With the exception of the prostitutes, who are portrayed as good, the women in One Flew Over the Cuckoo’s Nest are uniformly threatening and terrifying figures. Bromden, the narrator, and McMurphy, the protagonist, both tend to describe the suffering of the mental patients as a matter of emasculation or castration at the hands of Nurse Ratched and the hospital supervisor, who is also a woman. The fear of women is one of the novel’s most central features. The male characters seem to agree with Harding, who complains, “We are victims of a matriarchy here.”

Indeed, most of the male patients have been damaged by relationships with overpowering women. For instance, Bromden’s mother is portrayed as a castrating woman; her husband took her last name, and she turned a big, strong chief into a small, weak alcoholic. According to Bromden, she built herself up emotionally, becoming bigger than either he or his father, by constantly putting them down. Similarly, Billy Bibbit’s mother treats him like an infant and does not allow him to develop sexually. Through sex with Candy, Billy briefly regains his confidence. It is no coincidence that this act, which symbolically resurrects his manhood, also literally introduces his penis to sexual activity. Thus, his manhood—in both senses—returns until Ratched takes it away by threatening to tell his mother and driving him to commit suicide.

More explicit images of and references to castration appear later in the novel, cementing Kesey’s idea of emasculation by the frigid nurse. When Rawler, a patient in the Disturbed ward, commits suicide by cutting off his own testicles, Bromden remarks that “all the guy had to do was wait,” implying that the institution itself would have castrated him in the long run. The hospital, run by women, treats only male patients, showing how women have the ability to emasculate even the most masculine of men. Finally, near the end of the novel, after McMurphy has already received three shock treatments that do not seem to have had an effect on him, Nurse Ratched suggests taking more drastic measures: “an operation.” She means, of course, a lobotomy, but McMurphy beats her to the punch by joking about castration. Both operations remove a man’s individuality, freedom, and ability for sexual expression. Kesey portrays the two operations as symbolically the same.

Kesey uses mechanical imagery to represent modern society and biological imagery to represent nature. By means of mechanisms and machines, society gains control of and suppresses individuality and natural impulses. The hospital, representative of society at large, is decidedly unnatural: the aides and Nurse Ratched are described as being made of motley machine parts. In Chief Bromden’s dream, when Blastic is disemboweled, rust, not blood, spills out, revealing that the hospital destroyed not only his life but his humanity as well. Bromden’s realization that the hospital treats human beings in an unnatural fashion, and his concomitant growing self-awareness, occur as a surrounding fog dissipates. It is no surprise that Bromden believes this fog is a construction of machines controlled by the hospital and by Nurse Ratched.

Bromden, as the son of an Indian chief, is a combination of pure, natural individuality and a spirit almost completely subverted by mechanized society. Early on, he had free will, and he can remember and describe going hunting in the woods with his relatives and the way they spear salmon. The government, however, eventually succeeds in paying off the tribe so their fishing area can be converted into a profitable hydroelectric dam. The tribe members are banished into the technological workforce, where they become “hypnotized by routine,” like the “half-life things” that Bromden witnesses coming out of the train while he is on fishing excursions. In the novel’s present time, Bromden himself ends up semi-catatonic and paranoid, a mechanical drone who is still able to think and conjecture to some extent on his own.

McMurphy represents unbridled individuality and free expression—both intellectual and sexual. One idea presented in this novel is that a man’s virility is equated with a state of nature, and the state of civilized society requires that he be desexualized. But McMurphy battles against letting the oppressive society make him into a machinelike drone, and he manages to maintain his individuality until his ultimate objective—bringing this individuality to the others—is complete. However, when his wildness is provoked one too many times by Nurse Ratched, he ends up being destroyed by modern society’s machines of oppression.

It is implied throughout the novel that a healthy expression of sexuality is a key component of sanity, and that repression of sexuality leads directly to insanity. Most of the patients have warped sexual identities because of damaging relationships with women. Perverted sexual expressions are said to take place in the ward: the aides supposedly engage in illicit “sex acts” that nobody witnesses, and on several occasions it is suggested that they rape patients, such as Taber, with Ratched’s implicit permission, symbolized by the jar of Vaseline she leaves with them. Add to that the castrating power of Nurse Ratched, and the ward is left with, as Harding says, “comical little creatures who can’t even achieve masculinity in the rabbit world.” Missing from the halls of the mental hospital are healthy, natural expressions of sexuality between two people.

McMurphy’s bold assertion of his sexuality, symbolized from the start by his playing cards depicting fifty-two sexual positions, his pride in having had a voracious fifteen-year-old lover, and his Moby-Dick boxer shorts, clashes with the sterile and sexless ward that Nurse Ratched tries to maintain. We learn that McMurphy first had sex at age ten with a girl perhaps even younger, and that her dress from that momentous occasion, which inspired him to become a “dedicated lover,” still hangs outdoors for everyone to see. McMurphy’s refusal to conform to society mirrors his refusal to desexualize himself, and the sexuality exuding from his personality is like a dress waving in the wind like a flag.

McMurphy attempts to cure Billy Bibbit of his stutter by arranging for him to lose his virginity with Candy. Instead, Billy gets shamed into suicide by the puritanical Ratched. By the end of the novel, McMurphy has been beaten into the ground to the point that he resorts to sexual violence—which had never been a part of his persona previous to being committed, despite Nurse Pilbow’s fears—by ripping open Ratched’s uniform.

McMurphy’s sanity, symbolized by his free laughter, open sexuality, strength, size, and confidence, stands in contrast to what Kesey implies, ironically and tragically, is an insane institution. Nurse Ratched tells another nurse that McMurphy seems to be a manipulator, just like a former patient, Maxwell Taber. Taber, Bromden explains, was a “big, griping Acute” who once asked a nurse what kind of medication he was being given. He was subjected to electroshock treatments and possibly brain work, which left him docile and unable to think. The insanity of the institution is foregrounded when a man who asks a simple question is tortured and rendered inhuman. It is a Catch-22: only a sane man would question an irrational system, but the act of questioning means his sanity will inevitably be compromised.

Throughout the novel, the sane actions of men contrast with the insane actions of the institution. At the end of Part II, when McMurphy and the patients stage a protest against Nurse Ratched for not letting them watch the World Series, a sensible request for which McMurphy generates a sensible solution, she loses control and, as Bromden notes, looks as crazy as they do. Moreover, Kesey encourages the reader to consider the value of alternative states of perception, which some people also might consider crazy. For instance, Bromden’s hallucinations about hidden machinery may seem crazy, but in actuality they reveal his insight into the hospital’s insidious power over the patients.

In addition, when the patients go on the fishing excursion they discover that mental illness can have an aspect of power in that they can intimidate the station attendants with their insanity. Harding gives Hitler as an example in discussing Ratched, suggesting that she, like Hitler, is a psychopath who has discovered how to use her insanity to her advantage. Bromden, at one point, thinks to himself, “You’re making sense, old man, a sense of your own. You’re not crazy the way they think.” “[C]razy the way they think,” however, is all that matters in this hospital. The authority figures decide who is sane and who is insane, and by deciding it, they make it reality.

Many important elements in the novel are either hidden from view or invisible. For example, Bromden tries to be as invisible as possible. He has achieved this invisibility by pretending not to understand what is going on around him, so people notice him less and less. Moreover, he imagines a fog surrounding him that hides him and keeps him safe. He keeps both his body and his mind hidden.

Bromden’s hallucinations about hidden machines that control the patients call attention to the fact that the power over the patients is usually covert. He imagines that the patients are implanted with tiny machines that record and control their movements from the inside. The truth is that Nurse Ratched manages to rule by insinuation, without ever having to be explicit about her accusations and threats, so it seems as though the patients themselves have absorbed her influence—she becomes a sort of twisted conscience.

When McMurphy smashes through the glass window of the Nurses’ Station, his excuse is that the glass was so clean he could not see it. By smashing it, he reminds the patients that although they cannot always see Ratched’s or society’s manipulation, it still operates on them.

The power of laughter resonates throughout the novel. McMurphy’s laughter is the first genuine laughter heard on the ward in years. McMurphy’s first inkling that things are strange among the patients is that none of them are able to laugh; they can only smile and snicker behind their hands. Bromden remembers a scene from his childhood when his father and relatives mocked some government officials, and he realizes how powerful their laughter was: “I forget sometimes what laughter can do.” For McMurphy, laughter is a potent defense against society’s insanity, and anyone who cannot laugh properly has no chance of surviving. By the end of the fishing trip, Harding, Scanlon, Doctor Spivey, and Sefelt are all finally able to participate in real, thunderous laughter, a sign of their physical and psychological recovery.

Bromden describes people by their true size, not merely their physical size. Kesey implies that when people allow others, such as governments and institutions, to define their worth, they can end up far from their natural state. Nurse Ratched’s true size, for example, is “big as a tractor,” because she is powerful and unstoppable. Bromden, though he is six feet seven inches tall, feels much smaller and weaker. He tells McMurphy, “I used to be big, but not no more.” As for McMurphy, Bromden says he is “broad as Papa was tall,” and his father was named The Pine That Stands Tallest on the Mountain. Bromden says his mother was twice the size of he and his father put together, because she belittled them both so much. With McMurphy’s help, Bromden is gradually “blown back up to full size” as he regains his self-esteem, sexuality, and individuality.

Fog is a phenomenon that clouds our vision of the world. In this novel, fogs symbolize a lack of insight and an escape from reality. When Bromden starts to slip away from reality, because of his medication or out of fear, he hallucinates fog drifting into the ward. He imagines that there are hidden fog machines in the vents and that they are controlled by the staff. Although it can be frightening at times, Bromden considers the fog to be a safe place; he can hide in it and ignore reality. Beyond what it means for Bromden, the fog represents the state of mind that Ratched imposes on the patients with her strict, mind-numbing routines and humiliating treatment. When McMurphy arrives, he drags all the patients out of the fog.

McMurphy’s boxer shorts are black satin with a pattern of white whales with red eyes. A literature major gave them to him, saying that McMurphy is himself a symbol. The shorts, of course, are also highly symbolic. First, the white whales call to mind Moby-Dick, one of the most potent symbols in American literature. One common interpretation of Moby-Dick is that the whale is a phallic symbol, which obviously suggests McMurphy’s blatant sexuality—the little white whales cover McMurphy’s underwear, which he gleefully reveals to Nurse Ratched. Moby-Dick also represents the pervasive evil that inspires Ahab’s obsessive, futile pursuit. Here, the implication is that McMurphy is to Moby-Dick as Ratched is to Ahab. A third interpretation is that Moby-Dick stands for the power of nature, signifying McMurphy’s untamed nature that conflicts with the controlled institution. Lastly, in Melville’s novel Moby-Dick is associated with God, which resonates with McMurphy’s role as a Christ figure. Finally, the whale boxer shorts poke fun at academia and its elaborate interpretations of symbols.

The electroshock therapy table is explicitly associated with crucifixion. It is shaped like a cross, with straps across the wrists and over the head. Moreover, the table performs a function similar to the public crucifixions of Roman times. Ellis, Ruckly, and Taber—Acutes whose lives were destroyed by electroshock therapy—serve as public examples of what happens to those who rebel against the ruling powers. Ellis makes the reference explicit: he is actually nailed to the wall. This foreshadows that McMurphy, who is associated with Christ images, will be sacrificed.