Ms. Lopez
One Flew Over the Cuckoo’s Nest Diagnosis Exercise
As a new diagnostic team working on Big Nurse’s ward, you have been assigned the task
of reviewing the psychiatric diagnosis of the hospital’s longest resident, Chief Bromden.
Having come to the Chief’s file, you attempt to apply the criteria for a diagnosis of
paranoid schizophrenic to his behavior and condition.
You have been “observing” Chief Bromden by reading pages 3-18, and attached are your
“notes” derived from your observations. For each diagnostic symptom listed below, give
an example of the Chief’s behavior from your observations that you believe matches the
criteria and explain how or why it is the symptom. Give more than one example as
prompted.
Some Diagnostic Criteria for Paranoid Schizophrenia
I.
HALLUCINATIONS (a perception of something that is not really there that involves
any of the senses)
A.
Auditory (hearing voices, conversations, sounds, etc. that are not occurring)
1.
2.
B.
II.
Visionary (seeing events, etc. that are not occurring)
DISORGANIZED BEHAVIOR
A.
Restrictions on Fluency of Speech and Thought (limited speech, unclear
thoughts)
1.
2.
B.
Brief and Empty Vocalizations
III.
DELUSIONS (Erroneous beliefs that involve misinterpretations of perceptions and
experiences)
A.
Persecutory (being tormented, tricked, spied on)
1.
tormented
2.
tricked
3.
spied on
B.
Loss of Control over Mind/Body-Thought Withdrawal/Insertion (the belief that
an outside agent has the ability to take away or insert thoughts or force others
to act)
C.
Multiple and Organized Delusions (delusions that are many but are all
centered around a common, usually paranoid, theme)
1.
The Chief is primarily afraid of one kind of object:
2.
The Chief believes in a dangerous organization he calls:
Now, you are ready to write “a report” that explains why you concur with the
original diagnosis of paranoid schizophrenia for Chief Bromden. Cite at least
three criteria from the list to support your diagnosis. Use parenthetical
citations of page number only
NOTES
(3)
“Black boys in white suits up before me to commit sex acts in the hall and get it
mopped up before I can catch them.”
(3)
“When they hate like this, better if they don’t see me. I creep along the wall quiet
as dust in my canvas shoes, but they got special sensitive equipment detects my
fear and they all look up, all three at once ....”
(4)
“Hum of black machinery, humming hate and death and other hospital secrets.”
(4)
”machinery”
(5)
“She’s swelling up, swells till her back’s splitting out of the white uniform and
she’s let her arms section out long enough to wrap around the three of them five,
six times.”
(6)
“the Combine”
(6)
“But like always when I try to place my thoughts in the past and hide there, the
fear close at hand seeps in through the memory.”
(7)
“so loud it’s like no sound, everybody yelling at me, hands over their ears from
behind a glass wall, faces working around in talk circles but no sound from the
mouths. My sound soaks up all other sound.”
(7)
“They hold me down while she jams wicker bag and all into my mouth and
shoves it down with a mop handle.”
(8)
“It’s still hard for me to have a clear mind thinking on it.”
(10)
“He sounds like he’s way above them, talking down, like he’s sailing fifty yards
overhead ....”
(18)
“They’re fidgeting and twitching, responding to the dials in the control panel ....”