Nurse Ratched is notorious for her desire to exercise complete control over the men who are under her jurisdiction on the psych ward, both as patients and as employees. In doing so, Nurse Ratched becomes a metaphor for the entire mental institution, the government, society at large—or to put it simply: any and every powerful institution that exists to regulate, control, and categorize groups of people. In order to determine the difference between sanity and insanity, for instance, some agent of power (society, the psych ward, Nurse Ratched) must first define the boundaries of what each word means. After this definition is decided upon, it can be used to control and categorize people to make them easier to control. The institutions of One Flew Over the Cuckoo’s Nest claim that they categorize the patients as insane in order to "treat" and "rehabilitate" them. But it quickly becomes clear in the novel that this rehabilitation is more punitive and controlling than it is helpful for any mental ailment: the shock treatment table, the red pills that cause memory loss, the daily meetings that pit men against each other, and the list on Nurse Ratched’s desk to record and reward the men for betraying each other's secrets are all ways to force people to obey, not to make them well.
The categorization of the men as Acutes and Chronics shows the inherent loss of human dignity that results from relying on such categories. As the novel opens, the men in the ward do not have names: they have broad labels: Acute or Chronic. That is the only marker of meaning regarding them: not who they are, not what they care about. Just Acute or Chronic. Further, the ward allows for little freedom of expression—though it is feigned with “democratic” group meetings. There is no recreation outdoors. There is little exposure to the outside world. All activities and therapy sessions are scheduled with precision, and to deviate from that schedule is to be a nuisance to Nurse Ratched. This is exactly as Nurse Ratched prefers it to be, because she can strip the humanity of her patients in order to be in complete control and run her ward like a well-oiled machine.
It is when Randle McMurphy becomes a patient—and begins to treat other patients with dignity—that the cold categorization of the institution begins to be subverted: the fog lifts for Chief Bromden, the men joke and play, they go on outings. The climactic party scene illustrates how the men (sane or insane) still possess the same desires as a nominally “sane” person: to have fun, to be free, to be respected. McMurphy’s introduction of human dignity to the patients transforms the ward—the men realize that they have sacrificed not just their rights but their very beings by electing to be committed to the institution, but as they rediscover their own human dignity with the aid of McMurphy they attempt to wrest back that control.
Related Themes from Other Texts
Institutional Control vs. Human Dignity ThemeTracker
Institutional Control vs. Human Dignity Quotes in One Flew Over the Cuckoo's Nest
Across the room from the Acutes are the culls of the Combine’s product, the Chronics. Not in the hospital, these, to get fixed, but just to keep them from walking around the streets giving the product a bad name. Chronics are in for good, the staff concedes. Chronics are divided into Walkers like me, can still get around if you keep them fed, and Wheelers and Vegetables. What the Chronics are—or most of us—are machines with flaws inside that can’t be repaired, flaws born in, or flaws beat in over so many years of the guy running head-on into solid things that by the time the hospital found him he was bleeding rust in some vacant lot.
There’s something strange about a place where the men won’t let themselves loose and laugh, something strange about the way they all knuckle under to that smiling flour-faced old mother there with the too-red lipstick and the too-big boobs. And he thinks he’ll just wait a while to see what the story is in this new place before he makes any kind of play. That’s a good rule for a smart gambler: look the game over awhile before you draw yourself a hand.
This world…belongs to the strong, my friend! The ritual of our existence is based on the strong getting stronger by devouring the weak. We must face up to this. Nor more than right that it should be this way. We must learn to accept it as a law of the natural world. The rabbits accept their role in the ritual and recognize the wolf as the strong. In defense, the rabbit becomes sly and frightened and elusive and he digs holes and hides when the wolf is about. And he endures, he goes on. He knows his place. He most certainly doesn’t challenge the wolf to combat. Now, would that be wise? Would it?
You know, that's the first thing that got me about this place, that there wasn’t anybody laughing. I haven’t heard a real laugh since I came through that door, do you know that? Man, when you lose your laugh you lose your footing. A man go around lettin’ a woman whup him up and down till he can’t laugh any more, and he loses one of the biggest edges he’s got on his side. First thing you know he’ll begin to think she’s tougher than he is…
You’re making sense, old man, a sense of your own. You’re not crazy the way they think.
If somebody’d of come in and took a look, men watching a blank TV, a fifty-year –old woman hollering and squealing at the back of their heads about discipline and order and recriminations, they’d of thought the whole bunch was crazy as loons.
They’re trying to act like they still got their eyes on nothing but that blank TV in front of us, but anyone can see they’re all sneaking looks at the Big Nurse behind her glass there, just the same as I am. For the first time she’s on the other side of the glass and getting a taste of how it feels to be watched when you wish more than anything else to be able to pull a green shade between your face and all the eyes that you can’t get away from.
There was times that week when I’d hear that full-throttled laugh, watch [McMurphy] scratching his belly and stretching and yawning and leaning back to wink at whoever he was joking with, everything coming to him just as natural as drawing breath, and I’d quit worrying about the Big Nurse and the Combine behind her. I’d think he was strong enough being his own self that he would never back down the way she was hoping he would. I’d think, maybe he truly is something extraordinary. He’s what he is, that’s it. Maybe that makes him strong enough, being what he is. The Combine hasn’t got to him in all these years; what makes the nurse think she’s gonna be able to do it in a few weeks? He’s not gonna let them twist him and manufacture him.
In the group meetings there were gripes coming up that had been buried so long the thing being griped about had already changed. Now that McMurphy was around to back them up, the guys started letting fly at everything that had ever happened on the ward they didn’t like.
I’m committed…I’d of left here before now if it was up to me. Maybe I couldn’t play first string, with this bum arm, but I could of folded towels, couldn’t I? I could of done something. That nurse on my ward, she keeps telling the doctor I ain’t ready. Not even to fold towels in the crummy old locker room, I ain’t ready.
EST isn’t always used for punitive measures, as our nurse uses it, and it isn’t pure sadism on the staff’s part, either. A number of supposed Irrecoverables were brought back into contact with shock, just as a number were helped with lobotomy and leucotomy. Shock treatment has some advantages; it’s cheap, quick, entirely painless. It simply induces a seizure.
McMurphy doesn’t know it, but he’s onto what I realized a long time back, that it’s not just the Big Nurse by herself, but it’s the whole Combine, the nation-wide Combine that’s the really big force, and the nurse is just a high-ranking official for them.
I couldn’t figure it at first, why you guys were coming to me like I was some kind of savior. Then I just happened to find out about the way the nurses have the big say as to who gets discharged and who doesn’t. And I got wise awful damned fast. I said, ‘Why, those slippery bastards have conned me, snowed me into holding their bag. If that don’t beat all, conned ol’ R. P. McMurphy,’…Well I don’t mean nothing personal, you understand, buddies, but screw that noise. I want out of here just as much as the rest of you. I got just as much to lose hassling that old buzzard as you do.
Tell me why. You gripe, you bitch for weeks on end about how you can’t stand this place, can’t stand the nurse or anything about her, and all the time you ain’t committed. I can understand it with some of those old guys on the ward. They’re nuts. But you, you’re not exactly the everyday man on the street, but you’re not nuts.
Please understand: We do not impose certain rules and restrictions on you without a great deal of thought about their therapeutic value. A good many of you are in here because you could not adjust to the rules of society in the Outside World, because you refused to face up to them, because you tried to circumvent them and avoid them. At some time—perhaps in your childhood—you may have been allowed to get away with flouting the rules of society. When you broke a rule you knew it. You wanted to be dealt with, needed it, but the punishment did not come. That foolish lenience on the part of your parents may have been the germ that grew into your present illness. I tell you this hoping you will understand that it is entirely for your own good that we enforce discipline and order.
[Nurse Ratched] knew that people, being like they are, sooner or later are going to draw back a ways from somebody who seems to be giving a little more than ordinary, form Santa Clauses and missionaries and men donating funds to worthy causes, and begin to wonder: what’s in it for them? Grin out of the side of their mouths when the young lawyer, say, brings a sack of pecans to the kids in his district school—just before nominations for state senate, the sly devil—and say to one another, He’s nobody’s fool.
I still had my own notions—how McMurphy was a giant come out of the sky to save us from the Combine that was networking the land with copper wire and crystal, how he was too big to be bothered with something as measly as money—but even I came halfway to thinking like the others. What happened was this: He’d helped carry the tables into the tub room before one of the group meetings and was looking at me standing beside the control panel.
I tried to talk to [McMurphy] into playing along with [Nurse Ratched] so’s to get out of the treatments, but he just laughed and told me Hell, all they was doin’ was chargin’ his battery for him, free for nothing.
First Charles Cheswick and now William Bibbit! I hope you’re finally satisfied. Playing with human lives—gambling with human lives—as if you thought yourself to be a God!
She tried to get her ward back into shape, but it was difficult with McMurphy’s presence still tromping up and down the halls and laughing out loud in the meetings and singing in the latrines. She couldn’t rule with her old power any more, not by writing things on pieces of paper. She was losing her patients one after the other. After Harding signed out and was picked up by his wife, and George transferred to a different ward, just three of us were left out of the group that had been on the fishing crew, myself and Martini and Scanlon.
I was only sure of one thing: [McMurphy] wouldn’t have left something like that sit there in the day room with his name tacked on it for twenty or thirty years so the Big Nurse could use it as an example of what can happen if you buck the system. I was sure of that.
The big, hard body had a tough grip on life. It fought a long time against having it taken away, flailing and thrashing around so much I finally had to lie full length on top of it and scissor the kicking legs with mine while I mashed the pillow into the face. I lay there on top of the body for what seemed days. Until the thrashing stopped. Until it was still a while and had shuddered once and was still again. Then I rolled off. I lifted the pillow, and in the moonlight I saw the expression hadn’t changed from the blank, dead-end look the least bit, even under suffocation. I took my thumbs and pushed the lids down and held them till they stayed. Then I lay back on my bed.
I been away a long time.
