The rise of the circuit-based human

Image from Sociedad Española de NeuroCienciasI’ve got a piece in The Observer about how we’re moving towards viewing the brain as a series of modifiable brain circuits each responsible for distinct aspects of experience and behaviour.

The ‘brain circuit’ aspect is not new but the fact that neuroscience and medicine, on the billion-dollar global level, are reorienting themselves to focus on identifying and, crucially, altering brain circuits is a significant change we’ve seen only recently.

What many people don’t realise, is the extent to which direct stimulation of brain circuits by implanted electrodes is already happening.

Perhaps more surprising for some is the explosion in deep brain stimulation procedures, where electrodes are implanted in the brains of patients to alter electronically the activity in specific neural circuits. Medtronic, just one of the manufacturers of these devices, claims that its stimulators have been used in more than 100,000 patients. Most of these involve well-tested and validated treatments for Parkinson’s disease, but increasingly they are being trialled for a wider range of problems. Recent studies have examined direct brain stimulation for treating pain, epilepsy, eating disorders, addiction, controlling aggression, enhancing memory and for intervening in a range of other behavioural problems.

More on how we are increasingly focussed on hacking our circuits in the rest of the article.
 

Link to ‘Changing brains: why neuroscience is ending the Prozac era’.

A comic repeat with video games and violence

An article in the Guardian Headquarters blog discusses the not very clear evidence for the link between computer games and violence and makes a comparison to the panic over ‘horror comics’ in the 1950s.

The Fifties campaign against comics was driven by a psychiatrist called Fredric Wertham and his book The Seduction of the Innocent.

We’ve discussed before on Mind Hacks how Wertham has been misunderstood. He wasn’t out to ban comics, just keep adult themes out of kids magazines.

However, his idea of what ‘adult themes’ might be were certainly pretty odd. This is Wertham’s testimony to a hearing in the US Senate.

I would like to point out to you one other crime comic book which we have found to be particularly injurious to the ethical development of children and those are the Superman comic books. They arose in children’s fantasies of sadistic joy in seeing other people punished over and over again, while you yourself remain immune. We have called it the “Superman complex.” In these comic books, the crime is always real and Superman’s triumph over [evil] is unreal. Moreover, these books like any other, teach complete contempt of the police…

I may say here on this subject there is practically no controversy… as long as the crime comic books industry exists in its present form, there are no secure homes. …crime comic books, as I define them, are the overwhelming majority of all comic books… There is an endless stream of brutality… I can only say that, in my opinion, this is a public-health problem.

The ‘Superman causes sadism’ part aside, this is a remarkably similar argument to the one used about violent video games. It’s not a matter of taste or decency, it’s a public health problem.

In fact, an article in the Mayo Clinic Proceedings had a neat comparison between arguments about 1950s comic books and modern day video games which turn out to be very similar.

Moral of the story: wait for sixty years when the debate about violent holograms kicks off and they’ll leave you to play your video games in peace.
 

Link to ‘What is the link between violent video games and aggression?’
Link to article on video games and comic panics in Mayo Clinic Proceedings.

A coming revolution walks a fine line

The Chronicle of Higher Education has an excellent in-depth article on the most likely candidate for a revolution in mental health research: the National Institute of Mental Health’s RDoC or Research Domain Criteria project.

The article is probably the best description of the project this side of the scientific literature and considering that the RDoC is likely to fundamentally change how mental illness is understood, and eventually, treated, it is essential reading.

It is also interesting for the fact that the leaders of the RDoC project continue to hammer the reputation of the long-standing psychiatric diagnosis manual – the DSM.

First though, it’s worth knowing a little about what the RDoC actually is. Essentially, it’s a catalogue of well-defined neural circuits that are associated with specific cognitive functions or emotional responses.

If you look at the RDoC matrix you can see how everything has been divided. For example, stress regulation is associated with the raphe nuclei circuits and serotonin system.

The idea is that mental illnesses would be better understood as dysfunctions in various of these core components of behaviour rather than the traditional collections of symptoms that have been rather haphazardly formed into diagnoses.

Conceptually, it’s like a sort of neuropsychological Lego that should allow researchers to focus on agreed components of the brain and see how they map on to genes, behaviour, experience and so on.

It’s meant to be updated over time so ‘bricks’ can be modified or added as they become confirmed. An advantage is that is may allow a more accessible structure to understanding the brain for those not trained in neuroscience but there is a danger that it will over-simplify the components of experience and behaviour in some people’s minds (and, of course, research).

The RDoC has been around for several years but it recently hit the headlines when NIMH director Thomas Insel wrote a blog post promoting it two weeks before the launch of the American Psychiatric Association’s diagnostic manual, the DSM-5, saying that the DSM ‘lacks validity’ and that “patients with mental disorders deserve better”.

After a media storm, Insel wrote another piece jointly with the president of the American Psychiatric Association that involved some furious backpeddling where the DSM was described as a “key resource for delivering the best available care” and “complementary” to the RDoC approach.

But in the Chronicle article, head of the RDoC project, Bruce Cuthbert, makes no bones about the DSM’s faults:

“If you think about it the way I think about it, actually the DSM is sloppy in both counts. There’s no particular biological test in it, but the psychology is also very weak psychology. It’s folk psychology without any quantification involved.”

The DSM will not, of course, suddenly disappear. “As flawed as the DSM is, we have no substitute for the clinical realm for insurance reimbursement,” ex-NIMH Director Steven Hyman says in the article.

It’s worth noting that this is not actually true. In the US, diagnosis is usually made according to DSM definitions but insurance reimbursement is charged by codes from the ICD-10 – the free diagnostic manual from the World Health Organisation.

But the fact that the most senior psychiatric researchers in the US are now openly and persistently highlighting that the DSM is not fit for the purpose of advancing science and psychiatric treatment is a damning condemnation of the manual – no matter how they try and sugar-coat it.

The fact is, the NIMH have to walk a fine line. They need to both condemn the DSM for being a mess while trying not to shatter confidence in a system used to treat millions of patients every year.

Best of luck with that.
 

Link to Chronicle article ‘A Revolution in Mental Health’.

Peter Huttenlocher has left the building

The New York Times has an obituary for child neurologist Peter Huttenlocher, who surprised everyone by finding that the human brain loses connections as part of growing into adulthood.

Huttenlocher counted synapses – the connections between neurons – and as a paediatric neurologist was particularly interested in how the number of synapses changed as we grow from children to adults.

Before Huttenlocher’s work we tended to think that our brain’s just got more connected as we got older, but what he showed was that we hit peak connectivity in the first year of life and much of brain development is actually removing the unneeded connections.

This is know as synpatic pruning and it was demonstrated with this graph from classic 1990 paper.

I love this graph for a couple of reasons. Firstly, it’s a bit wonky. It was hand-drawn and whenever it is reproduced, as it has been in many textbooks, it’s always a bit off-centre.

Secondly, it’s crystal clear. It’s a graph showing the density of synaptic connections in the visual cortex of the human brain and you can see it’s rapidly downhill from the first year of life until the late teens where things start to even out.

This is a good thing as the infant brain starts over-connected but loses anything that isn’t needed as we learn which skills are most important, and we are left with only the most efficient neural connections, through the experience of growing up.

One of Huttenlocher’s discoveries was that this process of synaptic pruning may go wrong in people who have neurodevelopmental disorders.
 

Link to NYT obituary for Peter Huttenlocher.

Super-recogniser officers policing Europe’s biggest party

The Guardian are reporting that the London Metropolitan Police have deployed ‘super recogniser’ officers to Notting Hill Carnival to pick out known criminals from the crowd.

This is curious because this is a verified ability that has only recently been reported in the scientific literature.

It has been long known that some people have severe difficulties recognising faces – something called prosopagnosia and sometimes inaccurately labelled ‘face blindness’.

But more recently, it was discovered that a tiny minority of people are ‘super recognisers’ – with exceptional face recognition abilities – meaning they can pick out a previously identified face from huge numbers of possibilities.

A more recent fMRI study found that super recognisers tend to show a greater level of activity in the fusiform gyrus.

This area is heavily associated with face recognition, although debates are ongoing whether it is face-dedicated or just specialised for learned fine-grained visual recognition of various sorts.

It’s not clear how the Met Police identified their ‘super recogniser’ officers but it seems it might be an interesting exercise in screening for key neuropsychological characteristics and deploying those officers to the appropriate task.

Needless to say, picking out a few dodgy faces from a street party that welcomes a million people every year would be exactly this sort of job.

More details from the The Guardian report:

…17 specialist officers will be holed up in a central control room several miles away in Earls Court monitoring live footage in an attempt to identify known offenders.

Chief superintendent Mick Johnson from the Metropolitan police said it was the first time the “recognisers” – who have been selected for their ability to remember hundreds of offenders’ faces – have been used to monitor a live event.

“This type of proactive operation is the first one we have done in earnest in real time so we are going to be looking at it very closely to see how effective it is and what we get out of it,” he said.

The Met has 180 so-called super recognisers – most of whom came to the fore in the aftermath of the London riots when they managed to identify more than a quarter of the suspects who were caught on CCTV footage…

One of the super recognisers on duty will be Patrick O’Riordan, who says he has had an ability to pick people out in a crowd and recall faces since he joined the Met 11 years ago.

“It is with me all the time. Often when I am on a day off or out with my girlfriend I will see someone and know straight away who they are and where they fit in,” said 45-year-old. “It could be their eyes or the shape of their forehead or their gait, but something usually sticks with me. It something that started from day one as a police officer – really it is just something that I took too naturally.”

 
Link to Guardian article on super recogniser officers at the Carnival.
Link to summary of study that identified ‘super recognisers’.
pdf of full-text of the same paper.

#DearMentalHealthProfessionals

Photo by Flickr user William Arthur Fine Stationery's. Click for source.Just a quick post to say that the #DearMentalHealthProfessionals hashtag on Twitter is one of the most interesting and helpful things I’ve read online in a long time.

It contains heartfelt feedback, gratitude, anger, and useful insights and makes for essential reading.

If you don’t use Twitter you can read it live here and some of the responses have been archived here.

A half hour of hallucinations

I’m on the latest PLOS Mind the Brain podcast discussing the science of hallucinations with the inimitable Ruchir Shah.

We cover everything from the experience of ‘hearing voices’ and its relation to mental illness to how chemists are pioneering new variations of psychoactive substances to get around drugs laws.

In this podcast, we discuss one of Vaughan’s clinical research interests, which is hallucinations. What are they, and how are they diagnosed? We start by discussing some examples of hallucinations, and why auditory and visual hallucinations might be more common than other types, like taste or smell hallucinations. We then discuss the role that culture might play, and the interesting phenomenon that certain types of hallucinations are actually more common in specific countries.

When then move on to another of Vaughan’s academic interests, that of psychoactive drugs, and their potential relationship to hallucinations and psychosis. Finally, we end with a discussion about designer drugs, and how labs all over the world are synthesizing new psychoactive compounds much faster than governments could possibly ban then, effectively making the “war on drugs” irrelevant.

A thoroughly enjoyable discussion which you can download from the link below.
 

Link to hallucinations in Mind the Brain podcast Episode 3.

A concise, solid grounding in neuroscience

50IdeasHumanBrainI often get asked ‘how can I avoid common misunderstandings in neuroscience’ which I always think is a bit of an odd question because the answer is ‘learn a lot about neuroscience’.

This is easier than it sounds, of course, but if you want a solid introduction, a book by Mo Costandi called 50 Human Brain Ideas You Really Need to Know is an excellent starting point.

If you recognise the name Mo Costandi its because he has been writing the brilliant Neurophilosophy blog for the best part of the last decade as he’s moved from being a neurobiologist to a science journalist.

The book consists of 50 four page chapters each of which condenses a key area of neuroscience in a remarkably lucid way.

There is no pandering to the feint of heart in the selected topics (from free will to neural stem cells) but neither is there a glossing over of conflicting evidence or controversy.

You won’t get poorly researched hype here about ‘mirror neurons’ being ‘responsible for empathy’ or brain scans showing how the brain ‘lights up’ but you will get a concise, balanced and entertaining introduction to key concepts in neuroscience.

It’s worth noting that the book does not hand-hold you. It’s not a complete beginners guide. It’s aimed at a ‘smart high-school kid and up’ level but if that’s you, and you want to get to grips with the brain, this book is ideal.
 

Link to more details on 50 Human Brain Ideas You Really Need to Know.

Shuffle Festival

A festival of music, film and neuroscience is about to kick off in an abandoned psychiatric hospital in East London. Called Shuffle Festival, it runs from the 8th – 18th August.

It is happening in the old St Clement’s Hospital on Mile End Road and is being curated by Oscar winning film director Danny Boyle.

If you check the programme, August 11th is the ‘Day of the Mind’ where during the day you can enter for free and experience a host of neuroscience events, stalls and experiments.

Later in the evening there is an event with Ruby Wax, following by an extract of Luke Fowler’s R.D Laing documentary All Divided Selves.

After I’ll be taking part in a discussion about the legacy of R.D. Laing, neuroscience and mental health and later in the evening there’s the inevitable showing of One Flew Over the Cuckoo’s Nest.

The story of how I got involved in the event is a little curious. One Saturday, I decide to walk from Kingsley Hall, the location of R.D. Laing chaotic 60s experiment in mental health care, to Liverpool Street Station, the location of the original ‘Bedlam’ hospitals.

As I was passing St Clement’s Hospital I noticed some folks on the inside, shouted until I get their attention and asked if they could let me in. It turns out it was the organiser and friends scoping the place out.

I got to take some great photos, gave them my email address and despite starting the day by yelling excitedly at them, they’ve asked me to speak.

By the way, I’ve had a morbid interest in charting how some of London’s biggest Victoria asylums have been converted into luxury apartments but after the festival St Clement’s is going to be turned into affordable housing for East London which makes a nice change.

If you’re interested in the Shuffle Festival, a lot of the events are selling out quickly so grab tickets while you can.
 

Link to Shuffle Festival.

Life of a Neuro Pope

The late Pope John Paul II is to be made a saint by the Catholic church after having two miracles confirmed – both of which allegedly involved curing neurological disorders.

As Popes go, John Paul was particularly interested in neuroscience and seems to have continued his interest in the, er, afterlife.

His post-mortem miracles have allegedly involved, on one occasion, curing a woman of a ‘brain aneurysm’, and on another, curing a nun of Parkinson’s disease.

The neurosurgeon involved in the latter cases was recently interviewed about the case to explain why he thinks it was a miracle – rather than, for example, a misdiagnosis.

However, this was not the first time it was claimed that the late Pope miraculously aided a neuroscientist. He beatified 17th Century neuroscientist Nicolas Steno who became the first brain specialist to start his journey toward sainthood.

Pope John Paul II also commented on neuroscientific issues. He defended dualism – the belief that the mind and brain are separate entities in a 1996 address, saying:

Consequently, theories of evolution which, in accordance with the philosophies inspiring them, consider the mind as emerging from the forces of living matter, or as a mere epiphenomenon of this matter, are incompatible with the truth about man. Nor are they able to ground the dignity of the person.

But perhaps paradoxically he also supported the medical consensus on death being ‘brain death’ rather than respiratory failure – noting in the year 2000 that the “complete and irreversible cessation of all brain activity” was an acceptable definition.

However, this issue clearly troubled him for some time after, because in 2006 he convened a conference of medics and neuroscientists to debate exactly this issue, producing the famous ‘Signs of Death’ publication from the Vatican.

He also commented on cases of people in coma-like persistent vegetative states, saying that even without their ‘higher functions’ that may have been affected by brain damage, they should be always be treated to keep them alive.

John Paul’s interest in the brain may have had a personal aspect. He developed Parkinson’s disease himself which was not made public for many years.

Nevertheless, he was not the first Pope to have a neurological disorder. Pope Pius IX had epilepsy – something else which was barely mentioned by the Vatican during his time as the head of the Catholic Church.

In fact, even now they only describe his condition as “a disease not well diagnosed, which some called epilepsy” – possibly because it is still associated with possession by cultures across the world.

The Connected Brain: Edinburgh

From Flickr, click for link

I’m giving at talk at the Edinburgh festival on August 9th, called The Connected Brain. It will be at Summerhall (Fringe Venue 26 during the festival), cost £3, and here is the blurb:

Headlines often ask if facebook is making us shallow, or google eroding our memories. In this talk we will look “under the hood” of research on how digital technology is affecting us. We will try and chart a course between moral panic and techno-utopianism to reveal the real risks of technology and show how we can cement the great opportunities that it presents for the human mind.

The talk will be similar to the one I did in London recently at the School of Life. Ben Martynoga wrote up some details of that talk, which you can find here. The ideas in the talk involve using some examples from the Mind Hacks book to illustrate some principles of how the mind works, looking at the extended mind hypothesis and reminding ourselves of some of the history of moral panics around information technologies, which Vaughan has written so engagingly and often about (thanks Vaughan!). The place I get to, which is where I’m at with my thinking and where I hope to start a discussion with the audience, is that, rather than panic about technology making us dumb, distracted and alone, we need to identify the principles which will help us design technology which makes use smart, able to concentrate and empathetic.

So that’s, me + Edinburgh + August the 9th. Link for tickets : The Connected Brain

Is social psychology really in crisis?

My latest ‘behind the headlines’ column for The Conversation. Probably all old news for you wised-up mindhacks.com readers, but here you go:

The headlines

Disputed results a fresh blow for social psychology

Replication studies: Bad copy

The story

Controversy is simmering in the world of psychology research over claims that many famous effects reported in the literature aren’t reliable, or may even not exist at all.

The latest headlines follow the publication of experiments which failed to replicate a landmark study by Dutch psychologist Ap Dijksterhuis. These experiments are examples of what psychologists call “social priming”, which is a phenomenon where people who are exposed to ideas unconsciously incorporate them into their behaviour. So people who are reminded of old age are reported to walk slower, and people asked to think about university professors do better on a trivial pursuit knowledge test.

What they actually did

The first of Dijksterhuis’ original experiments asked people to think about the typical university professor and list on paper their appearance, lifestyle and behaviours. After this they answered 42 questions taken from Trivial Pursuit.

The experiment found that people who had thought about professors scored 10% higher than people who hadn’t been primed in this way. In this latest report, David Shanks, Head of the Division of Psychology and Language Sciences at University College London and colleagues tried to replicate this effect in nine separate experiments. They didn’t find the effect in any of their experiments, which they suggest calls into question the validity of the original research.

How plausible is it

It’s extremely plausible that people are influenced by recent activities and thoughts – the concept of priming is beyond question, having been supported by decades of research.

What’s less established is whether these effects are really “unconscious” (whatever that means) and whether sophisticated concepts like intelligence can really worm their way into our behaviour in such a profound way.

Tom’s take

The headline reporting of this spat is misleading – there’s nothing worrying about disputed results for social psychology. The process of affirming, disputing and denying results is part of the normal part of science. What is worrying is that this failed replication comes on top of other failed replications of famous social priming results and after the discovery of some high profile frauds in psychology, such as Diederik Stapel.

This has led some to talk of a crisis in experimental social psychology, centring on whether standards of research in the area have slipped enough to allow false results to become easily accepted.

The whole situation is a wonderful opportunity to see “under the hood” of science and see how it really works (rather than how we’re taught it should work). Everything is in the mix: fundamental conceptual disagreements (about the nature of unconscious processing), disciplinary tribalism (between cognitive psychologists and social psychologists), big dog personalities and emotions running high, academic fashion creating a scientific “bubble” (this is that bubble bursting) and soul-searching questions about whether our methods as researchers are fit for purpose.

My guess is that, when the dust settles, we’ll find out that priming effects can work – but they aren’t as strong or common as reported. I have faith that most effects reported in the literature will turn out to true in some form – the vast majority of psychologists are honest and methodical – but we also know for sure than some effects will turn out to have been chimeras, we just can’t say for sure in advance which.

The really interesting aspects to the debate, from my point of view, is going to be clarifying exactly how unconscious these effects are. My prejudice is that social psychologists have been overly casual about using that word, using it in circumstances which would contradict the way most people use it, whether they’re psychologists or not.

Read more

Shanks, D. R., Newell, B. R., Lee, E. H., Balakrishnan, D., Ekelund, L., Cenac, Z., Fragkiski, K. & Moore, C. (2013). Priming Intelligent Behavior: An Elusive Phenomenon, PloS one, 8(4), e56515.

Ed Yong on Bargh’s response to another failure to replicate

Rolf Zwaan on the theory of social priming

Rolf Zwaan on replication done right

Tom Stafford does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

The Conversation

This article was originally published at The Conversation.
Read the original article.

An unrecognised revolution in street drug design

I’ve got an article in The Observer about the ongoing but little recognised revolution in street drug design being pushed forward by the ‘legal high’ market.

Since 2008 we’ve seen the first genuine wave of ‘designer drugs’ that are being produced by science-savvy professional labs that are deliberately producing substances to avoid drug laws.

New substances are appearing at a rate of more than one-a-week and some are completely new to science.

The article looks at how the clandestine labs are creating these new highs and what this almost impossible to regulate situation means for the ‘war on drugs’ approach to recreational drug use.
 

Link to article in The Observer.

A radio guide to global mental health

The BBC World Service is in the midst of an excellent series on global mental health – called The Truth About Mental Health.

It is currently half-way through and is remarkably well done, looking at everything from the war in Syria, to the effects of solitary confinement, to treatment in developing countries.

The programme also takes a considered look at the important question of whether mental illness is universal or whether it is tightly bound to the culture in which we live.

You can get the episode guide and streaming audio from this page but because the BBC is a bit rubbish at the internet, the podcasts are on an entirely different page, not linked from the episode guide, under the heading of a different programme and mixed in with another series.

Oh, and they’re only available for a few weeks. It’s fine, those interactive Pods will never catch on.

Don’t let this put you off though, whether you manage to catch the podcasts or can stream the programmes online, they’re an excellent guide to the increasingly important field of global mental health.
 

Link to guide and streamed audio of The Truth About Mental Health
Link to podcasts.

National Institute of Mental Health abandoning the DSM

In a potentially seismic move, the National Institute of Mental Health – the world’s biggest mental health research funder, has announced only two weeks before the launch of the DSM-5 diagnostic manual that it will be “re-orienting its research away from DSM categories”.

In the announcement, NIMH Director Thomas Insel says the DSM lacks validity and that “patients with mental disorders deserve better”.

This is something that will make very uncomfortable reading for the American Psychiatric Association as they trumpet what they claim is the ‘future of psychiatric diagnosis’ only two weeks before it hits the shelves.

As a result the NIMH will now be preferentially funding research that does not stick to DSM categories:

Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. What does this mean for applicants? Clinical trials might study all patients in a mood clinic rather than those meeting strict major depressive disorder criteria. Studies of biomarkers for “depression” might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms. What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system.

As an alternative approach, Insel suggests the Research Domain Criteria (RDoC) project, which aims to uncover what it sees as the ‘component parts’ of psychological dysregulation by understanding difficulties in terms of cognitive, neural and genetic differences.

For example, difficulties with regulating the arousal system might be equally as involved in generating anxiety in PTSD as generating manic states in bipolar disorder.

Of course, this ‘component part’ approach is already a large part of mental health research but the RDoC project aims to combine this into a system that allows these to be mapped out and integrated.

It’s worth saying that this won’t be changing how psychiatrists treat their patients any time soon. DSM-style disorders will still be the order of the day, not least because a great deal of the evidence for the effectiveness of medication is based on giving people standard diagnoses.

It is also true to say that RDoC is currently little more than a plan at the moment – a bit like the Mars mission: you can see how it would be feasible but actually getting there seems a long way off. In fact, until now, the RDoC project has largely been considered to be an experimental project in thinking up alternative approaches.

The project was partly thought to be radical because it has many similarities to the approach taken by scientific critics of mainstream psychiatry who have argued for a symptom-based approach to understanding mental health difficulties that has often been rejected by the ‘diagnoses represent distinct diseases’ camp.

The NIMH has often been one of the most staunch supporters of the latter view, so the fact that it has put the RDoC front and centre is not only a slap in the face for the American Psychiatric Association and the DSM, it also heralds a massive change in how we might think of mental disorders in decades to come.
 

Link to NIMH announcement ‘Transforming Diagnosis’.

A cuckoo’s nest museum

The New York Times reports that the psychiatric hospital used as the backdrop for the 1975 film One Flew Over the Cuckoo’s Nest has been turned into a museum of mental health.

In real life the institution was Oregon State Hospital and the article is accompanied by a slide show of images from the hospital and museum.

The piece also mentions some fascinating facts about the film – not least that some of the actors were actually genuine employees and patients in the hospital.

But the melding of real life and art went far beyond the film set. Take the character of John Spivey, a doctor who ministers to Jack Nicholson’s doomed insurrectionist character, Randle McMurphy. Dr. Spivey was played by Dr. Dean Brooks, the real hospital’s superintendent at the time.

Dr. Brooks read for the role, he said, and threw the script to the floor, calling it unrealistic — a tirade that apparently impressed the director, Milos Forman. Mr. Forman ultimately offered him the part, Dr. Brooks said, and told the doctor-turned-actor to rewrite his lines to make them medically correct. Other hospital staff members and patients had walk-on roles.

 

Link to NYT article ‘Once a ‘Cuckoo’s Nest,’ Now a Museum’.