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The lines between madness and a keen sense of reality are blurred in this book. Take Chief Bromden for example. He is thought to be deaf and dumb, lost in the fog of medication and memories of WW2. Chief Bromden actually has a very sane take on the institution and the world in general. Bromden sees modern society as a huge, oppressive institution that he calls the Combine. He sees the mental hospital as a place that tortures people, who do not conform, into submission. While the staff considers the Chief crazy, he is quietly chronicling the craziness of the hospital and its staff,
"They don't bother not talking out loud about their hate secrets when I'm nearby because they think I'm deaf and dumb. Everybody thinks so. I'm cagey enough to fool them that much. If my being half Indian ever helped me in any way in this dirty life, it helped me being cagey, helped me all these years. "
Like McMurphy, Chief was not crazy when he came in but certainly sick when he left.