Thursday, June 25, 2009

One flew over the cuckoo's nest is mentioned a lot at my job

My job is to be a Psychiatric Nurse Practitioner. Nurse for short. I work at an outpatient mental health clinic. I love my job.

There is a stigma attached to mental health care. A stigma to both the diagnoses and the treatments. I discuss this stigma during the intake appointments. Most everyone fears being called crazy and being put in the hospital. The other ideas and stigmas are more age specific.

I have older patients (80's) who are open to the process. However, they are often puzzled about seeing me. They had no idea anything was wrong. Their visits are usually triggered by a screening questionnare during a visit with their primary care doctor. They answer some basic questions and it comes up flaming positive. Again, they had no idea.

For instance, I recently asked an older gentleman about his sleep. He denied any issues, said his sleep was just fine really. Then I asked him if his wife had noticed anything about his sleep. He said, "Well, she hasn't slept in the same bed for 20 years because I thrash around and have nightmares most nights." This floors me. Absolutely makes my jaw drop.

Then, there are the younger people 18-24, barely able to shave. These patients are fun. They have a better understanding of what they are doing here. They are in a hurry and just want it 'fixed'. They are malleable and energetic. Perfect for 'fixing'. There is a difficulty though, with this age group. They often have a hard time listening. I adjust the language I use accordingly.

Then there are the men of a certain age. A group of men who have distinct fears and distrust. They are mostly 45-60 years of age. During the intake appointment, most every time, they almost always bring up this movie.

One flew over the Cookoos' Nest.

This movie, I swear to you, is mentioned at least once a week at my job. Yesterday was some kind of record, I heard about it three times in one day.

Now, I have not seen this movie. It came out a year before I was born. I haven't looked it up in wikipedia either. Every time a patient brings it up, I ask them to tell me about it. What they know and feel about the movie is more important then me seeing it.

Most everyone has strong feelings about this movie. And they have a lot to say about it. They tell me about Jack Nicholson, that it was one of his best movies. They mention some sort of uprising among the inmates (?) and mention the horrors of the psychiatric 'treatment'. They talk about the anger and rage they felt when Jack was forced to undergo ECT. Then, they always mention this woman. Always.

I have heard about her before this job, during my stint as a County Jail Nurse. Again, it's male patients around the age of 45-60. They don't say much about her though. They just say the name, "Nurse Rachette" and kind of shudder. I can tell that she is not a nurse. She looks like a horrible person. A wolf in sheep's clothing.

During the discussion of this movie, I assuage their fears. There are no men in white coats outside the door. We don't inject anyone with anything here. I tell them I don't really admit anyone to a psychiatric hospital. I don't use the medications that cause zombification.

I tell them this is an outpatient clinic, all that happens here, is a conversation. We just talk. That's all. Yet here's the thing.

The simplicity of the method and means is the source of it's power.

This conversation, them coming here, maybe starting medication, seeing a therapist, all of it is powerful. More powerful than the King Kong that's been pounding on their chest. More powerful then the python knotted and twisting in their stomach. I have the privilege of working with people who are changing and growing. People who come out on the other side healed.

The first step is dissolving the stigma. To have them hear what I say. My job is part sales and part tailor. I give them a sales pitch of the treatment plan I am proposing. I explain my logic in the plan, to reach their goals. A treatment plan tailored to their individual needs. This is the art and science of nursing. And this is the beauty of being a nurse.

Like I said, I love my job.

12 Left a message at the beep:

Holly said...

As a communications consultant, I would tell you that you need to watch the movie so that you can relate to the iconography of your client base.

You'll be able to relate to the ick of it all.

It's a good movie...more to your point of what caused all the stigma of being and going and coming back from crazy.

I like what you say about being tailor and sales person. That's so true and well said.

You are perfect for this job. Perfect.

B.E. Earl said...

Great novel and great film, even if they take two different paths to the same result.

"Vintery, mintery, cutery, corn,
Apple seed and apple thorn;
Wire, briar, limber lock,
Three geese in a flock.
One flew east,
And one flew west,
And one flew over the cuckoo's nest." - Mother Goose

In the context of the novel and the film, the ones flying east and west are the two characters who oppose each other. McMurphy and Nurse Ratched. The one that flew over the cuckoo's nest is actually Chief. Interesting.

Mrs. Holly Hall said...

Holly: I am not sure if watching it would help me understand the iconography, i mean, it's not my iconography. It's theirs, which is more important for the purposes for which I see them.

plus, i work in mental health, no need to watch films about such things on my off hours!

Earl: See now, that type of comment right there, that makes me all interested in the book/film.

perhaps I had just passed it off as a snuff film of sorts. hmm

Cam said...

I had to watch it for a psychology class, interestingly enough.

I liked it...

I think you would like it...

I mean, Jack Nicholson was so smoking hot in this movie!

I've come across several Nurse Rachette's in my day, and you are right, they only deserve the clinical title, for putting in the clinical education & hours, and not the love & compassion for their fellow man that makes them a REAL nurse.

I'd watch it again if I had some free time...

Have a great weekend, Mrs!!

James said...

A superb, fantastic film. Unlike Earl, I have not read the book.
Ah, nurse Ratchette...Jack's immortal line in the movie "er...something of a c*** ain't she doc?" springs to mind....

Bruce said...

I still don't understand this whole "I Love My Job" concept, but I am working on it.

As for the film. It is a masterpeice, but more so becuase of Nickelson's portrayal and Nurse Rachette as his conterpoint. One would not have worked without the other. Louise Flecther is fabulous in her role and in face is NOT the bad person in this film. Since most men identify with the rebelious nature of Nickelson's character, they naturally dispise Nurse Rachette. Her only failing is that she is a bit of a control freak and likes to maintain order in a psychotic ward. She cares for her patients, but she just dosen't show a lot of empathy. Nickelson upsets the apple cart in her world and he IS disruptive to say the least.

However, this film bears little resemblance to modern psychitric out-patient services, espeically since it is a locked state run facility in the 1950s.

Joanna Jenkins said...

You have an interesting job! I never thought of the saleman approach, but it makes perfect sense.

Holly said...

Glad Earl could give you a possible thread to consider that I didn't. Whenever your audience makes a reference multiple times, as one who is interested in relating well to their audience, it only makes sense to understand the reference, too.

Slyde said...

what a great that i havent seen in ages. i need to recitify that soon.

as far as mental health and the elderly, i often used to think that my grandfather could have benefited from seeing someone, although in his last years im not sure he'd even really realize what was happeneing and who he was talking to.

Mrs. Holly Hall said...

Cam: You said it best "putting in the clinical education and hours" is only part of the title of nurse.

it's the love and compassion for their feel man that makes a REAL NURSE!! Bravo!!!

James: Glad you liked the film. but jeez, that line is HARSH!!

Bruce: HMMM interesting insight into character dynamic. I KNEW YOU'D HAVE SOMETHING to offer about this film. You are the demographic I am talking about in the post.

And yes, good luck on developing less postal rage type feelings at your job, maybe just maybe you can develop tolerence, then perhaps o i don't know, like? who knows?

and really, even though that movie looks nothing like my office, the men ALWAYS bring it up on the first visit. I never bring it up. I simply ask if they have any questions/concerns about coming to the mental health office... and this springs to mind :)

Joanna: I DARE SAY every job has a salesman compenent. We are all selling something right? For me, I sell hope and reasonable solutions. :)

Holly: Yeah, maybe I'll read the book first. . . .:)

Mrs. Holly Hall said...

Slyde: I say this, what matters when working with the elderly is quality of life. And given enough time and enough age all of us will go a little confused towards the end.

But, there is a term used, in mental health, "pleasantly confused". What that means is that if they have the quality of life they want, can give and recieve love, well, really, this is most important.

and as for your Grandfather . . . it looks like he had all over that. Which is a credit the the very cool dude you are Slyde :)


Anonymous said...

Jeez, I can't believe you haven't seen this movie. Aside from your relationship to it it is one of the greatest movies ever made.

I also think that nurses should start wearing those dandy caps again, LOL.


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