Ken Kesey's One Flew Over the Cuckoo's Nest relates events that unfold after a rebellious patient, Randle McMurphy, arrives at a psychiatric facility where the repressive Nurse Ratched firmly controls her male patients. Kesey’s novel delves into the psychological effects of institutionalization, as well as the conflicts that naturally emerge in the struggle for power between individuals and institutions. The novel suggests that, in an oppressive environment, an individual's desire for freedom and self-determination stand at sometimes tragic odds with institutional goals of conformity and control.

Told from the narrative viewpoint of Chief Bromden, a patient with schizophrenia, the novel relates the horrible and dehumanizing experiences of the patients at the hands of a barbaric system. McMurphy’s arrival at the facility sets the plot in motion, and it is clear from the start that he is a non-conforming force that contrasts with the docile submission of the other patients. The central conflict is between the patients’ struggle to resist Nurse Ratched’s emasculating repression, led by McMurphy, and Ratched’s attempts to humiliate and discredit McMurphy.

Following McMurphy’s arrival, the ward begins a slow cascade toward disorder. McMurphy continually violates Ratched’s rules, and he sustains efforts to assert his individuality and independence, affecting the other patients. Bromden, whose descriptions of the fog symbolize the confused and dulled state in which Ratched and other staff keep patients, starts to think of McMurphy’s actions as dragging him and the others out of the fog. In the inciting incident, McMurphy challenges Ratched’s tyrannical authority when he refuses to move away from the television. The other patients join his resistance, and under McMurphy’s leadership, Bromden starts to see the system, or machine, as defective, realizing that he can resist as well.

As the novel moves through the events of the rising action, McMurphy’s struggle to assert his individuality and dominance over Nurse Ratched and the ward becomes more intense. Though he becomes aware of the power Ratched has over patients, such as moving them or lobotomizing them, McMurphy functions as the ward’s de facto leader. He encourages other patients to rebel against Ratched’s strict rules and schedules, and he even goes so far as to arrange a fishing trip for them outside of the hospital. Ratched, however, recognizes the threat he poses. She tries, unsuccessfully, to drive a wedge between McMurphy and the other patients. They already have gained a sense of independence, and they have become willing to engage in independent thinking.

The struggle between Ratched and McMurphy, symbolic of the struggle between repression and individualism, reaches its climax when Billy Bibbit, one of McMurphy’s allies, commits suicide after Ratched humiliates him. McMurphy, revealing the depth of his hatred for her and the strength of his desire to break free from her control, attempts to strangle Ratched. He manages to silence her, but it leads to his tragic end.

As the novel’s falling action reveals, McMurphy’s violent attack on Ratched ends his freedom altogether. The institution sends him to receive a lobotomy, and he loses his personality and free will. McMurphy may have asserted his individuality, choosing to sacrifice himself for others in the ward, but his fight against the system has reached a tragic conclusion. The other patients begin to lose hope and resign themselves to their fates, realizing that they are trapped within a system they cannot overcome. The hospital resumes its status quo, with Ratched returning to her post, and the patients suffer the consequences of McMurphy's rebellion. The system, they now know, has the power to crush the individuality and freedom of even the strongest people.

The novel’s resolution is bittersweet. Bromden suffocates McMurphy in his sleep, allowing him to escape the oppressive institution once and for all, a final rebellion against the vegetative state the hospital forced on him. However, Bromden escapes the hospital and symbolically reclaims his own identity and autonomy. The novel's resolution shows the devastating consequences of rebelling against the system and the oppressive forces that control it. Still, the novel suggests that while individual rebellion may have disastrous consequences, it can inspire others to stand up for their own freedom and autonomy. Ultimately, the resolution of One Flew Over the Cuckoo's Nest emphasizes the importance of individualism and the dangers of blind conformity.