One Flew Over the Cuckoo's Nest was written in 1959 and published in 1962 in the midst of the Civil Rights Movement and deep changes to the way psychology and psychiatry were being approached in America. The 1960s began the controversial movement towards deinstitutionalization, an act that would have affected the characters in Kesey's novel. The novel is 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 also voluntarily took psychoactive drugs, including mescaline and LSD, as part of Project MKUltra.
In addition to his work with Project MKUltra, Kesey took LSD recreationally. He advocated for drug use as a path to individual freedom, an attitude that was reflected in the views of psychological researchers of the time. In the 1960s LSD was thought to offer the best access to the human mind. Each individual's experiences were said to vary; emotions and experiences ranged from transformations into other life forms, religious experiences, and extreme empathy. It was Kesey's experience with LSD and other psychedelics that made him 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 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 patient who is domineered by both Nurse Ratched and his mother.
Central elements of One Flew over the Cuckoo's Nest embody Erving Goffman's sociological analysis of total institutions, particularly the analytical subset of mental hospitals. Goffman's description of admission procedures in total institutions, for example, reflects the notion of "the combine" espoused by Chief Bromden's character: "Admission procedures might be called 'trimming' or 'programming' because, in thus being squared away, the new arrival allows himself to be shaped and coded into an object that can be fed into the administrative machinery, to be worked on smoothly by routine operations" (p. 16). Further, the behavior of the patients in One Flew over the Cuckoo's Nest represent the range of adaptations to total institutions delineated in section VI of "The Inmate World" in the essay, "Characteristics of Total Institutions."