Book Review: One Flew Over the Cuckoo’s Nest by Ken Kesey

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The hero of Ken Kesey’s classic novel is Randle Patrick McMurphy, a boisterous, brawling, fun-loving rebel who swaggers into the world of a mental hospital and takes it over. McMurphy is a lusty, life-affirming fighter who rallies the other patients around him by opposing Nurse Ratched’s dictatorship. 

Throughout the ward, he smuggles in wine and women, promotes gambling, and defies every rule. Although this sport initially starts as a sport, it soon turns into a struggle, an all-out war between Nurse Ratched, who is fully backed by the authority, and McMurphy, who is backed only by his own indomitable will. 

In the story, the shocking climax occurs when Nurse Ratched uses her ultimate weapon against McMurphy.

You may still be wondering if you should read the book. This book review will tell you everything about this book so you can decide if it is worth your time.

Without further ado, let’s get started. 

Plot Summary

A con man who is committed to a mental hospital loses his life while helping the patients challenge the hospital authorities.

Part 1 

Chief Bromden, a half-Indian patient in an Oregon mental hospital, is the narrator of the novel. Suffering from paranoia, he believes people are out to get him (“they’re out there”), and in order to protect himself from the world, he pretends to be a deaf-mute. 

His hallucinations are filled with images of machines that control society, and when he becomes tense or afraid his mind clouds over.

A large, powerful man, he has low self-esteem and consequently believes that he is small and weak. He suffers from anxiety whenever he thinks of the “Combine”—his term for modern society, with its destructive, mechanical forces.

Nurse Ratched, also known as Big Nurse, contributes to his fears. She is a large, machinelike authority figure—a former army nurse—who runs the ward as a sadistic tyrant, molding patients into orderly, submissive robots. In the Group Therapy sessions, she encourages patients to criticize each other in a hostile, damaging way; she dwells on their weaknesses and reinforces their fears.

Her ward has two types of patients: the Acutes (who can be cured by therapy) and the Chronics (incurable). Though she is a representative of the Combine, Nurse Ratched does have a weakness: she is nervous about sexuality, and hides her large breasts underneath a stiffly starched uniform.

One day, a new patient, Randle Patrick McMurphy, is admitted to the “Cuckoo’s Nest” (psychiatric ward). He is a con man who had himself diagnosed as a psychotic so that he would be committed to the mental hospital instead of having to work at Pendleton, the state prison farm. 

He is a redheaded, energetic, “sane” man who enjoys laughing, telling jokes, and challenging authority. He captivates the patients with his stories of the outside world (sex, fighting, gambling), and Nurse Ratched immediately sees him as a “disruptive” force.

Upon entering the ward, McMurphy shakes the hand of Billy Bibbit, a shy, stuttering 31-year-old whose domineering mother treats him like a child. Nurse Ratched, a good friend of Billy’s mother, cooperates with her friend by dominating Billy in the same way. McMurphy moves on to Dale Harding, an intelligent man who dreads his effeminacy and whose wife, Vera Harding, thinks he is gay.

His white, dainty hands flutter whenever he is nervous. McMurphy wanders over to the Chronics, where he jokes with the Chief. Though Bromden plays his deaf-mute routine, McMurphy shakes his hand, and the Chief feels a rush of power surging through his body, as if McMurphy’s hands have healing power. The patients begin their days at 6:45 A.M. 

They dress, eat breakfast, go to the day room, and wait for Big Nurse to push a button from behind the glass wall of her control room, signaling that things should “come to order.” Seated in their assigned places, the patients receive medications, play cards, read their mail, and watch the hypocritical Public Relations Man tour groups of women through the ward, praising the care that the patients receive. 

Whenever patients get out of control, Big Nurse turns on the fog machine from her control panel, thus filling the room with fog and preventing the patients from seeing each other. Once there is order, she begins the daily Group Meetings. In his first Meeting, McMurphy challenges Big Nurse by injecting sexual innuendos into the discussion. 

He is a highly sexed, aggressive man who will not take orders from a haughty nurse or from the insolent “black boys” (orderlies). Dr. Spivey, a morphine addict who works in Big Nurse’s ward, finds it amusing that McMurphy deals so nonchalantly with her. 

Though he is sympathetic to the patients’ problems, he must cooperate with Big Nurse since she “knows” about his drug habit and could report him to the authorities.

McMurphy decides to organize the men into a protest against Big Nurse, but the men fear the consequences—Electro-Shock Therapy (EST) and trips to the Disturbed Ward. McMurphy realizes that the only way to win the battle with Big Nurse is to anger her without breaking any of the rules. 

He scores his first major victory when he convinces the patients to vote for the privilege of watching the World Series baseball games, which are to be televised during a time when the inmates are scheduled to be doing something else. When Chief Bromden raises his hand in that vote, he takes the first step in his fight against the Combine.

Nurse Ratched angrily cuts off the television’s power, but the patients continue to sit in front of the set, watching the blank screen. It is their way of demonstrating that they can assert themselves with McMurphy’s help.

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Part 2 

Patients who have been involuntarily committed to the hospital (as McMurphy has) can be released only when Big Nurse authorizes it. McMurphy begins to fear the consequences of protesting against her, and his instinct for self-preservation temporarily replaces his need to rebel. 

But he soon realizes that the patients, especially the Chief, have come to depend on him; this is made tragically clear when Cheswick, one of McMurphy’s biggest admirers, drowns himself because of McMurphy’s change in behavior. 

McMurphy decides to take a stand and become a leader, recognizing that he can no longer act solely for himself. When Big Nurse takes away the men’s tub room privileges (where they had played games), McMurphy angrily smashes the window of the Nurse’s Station. This scares Big Nurse, but she bides her time for him to make a major mistake.

Part 3 

Since Big Nurse has not yet made her move against McMurphy, he takes advantage of the situation by organizing a fishing trip with 12 inmates and Dr. Spivey. The night before the trip, the Chief makes a major breakthrough when thoughts of the fishing trip remind him of a painful moment in his childhood. 

Two white men and a woman had come to his Indian village to negotiate rights for building a hydroelectric dam. Instead of dealing with the Chiefs father, who was considered “weak” because of his alcoholism, they negotiated with the Chief’s mother, Mary Louise Bromden, a domineering white woman who had nagged her gentle husband into alcoholism and forced her son to take her name. 

She “sold out” the Indian village to the Combine and brought disgrace to her family. Excited about remembering this trauma from his childhood, the Chief speaks his first words in years when McMurphy offers him some chewing gum. 

He agrees to go on the fishing trip, especially since Candy Starr, a prostitute and a friend of McMurphy’s from Oregon, has agreed to meet them at the ocean. Since the Chief has no money for the trip, McMurphy agrees to pay for him; in exchange, however, the Chief must agree to lift Big Nurse’s control panel as proof of his strength.

The fishing trip shows McMurphy at the height of his influence on the men. Once outside the institution, the men begin to rediscover their self-respect and masculinity. They no longer behave like the “rabbits” which Harding had once called them. Bromden, in particular, is restored to a sense of harmony with nature. 

Yet, while the others acquire strength, McMurphy begins to lose it; his role as a “savior” has taken its toll. He feels worn down by the System, but invites Candy to a party on the ward so that she can help the virgin Billy Bibbit become a “man.”

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Part 4 

The day after the fishing trip, Big Nurse charges McMurphy with taking advantage of the men; she points out that he continually wins from them in his gambling games. Harding defends McMurphy’s “faults” as being human, but McMurphy makes an unfortunate error: He had promised to help the Chief regain his strength and individuality, and after he discovers in a trial run that the Chief is strong enough to lift the control panel, he challenges the Chief to lift the panel in front of the patients but persuades the men to bet against the Chief.

When the Chief successfully lifts it, everyone but McMurphy loses money. The men—including Bromden—feel conned and begin to feel that Big Nurse’s accusations against McMurphy are true.

McMurphy quickly restores their faith, however, when he defends George, a patient who refuses to be given an enema in the shower. A fight breaks out between McMurphy and the “black boys,” and the Chief helps McMurphy defeat them. When McMurphy refuses to apologize to Big Nurse for his actions, he and the Chief are sent to Electro-Shock Therapy. There, they meet a sympathetic Japanese Nurse who is critical of Nurse Ratched’s methods.

The Chief returns to the ward after a week. Now that he no longer pretends to be a deaf-mute, he gets the men talking and laughing—something only McMurphy had been able to do up to now. McMurphy returns after three shock treatments. During his absence, some of the patients had helped to plan his escape, knowing that things could only get worse for him. 

But instead of going along with their plan, he prefers to live up to his promise to Billy, to sneak Candy into the ward for Billy’s big night with her. The escape becomes part of the plan for the night of the party.

Candy arrives at the party with her friend Sandy, another prostitute, and the men bribe one of the aides, Mr. Turkle, to open the Seclusion Room, where Candy and Billy go to make love. McMurphy’s escape plan calls for the men to tie up Turkle and make it look as if McMurphy has gone on a rampage. 

But he fails to wake up in the morning as planned, and aides catch him in bed with Sandy. Big Nurse discovers Billy in Candy’s arms, no longer stuttering, and threatens to tell his mother. He begins to stutter again, and when left alone, he slits his throat.

Big Nurse blames McMurphy for Billy’s death, which finally drives him to attack her. He rips open her uniform, and though he is restrained from choking her, he manages to expose her large breasts—an act that destroys her power over the patients, who now see her as a sexual human being, not a machine. 

When McMurphy is sent off for a lobotomy, most of the men who had admitted themselves voluntarily to the hospital make the courageous decision to leave. As a result of the profound shock that the exposure of her sexuality has caused Big Nurse, she becomes a mute who must communicate with patients in writing.

McMurphy returns to the ward, a total vegetable, and as an act of mercy, the Chief smothers him to death. Then he lifts the control panel with all the strength that McMurphy had helped him to regain, smashes it through the window, and escapes to the outside world.

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Themes and Ideas

1. Hero vs. Enemy 

In the stifling world of machines and authority figures, people sometimes need role models or heroes to help preserve what is most natural and human about their character. McMurphy is a hero for the patients in his ward; he is “not an ordinary man.” 

According to the Chief, McMurphy has remained unharmed because the Combine couldn’t get him. His goal is to enjoy life by being free, by helping others enjoy the same freedom, and by showing others how to laugh at the world. 

It is his way of offering them hope for escaping the “fog” (anxiety). He stands up for the individual and protests against institutional repression. Big Nurse is his enemy because she withholds freedom from patients. 

Using the example of a hospital, Kesey depicts life as a constant struggle between good and evil, heroes and villains, humanity and technology, self-assertiveness and repressed obedience to authority figures. 

One Flew Over the Cuckoo’s Nest is a protest against the Establishment; it shows the destruction of humans by both machines and dehumanized humans. Kesey’s conclusion is that the individual can have an impact on society, but cannot alone change the system. If he tries, as does McMurphy, he will exhaust himself and become unable to resist his adversaries.

2. Men vs. Women 

Most of the men are in the hospital because of traumatic experiences with women. Their trauma is made worse by the threatening presence of Big Nurse, who epitomizes other women in their lives. In an unflattering portrait of women as repressors of men (“ball cutters”), Kesey shows women either as prostitutes or as huge creatures who dominate their “small and weak” men. 

For example: (a) The Chiefs father was a big man who became alcoholic after the Chiefs mother began nagging at him. In time, the father began to “shrink” in the Chief’s mind (he became impotent). The Chief adopted the name of his Caucasian mother, symbolizing her domination over her Indian husband and male child. The father was considered weak, and when outsiders came to build the hydroelectric dam, they negotiated with the Chief’s mother, not the father. This caused family shame and led to the Chief’s mental problems. 

(b) Billy Bibbit is 31 years old, but behaves like an adolescent and stutters when under stress. Due to his mother’s stifling influence, he is still a virgin at the beginning of the novel; this symbolizes his inability to become a “man.” 

(c) Dale Harding is a sensitive, intelligent man ashamed of his effeminacy. His dainty white hands tremble uncontrollably when he is anxious, especially when his wife, whom he fears, mentions homosexuality. 

(d) Big Nurse is portrayed as a symbolic castrator who seeks to destroy male sexuality and morale. Kesey’s message is that humans are “victims of a matriarchy” and must strive to be natural, spontaneous individuals who refuse to allow others to control their lives.

3. Machines and Nature

Machines are everywhere in the mental hospital, yet fail to maintain the order that exists effortlessly in nature. Kesey shows that humans require the harmony that only nature can provide (e.g., the fishing trip, Part 3). 

Natural harmony is absent in the hospital: the fog isolates and confuses patients; Electro-Shock machines destroy them by making them lose control over their thoughts and actions. The mechanical word is designed to make humans conform to a set pattern of behavior; in Kesey’s mind, such conformism is inhuman and despicable.

4. Freedom and Control

Big Nurse always has her hands over the controls (mechanical and emotional). McMurphy sees that the only way to defeat her is to attack her where she is vulnerable—in the human area of laughter and sex. 

He gets the men to laugh again. His laughter is “free and loud and it comes out of his wide grinning mouth and spreads in rings bigger and bigger till it’s lapping against the walls of the ward.” But when he cannot get Big Nurse to laugh, he becomes violent and exposes her sexuality to the men. She thus feels weak and afraid since she considers sex a weakness.

5. Christ Imagery

McMurphy’s story has many parallels to Christ’s sacrifice and crucifixion: like Christ, he has 12 “apostles” (patients whom he takes on the fishing trip); for shock treatments, his temples are anointed and he is bound like Christ on the cross; he has “healing hands”; in the end, the patients temporarily betray him, like Judas, when they blame McMurphy for the chaos in the ward. 

As Christ died to save sinners, McMurphy saves the men, freeing them from their emotional pain, and making it possible for them to leave the hospital and seek happiness outside.

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1. A Powerful Exploration of Freedom and Power

At its core, “One Flew Over the Cuckoo’s Nest” delves into the complex relationship between freedom and power. Kesey masterfully portrays how mental illness can develop when individuals are dominated by the power of others to such an extent that their freedom is suppressed.

The patients in the hospital, lacking courage and self-belief, are discouraged from asserting themselves and acting independently. Kesey astutely criticizes the institutional power that exacerbates their conditions instead of helping them recover. This exploration of power dynamics and its impact on personal freedom is both thought-provoking and relevant.

2. Chief Bromden’s Unique Perspective

The book is narrated through the eyes of Chief Bromden, a part-Indian man who has spent a significant amount of time in the mental hospital. Chief’s perspective provides a compelling insight into the actual experiences of mental illness.

Kesey challenges the notion that mental illness is unreal and highlights how it can be abused to control individuals. Chief’s hallucinations, depicted through powerful metaphors, offer a window into his perception of reality.

This approach aligns with R.D. Laing’s concept from “The Divided Self,” where mental illness is seen as a retreat from the pain of reality. Chief’s narrative adds depth and authenticity to the story, shedding light on the intricate complexities of mental illness.

3. The Dynamic Power Struggle

Throughout the novel, the power struggle between Randle McMurphy and the Big Nurse takes center stage. McMurphy, transferred to the mental hospital to escape a work farm, poses a threat to the Big Nurse due to his fearless and rebellious nature.

Unlike the other patients, McMurphy is unafraid of authority and questions the established processes. The Big Nurse, solely concerned with maintaining her power, uses manipulative techniques to exert control. This dynamic exploration of power challenges the concept of individual freedom.

Kesey’s portrayal of McMurphy as a Sartrean hero, unyielding in the face of oppression, questions the limits of personal freedom and the consequences of defying power structures.


1. Confusing Terminology and Offensive Language

As someone without a psychiatric background, I found the medical terminology used in the book, such as lobotomy, electric shock therapy, and electroencephalograph, to be confusing. The abundance of medical jargon made it challenging for me to fully grasp certain aspects of the story.

Moreover, I was disappointed by the derogatory comments towards minorities and women present throughout the book. While it may reflect the time period in which the story is set, I believe it to be offensive and inappropriate, especially for the targeted audience of young readers.

2. Disorganized Structure

The book is divided into four large sections instead of traditional chapters, which I found to be disorganized and prolonged. The lack of clear breaks in the narrative made it difficult for me to track the progression of the story and disrupted the flow of my reading experience. I would have preferred a more cohesive and structured approach to the storytelling.

3. Difficulty Connecting with the Story and Characters

Despite the book’s well-written prose, vivid characters, and interesting plot, I personally struggled to connect with the story. I felt disconnected from the narrative and found it challenging to form an emotional bond with the characters. This lack of connection hindered my overall engagement with the book and made it difficult for me to fully appreciate its merits.


“One Flew Over the Cuckoo’s Nest” by Ken Kesey is a timeless masterpiece that shines both as a novel and a film adaptation. With each re-read, it continues to captivate readers, providing a rich and enjoyable experience.

The story unfolds through the eyes of Chief Bromden, offering a glimpse into his paranoid perspective rooted in the historical oppression his people faced. Despite his imposing physical presence, Bromden remains silent, symbolizing resistance against the oppressive forces called the Combine. The mental institution where Bromden resides becomes a microcosm of his fears and a battleground for control between Nurse Ratched and the newcomer, McMurphy.

Kesey’s writing is exceptional, breathing life into the characters and giving them depth and authenticity. McMurphy, portrayed as a spirited rebel and the embodiment of freedom, stands in stark contrast to the domineering Nurse Ratched, resulting in a gripping and thought-provoking narrative. The exploration of power dynamics and the complexities of mental health further amplify the book’s impact.

About The Author

Ken Kesey, originally from La Junta, Colorado, later settled in Pleasant Hill, Oregon. He completed his education at the University of Oregon in 1957 and then pursued the creative writing program at Stanford University in 1958.

During his life, Kesey became involved in significant events. He volunteered as a subject for government drug testing in 1960. Unfortunately, he faced legal trouble when he was arrested for marijuana possession in 1966 and subsequently fled to Mexico. Upon his return to the United States, he served a jail term in 1967. Kesey’s notable literary works include the novel “Sometimes a Great Notion” published in 1964 and his autobiographical collection “Kesey’s Garage Sale” from 1973. Additionally, he is the central figure in Tom Wolfe’s book “The Electric Kool-Aid Acid Test” published in 1976.

In 1975, Kesey’s renowned novel “One Flew Over the Cuckoo’s Nest” was adapted into a film.

Buy The Book: One Flew Over the Cuckoo’s Nest

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