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.