The following is taken from the movie adaptation of the book by Ken Kesey, which is essential reading for anyone interested in behaviours that occur within psychiatric institutions. Despite the age of the book, I would suggest that most of the issues raised are still current today.
The frame in this discussion is set as a group therapy session. A number of human beings assigned the role of 'patient' sit in a circle. Another two human beings assigned the role of 'therapist/nurse' sit with them and encourage them to talk about themselves in a manner that is designated 'therapeutic'.
Nurse Ratched: "Billy, did you tell her how you felt about her?"
Nurse Ratched is asking the human being called Billy about a woman he had an emotion for. Nurse Ratched's question and tonality presupposes that if Billy had a feeling, then he should have communicated it.
The greater frame setting of 'therapy' suggests that Billy's answer will reveal reasons as to why he needs this thing called 'therapy'. The question is about the very thing that caused Billy to need therapy. This is reinforced by Nurse Ratched serious and yet gentle tonality.
Billy: (long pause - stammering) "Well, I went over to her house, on Sunday afternoon, I bought her some flowers and I said, 'C-C-C-CCelia, ww-w-w-will y-y-y-y-you m-m-m-m-arry m-m-me?"
Much laughter from the group. Billy starts to laugh too, sharing the humour. Nurse Ratched remains stoical.
Billy reveals some content, a part of his story to Nurse Ratched and to the group. Here, a separate framing is opened alien to that set by Nurse Ratched. The group laughter reframes Billy's speech difficulty into something humorous. Nurse Ratched's response is to ignore the group, thus creating a slight paradox. This is "group therapy" and yet meta-framing and feedback from the group is to be ignored. Her tonality and posture indicate that this is a serious issue and is not to be made into a joke.
Nurse Ratched: "Billy, why did you want to marry her?"
Staying within her meta-frame of seriousness, she asks a question that opens up a new conversational frame. The frame of 'feelings' is left open and a new frame of 'why marriage?' is opened. Nurse Ratched's tonality implies that she is already familiar with Billy's story.
Billy: (stammering) "Well, I was in love with her."
Billy stays within the frame of 'feelings', rather than switching frame to something like, "She was wealthy", "She was very beautiful" etc. Here, there is a causal linkage of 'Being in love' = 'Wanting to marry'.
Billy is being self-referential. He is not indicating any external causality such as, "I was always told to marry someone I loved" or, "She made me feel this way" which makes the next statement from Nurse Ratched all the more shocking for him:
Nurse Ratched: "Your mother told me that you never told her about it."
Billy: (Long pause. Trying to form words).
Nurse Ratched's statement suddenly shifts meta-frames and reframes the entire communication. It suddenly becomes apparent that Nurse Ratched has already had a conversation about Billy and the woman he asked to marry him, with Billy's mother. Nurse Ratched is not asking Billy for new information but she is testing him. The nature of this test is not clear and leaving Billy unsure of the new and correct meta-frame.
The other presuppositions in Nurse Ratched's statement are:
1. Sons (or at least Billy) should tell their mother when they propose to someone.
2. Not telling his mother about the proposal makes the proposal an issue for 'therapy'.
3. Billy's mother has most probably told Nurse Ratched other things about him and his behaviour.
4. Nurse Ratched is likely to be in possession of knowledge about Billy of which he is not aware.
5. Nurse Ratched already knows the correct answers to the questions that she is asking Billy.
The issue of Billy proposing to a girl he loved is now dropped. The new frame is about why he didn't tell his mother. This has the rapid and nasty effect of anchoring Billy's feelings of love to that of his difficulties with his mother.
Nurse Ratched: Billy? Why didn't you tell her about it?"
Billy: (Long pause).
The switching of the statement into a question attempts to fill in a piece of the puzzle for Nurse Ratched. The question appears to be innocently framed, however, prior framing implies that there is a correct answer that Billy must give. What is interesting here is that the question is asked despite this clearly being difficult issue for Billy to talk about. Not only that but the question is being asked in front of Billy's peers (ie the rest of the group) with whom Billy has a relationship defined differently from that relationship with nurse Ratched.
Implied within the line of questioning is the activity of failure. Nurse Ratched has stacked presupposition upon presupposition and it is already clear by this point that Billy' s proposal of marriage failed and didn't get the result he desired. Tragically, Billy's failure is being paraded in front of his peers and friends. A simple rejection is becoming framed and anchored into something much greater. We don't know the nature of the woman he loved, her behaviour or even a context to this failure. All we know is that the failure was Billy's and Billy's alone.
From an opportunity to utilise the humour provided by the group a few moments earlier, Nurse Ratched has successfully channelled Billy into a grossly negative state and has anchored this to any feelings of love he may possess. The next line triggers this state anchor beautifully:
Nurse Ratched: "Billy? Wasn't that the first time you tried to commit suicide?"
Billy: Long Pause. (Tries to form words).
The presuppositions continue to stack against any possibility of Billy feeling any sort of good feeling during this 'therapy'. It once again becomes clear that Nurse Ratched's already knows the answers and the story behind the questions she is asking. Her tag question, "wasn't that. . ." requires a conscious/unconscious agreement by Billy and again parades Billy's failures in front of the group.
Presupposed in the question is that Billy has attempted suicide at least once more time after this episode that is being alluded to. Again, lack of referential index leaves the framing of these failures open.
So far, Nurse Ratched's apparent elicitation of information has also installed the following logical and kinesthetic chain:
[Feelings of love=Proposal of marriage]>>[Feel bad in relation to mother]>>[Attempt suicide]
Mr. Cheswick: (Under breath) "Oh my God!"
Mr. Cheswick interrupts what has become clearly a distressing and damaging experience for Billy. His statement enables him to communicate a feeling he has in order to frame his own active entry into the communication.
Nurse Ratched: "Yes, Mr. Cheswick?"
Mr. Cheswick: (distressed) "Nurse Ratched, I'd like to ask you a question please."
Nurse Ratched: "Go ahead."
Keeping the frames relating to Billy open, Nurse Ratched provide permission for Mr. Cheswick to open a new frame.
The human being designated as 'therapist' is allowing another human being designated 'patient' to communicate.
Mr. Cheswick: "Ok, er, You know, if, er, Billy doesn't feel like talking, I mean, er, why are you pressing him? Why can't we go onto some new business, huh?"
Here, Mr. Cheswick fires off three new frames and presuppositions for Nurse Ratched.
1. Billy doesn't feel like talking.
2. Nurse Ratched is 'pressing' Billy.
3. There is 'new business' that is better discussed than Billy's affairs.
Unfortunately, Mr. Cheswick's number of presuppositions and new frames are just not enough to overload Nurse Ratched's rationale.
She broadsides with a return reframe, pivoting on Mr. Cheswick's use of the word 'business.'
Nurse Ratched: "The business of this meeting, Mr. Cheswick, is therapy."
This broadside effectively blows out the three presuppositions proposed by Mr. Cheswick. Answering any one of them would not have been this effective. This magnificent sleight of mouth reframe effectively closes down the frames opened up earlier and frames the entire communication once again as 'therapy'.
Mr. Cheswick: "ohhh. You know, I can understand this Miss Ratched, because, I don't, er, Mr. McMurphy, he said something yesterday about a world series? A baseball game? You know, I've never been to a baseball game and I'd actually quite like to see one, and, that would be good therapy too, wouldn't it?"
Following the same line of logic, Mr. Cheswick answers with a reframe of his own. He shifts the context of 'therapy' away from Billy sideways into that of him seeing a baseball game for the first time.
What Mr. Cheswick does most elegantly is to use the line, " and, that would be good therapy too, wouldn't it?" Here is the presupposition and implied complement that Nurse Ratched is already doing good therapy with Billy and supplies a subtle tag question that requires her to agree. A disagreement about the baseball game being good therapy too would frame Nurse Ratched's 'therapy' with Billy as not being 'good therapy' too.
This presupposition, linked elegantly to 'seeing a baseball game', creates an effective sideways shift of frame.
Nurse Ratched: "I thought we'd decided that issue."
Another magnificent broadside from Nurse Ratched as she attempts to close this frame down immediately. She ignores the issue of therapy, and thus extricates herself from the bind developed by Mr. Cheswick.
Her presupposition is that a decision has been made. "...we'd decided.." implies that the decision was collective and closed.
Mr. Cheswick: "Well, I don't think so, because, I mean, we discussed that yesterday and we have, er, a new game today, I think, don't we Mac?"
Using modifiers in his language, Mr. Cheswick gently challenges Nurse Ratched's presuppositions by framing the decision as being 'yesterdays decision'. His presupposition and causal modeling is that a new game requires a new decision. Therefore, the decision referred to by Nurse Ratched is invalid.
He expands his frame and meta-frame by directing his tag question towards "Mac" using his informal name of reference towards Nurse Ratched.
MacMurphy: "That's right, Ches. We want a new vote on it, don't we?"
MacMurphy replies using the same mode of informality. The use of formal names by Nurse Ratched implies a certain type of relationship, different from that relationship between the human beings designated as 'patients'.
Yet we can see that whilst Nurse Ratched refers to the other human beings as "Mr." she refers to only one in an informal basis. Billy. What is worth noting here is the implied relationship between Nurse Ratched and Billy' s mother, previously mentioned. Nurse Ratched uses the name 'Billy' in an implied manner that is different to that name 'Billy' used by Billy's friends.
Although MacMurphy is answering Mr. Cheswick, his line: "We want a new vote on it, don't we?" does not supply the referential index on the word "we".
Where Nurse Ratched' s communications have been quite clearly digitally and analogically marked out by her use of formal names within her communications - the scope of her communications is being forced into a broader frame.
Whereas initially she was communicating specifically towards Billy, forcing his answers open to the group, the scope is shifting. Now her scope includes MacMurphy and Mr. Cheswick and possibly everyone else as well.
She recovers her control over the scope with the following line:
Nurse Ratched: "Would one more vote satisfy you, Mr. MacMurphy?"
Here, she both digitally and analogically marks out her communication to being specifically for MacMurphy. She does this (digitally) with the use of addressing her comunication towards "Mr. MacMurphy" and analogically with the presupposition of MacMurphy's 'dissatisfaction'.
What is also presupposed is that it is the "one more vote" that will satisfy MacMurphy, but not the outcome of this vote.
There is also an implied challenge in Nurse Ratched's tone. She is giving MacMurphy an opportunity for her authority to be challenged over the issue of the 'decision' that she "believed we had decided on [that issue]". Previous experience of Nurse Ratched's behaviour would suggest that this might be a trap.
MacMurphy: "Yes. It would satisfy me."
MacMurphy takes the bait and stays within the frame and complex equivalence (vote=satisfaction) opened by Nurse Ratched. He misses the opportunity for a meta-comment and/or reframe upon this.
Nurse Ratched: "There is a vote before the group. Everyone in favour of changing the schedule, please raise your hand."
The strategy employed here is typical of Nurse Ratched's cunning and sheer brilliance.
Her scope of reference is addressed to the nine people sat in the circle. She does not specify the referential index on the words "group" or "everyone". Her analogue behaviours indicate that she is only talking to the nine people sat around in the group 'therapy' circle. It appears that Mr. Cheswick and MacMurphy have succeeded in broadening the scope of Nurse Ratched' s communication to that of the group.
MacMurphy: "OK. I want to see the hands. Come on! Which one of you nuts has got any guts?"
All nine people in the circle raise their hands.
MacMurphy: "All right!"
Nurse Ratched: "I only count nine votes, Mr. MacMurphy."
Nurse Ratched verbalises an ambiguous truism as a meta-comment. Despite the fact that everyone in the circle has raised their hands, she throws out a presupposition that there is something more, " only nine votes.."
MacMurphy's excitement is premature and incorrect. Nurse Ratched reasserts her control with the "I only count " It is Nurse Ratched who is clearly not satisfied with the outcome.
MacMurphy: "Ha ha ha! You only count nine? Only nine! It's a landslide!" (group laughter)
Nurse Ratched: (interrupting laughter) "There are eighteen patients on this ward, Mr. MacMurphy, and you have to have a majority to change ward policy. You gentlemen can put your hands down now."
Now Nurse Ratched closes her brilliant trap by shifting the referential index of the words "group" and "everyone" from her previous communications.
The brilliance lies in that she allowed the scope of her communication to be broadened by MacMurphy, only she extended the scope of her referential index beyond that of the group to that of the entire ward, whilst maintaining direct digital and analogical communication towards MacMurphy.
This has the effect of taking the logic beyond that of the immediate reference used by MacMurphy and reframes the entire debate.
The shifting of the process of "Ward Policy" into a nominalisation makes MacMurphy's situation almost impossible. He misses an opportunity for a reframing meta-comment upon this and attempts to reason within the existing frame:
MacMurphy: "You trying to tell me that you count these, these poor son-of-a-bitches don't even know what we are talking about..."
Unable to counter all the frames opened up by Nurse Ratched, MacMurphy goes for a direct attack and appeal to reason by referring to the incompetency of the other ward patients not in the 'therapy' circle. Nurse Ratchet has clearly incorporated them into a frame that had previously not included them.
Nurse Ratched: "Well, I have to disagree with you, Mr. MacMurphy, these men are members of the ward just as you are."
Nurse Ratched delivers a beautiful line that aligns MacMurphy with the "poor son-of-a-bitches" he has just referred too. Reminding MacMurphy that he too is "just" a member of the ward returns him to the place where she wants to keep him. She is telling him that he is no different from those mentally incompetent men wandering around in the background.