What flew over the Cuckoos Nest?

The punctiliously cruel psychiatric ward tyrant in the book and movie One Flew Over the Cuckoos Nest was brought to cinematic life by the actress Louise Fletcher during filming in Salem at the Oregon State Hospital in the 1970s.

But the melding of real life and art went far beyond the film set. Take the character of John Spivey,a doctor who ministers to Jack Nicholsons doomed insurrectionist character,Randle McMurphy. Dr Spivey was played by Dr Dean Brooks,the real hospitals superintendent at the time.

Brooks read for the role,he said,and threw the script,calling it unrealistica tirade that apparently impressed the director,Milos Forman. Forman ultimately offered him the part,and told the doctor-turned-actor to rewrite his lines to make them medically correct. Other hospital staff members and patients had walk-on roles.

Now jump cut to the present: The office and treatment rooms of the hospital,which opened in 1883,have been turned into a Museum of Mental Healthone of only a few that are part of a functioning hospital.

A steel examination table sits near a photograph of the Oregon State Insane Asylum baseball team,which once played against local challengers. A straitjacket and a spilled bag of handcuffs fill another display,with a notation from the night watch book recorded at 2 am on February 25,1913.

The juxtaposition of real and celluloid,truth and fiction,that emerged on the Cuckoos Nest set continues. A photograph of Fletchers character,steely smile and nurses cap in place,adorns a wall near a television that blares the movie itself on a continuous loop showing the movies patients watching that very television.

The result creates questions that McMurphy and his cohorts might have asked. What is real and what merely seems real? Was the hospital,which had a large number of voluntary admissions in its early years,a place of sanctuary,or of confinement?

Brooks,now 96,and living near the hospital in a retirement home,minces no words when he says that mental health treatment in years past had its flaws. But anyone looking back,he said,should also look hard at the present.

Institutions like the Oregon State Hospital,which he supervised for 30 years,might not have been perfect,he said,but they were trying to help. Today,he said,prisons have taken over the job. Three-fourths of all mentally ill people are in jails or penitentiaries.

But the new museum raises questions about what the hospitals themselves were created to do,and how many patients were mentally ill by modern definitions. In its early days,the museums records suggest,there was no pattern to admissions at all. Alcoholics,dementia patients,syphilis sufferers and others given the catch-all diagnosis of mania were all taken in.

That aspect has since been forgotten in the wave of harsh imagery in films and books like Cuckoos Nest,which was written by Ken Kesey and published in 1962.

The old model of an insane asylum coincided with an era that revered the value of work. Patients were expected to sew or cook or grow the food they ate because work itself was considered therapeutic,said Kathryn Dysart,a museum volunteer.

In the new hospital,music and art therapy areas line a corridor that includes rooms where patients can practise skills they will need when they are released. One was created to look like a bank and allows patients to withdraw funds. Other preconceptions about the outside world do not hold up so well. Fletcher,who won an Oscar for her portrayal of Nurse Ratchedthe film won five Oscars in 1976came to the Mental Health Museums opening last fall,and turned out to be very nice.

Charming lady, said Hazel Patton,the president of the museums board of directors.