As a villain, Nurse Ratched is legendary. That’s not meant to be facetious: She’s No. 5 on the American Film Institute’s list of the 100 biggest villains of all time (after Hannibal Lecter, Norman Bates, Darth Vader, and the Wicked Witch of the West). As the head nurse in the 1975 film One Flew Over the Cuckoo’s Nest—and the 1962 Ken Kesey book on which it was based—she runs her psychiatric hospital with seeming cruelty, doling out electroshock therapy and lobotomies as retribution for even the smallest infractions. She is the antithesis of R.P. McMurphy’s fuck rules, man antihero. She also may be the most legendarily misunderstood villain of all time.
It’s not that Mildred Ratched doesn’t do extremely unhelpful things to the patients in her care. It’s that the way she’s drawn as a character is, as the scholar Leslie Horst wrote in 1977, a manifestation of “male terror of women who have power.” Cuckoo’s Nest director Milos Forman wrote in his autobiography that Kesey’s novel portrayed her as “an order-mad, killjoy harpy.” As the head nurse, she is the one trying to get McMurphy et al. to conform to psychiatry’s definition of mental fitness. She represents capital-S Society trying to keep them down. It’s easy to forget, though, that while her methods may have been grotesque, she was operating within what she understood to be the parameters of treatment of mental illness at the time. She’s a counterbalance to Kesey’s central question about the nature of sanity. When McMurphy asks his fellow patients, “What do you think you are for Chrissakes, crazy or somethin’?” he’s really asking them to look around and see if what they’re doing is any less rational than pumping people full of drugs and/or denying them the chance to watch the World Series.
“I remember when I first saw the movie, years ago, thinking that she was absolutely a villain,” says Sarah Paulson, who is now playing Mildred in the new series Ratched. “Then, when I watched it before we started [filming], I thought, ‘You know, this is a woman who’s sort of a victim of a patriarchal infrastructure in this hospital.’ Some people might [push back on that] and get fired, and other people might think ‘I better toe the line.’ The ramifications and the consequences were devastating to many of the men under her care, but I had to believe, if I was going to play it, that she did it because she thought she was adhering to some kind of rule that she thought was most right.”
Ratched, which premieres today on Netflix, is an attempt to reclaim the iconic nurse’s legacy. Set in 1947, it traces how she went from someone who faked her way into taking care of soldiers during World War II to a nurse looking after patients in a Northern California psychiatric hospital. In doing so, it also attempts—only somewhat successfully—to examine both how mental illness is handled on-screen and in the world at large.
It’s an issue in need of some convalescence. USC Annenberg recently examined 100 films and 50 popular TV series and found that fewer than 2 percent of movie characters and some 7 percent of television characters dealt with mental health conditions, even though nearly 20 percent of the US population does each year. The results, which Annenberg published last year, found that those portrayals—or lack thereof—”dehumanize and trivialize” characters coping with mental health issues. It’s a problem that’s been going on for decades, largely because translating conditions like depression, schizophrenia, bipolar disorder, or any other condition onscreen is a “complicated thing to do,” says Donald Diefenbach, who is the chair of mass communication at UNC Asheville and whose research focuses on media portrayals of mental health. (It’s worth noting that some of Paulson’s best work, in movies like Martha Marcy May Marlene and shows like American Horror Story, has dealt with mental health.)
“One approach is to not address these issues at all, but then you’ve got symbolic annihilation, where people with mental disorders don’t exist in the world of media, and then they’re not important. That’s not a good thing,” Diefenbach says. “Then, when you go and portray somebody [with mental health issues], if there are no real consequences, there’s the criticism that ‘Wait, there are real hardships and there are real challenges,’ and it can feel overly sanitized. It’s also really easy to go too far the other way, where you’re just portraying somebody in a stereotypical way. It’s really tough to thread the needle.”
Ratched seems determined to avoid those pitfalls, yet it trips almost headlong into many of them. In its attempt to humanize Mildred Ratched, it presents her as someone who is empathetic and often horrified by the mistreatment of the patients at her hospital, where lobotomies, hydrotherapy, and other extreme procedures are overprescribed. Simultaneously, it also shows her using those very procedures—as well as all forms of manipulation and sabotage—to her own ends. When it’s later implied that her behavior results from childhood trauma, the message is only muddied more. Try as Paulson might (and she truly does; Sarah Paulson rarely falters), her Nurse Ratched ends up more well-rounded and sympathetic than she was in Cuckoo’s Nest, but she’s far from whole, and definitely not realistic. (I know, nothing is realistic in a Ryan Murphy production. More on that later.) Ratched’s shortcomings are only compounded by Ratched’s broader cast of characters, which include a murderer whose mental health becomes a political football in a game being played between the state’s pro-death-penalty governor and the hospital’s staff and a woman named Charlotte (Sophie Okonedo) who is struggling with dissociative identity disorder but who ultimately ends up being a plot device—a patient, and not much else.
If there is one point Ratched successfully makes, it’s holding a mirror up to the psychological community’s treatment of homosexuality. For years homosexuality was seen as a mental health disorder, and it wasn’t until 1973 that the American Psychiatric Association removed it from the Diagnostic and Statistical Manual, effectively depathologizing it. Ratched brings this to the forefront, “diagnosing” several characters with lesbianism, including Ratched, who effectively diagnoses herself after confronting her feelings for the governor’s assistant Gwendolyn (Cynthia Nixon). “One of the overarching themes of Ratched is not only the brutal treatments that were used against people who were deemed mentally ill, but what fell under the umbrella of mental illness,” Nixon says. “Obviously, we have all these examples of gay characters who were persecuted for their gayness, but I think the bigger umbrella is people who, for whatever reason, didn’t fit in a very narrow 1940s/1950s-acceptable box, and what our medical establishment chose to do about it.”
To Nixon’s point, Ratched does lay that groundwork, but because of the very nature of the show—it’s a horror-thriller with an ever-present Murphy-esque air of camp—it leaves many of the questions it presents unanswered, or answered poorly. Perhaps that is its aim: to, through grotesquery, point out the failings in how society treats, and has treated, those who are struggling. The kinds of institutions in Ratched and One Flew Over the Cuckoo’s Nest aren’t too far off from the goings-on at real mental health facilities in the early 20th century. “Straightjackets, forced medication, authoritarian staff—this was the reality, not some fantasy of the media,” says Stephen Hinshaw, a professor of psychology at UC Berkeley. “My father was placed in numerous such facilities from the 1930s through the early 1960s, nearly losing his life from neglect, beatings. State hospitals originated in the 19th century as alternatives to poorhouses or orphanages, based on theories of humanitarian care, but quickly became large, decrepit snake pits.” If anything, Ratched is, as Cuckoo’s Nest was, a plea to not dismiss what’s not understood. To learn and care, instead.
If that is the point, though, it’s only reached by leaving viewers ready to treat its characters better than the show does—and that’s not always how TV works. As Diefenbach says, “laying something bare in a campy way can take away its power.” When so few shows address mental illness head-on, it’s even more important that it’s done well. (Asked for examples, Hinshaw and Diefenbach both point to Claire Danes’ portrayal of bipolar disorder in Homeland as one that almost gets it right.) Ratched, with its high style and soapy drama, has its perks, but it ultimately doesn’t have a firm enough hand. “[As viewers], we are all affected, at least subconsciously, when we’re put in a mental hospital where horrible things are happening and there are horrible people on the patient side and the staff side,” Diefenbach says. “Even if we say, ‘Well, this is just make-believe,’ it’s going to do something deep in our heads.”