How a Cuckoo's Nest works

What we mean by a Cuckoo's Nest is a typical state mental hospital. This is some information about what happens when a patient is admitted and what the wards are like and what all the other buildings are used for. We hope you'll enjoy your stay with us.

Admission Procedure

The patent goes to the Admissions Office and signs in. They take a picture of the patient with a Polaroid camera which makes four photos with every shot. Then they take the patient to the Admissions Ward in a carry-all van. This ward is called a locked ward because the doors to the outside are kept locked at all times. The attendant takes the patient to the clothing room and tells him to take off his clothes and put on a white hospital gown. Then they send the clothes to be marked with the patient's name and ward number. The nurse takes the patient's vitals and about 30 minutes later, the doctor interviews him.

After 48 hours, they give the patients his clothes back and if he's been on his best behavior, he gets his buddy privileges, which means he can leave the ward if he goes and returns with another patient. After about a week, the patient gets his outside privileges, which means he no longer needs a buddy to be let outside.

The patient stays on the locked ward for 45 days of observation, which is about six weeks. During this time, they give the patient an EEG, a blood test and several psychological tests including the MMPI. After the 45 days are up (maybe a week sooner for good behavior), they transfer the patient to an open ward, which is only locked at night. This is when the patient's actual therapy begins. They send the patient to the vocational rehab. building to take some vocational tests and then assign him some job at the mental institution. The patient also starts going to group therapy. Another thing that happens at this time is the patient starts getting weekend passes.

Volunteer patients vs. Court Committed Ones

The first thing Public Relations tells you when they're showing you around the hospital is that about 90 percent of the patients in the hospital are volunteer patients and the rest are court committed. That gets you wondering about a lot of things. First of all, you can understand why most of the adolescents are volunteer. They're given a choice of volunteering or being court committed, so naturally, they volunteer. But what about the adult patients? Why would they volunteer? The only thing I can figure out is they find it a better alternative to being out on the street or in jail. They're trying to get to the point where they can hold down a job. I noticed that most of them didn't have much of an education.

The Acutes vs. the Chronics

As Kesey's book pointed out, there are two types of patients, the Acutes, who's brains are still intact and they just need a little head work to be able to fit into society. The other patients are the Chronics, the ones that the hospital staff admit are ruined for good. These are the ones they don't know how to fix. They're not in the Hospital to be fixed, but to be kept off the streets so they won't give the product a bad name. But unlike in Kesey's book, they don't keep the Acutes and the Chronics on the same ward, except for the case of the Admissions Wards and the Adolescent Wards. They're trying to correct the problem on the Adolescent Wards though, because the Adolescents keep pestering the Chronics, and one of them got so mad that he threw a chair at the medicine cart. They've decided to remodel Ward R and put all the adolescents on that ward without any other patients for them to tease.

Other types of wards in the Cuckoo's Nest

Some of the locked wards are not Admissions Wards. They are for the patients that are too nuts to be on an open ward, like the psychotic patients and the geriatric patients. They keep the patients who need maximum restraint (because they're likely to hurt someone) on the Disturbed Wards. The ward building looks like a torture chamber and it has a wooden ramp leading up to the front door to make the job of dragging screaming patients in there easier. The Disturbed Wards usually have their own Shock Shop because transporting the patients to the Shock Shop in the MS Building is too risky.

The Geriatric Wards are another example of a locked ward. This is where they keep the patients that hardly have any brain function at all, just enough to keep them alive. Usually, these patients are very old. They feed the geriatric patients liquid food. Most of the staff call these patients vegetables but the patients prefer to call them zombies. They look like side show freaks because their bodies are all distorted like if you were looking at them through a fun house mirror. Kesey calls them "all twisted out of shape." Usually they make able-bodied patients from another ward clean up the mess on the Geriatric Wards.

Finally, there's the Pediatric Wards and the only differences in the Pediatric Wards and the Geriatric wards is the age of the patients on the Pediatric Wards is much younger, but they also have severe brain disease. They feed them the same liquid food that the geriatric patients get. The Pediatric Wards also have their own Shock Shop so they don't have to take the patients all the way to the MS Building.

There are also many different kinds of open wards and most of them do not have Shock Shops. There's usually a couple of wards for the wheelchair patients, another pair of wards for the alcoholic patients, and a couple of Adolescent Wards. The Big Nurse is usually assigned to the Adolescent Wards because these are the patients who are least likely to conform and fixing them requires a whole lot of electro-shock therapy or maybe even a lobotomy.

The layout of the wards

The wards have four main parts. The first is a sitting area or day room. It usually has a television and the nurse's station is usually near this area. This is where the patients are required to be during the day (from lights on to lights out). There's also a porch the patients can go out on. The third area contains the dorms, which are usually partitioned off into four areas with 10 beds each. The fourth area contains the stool room where the prison type toilets are, the tub and shower room, the clothing room, the laundry room, the lockups or seclusion rooms, the mop room and a visitors room. In addition, some wards also have a shock shop, and the Geriatric and Pediatric Wards also have a dining room, but all the other wards use a dining room somewhere else in the ward building that isn't part of the ward.

Each ward has a door buzzer device in the attendant's office/nurse's station. Each door leading into the ward has a buzzer button for patients to push when they need someone to let them into the ward. The buzzer device has flags on it so that the attendant will know which door buzzer has been pushed and it has a reset button to reset the flags.

On the locked wards, they make the patients clean the ward before each meal and before bedtime. This mainly consists of sweeping and moping the floors. This is also when the medicine is doled out. On the open wards, they only make the patients clean the ward once a day, but they are likely to send the patients upstairs to clean one of the Geriatric Wards, which are always in a mess. The locked wards usually have about four attendants and one nurse, but the open wards usually have only one attendant and one nurse.

Other Parts of the Nuthouse

The Mental Institution Park

They put this here mainly for the visitors to make the mental institution look better than it really is. They hope that the trees will dampen some of the racket caused by the screaming patients.

The Rec Hall

They use it for dances and other recreational activities. It's the only building in the funny farm that isn't air conditioned.

The Alcoholic Wards

I think they used a combination of Alcoholics Anonymous/electro-shock therapy to fix the alcoholic patients and it didn't seem to have a very good batting average.

The Wheelchair Patient Wards

They seemed to have better success with the wheelchair patients, as long as they didn't take them anywhere near the MS Building, that is. Every time they took one over there for some kind of test, and the attendant needed to leave the patient to hassle with the paperwork, the wheelchair had a real nasty habit of migrating toward the stairwell and falling into the morgue, killing the patient. The attendant would go back to get his patient, only to find no patient, no wheelchair, no nothing. Then he'd hear someone hollering downstairs, "Somebody help me get a Gurney over here." The attendant would run downstairs and find the wheelchair and his patient, belly up on a Gurney with a sheet over it.

The thing the wheelchair patients really liked were the square dances we had for them on their ward. The staff would swing them around the dance floor in their wheelchairs and everyone had great fun.

Admissions, Clothes Marking and the Library

Besides the laundry, this basement had a few other thing. First, there's the Admissions Office. Besides admitting patients, the Admissions Office also is in charge of transferring patients from one ward to another. They're the men in the clean white coats, also known as the escort men. The basement also has the clothes marking room, where they mark all the patient's clothes with their name and ward number. Finally, the basement has a Library for the staff and the patients. I'm not sure what kind of patients they had on those wards.

The Administration Building

The basement of this building is where they keep duplicate records on each patient. These are the same records that are in the nurse's station and also in the Doctor's office. Social workers use them when they are working with the patient's family or with the patient. The first floor has a visitor area where the visitors check in when they want to visit a patient or take one out for their pass. The switchboard for the entire hospital is located here. They also have a credit union here for the employees and a trust fund that doles out money to the patients. In the back is a snack area with vending machines. They also have a dentist's office somewhere in this building.

Wards A-1, A-2 and A-3

The A wards are all women's wards. A-1 is the Admissions Ward, A-2 is an open ward and A-3 is the Geriatric Ward.

The Chapel

The chapel has three functions. First, it's used to calm down the relatives of patients that the hospital "lost." Since the science of treating mental illness is not perfect, occasionally, some patient dies. Sometimes accidents happen in the shock shop and some patient shorts out. Other times, a Gurney might get away from some attendant and go crashing down the stairs or maybe the chisel slipped when they were trying to do a lobotomy. Some patients have been known to somehow wonder out of the loony bin and get run over before the men in their clean white coats can swoop them up in a butterfly net and return them to their ward. Also, patients have been known to die on their own accord, especially on the Geriatric Wards. It's nice to have the chapel to help the loved ones get through their grief.

The chapel also helps the patients overcome their fears of things that might go wrong, like the medicine turning them into vegetables or getting burned to a crisp in the Shock Shop, or getting sent to the Disturbed Ward. They've also got all sorts of worries about the mental institution food, and the sweetener they put in the coffee (which turned out to be cyclamate) and the syrup they put on the pancakes. They also get a little nervous whenever they see one of the staff get out a Gurney, because they know that can only mean that somebody just died or somebody's about to get a little electro-shock therapy.

Finally, the chapel is a great relief for the staff when things go wrong, like when the Dairy Queen calls and says that one of their patients is over there giving the product a bad name, or when a bottle of Seconal turns up missing, or when the apple juice gets mixed up with the urine specimens. Yes, the staff have almost as much to worry about as the patients, especially when some patient somehow gets loose from the Disturbed Ward.

Medical and Surgical

This is where they try to fix the physical problems of the patients. The MS basement (MS-B) contains the morgue for the entire hospital. Patients on unattended Gurneys (destined for the Shock shop) or in unattended wheelchairs have a nasty habit of migrating toward the stairwell leading to the morgue and when they go over the edge, the fall usually kills them, and the people in the morgue grumble about the unconventional ways that the staff have been using to deliver corpses to the morgue these days. The first floor (MS-1) contains all the medical examination stuff like X-RAY, EEG, eyes, ears, nose, throat, etc. It also has a medical lab that analyzes the urine specimens and blood tests. It has a kitchen for the wards on the other floors. It also has an operating room where they do the lobotomies. MS-2 is a ward of patients recovering from illness, MS-3 is the Acute Disturbed Ward for male patients who aren't able to hack it on the usual Admissions Ward. Usually, all it takes is a little electro-shock therapy to get these patients into into the swing of things, and then they can transfer them back to the Admissions Ward, but if they can't fix them on MS-3, all they have to do is transfer them to the Chronic Disturbed Ward (Ward 13 or 14), also known as lobotomy row. MS-4 is the Acute Disturbed Ward for women patients. Each of these Acute Disturbed Wards has a Shock Shop that's also used for patients from other wards.

The Canteen

This is what's known as positive reinforcement in behavior modification lingo. If a patient has been on their best behavior, they get to go to the canteen and have a Coke or something. They have various types of food here and you can also buy cigarettes. It's where the patients can go and socialize. They've got tables where the patients can sit and talk about the latest patient to get a lobotomy on their ward and all the other news likely to happen around a mental institution.

The Shock Shop

This is what's known as negative reinforcement in behavior modification lingo. If a patient isn't on their best behavior, they usually drag them screaming and kicking into the Shock Shock and about two minutes, they come shooting out of the treatment on a Gurney, still shaking from the treatment.

The Lockups and Seclusion Rooms

This is also known as negative reinforcement in behavior modification lingo. Before mental institutions got the major tranquilizers, the only way to keep some patients from hurting themselves is to throw them in a padded cell. Since then, they have replaced the padded cells with the lockups and seclusion rooms. The difference in the two is the lockups aren't totally dark inside, like the seclusion rooms are. In both cases, the rooms are about four by eight feet, usually with a mattress in the floor that the patients like to wet and there's a drain in the floor for the urine to run out. Usually, it's the newer wards that have the seclusion rooms.

The Boiler Room, Chill Water Plant and Filter Cleaning Area

This is part of the loony bin's physical plant. The physical plant takes care of the heating and air conditioning of all the buildings in the loony bin, and also provides steam used by the dish washing machines and other equipment that needs steam. The physical plant consists of the boiler room, that provides the steam, the chill water plant (located behind the Ward F building) that provides chill water for the air conditioning, and the filter cleaning area, which consisted of racks to hold the furnace filters and a water cannon to clean them. Because it was located right next to the Disturbed Wards, the water cannon could also be used to put down any riots that might break out on Disturbed.

The Adolescent Wards

The Adolescent Wards are in this funny looking ward building that consists of 8 wards, two of which are the Adolescent Wards. It is one of the newer ward buildings and it has seclusion rooms rather than the lockups. Another difference is it has a day room instead of the open sitting area that the other wards have. There are only about 10 adolescents on each ward and the other 30 patients have serious problems and the adolescents get their kicks from pestering them, but if the Big Nurse catches them, she has them taken right to the Shock Shop.

The entrance to the ward building is between L and N, the kitchen and mess hall are between K and M. Between K and L is a fenced in recreational area that the four wards share (instead of the usual porch) and between M and N, there is another similar area for those four wards.

The The H Ward Complex

This is the ward building where they had the big dispute over the Shock Shop. The Big Nurse put this Shock Shop here because she was tired of having to take the adolescents all the way over to Disturbed for their treatments. She would have put it on the Adolescent Ward, but she didn't want the parents of the adolescents to find out about it, so she put it in the next building. One day, all the other Shock Shops in the hospital were out of commission except for the one in this building, so they decided to bring all the patients over there for their treatments. They couldn't have timed it worse because Public Relations was about to show a bunch of visitors through that ward building and the last thing he wanted them to see are screaming patients being manhandled into the treatment room. The Big Nurse lost that round and the patients didn't get their treatments.

The Vocational Rehabilitation Building

This building is where the patients do their Occupational Therapy (OT). That would normally be the basket weaving, but when I was employed there, we had them making clay ash trays for some reason. Anyway, the whole point of the thing is to try to improve their coordination to the point where they're employable somewhere. The building also has an auditorium, where the patients watch movies every Friday afternoon. They also give job-related psychometric testing here and applicants to work at the Hospital are also tested here and lectured to about what all working at the nuthouse involves. It takes a whole day to apply for a job at the hospital.

The Pediatric Wards

There is disagreement among the staff about which are the worst wards in the hospital, the Disturbed Wards or the Pediatric Wards. In both cases, the patients are in pretty deplorable shape. They are also Chronics, which means they're too far gone to be fixed. To the side of the ward building is a playground, which is a joke, because they never let these kids see the light of day. They have enough trouble trying to keep them from injuring themselves inside the ward, and the damage they could do on a playground is unreal. This ward building has it's own Shock Shop, which they use whenever one of the patients has a spastic attack to bring them out of it. The patients on the Pediatric Wards range from mildly retarded to complete vegetables. Almost all of them wet the bed each night and you usually see the mattresses stacked around the outside of the ward building to air out in the sun during the day. God knows what they do on a rainy day. Staff on these wards tend to burnout in record time.

Copyright © 1997, Colin Pringle
Last update: 4-17-97