One of the notable achievements of One Flew Over the Cuckoo's Nest was its incorporation of an actual mental hospital and its patients into filming. Milos Forman was committed to cinematic realism, and wanted to create an entire world and authentic setting for the adaptation of Ken Kesey's chilling novel. An article in the New York Times from 1975 about the filming of the movie compares film acting to the atypical behavior of mental patients: "At first glance, the difference between the patients and the actors who play the patients—a group carefully selected for their eccentric manner—seemed to be that the former tried desperately to appear sane and the latter didn't." ("A Real Mental Aid Becomes a Movie's 'Cuckoo's Nest,'").
Milos Forman chose to shoot the movie in the Oregon State Hospital, an actual hospital, and cast Dean Brooks, the actual director of the hospital, as the compliant Dr. Spivey. While Brooks was game to participate in the filming, however, many doctors and workers at the hospital worried what effect filming might have on the reputation of the hospital and on the well-being of the patients, as Kesey's novel is known to be an unflattering depiction of the mental health industry. An article in Psychology Today by Wind Goodfriend outlines how early mental institutions could not handle the number of patients who were committed and therefore treated the patients badly. In the mid-19th century, The Kirkbride Plan was designed to rectify these issues, calling for spacious and accommodating facilities for patients. The Oregon State Hospital was built under this plan. Goodfriend writes, "What’s interesting about the Kirkbride Plan and Moral Management was not just the physical expectations, however; patients were also supposed to be treated with a high level of ethical respect." The Kirkbride plan not only called for pleasing facilities, but a compassionate and hands-on approach to treatment.
Nurse Ratched's character comes to represent the way good intentions can became a smokescreen for the desire for absolute control. While undoubtedly many mental institutions exploited and abused patients, there were also many doctors looking to do what was best for the patient. While the film's depiction of procedures like electroshock therapy and lobotomies are viewed by some as caricatures of mental hospitals, these techniques were the technologies available and used by institutions at the time. Electroshock therapy was historically employed as a treatment for schizophrenia, rather than as a punishment. From a psychiatrist's perspective, the film depicts a particularly unethical and horrific institution, and the ways that cultural institutions that work for the good of the individual are in fact corruptible and capable of great harm. Forman's perspective on psychiatry and mental illness treatment, as reflected through the viewer's alignment with the patients, is a largely pejorative one. Kesey's story and Forman's direction horrifyingly depict the ways that allegedly benevolent modes of institutional support such as psychoanalysis and mental health rehabilitation can become insidious, dictatorial, and harmful to the well being of the individual seeking help.
