Book Review: "One Flew Over the Cuckoo's Nest" by Ken Kesey
Summary
The story unfolds in the ward of a psychiatric hospital, during the 1950s. The protagonist is a man who suffers from schizophrenia and has been living there for some time before the events of the novel.
Through his eyes, we get to see the reality experienced by the patients: their living conditions, the medical treatments they are subjected to, and the domination regime imparted by the middle-aged nurse, Miss Ratched.
A common criminal, who faked insanity to avoid going to jail, turns the ward upside down and gives the patients some of the courage the "outside world" has taken away from them.
If you don't watch it people will force you one way or the other, into doing what they think you should do, or into just being mule-stubborn and doing the opposite out of spite.”
— Ken Kesey
An Untrustworthy Narrator
This book has many points that stand out.
In the first place, we have a main character that speaks to us in the first person, carrying us throughout the plot.
Bromdem is an observant person, and his pretense of being deaf and mute gives him access to places and meetings the other patients cannot reach. This allows him to listen to the staff's conversations and find out about their plans. That is why he has his very own theories on the way the hospital functions.
He believes the "exterior" (the world outside the hospital) is ruled by an organization called "the Combine." He describes it as a mechanical system that controls everything. All people receive some kind of intervention that makes them part of that giant machine. The hospital is just a factory for the Combine, a place where they can fix the ones who do not behave in the way society expects.
This is why the comparisons between the hospital and the staff with a machine are constant throughout the story.
The level of detail and the precision when it comes to describing the emotions of the main character and of the ones that move around him are one of the greatest things about the novel.
The storytelling is confusing at the beginning until we start to realize that Bromdem suffers from hallucinations. He loses touch with reality at times, or as he says, "get lost in the fog," for he is sure that the hospital owns a fog machine and that they turn it on when they want to confuse the patients.
Those episodes can be disorienting, for they make the reader question, not only the sanity of the character but his understanding of the story.
But despite that, the narrative is so fluid that once you are past the first chapters, it becomes easy to read.
Mental Illness and Treatment
In some way, what the novel wants to do is question the idea of "insanity" that existed at the time, and wonder how much of it is an illness, and how much is simply intolerance.
McMurphy expresses that idea at one point, by saying that the group of patients in the ward, despite some attitudes, looks like normal men to him.
And this leads us to the treatments those patients receive as part of their "recovery." Apart from medications, patients are also exposed to electroshock therapy or, in some cases, to psychosurgery.
A certain improvement in the procedures and their effects is suggested by some characters when compared to the past, but still, some of them are dangerous and have serious side effects.
Electroshock, now known as electroconvulsive therapy (ECT), is still applied to patients with certain conditions, such as major depressive disorder or catatonia, when other treatments are unsuccessful, but only with informed consent.
Lobotomy, on the other hand, while popular as a treatment during the 1940s and '50s, stopped being used due to the high risk for the patients. Even though those surgeries could represent a certain improvement in the patient's behavior, they went hand-in-hand with serious intellectual and emotional deficits.
You are touched on each side of the head with wires. Zap! Five cents' worth electricity through the brain and you are jointly administered therapy and a punishment for your hostile go-to-hell behaviour, on top of being put out of everyone's way for six hours to three days, depending on the individual [...] Enough of this treatment and a man could turn out like Mr. Ellis [...] a drooling, pants-wetting idiot at thirty five.”
— Ken Kesey
Nurse Ratched: A Great Villain
The book depicts a ward where those treatments are not only used to help recovery, but also as punishment.
And here we come to one of the key characters of the story: Nurse Ratched.
Head nurse of the ward, Miss Ratched has full control over her workplace, the patients, and the staff members, using her manipulative nature to intimidate them all. Bromdem's description gives her monster-like traits and points her out as a Combine's agent. We are dealing with a well-constructed villain, one of the best I know.
The danger of Ratched does not reside in her open cruelty, but in her methods of humiliation and her impeccable way of manipulating people to make them believe they are making their own decisions, instead of being controlled by her. She has hate within herself, which makes her merciless and produces the fear of the people under her influence.
Patients live with the knowledge that she is invincible and are continuously afraid of giving her a reason to hurt them. Ratched does not hesitate to recommend a special "treatment" to cure the opponent's rebellion.
Her major collaborators are "the black boys," three men hired by her who help to keep the place in order. They use the favor of the nurse to neglect their work (they often make Bromdem and other men clean for them) and to physically and sexually abuse the patients.
Randall McMurphy's arrival comes to challenge Ratched's power, and it starts a war between those two characters.
McMurphy defies her constantly, and starts to influence the other patients to do the same. At first, it is a matter of ignorance, for he does not know that the nurse plays an important part in deciding whether he regains his freedom or remains in the hospital.
For one thing, she wasn't about to recommend release; the fight could go for as long as she wanted, till he made a mistake or till he just gave out, or until she could come up with some new tactic that would put her back on top in everybody's eyes.”
— Ken Kesey
Antihero
Ever since McMurphy's first appearance, Bromdem regards him as a kind of hero, someone who could evade the Combine's surveillance.
As readers, we can see that McMurphy is not a hero. He acts at his convenience, always trying to make a profit; a characteristic Ratched highlights whenever she has the chance, along with the criminal life he led before being sent to the hospital.
But in the course of the novel, McMurphy experiences a transformation. I think at a certain level, he starts to understand why men behave the way they do. He begins to understand his fears and to feel real regard for some of them.
His attack on the nurse in the last chapters finishes her reign for good and is a sort of sacrifice for the rest of the group. So he ends up being a hero after all.
Some scenes of the novel are somehow disturbing, which is one reason why One Flew Over the Cuckoo's Nest, like many other amazing books, has sometimes been challenged and banned in some areas of the United States. But far from being just a polemic text, its literary value cannot be questioned.
So, if you enjoy stories that go deep and crudely into human thoughts and emotions, and you do not mind a hint of suspense, One Flew Over the Cuckoo's Nest may be the book for you.
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