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Table of Contents    
Year : 2020  |  Volume : 68  |  Issue : 5  |  Page : 1271-1272

Why Fly Over the Cuckoo's Nest? Psychosurgery in my Brain Please

Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication27-Oct-2020

Correspondence Address:
Dr. Manjul Tripathi
Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.299155

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How to cite this article:
Tripathi M, Agrahari A. Why Fly Over the Cuckoo's Nest? Psychosurgery in my Brain Please. Neurol India 2020;68:1271-2

How to cite this URL:
Tripathi M, Agrahari A. Why Fly Over the Cuckoo's Nest? Psychosurgery in my Brain Please. Neurol India [serial online] 2020 [cited 2021 Aug 4];68:1271-2. Available from:

Author : Antonio de Salles

Edition : 2011

Publisher: Education Health Advisor, Inc. USA

Page : 416 (Paperback)

The history of psychosurgery has seen more oops than wow moments. Dating back from prehistoric trephinations to modern deep brain stimulations, several surgeons faced humiliating ostracization and innumerable patients faced social stigmas, penalties, and untimely deaths. The final nail in the psychosurgery attempts was Ken Kesey's novel “One Fly over the Cuckoo's Nest.” The motion picture by the same name in 1975, is one of the only three movies in the history of world cinema to win the big five Oscars in a year. Brilliantly portrayed by Jack Nicholson, the film brutally thread-bared the dark side of the moon. No doubt, the complications of infamous surgeries such as “ice-pick lobotomy” and over-enthusiastic personalities such as Walter Freeman were now on the silver screen, and the world suddenly shifted away from a promising field, which was struggling in an era of primitive radiologies, limited medications, skeptical environments, and growing medicolegal troubles. This is a science fiction novel, which highlights the legal, medical, and ethical issues of psychosurgery in a very legally restrictive environment.

Over the course of time, the misery did not change much, but the world then witnessed an increasing role of stimulation techniques in the 90s. The spectrum of the benefitted disorders was predominantly neurologic such as in Parkinson's. The same enthusiasm was not witnessed with psychological disorders as the level of evidence could not be found in the absence of the cases and the psychologists were not as enthusiastic as the neurologists.

“Why Fly Over The Cuckoos' Nest? Psychosurgery In My Brain Please!” is an enthralling tale of this dilemma. Authored by Antonio de Salles, a noted Brazilian neurosurgeon is a riveting tale of a promising personality that goes haywire because of his failure to control anger and rage attacks. The novel's protagonist is Jill, an anthropologist and aspiring neurobehavioral researcher who happens to be the girlfriend of Charles, a Latin American football player and mathematician. Charles is a gifted player but gets enraged and impulsive after getting bullied or attacked. His aggressive behavior remains a unique selling proposition on the field but overwhelms his social and personal lives. He finds solace and love in the company of his girlfriend and playmate Roberto. He somehow manages to continue on- field and gets a place as the main striker in the World Cup US soccer team. His attack on a shrewd opponent after getting physically hurt during the game prematurely terminates his career as a player.

Jill longs for his love. A strong love and respect towards other's work bring these tender hearts together. They get married and work in the same neurosurgical team, which is trying to find out the neurobehavioral reasons for rage attacks in monkeys. Both continue in their grad school and Jill works extra for her doctorate thesis. Her accidental pregnancy mounts the pressure on already overstretched family and they gradually get financially, emotionally, and physically insecure. The story takes an ugly turn when their infant son throws a seizure and on the same day, a provoked Charles kills a drug dealer in a brutal attack and later attempts suicide in police custody. He ends up semicomatose in a psychiatry ward. Finding herself unable to handle so much pressure, Jill loses her faith and admiration of Charles's persona and starts cursing her fate for choosing him as a life partner. But the love in her heart and her perseverance to find some sort of answers to the apparent life-changing questions keep her going. Finally, with the help from her support system, which includes their family and neuroscientist fraternity, she gets a breakthrough in identifying the responsible foci in the brain for controlling the rage attacks. He gets treated with deep brain stimulator (DBS) implantation in Vicq d'Azyr. Life takes a full circle when her son gets diagnosed with a small hypothalamic hamartoma and knocks down his schoolmate at a tender age of seven.

On one hand, the book challenges the human knowledge of the brain function while on another hand, its description of experimental results in primates brings forth hope in the desperate families, who are unable to find any listening ear. This book has highlighted a neurosurgeon's frustration in handling bureaucracy, ethics committees, and politics in medical science while taking care of the patient. However, the emotional upheavals have been addressed in a very rational way through the wisdom, patience, and compassion of the senior neurosurgeons in the story. The book is brutally candid in showing the problems of a young female neurosurgeon in an environment dominated by alpha males, and how she has to use her intelligence, wit, charm, and endurance while maintaining the driving force of her love to unveil the hopeful propositions of neurosurgery in psychiatric disorders. The author is able to beautifully illustrate the role of family, society, and colleagues in dealing with a sensitive yet gruelling environment of neurosurgical training. The personal sacrifices made by the team members are elegantly presented in this book. The zeal to achieve success in their mission to bring a positive change in the acceptable treatment of psychological patients is utmost palpable. The stakes are still high but special attention should be given to the advancements in neurosciences in the last three decades, which includes cutting edge techniques of brain mapping and growing experience with stimulation techniques. This book is worth reading not only for neuroscientists but also for common persons. It gives a brief but honest insight into the lives and plights of the psychological patients and their families. It points out how caregiver-doctor interaction, sharing of knowledge and ideas, and mutual admiration is paramount for bringing out the best possible outcome in the patients. The author Dr. Antonio de Salles is a noted functional neurosurgeon practicing at UCLA School of Medicine in Los Angeles, USA. His vision exudes his enthusiasm on this delicate subject, “A problem without a solution is no longer a problem. It is, however, a challenge and an opportunity for the unsettled mind to conquer the seemingly impossible.”


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