causes still poorly identified and numerous schools explain that problem from its point of view. As a result, depression is considered as a multifactorial disorder whereby genetics, life events and environmental factors have the major responsibility. From the pathophysiologic point of view depressive disorder is explained by a irregularity affecting neurotransmitter especially serotonin , dopamine and brain-derived neurotrophic factor (BDNF).Whereas several cases of depression appear during winter which can be explained only by alterations in circadian rhythm and sunlight exposure. (Chand ; Whitten, 2018)
Nowadays, the treatment of this illness is based on its causes and it is divided into drugs therapy and psychosocial care. The nature of the prescription depend on the choice of the physician but the principle rely stimulation of hormones cited previously. So, the two major categories widely used are Typical and atypical antipsychotics. For the psychosocial care, it relies on the education of the patient to build up his cognition and behaviors by scheduling session of education and seeking help of the family and his surroundings. In spite of all of these explanations, depression still poorly understood, patients find the suicidal ideas as the easiest way to escape their sadness and all the suffering that is why health care providers should behave professionally with them, avoid any hurting behaviors and triggering interventions.(Chand ; Whitten, 2018)
Moving on to the anti-social personality disorder by which Mr. McMurphy is affected. It is considered as a period of 1 week or more in which a person suffers from a state of abnormally elevated arousal, affect, and energy level that totally contradict the manifestations of depressive disorder.
Therapies
In the ward number Thirty-four there was seventy patients and the health care team try to take care of them professionally. They use a variety of therapeutic methods such as the music therapy, group therapy and patient engagement by organizing listening session to discuss reasons and problems that brought them to the ward. In order to see their consciousness about their illnesses and their improvements. All of these interventions are independent whereas the health care team committed some therapeutic errors on behalf of the dependent interventions.
On the one hand, music-therapy or Vocal -instrument’s sounds combination is used in a very organized way to enhance harmony and expression of people’s feelings. Thus, we can say that the brain and music are strongly attached to each other. Plato (428-347 BC) quoted “music gives wings to mind” because it has a heavy impact on one’s psychological status and helps humans to move from an emotion to another. That change in emotions passes through different processes. So, it has been discussed from different points of view such as the neurobiological basis that correlate music to various functions of the brain. like the perceptual processing, in which the transduction and transmission of waves play a major role, or the emotional processing known by the activation of the amygdala and medial orbitofrontal to affect one’s emotions (Fakhr Tabatabaie et al., 2014). The Third function is the autonomic processing that is about the relaxation effect of music, reduction of pain perception, or other vital sign. Whereas, The Behavioral or motor processing is the most appearing response to music in the form of dancing. Functional brain imagery shows that music activates the basal ganglia, cerebellum and motor area. These areas are the ones who coordinate motor movement in response to music. Additionally, the neurotransmitters hypothesis school relates the pathology of schizophrenia to the impairment of dopamine and Boso M, Politi P (2006) stipulated that the secretion of Dopamine could be increased by music. (Brisch et al., 2014)
Moreover, Music and spirituality are considered as protective measures from suicide. Especially because since its beginning the humanity have known the power of music for evoking the gods and obtaining spiritual insight, renew the relationship with gods and reinforce one’s hope. That’s could be explained from the neurobiological basis of music and its effect on hearing and on other senses. In other words, it helps to stimulate the imagination and the perception of other dimensions that are not observable by non-religious people. Thing which can distract the patient from his suffering and disruptive thoughts.
Forrester-Jones, Dietzfelbinger, Stedman, ; Richmond, 2018 cited that a range of studies as about the spirituality , the affiliation to spiritual group, the practice of a spiritual activity such as music spiritual and its relationship with the suicide and suicide attempts concluded that the suicide rate is four times higher in people who does not attend any spiritual activities. In addition, a study of 1610 older adults diagnosed with depression, found that those attending religious activities on a regular basis and have a spiritual faith were significantly less likely to have suicidal ideation. Chen et al. (2007) Furthermore, the spirituality has been found to be a crucial component in the recovery from severe mental illnesses (Corrigan et al. 2003). During the past two decades, research has connected spirituality to a variety of benefits, For instance increased hope, self-esteem, social supports as well as motivation towards growth. (see Snider and McPhedran 2014).
Therefore, music is a therapy that affect various dimensions, such as cognitive, emotional, spirituality and social fields. These dimensions are impacted by psychiatric conditions. A Systematic, randomized controlled study conducted about the effect music therapy among depressed and schizophrenic patient (Mossler et al, 2011) reported that music therapy improves mood and targets psychopathology. The main study stated that patients accept and participate efficiently in music therapy; evidenced by low dropout rates, which suggests that music has the ability to sustain the attention and the interest of patients. Moreover, melody, rhythm perception, and musical memory, are helpful to predict verbal working memory, verbal memory and facial emotion recognition in patients with schizophrenia (Chandrashekaran, 2015).
Secondly, in that movie Health care providers organizes group discussion sessions. Which guarantee the right to each patient to express his problems and the rest of patients share their knowledge and experiences in order to help each other. This therapy is cost-effective because it requires only a specialist to guide the discussion. Additionally, it promotes social interaction. Especially, for those who are diagnosed with social interaction impairment or speech disorders. These deficits may be found among individuals diagnosed with schizophrenia and depression. Recently, it have been found that the group therapy is effective in improving problem-solving skills, helping patients to cope with symptoms and remediating verbal problem-solving deficits . Jonathan Radcliffe (2016) reported that some studies dealed with benefits of group therapy and they emphasized on its role in patients engagement, identifying problems, reducing isolation and hospital-related anxiety.(Radcliffe ; Bird, 2016)
On the other hand, Health care providers committed some errors related to drugs administration. They offer the same medicine to the entire group at the same time without any verification of the identifiers and doses, which affect the quality of care, create more burdens and aggravate patient’s health status by increasing the risk of adverse drug events and medication errors. A study conducted by Fathi et al., 2017 stated that the most common cause of Medication errors is related to the administration of treatments at the wrong time followed by the administration of the wrong drug then errors related to the wrong patient. All of these errors are related to the basic rule of the eight rights. An American study showed that the Costs of medication errors is estimated between almost 6.1 to 6.5 billions of dollars in the USA from 2014 to 2015 .Also it can increase length of hospitalization, costs of hospitalization. (Stratton & Blegen, 2014; Grissinger & Kelly, 2015)
Secondly, the use of the electroconvulsive therapy on behalf of Mr. McMurphy was a mistaken intervention especially without explaining the procedure and obtaining the consent, which can be considered as a breach of the ethical principal of autonomy and the right of informed consent. So, nurses can be a subject of legal proceedings. Electroconvulsive therapy (ECT) is an effective treatment for mood disorders, Schizophrenia, catatonia and treatment option when urgency or resistance pharmacological treatments. Dusan kolar reported that after the practice of ECT vary significantly between countries or even within the same country, because of the absence of a universal consensus about its use. Consequently, practitioners should be aware its risks and side effects. The neurobiological assessment should be a crucial because of its cognitive side effects, Things which are absent in that movie.(Kolar, 2017)
To conclude, one flew over cuckoo’s nest is a movie that went viral and helped in Sensibilizing people about mental health illnesses. In addition, it is an opportunity to raise the awareness of people about different therapies such as music therapy and group discussion that would encourage patient to seek help and comply with the treatments. That is why the movie won all the big five academy awards. Nevertheless, the mistaken behaviors on behalf of Mr. McMurphy would increases people’s fear in seeking help, which reflect the absence of experts in medicine in the production of that movie. Thus, I highly recommend in every movie production about health conditions should be revised by health field experts in order to avoid diffusion of mistaken information.