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When the producers of One Flew over the Cuckoo's Nest secured the Oregon State Hospital (OSH) for their use in the winter of 1974–75, they were thrilled. Director Milos Forman wanted realism, and the OSH had it to spare. Cold white rooms, gray light pouring in through tall grated windows, and pale worn floors betokened a veracity rarely seen in the screen asylum. The fact that Forman had a whole wing of the institution to himself to film in also reflected the state of patient care. The OSH census had declined from a mid-century high of over a thousand residents to somewhere between two hundred and three hundred persons. New drugs and new laws, compounded by a sustained critique of inpatient regimes, had drastically reduced census numbers. By the 1970s, mental hospitals faced a crisis of existential proportions. Forman's groundbreaking film about rebelling against institutions found its moment.
America in the 1970s shuddered with internal conflict, with battles over civil rights, labor, feminist and gay liberation, and foreign policy marking these years.1 Cuckoo's Nest tapped into this zeitgeist, offering what critic Rex Reed called “a metaphor that symbolizes the plight of the individual caught up in a computerized and inhuman system of incarceration where humans are numbers and lives are filing cabinets.”2 The carceral system specifically addressed in Forman's film was the mental institution, and the historical context of his critique was deinstitutionalization. Broadly defined, deinstitutionalization refers to the undoing of the brick-and-mortar full-time care institutions for people suffering serious mental illness. This decline was part of a process initiated by the advent of cheap antipsychotic medicines and laws that steered patients away from long-term care. New drugs, especially Thorazine (chlorpromazine), encouraged state legislators to opt out of costly personal treatments in favor of the quick fix of sedation, while laws such as the Community Mental Health Act of 1963 and Medicare/Medicaid shifted the emphasis of care outside institutional walls.3 The end result of these innovations, which correlated with and were reinforced by an unwinding of the government's commitment to welfare state solutions, was that people formerly treated via extended care increasingly found themselves relegated to cramped and decrepit single-residency apartments or even suffering exposure on the streets. The demise of...