To clear up a few of the confusing parts, the flashbacks show what happened in Joe Buck's past that explains his motivations for wanting to travel to New York. He was sexually abused as a child by his aunt, and he and his girlfriend were also raped by a gang of Texas hoodlums. The book goes into more detail, and the aforementioned scene is really a condensed and simplified version of how Joe was really gang raped by a hustler and a gay Indian in the book. Joe's girlfriend was also institutionalized, but that is left out of the movie. It gives insight into Joe's damaged and somewhat warped psychology, and how he doesn't really care about turning tricks for homosexuals, even though he's not one himself. It also explains why Joe is so naive and crashes and burns so quickly in the city, and why he became violent at the end.
Also, as was explained in the movie, Ratso didn't want to see a doctor, because he knew he would be placed in an institution (seeing as he was homeless). He wanted to make it to Florida to live out his dream.
~ I'm a 21st century man and I don't wanna be here.
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