One Flew Over the Cuckoo's Nest is narrated by Chief Bromden (also known as Chief Broom), a mute Indian who ritually mops the mental institution where he is confined. The black boys in white suits who work in the ward mock Chief Broom, assuming that he is deaf and dumb and cannot hear them. Chief Broom never speaks, but we can hear his thoughts.
Nurse Ratched (also known as Big Nurse) enters, her lips and her fingernails both an odd orange. She carries a woven wicker bag filled with pills, needles, wire, and forceps. She moves with precise, automatic gestures, her face at once determined and calculated, but she cannot seem to hide her large breasts, which seem incongruous with the rest of her body and disposition. Ruthless and mechanical, she orders the black boys to shave Chief Bromden, who quickly hides in terror. While hiding, he thinks about his father and growing up on the banks of the Columbia River. Soon, one of the boys finds him, and they start to shave him. Terrified, the Chief hallucinates that an Air Raid has begun in the ward and that a thick fog begins to overwhelm him.
When the fog clears, Bromden realizes he is not in the Shock Shop, where patients are given electroshock treatment, so he relaxes. At that moment, an escort brings in another patient for admission. Nurse Ratched quickly orders that he receive a shower. The patient, a red-haired Irishman named Randall Patrick McMurphy, quickly retorts that every place he goes requires a shower—the courthouse, the jail—and he is already as clean as clean can be. He introduces his tall, strapping self to the ward as a “gambling fool” and takes out his pack of cards. McMurphy has arrived from a work farm named Pendleton, and he is wearing the shirt and pants of his farm uniform—and a leather jacket. McMurphy brags that he is a psychopath, but he clearly gives the impression that he is quite lucid.
The younger patients are known as Acutes because the doctors in the ward see them as possessing acute or temporary conditions, not chronic mental illness. Therefore they have been deemed capable of being treated and ultimately turned back to society, having become able to function there. Billy Bibbit, one of the Acutes, tries to roll a cigarette, while Martini, another Acute, ambles around the ward. The Acutes take up half of the ward, and the other half is filled with the Chronics, who are in the hospital for good. Some of these include the “Walkers,” like Chief Broom, who retain their physical capabilities, while others are “Vegetables,” essentially comatose. A number of the Chronics used to be Acutes until they began receiving large doses of electroshock therapy (EST). Ruckly and Ellis, for instance, were Acutes who were essentially lobotomized by intense EST. Ruckly now can only say “ffffuck da wife” over and over in a low, creepy tone. Colonel Matterson is the oldest Chronic, a World War I veteran, and Chief Bromden has been in the ward the longest.
McMurphy arrives, circling the Acutes to ask which one is “bull goose loony,” the craziest one to reckon with. In other words, he is asking who is really in charge. Billy Bibbit, a young man who stutters, introduces McMurphy to Harding, the president of the patients' council. Harding is a flat, nervous man and a college graduate. McMurphy tells Harding that there is not room for two bull goose loonies, so Harding will have to step aside. Harding and McMurphy compete to show their lunacy, both claiming they voted for Eisenhower. Harding finally defers to him, and McMurphy introduces himself to everybody, even the Chronics. He finally centers his attention on Chief Bromden. Harding tells McMurphy that Bromden is only half Indian and is deaf and dumb.
Nurse Ratched summons McMurphy and tells him that he must take his admission shower, for everybody must follow the rules. He answers that this what everyone tells him every time they figure he is about to do the opposite.
Nurse Ratched prepares hypodermic needles as a nurse asks her opinion of McMurphy. Ratched claims McMurphy is a “manipulator” who will use everyone and everything to his own ends. She claims that sometimes a manipulator's end is to disrup the ward. The nurse, Miss Flinn, asks what the motive would be, but Nurse Ratched reminds her that this is an insane asylum.
Chief Bromden notes how Ratched elicits complete control of the staff of the ward, which he now officially names the Combine. Even the doctors are obedient to her, and she has managed to organize a group of henchmen, the sadistic black boys. Most of all, Nurse Ratched is a believer in routine. Each morning she dispenses medications and sets about a carefully controlled scheme of actions. On this day, however, Mr. Taber demands to know what is in his medication, and Nurse Ratched refuses to say. Instead, she remarks coldly that there are means of taking the medicine other than orally. The black boys take him away and inject him.
Nurse Ratched calls a ward meeting. She interrupts Pete Bancini, who complains that he is tired, and tells the black boys to quiet him. Nobody will look at Ratched except for McMurphy, who still has his cap and deck of cards. She starts the meeting by bringing up Harding's marital problems. She reiterates how Harding is concerned about his well-endowed young wife and the attention she receives, as well as his own feelings of inferiority. She asks for comments, and McMurphy raises his hand.
McMurphy ignores the question and introduces himself as a Korean War veteran dishonorably discharged for insubordination and subsequently convicted of statutory rape. McMurphy argues with Dr. Spivey about who was the aggressor in that case, he or the young girl. Spivey questions whether McMurphy is merely a sane man feigning psychosis to escape the drudgery of farm work. Ratched tells McMurphy the theory of the Therapeutic Community: a person must learn to get along in a group before he will be able to function in society. Bancini, a fifty-year-old man who has been a Chronic all his life (his brain was damaged during childbirth), interrupts again to say that he is tired. Ratched orders the boys to take him for treatment after he starts ranting and raving.
After the meeting, McMurphy asks if the meeting procedure is always such a “pecking party,” where all the inmates descend on each other. Harding defends Nurse Ratched and claims that she is a strict middle-aged lady, but no monster. McMurphy replies that she has him by the balls. Harding claims that she is a “veritable angel of mercy” who is “unselfish as the wind”—but Harding finally relents and admits that McMurphy is right, only no one has actually said so before. Harding notes that Dr. Spivey, just like the patients, is afraid of Nurse Ratched. Harding compares the patients to rabbits who cannot adjust to their rabbithood, so they need a strong wolf like Nurse Ratched to teach them their places.
McMurphy says to the men that deep down, they are all lucid and can return to functioning society. Harding now relates the tools that Ratched uses to gain submission from the patients, including domination and even electroshock therapy (EST). McMurphy bets the patients that he can get Nurse Ratched to “crack” or show some vulnerability within a week.
In the first chapter, Kesey sets up the hierarchy, geography, and structures of the mental institution which serves as the novel's setting. The book's authority figure, the villain, is clearly Nurse Ratched, also known as Big Nurse, a woman whose characteristics are described as almost inhuman. Kesey makes her essentially a mechanized robot, completely devoted to order, precision, and control. She is an emblem of bureaucracy and authority, unable to feel compassion or recognize men as individuals. Instead, she believes simply in domination and the stamping out of individual characteristics in subjugation to group order. Still, even in this first chapter, there are indications that behind this inhuman facade lies a mortal instability. She seems ready to snap at the black boys at any moment and unleash her animalistic rage, barely suppressed. Besides, her breasts cannot be disguised, revealing that she is incapable of fully hiding her essential humanity.
The black boys at the institution, meanwhile, serve Nurse Ratched out of fear, though they are good for the job of serving her because their most prominent characteristic is their complete hatred for everyone around them. They are sadistic. Having them around permits Ratched to stay above the fray while the boys become her henchmen, externalizing her repressed anger. For her and for the reader, the boys serve as metaphors for the Nurse's deeply suppressed rage.
Although Chief Bromden is the story's narrator, at this point he cannot be trusted fully since his reliability is in question. For one thing, he is prone to hallucinations, most of which involve the Combine, a matrix which allows civil wars to erupt within the ward at the whim of a huge bureaucratic, unnamed “machine” government. The fog that descends is a metaphor for Bromden's lack of mental clarity, thickening whenever he becomes less stable, receding as he gains confidence. It also is significant that Bromden chooses to remain silent, representing the quiescent persons of society who relinquish their own voices when confronted with authority.
In the second chapter, we meet the protagonist, Randall Patrick McMurphy, who will lock horns with the villain, Nurse Ratched. McMurphy is exuberant, vital, vulgar—everything in his personality suggests a great torrent of energy and a great lack of control. Whereas Nurse Ratched represents bureaucracy and control, McMurphy represents the counterculture, for he is liberated, open, in touch with his true self. McMurphy might brag about being a psychopath, but it is easy to discern the ruse, for he is boisterous, entertaining, quick with words, and oddly gentle in his mannerisms. He clings to the idea that he belongs at the ward, but we already sense that he is the only lucid patient in the ward. We will rely on him to illuminate the true sanity and humanness of others. Even so, he is there for a reason. It is only because of statutory rape and avoiding the work farm, or is there a real problem with his open flouting of authority? Does his independence go too far in a repressive society that is not ready for the likes of a countercultural free spirit?
In Chapter Three, having described the support staff of the hospital, Chief Bromden turns to the patients who inhabit the institution. Most of the patients are Acutes, meaning that they have the possibility of rehabilitation and release, but Bromden makes the important point that they also have the possibility of worsening at the hands of Nurse Ratched and ultimately becoming Chronics like Ruckly and Ellis. Billy Bibbit and Harding stand out as important characters, and both will play major roles in the novel. Harding is most significant now because of his role as the leader of the patients. He leads by virtue of his education, but McMurphy already begins to usurp his power through his charisma and ebullience.
The lines of conflict between McMurphy and Nurse Ratched are already forming. She represents rules and order, while McMurphy represents anarchy, sexual freedom, and disobedience. They sense that this is going to be the root of their conflicts. McMurphy also is a threat to the order of the ward because of his showmanship. He grasps for attention, behaving like a politician on a campaign stop in order to be Top Dog. This choice to gain social approval rather than to be thoroughly an individualist will cause McMurphy to be an easy target for those in the institution, particularly Nurse Ratched. Such a choice also is an early sign that McMurphy will not simply be solipsistic on the ward and will take concern for the other men.
In Chapter Four, Nurse Ratched develops further as an unfeeling automaton dedicated to the service of bureaucracy. She is dispassionate and overly analytical, concerned primarily with the smooth functioning of the ward over any personal concerns. Her main insecurity involves the balance of power in the asylum. McMurphy is a threat to Nurse Ratched because he proves dangerous to the autocratic control she exerts over the others. The black boys, the nurses, and even the doctors are completely submissive to Nurse Ratched's authority, but McMurphy is not yet playing along. It is notable that her control is based as much on intimidation and hatred as efficiency, as demonstrated in this chapter by her threat against Mr. Taber.
Also in this chapter, Chief Bromden opens a critique of the mental institution into a larger societal critique. The social criticism here is based on the idea that the institution, even though it is for the mentally ill, is a microcosm of the rest of society. The mental institution is meant to repair damage done to people’s minds in various ways by religions, schools, and families, yet it operates in the same culture and under the same basic conditions as such organizations and thus suffers the same problems of control and conformity versus individual freedom.
The ward meetings in Chapter Five demonstrate the intimidation and domination techniques that Ratched uses to exert her control. The meeting begins with Nurse Ratched selecting a patient and humiliating him by describing his personal and psychological problems, then asking the other patients to comment on the problems she has described. Her purpose is to pit the patients against one another, thus fostering division among the patients so that they remain submissive to her as the true leader. McMurphy accurately describes this as a pecking party, for the patients are to attack each other as a distraction from the control which she is exerting over them.
The other patients, in particular Harding, realize Nurse Ratched's domination, but they blindly accept this problem as either necessary or insurmountable. Nurse Ratched even has control over the doctors and administrative staff of the hospital, so what could the patients do? Harding suggests that she is part of a matriarchy related to his problems with his wife and his sexual difficulties. Although they implicitly acknowledge Nurse Ratched's control, they do not resist because they have come to believe it is necessary for their convalescence and perhaps for their return to society. Since the inmates believe themselves to be weak, they accept the presence of an authority to control them, which is an important reason they have chosen to be in the asylum. In fact, most are capable of independent action, but they see no reason to resist. McMurphy remains the exception, alone resisting Nurse Ratched's control. This independence marks him as possibly sane, leading Dr. Spivey to suggest that McMurphy is feigning insanity in order to stay out of the work-farm. Spivey is likely right, for McMurphy is able to reason Harding into admitting openly that Ratched is the oppressor McMurphy says she is.