Chief Bromden, a long-term patient in Nurse Ratched’s psychiatric ward, narrates the events of the novel. The book begins as he awakens to a typical day on the ward, feeling paranoid about the illicit nighttime activities of the ward’s three black aides. The aides mock him for being a pushover, even though he is six feet seven inches tall, and they make him sweep the hallways for them, nicknaming him “Chief Broom.” Bromden is half Indian and pretends to be deaf and dumb; as a result, he overhears all the secrets on the ward and is barely noticed by anyone despite his stature.

Nurse Ratched, whom Bromden refers to as “the Big Nurse,” enters the ward with a gust of cold air. Bromden describes Ratched as having “skin like flesh-colored enamel” and lips and fingertips the strange orange color of polished steel. Her one feminine feature is her oversized bosom, which she tries to conceal beneath a starched white uniform. When she gets angry with the aides, Bromden sees her get “big as a tractor.” She orders the aides to shave Bromden, and he begins to scream and hallucinate that he is being surrounded by machine-made fog until he is forcedly medicated. He tells us that his forthcoming story about the hospital might seem “too awful to be the truth.”

Bromden regains consciousness in the day room. Here, he tells us that a public relations man sometimes leads tours around the ward, pointing out the cheery atmosphere and claiming that the ward is run without the brutality exercised in previous generations. Today, the ward’s monotony is interrupted when Randle McMurphy, a new patient, arrives. McMurphy’s appearance is preceded by his boisterous, brassy voice and his confident, iron-heeled walk. McMurphy laughs when the patients are stunned silent by his entrance. It is the first real laugh that the ward has heard in years.

McMurphy, a large redhead with a devilish grin, swaggers around the ward in his motorcycle cap and dirty work-farm clothes, with a leather jacket over one arm. He introduces himself as a gambling fool, saying that he requested to be transferred to the hospital to escape the drudgery of the Pendleton Work Farm. He asks to meet the “bull goose looney” so he can take over as the man in charge. He encounters Billy Bibbit, a thirty-one-year-old baby-faced man with a severe stutter, and Dale Harding, the effeminate and educated president of the Patients’ Council. All the while, McMurphy sidesteps the attempts of the daytime aides to herd him into the admission routine of a shower, an injection, and a rectal thermometer.

McMurphy surveys the day room. The patients are divided into two main categories: the Acutes, who are considered curable, and the Chronics, whom Bromden, himself a Chronic, calls “machines with flaws inside that can’t be repaired.” The Chronics who can move around are Walkers, and the rest are either Wheelers or Vegetables. Some Chronics are patients who arrived at the hospital as Acutes but were mentally crippled by excessive shock treatment or brain surgery, common practices in the hospital. Nurse Ratched encourages the Acutes to spy on one another. If one reveals an embarrassing or incriminating personal detail, the rest race to write it in the logbook. Their reward for such disclosures is sleeping late the next morning.

Nurse Ratched runs her ward on a strict schedule, controlling every movement with absolute precision. The nurse has selected her aides for their inherent cruelty and her staff for their submissiveness. Bromden recalls Maxwell Taber, a patient who demanded information about his medications. He was sent for multiple electroshock treatments and rendered completely docile. Eventually, he was considered cured and was discharged. Bromden conceives of society as a huge, oppressive conglomeration that he calls the Combine, and he sees the hospital as a factory for “fixing up mistakes made in the neighborhoods and in the schools and in the churches.”

During the Group Meeting, Nurse Ratched reopens the topic of Harding’s difficult relationship with his wife. When McMurphy makes lewd jokes at the nurse’s expense, she retaliates by reading his file aloud, focusing on his arrest for statutory rape. McMurphy regales the group with stories about the sexual appetite of his fifteen-year-old lover. Even Doctor Spivey enjoys McMurphy’s humorous rebellion against Ratched. The doctor reads from the file, “Don’t overlook the possibility that this man might be feigning psychosis to escape the drudgery of the work farm,” to which McMurphy responds, “Doctor, do I look like a sane man?” McMurphy has similar defiant retorts for almost any action Ratched can consider, which perturbs Ratched greatly. McMurphy is disconcerted that the patients and the doctor can smile but not laugh. Bromden remembers a meeting that was broken up when Pete Bancini, a lifelong Chronic who constantly declared he was tired, became lucid for a moment and hit one of the aides with a heavy iron ball. The nurse injected him with a sedative as he had a nervous breakdown.

During the meeting, the patients tear into Harding’s sexual problems. Afterward, they are embarrassed, as always, at their viciousness. As a new participant and observer, McMurphy tells Harding that the meeting was a “pecking party”—the men acted like a bunch of chickens pecking at another chicken’s wound. He warns them that a pecking party can wipe out the whole flock. When McMurphy points out that Nurse Ratched pecks first, Harding becomes defensive and states that Ratched’s procedure is therapeutic. McMurphy replies that she is merely a “ball-cutter.”

Harding finally agrees that Ratched is a cruel, vicious woman. He explains that everyone in the ward is a rabbit in a world ruled by wolves. They are in the hospital because they are unable to accept their roles as rabbits. Nurse Ratched is one of the wolves, and she is there to train them to accept their rabbit roles. She can make a patient shrink with shame and fear while acting like a concerned angel of mercy. Ratched never accuses directly, but she rules others through insinuation. McMurphy says that they should tell her to go to hell with her insinuating questions. Harding warns that such hostile behavior will earn a man electroshock therapy and a stay in the Disturbed ward. He points to Bromden, calling him “a six-foot-eight sweeping machine” as a result of all the shock treatment he has received. Harding asserts that the only power men have over women is sexual violence, but they cannot even exercise that power against the icy, impregnable nurse. McMurphy makes a bet with the other patients that he can make Nurse Ratched lose her temper within a week. He explains that he conned his way out of the work farm by feigning insanity, and Nurse Ratched is unprepared for an enemy with a “trigger-quick mind” like his.

Chief Bromden, the narrator of One Flew Over the Cuckoo’s Nest, is a complex character whose own story is revealed as he tells the story of the ward at large. Because he feigns deafness, he is privy to information that is kept from the other patients. In this way, he is a more informed narrator than any other patient. However, -Bromden’s reliability as a narrator is unclear because we constantly see reminders of his psychological disorder. The main indications of his illness are paranoia and frequent hallucinations. His paranoia is often justified, as the patients are indeed treated barbarically. But his hallucinations, though they seem crazy at first, metaphorically reveal his deep, intuitive understanding of his surroundings. For example, the fog machine he hallucinates represents his state of mind—he is overmedicated or simply too fearful to face the stark reality beyond the fog. The fog machine also represents the powerlessness of the patients, who are encouraged and sometimes forced by the staff to stay hidden in their own individual fogs.

Bromden sees modern society as a machinelike, oppressive force, and the hospital as a repair shop for the people who do not fit into their role as cogs in the machine. Bromden’s way of interpreting the world emphasizes the oppressive social pressure to conform: those who do not conform to society’s rules and conventions are considered defective products and are labeled mentally ill and sent for treatment. Thus, the mental hospital is a metaphor for the oppression Kesey sees in modern society, preceding the emergence of the 1960s counterculture. A hospital, normally a place where the ill go to be cured, becomes a dangerous place; Ellis, Ruckly, and Taber, for instance, are electroshocked until they become docile or even vegetables. The hospital is not about healing, but about dehumanizing and manipulating the patients until they are weak and willing to conform.

At the center of this controlled universe is Nurse Ratched, a representative of what Bromden calls the Combine, meaning the oppressive force of society and authority. Bromden describes her in mechanical, inhuman terms. She tries to conceal her large breasts as much as possible, and her face is like that of a doll, with a subtle edge of cruelty. Bromden imagines that the hospital is full of hidden machinery—wires, magnets, and more sinister contraptions—used by Nurse Ratched to control the patients. The nurse is, in fact, in complete control of the ward, and the tools she uses—psychological intimidation, divide-and-conquer techniques, and physical abuse—are every bit as powerful and insidious as the hidden machinery -Bromden imagines.

Immediately upon his arrival, McMurphy challenges the ward with his exuberant vitality and sexuality, which are directly opposed to the sterile, mechanical nature of the hospital and modern society. He is set up as an obvious foil to Nurse Ratched, as well as to the silent and repressed Bromden. McMurphy’s discussion with Harding reveals the misogynistic undertones of One Flew Over the Cuckoo’s Nest. The patients associate matriarchy with castration, explaining the lifelessness and oppressiveness of modern society as a product of female dominance.