By Sarah Fonseca
Evan Romansky’s series Ratched is a brash effort that proves American psychiatric history and psychological horror make excellent bedfellows. A sight for sore eyes, the first season whittles through literature, pop culture, and medical history to form a proper canon around Nurse Ratched, the domineering antagonist from the 1962 novel One Flew Over the Cuckoo’s Nest. Author Ken Kesey’s sturdy character was first portrayed by Joan Tetzel on stage in 1963 and then Louise Fletcher on screen in 1975.
It’s a relief to see modern psychiatry treated with flamboyance and contempt, particularly where Ratched’s queer characters are concerned. In the same country where Ratched is set, debates rage on regarding queer healthcare, particularly where trans youth are concerned. Instigated by outlier scribes and two-bit politicians, this argumentation repeats the mistakes of lobotomy pioneer Walter Freeman, psychoanalytic puritan Arthur Krim, and reckless sex assigner John Money. No matter the era, our gravest regrets rest on the shoulders of black-and-white thinkers whose intellect has been poisoned by a desire to alleviate the phenomena by which their absolutist beliefs are inconvenienced. This culture war, like the mid-century one regarding queer pathology that this series explores, will be long. But we have sex, wit, history, and Ratched on our side.
In the show, Mildred is Marnie-esque—well-dressed and determined in skillfully-shoplifted Hitchcock minx finery—with a bottle of French fashion designer Jean Patou’s 1929 fragrance Moment Suprême eau de cologne on her motel vanity. Played by executive producer Sarah Paulson, Mildred boasts the same 1940s coiffure that Fletcher once described in a 1975 New York Times feature as “a symbol that life had stopped for her [Mildred] a long time again.” Yet in Ratched’s 1947, life is not yet over for our Angel of Mercy. Granted, Mildred is a hair late to the newest fashions by virtue of her 1941 fashion magazine object choices. Yet she is hardly démodé. Life, and her highest hopes for it, remain possible.
Having grifted her way into a job at Lucia State Hospital on central California’s coast, Mildred charms the ill-fated Dr. Richard Hanover (musical theatre actor Jon Jon Briones)—a neurotic, idealistic physician who is a tidy composite of lobotomist Walter Freeman and Kesey’s own pushover authority from One Flew Over the Cuckoo’s Nest, Dr. John Spivey. A familial foil comes in the shape of Edward “Eddie” Tolleson (Finn Wittrock), a sensitive serial killer to the tune of four priests, taken into Dr. Hanover’s so-called care. Eddie also happens to be Mildred’s equally traumatized foster care sibling. Of lesser significance but further narrative tension is the progressive California Governor George Wilburn (Vincent D’Onofrio) who mines Lucia State Hospital’s experimental treatments for progressive political gain. Mildred, always professional, two-times powerful men and even a female love interest, Governor George Wilburn’s press secretary Gwendolyn Briggs (played by IRL political instigator Cynthia Nixon), in her attempts to free her brother from the systems—the death row, the asylum—that claim him.
Ratched asks a question worth considering in 2021: How does one idealistic little white woman become an essential part of a devastating system? But another, more pressing line of inquiry hides in Mildred’s glamorous and imposing shadow: How does a system become a system? These are lines of thought that Romansky and his co-executive producers, Ryan Murphy and Paulson, have likely broken countless sweats over while probing the annals of American psychiatric history themselves; the history which the production occasionally exploits for the darkest of laughs.
But despite Ratched’s humor and well-adorned feminine characters, the series takes historical context as gravely as Kesey did. As Romansky’s brainchild began to take form, Murphy assembled a discerning team of writers to empathetically probe the Big Nurse’s own psyche. “Nurse Ratched is sort of a shorthand for barbarism,” the gay television tycoon explained to Vanity Fair’s Julie Miller the summer before the series’ premiere. “She became almost like a catchphrase for any sort of institutional abuse of power. What was interesting was trying to create an emotional character from a reputation that’s very cold…trying to figure out every little detail about her childhood, her relationships, her sexuality. Because when people think of Ratched, they think of her as shut-off and cruel and uncaring.” Instead, Murphy encouraged the team to take a probing approach, explaining to them that “abusers are people who have been abused.”
Guaranteed for at least another season as part of Murphy’s unprecedented $300,000,000 deal with Netflix, Ratched’s study of this field will soon eclipse that of the source novel. Within a few years’ time, we might just have a complete and deliciously indicting historiography of the American mental health establishment in our Netflix queues.
As Ratched opens, Mildred, an unlettered nurse who served in World War II and has a few diner waitress shifts under her belt, is driving to Lucia, California (population: 985). This tiny, windswept village is home to Dr. Hanover’s Lucia State Hospital. As she hugs the coast’s curves, here is what Mildred likely sees in her seafoam Ford’s rear-view mirror: the first psychiatric hospitals, including England’s notorious Bethlem “Bedlam” Royal Hospital, founded in the 1400s; Dorothea Dix’s activism that brought state-run asylums like Lucia to the United States beginning in the mid-1800s; the creation of insulin coma therapies to treat schizophrenia in the late 1920s; the purported curing of bipolar and depression with electroconvulsive therapy a decade later.
By 1947, modern medicine was on the move. It was unlike anything Mildred Ratched had seen in the pup tents during World War II, and psychiatry’s terrible wonders awaited her at Lucia. It is significant that Romansky’s Mildred is identified as a queer herself early on, as this makes her personally vulnerable for the cures that intrigue her; cures that she will perform on other characters in Ratched as closed captioning announces the “wet thud” of her medical grade ice pick. Mildred’s supportive role in the lobotomization and desistance of two lesbian patients suggests the depths of her own black-and-white thinking. Likewise, her enthusiasm suggests obliviousness of how widespread the lobotomy was becoming, to unreliable success: between 1949 and 1952, more than 50,000 Americans would go under the ice pick for everything from mild depression to homosexuality; many of them would still experience the original affliction, never mind others brought on by having a metal sheath indiscriminately plunged through the delicate bone of the eye sockets.
Several oral histories from those who witnessed abnormal psychology’s treatments devastating effects on lesbians like Mildred exist in the annals of queer history. Dr. Evelyn Hooker, a friend to homosexuals during a time when many were friendless, cautiously began studying gay men in her guest house to prove that they were not psychopathological. Her research was risky, but massively impactful in the years leading to homosexuality’s removal from the DSM. In her final years, Hooker encountered a grateful lesbian who was not given electroshock because her psychiatrist had read Dr. Hooker’s work. Many were not so lucky. The late Village Voice doyenne Jill Johnston remembered meeting a housewife in the 1940s who was ostensibly gay, but had been jerry-rigged heterosexual with a paperclip marriage and chewing gum psychiatry:
“[I had] the terrible suspicion that the professor’s devoted wife, who would sit with us at teatime knitting and chattering and had once been lobotomized (a popular operation performed particularly on women, if emotionally over-wrought by anything, in the forties and fifties), was living with her husband under false pretences,” Johnston observed.
Mildred’s issues notwithstanding, lobotomy’s heyday is best summarized in a scene from Martin Scorsese’s Shutter Island (2010). Like Ratched and the existing One Flew Over the Cuckoo’s Nest universe, the psychological thriller dwells on the false binaries between male and female, madness and sanity, delinquent and authority, nature and illness, nevermind the undue confidence or uncertainty we feel about the mental health of those who provide or bankroll its services. Ratched concerns itself with the institutionalized, yes. But also of interest are those of institutions.
Set in 1954, Shutter Island introduces us to Edward “Teddy” Daniels (Leonardo DiCaprio), a United States Marshal on the trail of a missing psychiatric patient at the secluded Ashecliffe Hospital near Boston Harbor. DiCaprio here plays a sort of little cousin to Jack Nicholson’s R.P. McMurphy. As a Marshal, Teddy is an all-too-human cog in the machine. To viewers, his personal baggage deceptively renders Teddy a trustworthy outlier within the facility’s status quo in lieu of one who might warrant an extended stay; a man whose mental state seems to deteriorate only as he spends time within the brick walls of the asylum.
In a scene with Ashecliffe’s physician Dr. John Cawley (Ben Kingsley) and Teddy’s partner Chuck Aule (Mark Ruffalo), Dr. Cawley asks the two Feds if they understand the new tectonic plates in motion in the mental health field. Both men demur. “War,” Dr. Cawley says flatly. “The old school believes in surgical intervention. Psychosurgery. Procedures like the transorbital lobotomy. Some say the patients become reasonable, docile. Others say they become zombies.”
“And the new school?” Chuck asks from the corner of his mouth.
“Psychopharmacology,” Dr. Cawley replies. “A new drug has just been approved called Thorazine, which relaxes psychotic patients, you could say, tames them.”
Teddy presses him. “And which school are you, Doctor?”
“Me?!?” Declares Cawley. “I have this radical idea that if you treat a patient with respect, listen to him, try, and, understand, you just might reach him.”
By the film’s end, Dr. Cawley will resort to the lobotomy both men resent.
Cawley’s stance, compassionate for its era, is one that Mildred, in her most idealistic moments, will assume during her time at Lucia State as Dr. Hanover throws every new-fangled treatment at his patients to see what sticks. “The Ice Pick” is one of the strongest episodes in Ratched’s first season. Directed by Murphy and written by his long-time collaborator and Glee whiz Ian Brennan, much consideration is given to the human spirit, its deepest longings, and their futile suppression. This is done by picking up the ice pick that Dr. Walter Jackson Freeman II finally put down in 1972 (only after an estimated 15% of the procedure’s patients died from state-sanctioned cranial rape). Who, it is tempting to ask, is the real serial killer in a television universe where one man kills four priests in one night and another gives four transorbital lobotomies in one day? When a period project’s historical queercoding as spot-on as the history it centers, rewatches are both necessary and wonderfully indulgent.
In an oyster bar scene dripping with queer innuendo so seductive that one might miss what is being said, Gwendolyn asks Mildred whether or not she genuinely believes the barbaric treatment can help people:
“So you believe in it?” Gwendolyn asks, cutting to the chase.
“What?” Mildred asks bluntly.
“The lobotomy. You really believe in it?”
“If it does what they say it does, yes, absolutely,” Mildred replies as confidently as Drs. Money and Hanover. “A disordered mind cannot ease its own suffering. A person can be burdened by certain impulses and drives that are destroying their lives.”
“But then, aren’t we playing God?” Gwendolyn presses. “Aren’t we saying that there’s one feeling that’s right and another feeling that’s wrong?”
Mildred pauses, the horrors of her own life bleeding into their rapport. “Well, there are rights and there are wrong, Mrs. Briggs. I believe that. I believe it because I’ve seen it.”
Mildred’s optimism, unfathomable today, was once shared by many Great Depression survivors during this era, when sanitariums overflowed with staff and patients impacted by poverty and several major international conflicts. In Kesey’s novel, there are four notable survivors of World War on the Big Nurse’s ward: R.P. McMurphy, germaphobe George Sorenson, the senile WWI survivor Colonel Matterson, and the Big Nurse herself. Oral histories like theirs are at the fore of “The Lobotomist,” a 2008 American Experience episode that examines the fallout from Freeman’s purportedly liberating procedure. In one interview, a medical scholar repeats Gwendolyn’s hesitant thoughts: “Is the absence of pain what we should look for? The absence of suffering. That’s what this [the lobotomy’s existence] raises. What do we value about being human?”
Later in the season, as Mildred — in a moment of touching compassion — helps two lobotomized lesbians into a getaway car speeding far, far, away from inhumanity, she begins to — finally — answer this question for herself; as we all should in this very moment.