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.