Literary Analysis

One Flew Over the Cuckoo's Nest, one of the most influential novels of the twentieth century, derives from Ken Kesey's observations at a mental institution. Although it is a popular myth that Cuckoo's Nest sprung full-blown from Kesey's drug-induced state, he admits only some of it was inspired that way. Written during the post-World War II era of the psychedelic 1960s, when the U.S. faced a Communist threat, he wanted his black satire's good versus evil plot, rich with symbols, literary allusions, and bioethical and medical issues, to show how individuals must stand up to authority so their rights are not quashed by government control. As a prototypical depiction of mental illness, Cuckoo's Nest describes how the mentally ill were treated, and this analysis focuses on the effects of the therapies applied at the time.

Chief Bromden's observations as narrator make him the most important character in the novel. The "deaf and dumb" American Indian, who has seen his lands taken away to build a hydroelectric dam and his family destroyed, tells the story, at first in a flashback sequence and then in hallucinatory visions. It is possible to trace throughout the novel his self-evolving passage out of the fog of schizophrenia. The action centers on the free-spirited Randle P. McMurphy (Mack), who of course personifies the counterculture Beat Generation. He "was a giant come out of the sky to save us from the Combine," the Big Chief believes. Mack faces off against Nurse Ratched, who personifies governmental authority and repression and in whom the Combine (evil government forces seeking conformity) culminates. The Combine includes Ratched's network of handpicked and personally trained nurses, doctors, and aides. Mack, "crazy like a fox," has capitalist intent in feigning mental illness to leave a prison work farm. However much of a charming con man he appears to be, though, in setting up gambling opportunities, his antiauthoritarian rebelliousness makes him an imperfect antihero. Because he has been involuntarily committed by the prison, Ratched has absolute power to hold him until she deems him cured. But most of the other Acute patients who are deemed hardcore and seek institutional discipline can release themselves. In his battle with his nemesis, Nurse Ratched (symbolically a ratchet, a tool controlling by degree), he appears to be both a classic psychopath and a cocky comic book figure. Regardless of the impurity of Mack's self-serving hustling instincts, his antagonizing Ratched allows him to grow and the other patients to be liberated. Considering the complexity of mental states, it is ambiguous whether he extended his stay (breaking the nurses' station window twice) for his greed or for solidarity with the patients. Is he the victim of an ill-conceived plan or a martyr?

While Mack "walks out of step; hears another drum," a literary reference to Henry David Thoreau that is a leitmotif symbolizing individualism, the Chief stands for the vanishing American Indian, an invisible man diminished by white society. Kesey goes into great detail about how the Chief's disintegrating culture has paralyzed him into catatonia, effecting a split personality and sporadic loss of reality. The Chief has been on the ward the longest; Mac is the new patient. Each is putting on an act: the Chief's hallucinatory insights on hospital activities reflect his silent savvy; Mack's noisy bravado either agitates or rallies patients by challenging Ratched's matriarchal authority. Kesey's contrasting the Chief and Mack causes interest. But, the ingenious part of the novel is the ability to trace Mack's influence on the Chief. Inextricably linking mental prowess and physical size, the Chief in his mind's eye appears to grow physically bigger as he becomes mentally released from his schizophrenic fog. In an example of the complexity of Mack's motives, he uses the Chief to lift the control room panel as the basis of a bet, but at the same time it empowers the Chief.

The mental institution culture in Cuckoo's Nest reveals how the lines between sanity and insanity are often blurred. It describes many types of illness, divided between the Acutes and the Chronics, and includes the obsessive-compulsive disorder (OCD) patient who cannot get dirty, two epileptics with opposing drug administration problems, cowering depressives, self-mutilating passive-aggressives, hallucinating schizophrenics, and troublemaking psychopaths. In a group therapy meeting Mack sets out to challenge authority by persuading most of the patients to vote to watch the World Series during their work detail. Although a democratic vote is taken—modeling the type of behavior needed on the outside—Ratched wields her authority and cuts the power to the set. The patients then gather in front of it in a rebellious sit-in. The Chief tacitly observes they would all appear crazy to an outsider. Talk therapies based on ward log entries are run like confrontational pecking parties, with the patients acting like scared rabbits. Harding and others fear Ratched, viewed as a surrogate wife and mother, and want her to keep them in their place. Throughout the novel women are mostly portrayed as dominating "ballcutters" or submissive pleasure-givers.

Dale Harding, symbolizing the voice of reason as president of the Patients' Council, explains the system and treatments like electroshock therapy and lobotomy. What may be inexplicable, though, is the therapeutic role of nature and the healing power of laughter seen throughout the novel. In a classic road literature scenario, Mack and the other patients on a fishing trip learn and grow along the way as they face challenges and overcome obstacles. Mack laughs at fishing trip mishaps, the Chief tells us,

Because he knows you have to laugh at the things that hurt you just to keep yourself in balance, just to keep the world from running you plumb crazy. He knows there's a painful side; he knows my thumb smarts and his girl friend has a bruised breast and the doctor is losing his glasses, but he won't let the pain blot out the humor no more'n he'll let the humor blot out the pain.

The contagious laughter pumped the men up, as it "rang out on the water in ever-widening circles." Laughter, in fact, as a proponent of the holistic mind-body-spirit approach to health and healing, may relieve pain and renew hope. In 1964 Dr. Norman Cousins, diagnosed with the crippling and degenerative disease ankylosing spondylitis, with his doctor's permission removed himselffrom the clinical environment and checked into a hotel for combination therapy comprised of belly laughter (watching Marx Brothers films) and taking massive doses of vitamin C. His disease went into remission. He did not necessarily reject scientifically, Western medicine that documents how positive emotions affect the adrenal glands and the endocrine system, and how the placebo effect increases the mind's willpower over matter. Cousins, in writing up his account in Anatomy of an Illness (1981), answers critics and leaves others to speculate about his alternative therapy: "Laughter may or may not activate the endorphins or enhance respi ration, as some medical researchers contend. What seems clear, however, is that laughter is an antidote to apprehension and panic." He was, in effect, retaking control of his life. Since Cousin's classic book, others have espoused hope, faith, and love as therapeutic values, such as Bernie Siegel's Love, Medicine & Miracles. Nonetheless, when considering alternative or holistic approaches to medicine, it is wise to beware of age-old quackery.

Mack's therapeutic role—if it can be called such—demonstrates the importance of levity as well as of maintaining some self-respect in institutional living. Unfortunately, in Ratched's therapeutic community her dehumanizing and belittling ways "ballcut" all men, including Dr. Spivey. Contrary to today's conventional wisdom, she controls the population by diminishing the men's self-esteem. She also administers narcotic drugs daily. Her threats of using electroshock therapy and lobotomy as punishment would now be seen as unethical, at the least. Mack progressively builds up their masculine confidence. But then he lets them down, until in one last hurrah he puts his personal interests aside when he and the Chief protect George in a fistfight with the black aides who try to give him an enema. Although Ratched gives Mack a chance to get out of ECT as punishment by admitting he has been wrong, in a pivotal show of selfless solidarity, he refuses, feeling it would be the same as confessing to a "plot to overthrow the government." As he undergoes a series of ECT in the Disturbed Ward, his bravado creates a heroic legendary status that Ratched fears. In a psychological ploy to regain control, she brings him back to the ward where she can watch him—and plot.

Sexuality is also a part of life—even in an institution. Mack arranges for Billy Bibbit, 31 but mentally an adolescent controlled by his mother, to lose his virginity to a smuggled-in prostitute during a drunken evening on the ward. Mack's attempt to restore a manly independence in the men may release some from psychosomatic illness; however, for Billy, things are not that simple. Ratched, in her zeal to keep things under control, shames him into extreme guilt. Fearful of his mother, he commits suicide. At this point Cuckoo Nests rich literary references to Melville culminate in Moby Dick's good versus evil overtones and in a suggestion of Billy Budd's stuttering, innocent protagonist. Applying Darwinian reasoning to the pecking order of the mental ward, Ratched's "ballcutting" approach mandates that only the fittest survive. So Mack viciously attacks Ratched for Billy's suicide, leading to her final retaliation: his lobotomy. What makes Kesey's dramatization so compelling, however, is the way Christian imagery used throughout the novel coalesces into his final redemption: Mack is the martyred Christ who has compromised authority and released the patients from the Combine's control of them. In fact, Cuckoo's Nests grotesque description is so compelling it took lobotomy as therapeutic psychosurgery underground, until today when updated versions of it are deemed acceptable, beneficial treatments. In the end, the Chief's releasing Mack from his vegetative state and escaping out into a new life show the healing power of individuals. Nonetheless, life is messy, and Kesey's ambiguous conclusion causes speculation that the Combine, bigger than Nurse Ratched and her mental institution, cannot be so easily defeated.

The allegorical title, One Flew Over the Cuckoo's Nest, comes from a nursery rhyme the Chief recites in part 4:

Ting. Tingle, tingle, tremble toes, she's a good fisherman, catches hens, puts 'em inna pens . . . wire blier, limber lock, three geese inna flock . . . one flew east, one flew west, one flew over the cuckoo's nest. . . O-U-T spells out. . . goose swoops down and plucks you out.

The cuckoo's nest is the mental hospital; Ratched "tremble toes" pecks at the men; the Bull Goose Loony Mack "plucks out" the Chief, who embodies Mack's spirit as he makes his hopeful escape into the moonlight. Kesey's cautionary tale, a metaphor for how society socially constructs its attitudes toward mental illness, makes us question, conversely, how mental illness derives from culture as well as from disease. What is more clearly understood, however, is that views of insanity change in our culture and that therapies go in and out of fashion. Cuckoo's Nest makes us wonder how we should balance mental health care's need to control and to conform with maintaining individual rights. In Kesey's novel, the psychiatric staff are not always the good guys, and the patients often are more complicated than they first appear. With generational fluctuations in psychiatric perception, it is necessary to ask, by whose idea of normal should we be measured?

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