Mental Facilities and The Treatment of Their Patients
One flew over the cuckoo’s nest – the book written by Ken Kesey in the year 1968 – is considered to be one of the most astounding stories of the twentieth century. Milos Forman directed a movie over this book in 1975. After the movie won the top five Oscar awards, the story attracted attention of the mass audience and won even more fans than previously. The topic in the book is described so impressively and clearly that the reader forgets sometimes that it is a fiction, not the real description of life in the mental asylum.  
The basis of the book lies in the story of a person who was put into the mental hospital, and shows the real life of those considered to be mentally ill. Ken Kesey impressively portrayed the separate world of one particular mental clinic with its society and inner lifestyle. The relations between medical personnel and patients (and among patients themselves), their intentions and feelings, their fears and dreams, joys and disappointments are illustrated with very skillful way. It may seem to the reader that the author has been there and has seen everything himself, as for McMurphy, nurse Ratched and other characters of the book are portrayed dramatically realistic.
The hospital is of no doubt very different from the mental facilities of the recent years in the United States of America. The book was written in the year 1962, thus the reader is facing the way of treatment for the patients in mental facilities of that period. Medical science and medical facilities of the time when the story takes place was drastically different in general. The methods and approaches in the treatment and procedures of patients, especially within mental health facilities, were changing and evolving constantly during several decades. Nowadays, the ways of sixties may seem strange and unusual in comparison with those of present days. But let us focus on what a mental facility is, and what is its purpose and its difference from the common health care facility.
Mental hospital, or psychiatric hospital, is a medical care facility specializing in treatment of the patients suffering from mental disorders ranging from light forms, like depression, to the chronic mental illnesses, like schizophrenia. Normally psychiatric hospitals, also named as asylums, represent a separate facility, but there also exist so-called psychiatric wards, which are parts of larger common hospitals. All the psychiatric hospitals obviously differ from the other ones. The main differences of the way mental facilities are designed are: the establishing of procedures to prevent suicide by patients (like avoiding high open windows, appliances with cords, and so forth). Second feature of the mental asylum is decreasing a measure of sensory stimulation for patients in order the place to be as quiet as possible; finally the third difference is providing normal environment for the patients (like allowing them to wear common clothes instead of some special kind of clothes like in many other hospitals). 
Psychiatric hospitals of the past had one primary difference in general from the mental facilities of now. Till the sixties-seventies of the twentieth century, psychiatric hospitals represented separate institutions not belonging to the general health care system. Before the integration of mental institutions into the sector of general health, all the mental facilities had separate administration and funding. Since the development of approaches of psychiatric treatment the situation has changed drastically. Mental health facilities in the USA now represent the system of medical care centers belonging to the Ministry of Health and integrated to the general health care sector. The efforts made since the 1960s had improved the overall situation in mental health care in the entire world. However, still it is not perfect, as for some countries are not able to provide free health care for all or provide very limited funding. In this case the reduced funding of hospitals may lead to the consequences for those patients who can not pay for the treatment. Lacking of resources, staff, treatment and documentary remedies may affect patients in the wrong way. 
In Ken Kesey’s book “One flew over the cuckoo’s nest” the hospital portrayed is the one belonging to the general health care system. Because there are patients with different kinds of disorders and various purposes and reasons of staying in the asylum, all kept together in the same department, we may see it easily. In the hospital with the separate funding it would not be allowed keeping together patient with suicide disorder, the one from prison, the one with family problems and the one having schizophrenia. The story holds place in the 1960s, it was the very period of changing the entire system of psychiatric health care, and the reader faces the consequences of these changes. 
Unlike the hospital described by Ken Kesey in the book, the mental facilities of the present time are divided much more specifically to the different kinds of health care units. Now there exist a great number of types of mental hospitals according to the causes and nature of disorder, the purpose of treatment, the extent and reason of illnesses, the patients themselves and differences between them (meaning age, social status, family status, biography and so forth). Below there are the most distributed types of mental hospitals and wards. Crisis stabilization units where the patients are placed initially are used when the emergency involuntary commitment procedures are needed. Open units are wards in some hospitals with less strict conditions than in the crisis stabilization units, where there are kept the patients considered to be not dangerous to self or others. Medium-term is the type of psychiatric facility used for treatment care lasting no longer than several weeks in order to see the effect of drugs taken by patient. Juvenile wards are separate parts of some psychiatric hospitals for the treatment of children separately, unlike many facilities that treat children and adults in the same units. Geriatric wards specialize in treating older people, providing the appropriate conditions for those with mental illness. Half-way houses are community-based institutions that provide voluntary living for patients for an extended term, that ere considered to be very efficient by many psychiatrists. There also exist separate Hospitals for prisoners with mental illness, the special kind of mental facility for long-term care for those people who have committed crimes, which represent a combination of both prison and psychiatric hospital. There is no doubt that at the present time Randle Patrick McMurphy from the book “One flew over the cuckoo’s nest” would has been put in such kind of mental hospital separately from the other patients. There are many other kinds of mental facilities specializing on various psychiatric disorders in the USA now.
The history of the psychiatric hospitals in general is rather vivid and full of numerous events that influenced the whole establishing of the system of mental facilities. It is also linked with the development of psychiatric sciences and social attitudes towards mental illnesses. As both were constantly evolving during last centuries and even last decades, the view on mental hospitals has been changed greatly over the time. For many centuries the psychiatric hospitals were known for the harsh treatment of their patients, until Phillipe Pinel, the French doctor, first offered more soft and humane methods of treatment of persons with mental disorders. The enlightened approach of treatment in the United States were first introduced by Dorothea Dix, who was considered to be the reformer in the attitude towards mentally ill persons. Nevertheless, till the middle of the twentieth century the methods of treatment for people with mental illnesses were first of all headed not to the therapeutic effect for the patient but to the preventative effect for the society. The most effective ways of treatment patients were considered to be electroshock, insulin shock therapy and lobotomy. These techniques are no longer used now because of their too cruel and radical approach. In Ken Kesey’s book, however, these methods are implemented very severely towards the patients. Remember McMurphy telling his mates about the electroshock therapy, “They was giving me ten thousand watts a day, you know, and I'm hot to trot!..” However, the drug treatment was already provided in that time, thus in the hospital described in “One flew over the cuckoo’s nest” the reader may notice that there was the medical drug treatment for patients implemented besides severe methods mentioned above. I may suppose that the medicine provided for the patients in the book consisted of thorazine and some antidepressants, first discovered and introduced in the 1950s. Because the efficiency of psychosurgery appeared to be of the great doubt, this technique was refined since the time the book was written and published. The application of psychosurgery was narrowed to the reduced number of patients with very specific diagnosis since the 1960s. At the present time the methods and techniques of treatment for mentally ill persons are much more enlightened with comparison to the one showed in the book, as for the view of the problem of treatment patients in mental facilities was developing towards more humane and mild ways.
Thus, as we can see, medical health care system in general, and the psychiatric care in particular have changed since the year 1962, when the book “One flew over the cuckoo’s nest” by Ken Kesey was written. The mental hospitals of the United States of America in the present time are divided into much more specific facilities with better conditions for patients with various types and extents of mental illnesses. The development of medical sciences has come to discovering new kinds of medicine and introducing new efficient techniques avoiding psychosurgery and severe shock therapies, like electroshock therapy and lobotomy described in the book. Therefore, the methods of treatment for persons with mental disorders have changed towards more humane remedies.
Bibliography
1. Kesey, K. One Flew Over the Cuckoo’s Nest. Signet Book; Reissue edition. 1989.
2. Trent, J.W. Inventing the Feeble Mind: A History of Mental Retardation in the United States. University of California Press. 1995.
3. Valenstein, E. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. Basic Books. 1986.
4. Beard, J., Hayter, D., Shenkar, E. The Diagnosis and Treatment of Mental Illness: An Introduction. Wayne State University Press. 1989.
5. Horwitz, A. The Eclipse of State Mental Hospital: Policy, Stigma and Organization. The Article from the Journal of Social History. 1998.