The show Ratched on Netflix is set in a time where the biological model was used for understanding mental disorders and the only method of treatment was in-patient care in mental institutions. Most mental disorders were understood in physiological terms. This implies that the cause and therefore the treatment must be physiological. Mildred Ratched is a young woman in her late twenties, who fakes her identity to take care of the wounded soldiers in World War 2 as a nurse. She later ends up being the head nurse of Lucia State hospital for the mentally ill. Even though she isn’t licensed, she gets the job by blackmailing the psychiatrist in charge, Dr Hannover.
Ratched depicts the hospital staff abusing their position, with people being treated against their will and stripped of their dignity and choice. People with mental disorders like depression and schizophrenia were admitted to the facility. Homosexuals and people who didn’t fit the ‘normal criteria’ of society were also institutionalised. The nurses and physicians believed they were only doing what was required, even if it was harsh. Some patients benefit from a flathead screwdriver to the brain to prevent them from becoming insane. Hypnosis is used to treat one illness, LSD is used to treat another, and so on. Her ulterior motive of joining the hospital is made clear when she is vehemently in the favour of declaring a criminal, her brother, mentally ill. These reel descriptions make one ponder upon the ethical guidelines that the institutions in the twentieth century and the efficacy of the methods used for diagnosis and treatment.
Among the most terrifying treatments meted out to the patients, one of them involves administering LSD to a patient and replacing his limbs with the arms of another man; whom the patient had murdered. To provide more context this happened in the house of the patient, who was being treated for showing abnormal behaviour like burning and hitting the house staff. The administration of LSD, which is known to alter conscious thoughts, emotions and behaviour during the first interaction with the patient, who was otherwise harmless raises questions about the doctor’s method of diagnosis and treatment. In modern-day psychiatry, drugs are prescribed and administered only after a proper diagnosis and are deemed as a last resort of sorts when therapy and other forms of interventions fail. Further, this treatment was completely based on the physiological aspects and knowledge of the doctor. However, this fails to explain the exchange of limbs that ultimately led to a life-threatening infection in the name of psychiatric treatment.
Another tool used in the show is hydrotherapy. The shock of being immersed in hot or cold water was believed to shock the patient out of their illness, with a paper from London Asylum, Ontario, claiming to have found success in 1910. In a disgusting attempt to "cure" a lesbian girl of what was then considered a psychological condition, hydrotherapy is used.
The nurse places the patient in a large tub filled with hot water, seals her in with two metallic coverings, and raises the water's temperature. After spending some time in the extremely hot water, the patient is transported to a separate tub filled with ice for 5 minutes.
In an effort to avoid having to undergo yet another round of therapy, the patient claims to be "cured" afterwards. This is an example of negative reinforcement; only after they stop thinking and acting in this way, they are permitted to go into an ice bath. Following that, the women are shown to be quite wary of other women, especially those with whom they have had close relationships. Her refusal to even acknowledge the women she was intimate with depicts her fear of the treatment and how she’d go to any lengths to avoid it. The treatment was not only torturous and inhumane but also led to further trauma for the patient for acknowledging their sexuality. A patient who is already in a fragile state of mind because of the institutionalisation and treatment by society, this form of ‘therapy’ only dilapidated her condition. It wasn’t until 1973 that homosexuality was taken off of the list of disorders in the Diagnostic and Statistical Manual for Mental Disorder’s third version.
Present-day therapeutic interventions no longer use hydrotherapy and homosexuality and other non-heteronormative sexualities aren’t deemed as disorders. The ethics of the care provider come into question as she berates her patient for being homosexual and calls her names and how she deserves this treatment for being deviant. In the 20th century, the patients weren’t dealt with much care and the healthcare providers showed no empathy towards them. Talking rudely and even beating up the patients was considered normal until the moral management movement.
The last method of treatment for discussion is lobotomy. Dr Hanover mentions António Egas Moniz, the neurologist who first proposed the lobotomy, claiming that psychiatric illness was caused by a disruption in frontal lobe connections. He performs the procedure in front of journalists and the governor in an open theatre. Hanover tries the process using a drill at first, but after severe reactions to the large amounts of blood, he switches to the more 'sophisticated' method of putting an ice pick into the top of the eye socket with a hammer. This sounds unprofessional and dangerous, considering the low amount of control on multiple variables present in the operation theatre. This was also a time when lobotomies were performed for a broad variety of mental conditions, without looking at other alternatives that were safer and less invasive. Other problematic aspects include the use of non-medical tools like a manual drill and an ice pick. There is no surety if they are completely sterile and suitable for such sensitive medical procedures. Later in the show, lobotomy fails to resolve the ‘issue’ it was performed for and a patient also ends up losing his life and the hospital took no accountability for it. Further in the episode on lobotomies, the nurse, Ratched performs a lobotomy on a priest who was a witness in her brother’s criminal case. His behaviour changed drastically and he no longer seemed sure of what he had witnessed. This is a clear abuse of medical knowledge and a violation of the ethics of a medical practitioner.
Thus apart from the drawbacks of the biological model of understanding mental health, the show also throws light at the treatment meted out to patients during the time. The methods of treatment that the patients had to go through were degrading, inhumane and most often against their will. With reforms like deinstitutionalisation and the moral management movement, the condition of mental institutions has become much better and practitioners are now more accountable and are better trained.
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