Ken Kesey and the Rush to Deinstitutionalization

Whatever the literary strengths of One Flew Over the Cuckoo’s Nest, the book has done much to harm both the mentally ill and their communities.

This May the Kule Institute is organizing a hybrid exhibit/symposium on the Institution of Knowledge. We are bringing together a group of artists and thinkers to raise and address questions about institutional structures and knowledge. One question that the small group I’m part of discussed this week as the question of deinstitutionalization and the view, best captured by Ken Kesey in One Flew Over the Cuckoo’s Nest that asylums as institutions were sites that did more harm than good. Stephen Eide has a nice article about this, Ken Kesey and the Rush to Deinstitutionalization (Quilette, Nov. 14, 2022).

There are a number of aspects to the issue. The first thing to note is that the deinstitutionalization of people with serious mental health issues didn’t work as imagined. It was not the freeing of an oppressed constituency back to the community where the new drugs could help them integrate and get on with their lives. There wasn’t really a community that wanted them other than the street and many ended up in the very institutions asylums were meant to replace – prisons. Stephen Eide’s book Homelessness in America traces the effects of deinstitutionalization, changes in vagrancy laws, and the “cleaning” up of slums on homelessness leading to the problem as we see it today.

But what about the idea of deinstitutionalization? Important to this idea would be Foucault, changes in psychiatry and how the discipline conceives of the role of medicine (and its institutions), and changes in public policy and what jurisdictions try to do with institutions.

One aspect of the issues that we forget if we think of institutions as bureaucracy is the built presence of institutions. From Jefferson’s design of the campus of the University of Virginia to Olmstead’s asylum landscapes, architects have shaped our imagination and the literal structures of certain types of institutions. This raises the question of what new types of institutions might be in being designed?