by manipulation possibly
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Much like my previous answer, power is a tacitly agreed upon existence in this ward. Ratched has traded her sexual identity and her humanity in for power. The patients, except for McMurphy, have traded in their uncertainty and fear of the outside world to be emasculated and controlled by Ratched.Both parties, the patients and Ratched, seem to get what they want or perhaps deserve. McMurphy's presence changes the dynamics of power in the ward. Power becomes a commodity to be bet, bartered, and traded. As Ratched falls to McMurphy's primal power brokering, she exposes her sexual identity. This throws everybody's sense of power into disarray.