Bromden In The Movie One Flew Over The Tuckoo's N

Running Header: Avoidant Personal Disorder

Psychological Assessment of Chief Bromden from the movie “One flew over the cuckoo’s nest”: Avoidant Personal Disorder
by
Viktoria Kirichenko

Psychology: Basic Processes of Behaviour
To: Professor Sarah Farwell

Conestoga College, 2014
Abstract
This report will discuss one of the main characters of the movie “One flew over the cuckoo’s nest” – Chief Bromden, in detail to help better understand his mental health problems shown in the movie. We diagnosed him with an avoidant personal disorder, and in the report we will describe this disorder and its symptoms. We will relate these symptoms to Chief Bromden and discuss specific scenes which illustrate our diagnosis. We will also recommend

the proper treatment for a patient with avoidant disorder. The report is based on the information retrieved from the DSM-IV, A Parallel Process Growth Model of Avoidant Personality Disorder Symptoms and Personality Traits, Complex case: Avoidant Personal Disorder.

Introduction
Avoidant personality disorder is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation that begins at early adulthood and is present in a variety of contexts (The American Psychiatric Association, 2000).
Chief Bromden is a patient of the psychiatric clinic, pretending deaf-mute and out of mind character. He has been in a clinic for many years, and feels very comfortable there.
Many years ago, his father was a chief of an Indian community, but he was turned into an alcoholic by white people who wanted to get his tribe’s land. Bromden had a normal life when he was a kid: played football and went to school. Gradually he started to avoid the society that destroyed his father’s life and spent more and more time alone. We can see that the first symptoms appeared in his early adulthood, as the DSM-IV states. Later on he got into the mental illness clinic, and was being treated as a mentally ill person.
Trying to avoid taking medication, including lobotomy, Chief pretends deaf and speechless calm patient, who does not understand what is happening around and maintains this image for many years. Nurses and janitors see how humble and submissive he is and use him as a free workforce: making him sweeping and mopping floors in the clinic.
He had been living like that for a long time, unless the new patient – Randle McMurphy appears in the clinic. Randle McMurphy, a recidivist anti-authoritarian criminal serving a short sentence on a prison farm for statutory rape of a 15-year-old girl, is transferred to a mental institution for evaluation. McMurphy establishes himself immediately as the leader, and starts a war against the nurse Mildred Ratched, and her cruel rules and orders. Chief watches how McMurphy interacts with the men, what McMurphy is trying to do, and how the staff reacts. Because Chief pretends to be deaf and unable to speak, people talk freely around him, allowing him to learn their secrets. Although he appears powerless, he actually has a lot of power because of all the knowledge he’s gained through observation and listening in on conversations.
McMurphy is so charismatic, and he gives Chief hope that life outside is not as bad as he imagines.

Eventually, Chief reveals that he can talk and hear perfectly. Chief tries to protect McMurphy all the time, but eventually he fails to protect the man, and McMurphy finally returns to the ward as a lobotomized vegetable. Chief frees him from the physical prison of his body by smothering him with a pillow. Because of McMurphy, Chief finally has the courage to break free from the hospital and escapes through a window after breaking it the way McMurphy tried to.
One of the articles indicates, that the core pathology of avoidant personality disorder (AVPD) centers on a keen sensitivity to interpersonal rejection, exquisite fears of humiliation and judgment, and accordingly, avoidance of social and interpersonal situations, especially when it involves new people or new situations (Wright A.G, Pincus A.L., 2014). We can see all these symptoms presented in the Chief’s behaviour, as he pretends to be deaf-mute for many years, tries to avoid other patients and especially McMurphy when he first got into the clinic.
Patients diagnosed with avoidant personality disorder, according to Toshimasa Maruto (2012), are unwilling to get involved with people unless certain of being liked. Chief Bromden definitely likes McMurphy, as Chief decided to disclose himself and started talking only in front of him. This movie scene shows how important McMurphy was to Bromden, and that he was accepted and

trusted by Chief.

Method
Initially we watched a few movies from the list of the proposed movies. We decided to choose a movie “One flew over the cuckoo’s nest” as the plot of the movie takes place in a mental clinic, so we could choose from a variety of characters with different mental disorders. We picked Chief Bromden as the hero of our interest, even though he is not a main character. The main character in this movie is Randle McMurphy, but he has no mental disorder as he was just pretending being mentally ill in order to avoid jail. Then we watched the movie for one more time to become more familiar with the character and diagnosis. During the second time, we made notes of all the important scenes, monologues and dialogs that can be useful for our report.
We read and analyzed a lot of relevant information regarding diagnosis of the character from the DSM-IV.

We had a look at the information in the textbook regarding personal disorders in general. We used Conestoga Library database to find relevant and interesting articles for our report and explore diagnosis in depth. This was helpful to determine which mental health disorder Chief Bromden suffers from based on the symptoms he demonstrates. The information from the two articles confirmed and exposed the description of the disorder from the DSM-IV. After gathering and analyzing all the information, we watched the movie once again to make sure our diagnosis was

correct.
We faced some difficulties while writing this report. First of all, the lack of enough knowledge and background in psychology, therefore it was difficult to determine the right diagnosis and its symptoms. Second, was the difficulty in understanding many articles, as the language and terminology for most of them are very scientific and professional.

Discussion
According to the DSM-IV, patients diagnosed with the avoidant personal disorder usually demonstrate the following behaviour:
• Avoid occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection;
• Restrain within intimate relationships because of the fear of being shamed and ridiculed;
• View self as socially inept, personally unappealing, or inferior to others;
• Unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.
Most of the facts about the Chief’s Bromden life we know from a few short dialogs with McMurphy. As most time of the movie Chief keeps silence and pretends being deaf-mute. Only in the second half of the movie we are able to get some information about his previous and current life, experience, thoughts, feelings and emotions.
Bromden was a son of a tribe’s chief, and was supposed to inherit the power and authority of his father. That would require him to socialize with all the people in his community and be in charge of everything. Being a leader is a huge responsibility and involves criticism of the leader’s actions all the time. We think that avoidant personality disorder started forming in Bromden’s early adulthood, when he started to realize that “white” people wanted to turn his father into an alcoholic and get his land. Bromden did not want to repeat the fate of his father and preferred to step away from the responsibility and possibility of being disapproved and rejected.
As a typical representative of an avoidant personality disorder, Chief avoided making new friends unless he was sure to be accepted without criticism. People with this disorder have difficulty talking about themselves, and withhold intimate feelings for fear of being exposed or shamed (The American Psychiatric Association, 2000). Chief had spent most of his life in the clinic, but had not talk to anyone and stayed away from the “social” clinic’s life. He had only been observing the other patients and staff, but avoided any personal contacts, until he met Randle McMurphy. Brombed felt that this an open-minded person who would not criticize but accept him the way he was. Before Chief talked to McMurphy first time for so many years, he demonstrated that McMurphy is being trusted and taken care of. He tried to protect him when he got into a fight with the black orderlies. Then he tried to protect McMurphy again when they were subjected to electroshock therapy. But ultimately, he did not succeed in protecting the man from lobotomy.
Individuals with avoidant personality disorder tend to be shy, quiet, inhibited and “invisible”; they expect that no matter what they do or say, others will see it as “wrong” and believe they are socially inept. The dialog between Chief and McMurphy, when he explains his theory about the way the world works demonstrates the symptom of being socially inept. Bromben’s theory is that the world is a big machine, which he calls the Combine, and everyone is just a part of this machine. When a part gets broken, it is sent to this hospital to be "fixed" and then be back to the machine. He doesn’t want to be a part of it. He protests against it pretending to be deaf and speechless.
Individuals with this disorder prefer restricted lifestyle, which is a result from their need for certainty and security; they are prone to exaggerate the potential dangers of ordinary situations (Wright A.G, Pincus A.L., 2013). These individuals do not like to be involved in any new activities. During the movie, we can see Bromden sweeping all the time, although with the physical power he has, he could be involved in any activity. When McMurphy wanted to play basketball with him – he refused and pretended he did not understand what McMurphy wanted. He could easily help McMurphy to move the marble sink and break the window for escape, but he did not do that. Eventually, this is how he escapes from the clinic, but at the time when McMurphy tried to do it, Chief was not ready to make any changes in his ordinary restricted lifestyle.
The character of Chief Bromden seems to demonstrate all of the major symtoms decribed in DSM-IV, such as avoiding occupational activities that involve interpersonal contact, restrain within intimate relationships, socially inept feelings and reluctant to take personal risks or to engage in any new activities.
The depiction of the disorder is partly consistent with what was read in the course. As there are so many personality disorders described in the DSM-IV, the course material cannot cover them all. The material covers the most frequent and complex disorders in details, such as antisocial, borderline, narcissistic, but not avoidant. DSM-IV states that the prevalence of avoidant personality disorder in the general population is between 0.5% and 1.0%; and about 10% of outpatients seen in mental health clinics.
The disorder impacts the characters day-to-day life significantly. All the scenes in the movie evidence that, as most of the movie Chief keeps silence when his voice is necessary (when McMurphy tries to watch a baseball game on TV and makes everyone vote for that), sweeps the floor and does not participate in any life of the clinic (he does not take part in everyday discussions about patients’ private lives and feelings).
The cause of avoidant personal disorder is unknown. Every case is individual, so psychotherapy would be the most effective treatment for the disorder. The most popular types of the therapy are psychodynamic therapy and cognitive behavioral therapy (www.healthline.com/health/avoidant-personality-disorder#Treatment6, 2014). Though, both are forms of talkative therapy that help a patient to become self-aware about his/her unconscious thoughts and find the cause of the disorder. In Bromden’s case, it would not be an option, as he pretends speechless and deaf. The best solution for him would be antidepressant medication, in our opinion.
We think that Sigmund Freud would try to find a cause of the disorder in the early childhood live of Chief Bromden. He might diagnose that Chief has problems developing his superego, as it develops through interactions with others (mainly parents), who want the child to conform to the norms of society. The superego restricts the desires of the id, taking into account morals and values from society. Chief Bromden rejects the norms and behaviours of the society, tries to avoid it and pretends deaf-mute.

Conclusion
The following report explores and describes one of the characters from the movie “One flew over the cuckoo’s nest” – Chief Bromden. We believe that the character suffers from avoidant personal disorder. Bromden demonstrates all the symptoms of the disorder: avoid occupational activities that involve interpersonal contact, restrain within intimate relationships, believes he is socially inept and unappealing, reluctant to take personal risks or to engage in any new activities. His acceptance of McMurphy as his the only one friend, proves the diagnoses the best, as before meeting McMurphy Bromden had kept silence for many years and had not shared his feelings and thoughts with anyone else. We believe that our diagnosis is correct, and Chief Bromden suffers from avoidant personal disorder.

References:
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.).

Maruta T., Matsumuto C. , Iimori M. (2012) Complex case: Avoidant Personal Disorder. Published online 6 August 2012 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pmh.1210

Wright A., Pincus A., Lenzenweger M. (2013). A Parallel Process Growth Model of Avoidant Personality Disorder Symptoms and Personality Traits. Personality Disorders: Theory, Research, and Treatment © 2012 American Psychological Association
2013, Vol. 4, No. 3, 230–238

http://www.healthline.com/health/avoidant-personality-disorder#Treatment6