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The Transformation of Doctor's Character from Book to Film

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Ken Kesey’s One Flew Over the Cuckoo’s Nest is part of a select club of books that yield both fantastic reads and excellent film adaptions. The movie is enjoyable even though it altered the book, both for the sake of brevity and for artistic flair. One of these changes from book to movie is in the character of Dr. Spivey. When transformed from book to movie, Dr. Spivey remains a minor character who appears only briefly in both, but plays a more crucial role in the movie because the movie focuses on McMurphy; here, Dr. Spivey’s actions directly impact McMurphy’s development.

Kesey’s book is narrated from the perspective of Bromden, an insane Native American who pretends to be mute. Bromden’s first person narrative works well in the book because it provides a candid account of the events in the asylum. However, Bromden’s narrative includes frequent hallucinations which make for interesting reading in the book, but would have been difficult to portray in the movie. The written word is highly suitable when we enter Bromden’s schizophrenic mind, but the medium of the movie cannot easily convey well such inner thoughts even if the audience were able to “hear” the thoughts. That may be why the movie uses the third person perspective and Bromden is dropped as the narrator. We know nothing about his internal thoughts and can only see what he and the other characters do. This change from book to film was also necessary since one cannot have a mute character be the narrator without the benefit of seeing into the character’s mind. Bromden had to dropped as narrator in order for the move to be successful.

At the same time, the movie promotes McMurphy as protagonist. This is not surprising since the role of McMurphy went to Jack Nicholson, who was already a Hollywood star, with the potential to make this movie a blockbuster. Forman, the director of the movie, chose to focus on McMurphy’s character, and made him highly appealing to the audience. Whereas, in the book, the reader may have disliked some of McMurphy’s actions (most notably when he scams the ward out of money by having Chief lift the control console), viewers of the movie soundly support McMurphy, cheering him on in his rebellion against Nurse Ratched and the authorities. With such star power as Jack Nicholson’s, it is only natural that a director would want McMurphy to be the focus of the movie and push Bromden aside for most of the movie.

The difference in McMurphy’s role (between book and movie) is so sharp that it impacts the role of minor characters such as Dr. Spivey. In both book and movie, Dr. Spivey is in charge of diagnosing whether or not McMurphy is actually insane or if he is simply trying to get out of work. However, when carrying out this task, the doctor in the movie is quite different from that of the doctor in the book. The doctor is a somewhat weak character in the book, but strong in the movie. Further, his role in the movie (compared to the book) has a greater impact on McMurphy because McMurphy is the focus of the movie.

In the book, the doctor seems amused and delighted by McMurphy when he first meets him during the first interview. Bromden states, “He’s smiling a little as he turns through the folder, just as tickled by this new man’s brassy way of talking right up as the rest of us, but, just like the rest of us, he’s careful not to let himself come right out and laugh.“(45). Later in the book. Dr. Spivey becomes friendly towards McMurphy when he realizes that McMurphy and he went to same high school. Dr. Spivey is not so easygoing in the movie.

In the book, at a meeting with the interns and Nurse Ratched, Dr. Spivey shows he is too afraid to take a decision about McMurphy and, instead, he asks the others for their opinion of McMurphy: “[H]e is a disturbing factor, that’s obvious. So—ah—as I see it, our course in this discussion is to decide what action to take in dealing with him. I believe the nurse called this meeting—correct me if I’m off base here, Miss Ratched—to talk the situation out and unify the staff’s opinion of what should be done about Mr. McMurphy?”(133). Nurse Ratched called the meeting in the first place and the meeting not only implicitly focuses on pleasing her but ends up with the nurse taking over and having her way.

On the other hand, in the movie, during both interviews with McMurphy, Dr Spivey is professional and decisive. During the first interview in the movie, the doctor speaks plainly to McMurphy: “Well, you’re here for a ninety-day observation period, Mister McMurphy. I’d like you to understand you are here on a court order and we are responsible to the state. So, I’d like your cooperation.” During the second interview, he calls McMurphy out on faking insanity: “Yes, that may be so, but in making a careful study of your past record, along with your behavior since you arrived here, my feeling is that you are not mentally ill and it is going to be my recommendation that you be returned to Pendleton where they are better equipped to handle your case.” Dr Spivey does not waver nor relent when McMurphy protests that he is insane. The doctor insists that McMurphy should be discharged from the asylum despite the fact that the two most influential characters in the movie, McMurphy and Nurse Ratched, disagree (albeit for different reasons).

In a clear departure from the book, Dr. Spivey is on the side of the authorities in the movie, and is an opponent to McMurphy. This shift is apparent in Dr. Spivey’s interviews with McMurphy, which force McMurphy to take a more aggressive stance and break more rules, and face serious consequences. McMurphy is lobotomized and Bromden is so shaken that he kills McMurphy and escapes the asylum. Dr. Spivey’s medical decision causes the downfall of McMurphy and led to Bromden’s actions at the end of the movie when he kills McMurphy and escapes. While clearly a horrible act, this shows his strong influence in the movie.

Another difference from book to movie is in the doctor’s reactions to Nurse Ratched. In the book, the doctor is deferential towards the Nurse and even afraid of her. Harding says, “Doctor Spivey … is exactly like the rest of us, McMurphy, completely conscious of his inadequacy. He’s a frightened, desperate, ineffectual little rabbit, totally incapable of running this ward without our Miss Ratched’s help, and he knows it. And, worse, she knows he knows it and reminds him every chance she gets” (59). It is also implied that the doctor is a drug addict and afraid that the nurse will report him and get him fired. He does not want to lose his job; therefore he keeps quiet and lets her run the ward her way until McMurphy comes along and inadvertently empowers the doctor. Before long, Dr. Spivey allows the patients to have recreational privileges and even hosts the fishing trip for the ward despite Nurse Ratched’s campaign against it. The doctor in the book is finally able to use his vision of proper psychiatric treatment which certainly doesn’t involve Nurse Ratched’s coercion and bullying. The doctor in the book even refuses to resign after Billy’s suicide and McMurphy’s attack on Nurse Ratched, a change of personality that might have been caused by watching McMurphy rebel. In contrast, in the movie, Dr. Spivey is clearly on the side of the authorities throughout.

Dr. Spivey plays an important role in both the text and the movie, despite the small role that he is given. His role is that of an authority figure and he uses his authority to strongly impact the actions of the main character in the movie. However, he has less impact in the book on McMurphy’s character development.

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The Transformation of Doctor’s Character from Book to Film. (2018, May 06). GradesFixer. Retrieved October 24, 2021, from
“The Transformation of Doctor’s Character from Book to Film.” GradesFixer, 06 May 2018,
The Transformation of Doctor’s Character from Book to Film. [online]. Available at: <> [Accessed 24 Oct. 2021].
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