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The final chapter of One Flew Over the Cuckoo’s Nest culminates in a pyrrhic victory for Nurse Ratched and a pyrrhic victory for the martyred McMurphy. That is, they both win and both lose. The confrontation between the two characters finally becomes both violent and sexual, having been set up as sexual by the confrontation between Nurse Ratched and Billy Bibbit over the prostitute. Nurse Ratched has used repressive sexuality as a weapon against Billy Bibbit, instilling in him a sense of shame that stems from both religious sexual guilt and his domineering mother. Harding even makes a religious allusion to Jezebel that underscores the religious idea of certain kinds of sexuality as sinful. Yet it is when Nurse Ratched uses Billy Bibbit’s mother to instill a sense of shame that she drives him to suicide, showing with unerring finality the cause of Billy’s problems.
The religious theme continues as Nurse Ratched chastises McMurphy for playing God and causing the deaths of Cheswick and Billy Bibbit. The irony is that her policies and abuses of power are what drove them to their respective deaths. All of her criticisms of McMurphy can be better applied to Nurse Ratched herself, a vengeful goddess over the ward.
McMurphy’s attack on Nurse Ratched is about power and sexuality. He effects a literal and figurative exposing of the Big Nurse. When he attacks her, he exposes her breasts, the one barely suppressed sign of her femininity. This point also relates back to Harding’s earlier suggestion that sex is the cure for Nurse Ratched—here it is at least a cure for the men against her. The result of this fight is the final humanization of Nurse Ratched in that everyone learns what McMurphy has known from the beginning: she is human and weak and troubled like everyone else. When she returns to the ward after the fight, she is unable to speak and thus has lost a major sign of her power. While she loses this sign of humanity, she neatly parallels Chief Bromden, who in the course of the novel regains his voice and his humanity.
McMurphy ostensibly loses his battle against Nurse Ratched when she orders a lobotomy for him, but the victory is hollow, for she loses control of the ward as the other patients free themselves of her grip and voluntarily leave the hospital. This is an ultimate win for him and an ultimate loss for her. This circumstance also fits well with the Christian symbolism of the novel; although McMurphy dies for his cause, his disciples leave the hospital to live according to his teachings. They have gained the strength and the freedom to make independent choices as McMurphy proposed that they could.