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One Flew Over the Cuckoo\'s Nest takes place in a mental institution in the Pacific Northwest. The narrator of the novel is Chief Bromden, also known as Chief Broom, a catatonic half-Indian man whom everybody thinks is deaf and dumb. He often suffers from hallucinations in which he feels that the room is filled with fog. The institution is dominated by Nurse Ratched (Big Nurse), a cold, precise woman with calculated gestures and a calm, mechanical manner. When the story begins, a new patient, Randall Patrick McMurphy, arrives at the ward. He is a self-professed \'gambling fool\' who has just come from a work farm at Pendleton. He introduces himself to the other men on the ward, including Dale Harding, the president of the patient\'s council, and Billy Bibbit, a thirty-year old man who stutters and appears very young. Nurse Ratched immediately pegs McMurphy as a manipulator.
During the first therapy meeting that McMurphy attends, Nurse Ratched begins by examining Harding\'s difficulties with his wife. McMurphy tells that he was arrested for statutory rape, although he thought that the girl was of legal age, and Dr. Spivey, the main doctor for the ward, questions whether McMurphy is feigning insanity to get out of doing hard labor at the work farm. After the meeting, McMurphy confronts Harding on the way that the meetings are run. He compares it to a \'pecking-party\' in which each of the patients turn on each other. Harding pretends to defend Nurse Ratched, but then admits that all of the patients and even Dr. Spivey are afraid of Nurse Ratched. He tells McMurphy that the patients are rabbits who cannot adjust to their rabbithood and need Nurse Ratched to show them their place. McMurphy then bets him that he can get Nurse Ratched to crack within a week.
McMurphy awakes early the next morning to take a shower. He complains to one of the black boys who work in the institution that the patients are only allowed to brush their teeth at certain times. When Nurse Ratched arrives, McMurphy stands in front of her in a towel, claiming that his clothes were taken, and even threatens to drop his towel (he has shorts on the entire time). Nurse Ratched screams at one of the black boys to get McMurphy a new set of clothes.
When McMurphy complains to Nurse Ratched about the loud music that constantly plays on the ward, she refuses to turn it down, for it is the only consolation for the older patients who can barely hear. He suggests as an alternative opening the tub room as a game room, but she turns him down. At the next group meeting, Dr. Spivey says that he was talking to McMurphy, who manipulated Dr. Spivey into opening the tub room by using Nurse Ratched\'s arguments for the loud music. Nurse Ratched\'s hands begin to shake at the meeting, her first significant sign of weakness.
McMurphy then pushes for a schedule change so that the patients can watch the World Series during the day and do their work at night. He attempts to motivate the patients to push for this, and becomes angry at them for acting too \'chicken-shit\' and refusing to oppose Nurse Ratched. Billy Bibbit tells McMurphy that nothing he can do will be of any use in the long run, but McMurphy boasts that he will break out of the institution by lifting up the control panel in the tub room and throwing it through the window.
The patients gradually grow more assertive with regards to the black boys and Nurse Ratched. During another group meeting, after Billy Bibbit discusses how his stutter came about and how he proposed to a woman his mother disliked, McMurphy brings up the World Series once more. Nurse Ratched allows a vote. Although all twenty Acute patients vote for him, Nurse Ratched declares it a defeat, for none of the Chronics vote at all. McMurphy finally motivates Chief Bromden to vote for him, but once he does Nurse Ratched has declared the vote over. As a protest, McMurphy refuses to work and sits down in front of the television when the World Series is on. The other patients join him in this mutiny.
During a staff meeting, the doctors discuss McMurphy with Nurse Ratched. They believe that he is no ordinary man, and in fact might be dangerous. Nurse Ratched, however, claims that McMurphy is not an extraordinary man and is subject to all the fears and timidity of the other men. Nurse Ratched is confident that she can break McMurphy, for he is committed to the hospital and they can decide when he will be released.
McMurphy continues to behave aggressively, but Nurse Ratched does not respond. The other patients resume longstanding gripes against Nurse Ratched, such as the rationing of cigarettes and the tight control over their schedules. When the men make their weekly trip to the pool, McMurphy learns that he will only be released when Nurse Ratched and the doctors decide he is ready. At the next group meeting, Cheswick complains about the rationing of cigarettes, and two black boys are forced to drag him away to the Disturbed Ward. When he returns, presumably after having shock treatment, Cheswick drowns when he gets his fingers stuck in the grate at the bottom of the pool.
Nurse Ratched reassumes her control over the ward after McMurphy gives up his struggle against her, knowing that she controls whether or not he leaves. At the ward\'s trip to the library, Harding introduces McMurphy to his visiting wife, Vera. Harding and Vera are rude to one another, and she implies that he\'s a closeted homosexual, then suddenly leaves. When Harding asks McMurphy his opinion of Vera, McMurphy snaps back that he won\'t say how awful Vera is, even if that is what Vera wants to hear. McMurphy claims that he has worries of his own, and shouldn\'t have to deal with others\' problems.
When getting chest X-rays to check for TB in another part of the hospital, McMurphy learns about the \'shock shop,\' where patients get electroshock therapy, and also learns about lobotomies. He confronts Harding and the other patients about why they didn\'t tell him that Nurse Ratched controls whether or not he leaves, but they claim that they forgot he was committed; with a few exceptions, all of them entered the hospital voluntary. McMurphy cannot conceive that these men would choose to live in the hospital, but Billy tells him that they are too weak to leave.
Nurse Ratched closes the tub room that the patients had been using for several weeks on the grounds that the men did not apologize for their behavior during the World Series debacle. McMurphy responds to this by punching the glass at the Nurses\' Station. Nurse Ratched does little to retaliate, because she knows that she can prolong the fight. McMurphy requests an Accompanied Pass to go deep-sea fishing, and tries to recruit patients to go with him. Nurse Ratched posts newspaper clippings about the dangers of boating, which frighten several of the patients. McMurphy realizes that Chief Bromden is neither deaf nor dumb; one night McMurphy offers Chief Bromden a pack of chewing gum and gets him to speak about his family. McMurphy suggests that Chief Bromden pick up the control panel in the tub room and throw it through the window so that he can escape.
McMurphy signs up Chief Bromden for the deep-sea fishing trip, but when the day of the trip arrives, Nurse Ratched tries to derail it, for only one of the chaperones (a prostitute named Candy Starr) arrives instead of two. Dr. Spivey, however, acts as the second chaperone. When the men stop for gas on the way to the docks, the gas-station attendant asks if they are patients from the asylum. While Dr. Spivey claims that they are merely a work crew, McMurphy boldly brags that they are criminally insane. When they reach the docks, a couple of men yell disparaging comments about Candy and the patients. When McMurphy has trouble securing the boat because they lack a waiver, he takes the boat without a captain. After a day of fishing, the men return rejuvenated. The men on the docks no longer mock them.
Nurse Ratched makes her next move against McMurphy by posting the patients\' financial statements, which show that McMurphy has made a profit from the other patients since he arrived. She suggests in a meeting that McMurphy is trying to manipulate them. When the men confront McMurphy about this, he admits that he is no saint, but he has been perfectly honest about his intentions. McMurphy attempts to arrange for Candy to visit the institution for a visit with Billy Bibbit. During a cautionary cleansing that Nurse Ratched orders, several of the black boys harass one of the patients, George Sorenson. McMurphy defends him, and gets in a fight with them. Chief Bromden joins in when the black boys gang up on McMurphy, and both are taken away to the Disturbed Ward.
Down at the Disturbed Ward, a nurse treats McMurphy\'s and Chief Bromden\'s wounds, and tells them that not every ward is run as autocratically as Nurse Ratched\'s and that she wishes she could keep patients away from her ward. Nurse Ratched gives McMurphy and Chief Bromden a chance to apologize before administering shock treatment. McMurphy refuses. They administer shock treatment to him several times in one week, even though Chief Bromden tries to talk him into complying. He claims that the electroshock therapy energizes him. When Chief Bromden returns to the ward, Harding congratulates him and tells the Chief that he has heard rumors that McMurphy is not responding at all to EST. Nurse Ratched brings McMurphy back to the ward when his absence leads to legends about him.
Harding and the other patients decide to engineer McMurphy\'s escape when Candy arrives on Saturday night for her meeting with Billy. They bribe Mr. Turkle, the night watchman, with liquor and an offer of sex with Candy, and the other patients have a party that night. McMurphy delays leaving until early into the morning, however, and falls asleep. The black boys find him the next morning.
When Nurse Ratched arrives that morning, she gathers the patients together in one room to take roll. She realizes that Billy Bibbit is missing, and finds him in the Seclusion Room with Candy. She chastises him for having sex with such a cheap woman, then tells him that she will tell his mother about this. Billy begins to stutter again when Nurse Ratched threatens to tell his mother, but she takes him in the doctor\'s office so that he may calm down. When the doctor arrives, he finds that Billy has cut his throat and killed himself. Nurse Ratched blames McMurphy for Billy\'s suicide, and he responds by trying to strangle her. Although the black boys pull McMurphy off her before he can kill her, he rips her uniform, exposing her breasts. Afterward, Nurse Ratched takes time off to recuperate, and when she returns cannot speak. Many of the patients check out of the hospital, and McMurphy returns to the ward weeks later, comatose after a lobotomy. Chief Bromden smothers McMurphy with a pillow to put him out of his misery, then throws the control panel in the tub room through the window and escapes the institution, as McMurphy had long ago suggested.
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