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One Flew Over the Cuckoo's Nest was a direct product of Kesey's time working the graveyard shift as an orderly at a mental health facility in Menlo Park, California. Not only did he speak to the patients and witness the workings of the institution, he took psychoactive drugs, including Mescaline and LSD, as part of Project MKUltra. From this, he became sympathetic toward the patients.
The novel constantly refers to different authorities that control individuals through subtle and coercive methods. The novel's narrator, the Chief, combines these authorities in his mind, calling them "The Combine" in reference to the mechanistic way they manipulate and process individuals. The authority of The Combine is most often personified in the character of "Nurse Ratched" who controls the inhabitants of the novel's mental ward through a combination of rewards and subtle shame. Although she does not normally resort to conventionally harsh discipline, her actions are portrayed as more insidious than those of a conventional prison administrator. This is because the subtlety of her actions prevents her prisoners from understanding that they are being controlled at all. The Chief also sees the Combine in the damming of the wild Columbia River at Celilo Falls, where his Native American ancestors hunted, and in the broader conformity of post-war American consumer society. The novel's critique of the mental ward as an instrument of oppression comparable to the prison mirrored many of the claims that French intellectual Michel Foucault was making at the same time. Similarly, Foucault argued that invisible forms of discipline oppressed individuals on a broad societal scale, encouraging them to censor aspects of themselves and their actions. The novel also criticizes the emasculation of men in society, particularly in the character of Billy Bibbit, the stuttering acute who is domineered by both Nurse Ratched and his mother. These and other interpretive threads are synthesized and analyzed in Peter Swirski's "You're Not in Canada until You Can Hear the Loons Crying or Voting, People's Power and Ken Kesey's One Flew over the Cuckoo's Nest".
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