Sefelt, an epileptic, has a seizure during lunch because he refuses to take his medication. Sefelt has been giving his medication to Frederickson. McMurphy asks Frederickson why Sefelt refuses to take his medicine, Dilantin, and he answers that Dilantin makes one’s gums rot. The choice is between having his gums rot or having seizures. One of the boys removes two of Sefelt’s teeth as Scanlon mentions, “damned if you do and damned if you don’t.”
The clean, calculated movements of the ward resume as Nurse Ratched reassumes her complete control over the function and operation of the institution.
Chief Bromden goes with the Acutes to the library. One of the boys brings Harding’s wife into the library. She is as tall as he is and carries a black purse; her fingernails are blood red. Harding introduces McMurphy to his “counterpart and Nemesis.” Harding tells his wife, Vera, how McMurphy stood up to Nurse Ratched. She scolds her husband for making a mousy squeak when he laughs. This comment makes Harding nervous and jumpy. Vera then asks for a cigarette, and Harding tells her that the cigarettes have been rationed. This causes a fight between Harding and his wife; she asks whether he ever does have enough, and he asks her in return whether she is speaking symbolically.
McMurphy offers her a cigarette, and she leans forward to take it so that everyone can see down her blouse. Vera complains that Harding’s friends, “hoity-toity boys with the nice long hair combed so perfectly and the limp little wrists,” keep visiting the house to see him. She suddenly decides to leave. Harding asks McMurphy what he thinks of her, and he replies that she has breasts as big as Nurse Ratched’s. McMurphy gets angry when Harding asks for a more serious answer, telling Harding that he has worries of his own and does not want to deal with Harding’s. Later, McMurphy admits that he has been suffering from bad dreams over the past week.
Several weeks after the vote on the World Series, the patients are taken to another building to get chest X-rays for tuberculosis. McMurphy sees a room that is unmarked. He asks Harding what happens inside, and Harding tells him that the room is the Shock Shop. Although Harding says that they are witnessing the sunset of electroshock therapy (EST), Nurse Ratched is one of the few remaining advocates of it. Harding claims that EST is not always used for punitive means but “for a patient’s own good.”
Harding relates the history of EST. It came about when two psychiatrists were visiting a slaughterhouse and watched how a blow to the head would induce an epileptic convulsion in a cow, and they concluded that if a seizure could be induced in non-epileptics, great benefits might result. Harding claims that the process is painless, but the jolt sets off a wild carnival of images.
Harding also mentions lobotomy, which he calls “frontal lobe castration.” He says that if Ratched “can’t cut below the belt she’ll do it above the eyes.” McMurphy says that if Nurse Ratched is truly the patients’ problem, the solution is to throw her down and penetrate through her sexually repressive defenses. The other patients propose that McMurphy do the job.
McMurphy asks the other patients why they never told him that Nurse Ratched controls whether or not he can leave. Harding says that he forgot that McMurphy was committed involuntarily. Harding tells him that most of the patients are not committed involuntarily, just Scanlon and some of the Chronics. McMurphy asks why Billy is here if he does not have to be—he could be in a convertible “bird-dogging girls.” Billy claims that he is too weak to leave and likes it where he is. He then begins to cry as the scars on his wrist open and begin to bleed.
The other patients calm Billy as the patients return to the ward. Chief Bromden walks beside McMurphy and can tell that he is afflicted with some great worry. McMurphy asks Sam, one of the boys, if he can stop by the canteen to get cigarettes. At the canteen, McMurphy buys several cartons. During the meeting that afternoon, Nurse Ratched brings up their behavior several weeks ago. She claims that she waited too long to deal with it and give the men a chance to apologize. She claims that her discipline now is entirely for their own good. She is taking away tub room privileges. McMurphy says nothing. He stands up and walks with his normal swagger to the Nurses’ Station and punches the glass in order to get his cigarettes. He sarcastically says that the glass was so clean that he completely forgot it was there.
In Chapter Nineteen, Sefelt chooses not to take his medicine because it causes his gums to rot. This is not a psychosomatic fear; gum problems can be real side effects of the medicine. But because Sefelt refuses to take his medicine, he has seizures, ultimately causing him to lose teeth. Sefelt’s choice is thus between bad teeth or bad gums, as Scanlon puts it—”damned if you do and damned if you don’t.” This fatalism is a disappointing condition in the ward. What Scanlon fails to note is that the bad gums are a price to pay for the benefit of reducing seizures, while the bad teeth are tied to the extra troubles of the seizures. The choice should be easy—to take the medicine—but Sefelt chooses badly.
Chapter Twenty, just a paragraph long, marks the change in the ward after McMurphy gives up his struggle against Nurse Ratched. She once again reasserts her control over the rest of the patients, for McMurphy knows that to oppose her is to ensure that he will never leave the ward.
The confrontation between Harding and his wife in Chapter Twenty-One centers almost entirely around their sexual problems. Vera Harding is juxtaposed with Nurse Ratched. They are outwardly similar (especially in McMurphy’s eyes) because they both have large breasts, but while Big Nurse is repressed and cold, Vera Harding is imposing in her sexuality. Her blood-red fingernails are a complement and contrast to Nurse Ratched’s icy orange polish. Vera Harding intimidates her husband with her sexuality, leaning over to get a cigarette intentionally so that the other patients can see down her blouse. She goes on to complain about her husband’s inadequacies, which he perceives as a sexual metaphor, probably correctly. Vera additionally questions her husband’s sexual preference, mentioning the boys with “limp wrists” who visit their home—a stereotypical invocation of male homosexuality—who are Harding’s friends. Whether or not Harding is a closeted homosexual, Vera seems to be using this idea as a tactic to humiliate her husband by playing on his sexual anxieties.
McMurphy demonstrates some strain in this chapter as well. He seems to be weary of acting as the leader or authority figure for the men on the ward. If Cheswick might have caught a sense of this weariness, it becomes clearer when McMurphy refuses to give his appraisal of the problems between Harding and his wife. McMurphy is under some psychological strain, likely caused by worry that he will never be able to leave the institution.
Harding describes the processes of electroshock therapy and lobotomies in great detail in Chapter Twenty-Two, thus foreshadowing their use. He makes the important point that it is Nurse Ratched who uses these methods, even if they are becoming discredited. Though he notes that such treatment is not always for punitive means, he simultaneously suggests that these methods sometimes actually are used as punishment when Ratched is disobeyed. Harding also uses lobotomies as a metaphor for sexual crippling through “castration” of the frontal lobe. The conversation between McMurphy and Harding once again defines the opposition between McMurphy and Ratched in sexual terms. Nurse Ratched can use lobotomies as the equivalent of castration, while McMurphy suggests sex as the cure for Nurse Ratched’s repression and control. McMurphy also puts himself in the role of sexual liberator.
Billy Bibbit’s mother seems to control his actions, rendering him weak and at least symbolically impotent. There is a link between Mrs. Bibbit and Nurse Ratched; Billy claims that the two women are close friends. Nurse Ratched thus serves as a stand-in mother who can manipulate Billy Bibbit’s weaknesses and insecurities. This vulnerability will become important in future chapters.
When McMurphy realizes that most of the patients have made the choice to remain in the institution, he realizes that personal choice and fear of one’s problems in the outside world have put most of the inmates in the asylum. Only he and a small number are actually committed; the others remain under Nurse Ratched’s control out of fear or habit. This differentiates McMurphy from the other patients; he is sane because he uses his ability to make rational choices while the other patients are coded as insane through their refusal to take their chances out in the world.
Nurse Ratched has reasserted her control over the institution in Chapter Twenty-Three, again a mother or a warden who dominates the men. She speaks to them in utterly condescending terms, even referring to them as “boys” and treating them as children who cannot accept any sense of responsibility. Having treated these men with such great disrespect and taking away something of value to McMurphy, she triggers his anger. He responds with impudence. When he breaks the glass, this is the first physically aggressive action he takes against Nurse Ratched. This brings the confrontation between the two characters back to the fore, for McMurphy is aggressively acting out on behalf of the privileges of the patients. He is taking a risk in that the act will mean a longer stay in the institution, but at this moment his anger or rebellion is stronger than such a fear.