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Photo by John Barrois -- Amy Alvarez is the most vilified nurse in theater, Nurse Ratched, and Alex Martinez Wallace is Randle McMurphy in the NOLA Project's staging of 'One Flew Over the Cuckoo's Nest.' The show opens Thursday, Sept. 4, at NOCCA’S Nims Black Box Theatre in New Orleans.

Actress Amy Alvarez has strong feelings about the presentation of mental health issues on stage and screen.

“I’m probably hyper-aware of the different ways mental illness is portrayed in movies, plays and novels,” she said.

That’s because, along with portraying Nurse Ratched in the NOLA Project’s season premiere “One Flew Over the Cuckoo’s Nest,” Alvarez is a licensed clinical social worker.

The actress, who has been on practically every stage in New Orleans in musicals, dramas and cabarets, brings a unique perspective to Dale Wasserman’s adaptation of Ken Kesey’s iconic character.

“Mental illness can be very complicated,” Alvarez said, “and characters who are mentally ill can make for very interesting art — but I am concerned that too often, characters who clearly are suffering are used as illustrations for either some kind of major moral failing or some kind of savant/saint-like quality.”

With a master’s degree in social work, a master’s in public health and a post-grad certificate in forensic social work, Alvarez understands that dramatic literature cannot always be clinically precise.

She points to Stephen Sondheim’s “Sweeney Todd” as an example.

“Sweeney Todd and Mrs. Lovett are psychopaths, but I’m not interested in a deep exploration of their psyches onstage,” Alvarez said. “I want to watch them make people into pies.

“But that’s melodrama.”

However, when mental health issues are the focus of a text, Alvarez turns a more clinical eye to the proceedings.

“For a realistic piece like ‘Cuckoo’s Nest,’ it’s important to me that the characters are treated with dignity in both writing and portrayal, even though sometimes we laugh at their dialogue and behavior. Just because a character might do funny things, it doesn’t mean that we are viewing them as less than.”

Alvarez believes both Kesey and Wasserman do a credible job creating interesting characters with the potential to become emblematic of the conditions they suffer.

Alvarez was quick to point out that this is especially true with this production because her collaborators craft characters who “come across as human beings.”

After learning that the NOLA Project was doing “Cuckoo’s Nest,” Alvarez offered what she called “mental health dramaturgy,” and both artistic director A.J. Allegra and the production’s director Mark Routhier accepted with enthusiasm.

“Because as a clinician, few things bug me more than ‘bad mental health acting.’ You know, people just acting an uninformed idea of ‘crazy’ without having a basic understanding of mental disorders and the kinds of life experiences and historical ideas about ‘normalcy’ that might lead to a mental health diagnosis,” Alvarez said.

So, it was both thrilling and intimidating when she found herself offered the role as the principal antagonist of legendary anti-hero R.P. McMurphy. After all, the character of Ratched has existed in the shadow of Louise Fletcher’s Oscar-winning turn.

“It’s been interesting to play Nurse Ratched because, of course, in common shorthand, the term ‘Nurse Ratched’ indicates a cruel ball-buster,” she said.

But as a social worker herself, Alvarez sees another side of the nurse.

“The text of the play is very clear that she is usually very friendly … she genuinely cares about the patients. She’s physically attractive … she can be very warm ... but she is also a manipulator.”

In the actress’ eyes, some of that manipulation can be justified.

“The patients are engaged in a therapeutic community because, as she says, they have broken the rules of society. She sees her job is to help them learn how to live in society so that they can be released.”

Alvarez also understands her character goes too far, violating boundaries and turning vindictive.

“When she feels personally undermined … it is no longer about tolerating McMurphy’s misbehavior, in the way that a tolerant teacher might put up with an unruly child in the classroom. She’s out to get him.”

Like all the other characters in this world, Alvarez views her own creation as simply a human being, “with all the charms and faults that humans have.”

Jim Fitzmorris writes about theater. He can be reached at

‘One Flew Over the Cuckoo’s Nest’

Where: NOCCA’S Nims Black Box Theatre, 2800 Chartres St.

When: Sept. 4-21

Tickets: $20. (504) 302-9117 or