One Flew Over the Cuckoo's Nest | Part 1, Chapter 4 | Summary

Summary

Nurse Ratched informs Miss Flinn, a nurse, that McMurphy intends to take over the ward and describes him as a "manipulator." She rues the new "permissive philosophy" in mental hospitals that allows patients to get away with such behavior.

As Bromden sees, it Nurse Ratched's goal is to help patients become "adjusted to surroundings." She is a representative of what Bromden refers to as the "Combine," a "huge organization that aims to adjust the Outside as well as she has the Inside." Over the years, Nurse Ratched has built a network of coworkers who either adhere to her particular brand of therapy or are so cowed by her that they go along with whatever she says. The aides fall into the former category; the ward doctor falls into the latter.

Bromden outlines the daily routine on the ward, which brings him to memories of a former patient named Taber. Taber was an Acute who asked what kind of medication he was being given. Instead of getting an answer, Taber was hauled off by technicians, who installed an "Indwelling Curiosity Cutout" in him. He was then taken to the Shock Shop for additional therapy. Taber is an example of a faulty product (patient) who was fixed and sent back into regular society, where, in turn, he will "fix" his spouse and children. Nurse Ratched is happiest when patients like Taber have been reconditioned and sent back into society.

Analysis

Nurse Ratched is fixated on order. Bromden explains that "the Big Nurse gets real put out if anything keeps her outfit from running smooth." The only thing standing in her way is the patients themselves, particularly new admissions like McMurphy. She runs her ward like a factory, rehabilitating the men's faulty machinery to create model citizens for the Combine. Her closest allies, the three aides, are machine-like themselves. Bromden describes the aides as "replicas" of one another, suggesting that they are clones created to do Nurse Ratched's bidding.

The aides work in tandem with the hidden machinery that runs the ward. The machinery fumbles, however, when the ward isn't functioning as Nurse Ratched would like. This is particularly true when someone of higher rank, such as a medical resident, is interacting with the patients. When the medical residents leave, the ward is once again functioning smoothly, and Nurse Ratched is at peace.

Nurse Ratched is one of the only people who feels at peace on the ward. Newcomers and guests are ill at ease once they step inside the locked halls, particularly Public Relation, a fat paper pusher who leads tours of the facility. His laugh is the only one heard in the ward prior to McMurphy's arrival, but it is high-pitched, nervous, and nearly constant. He seems even crazier than the patients, spinning in circles "like a rubber toy." Although Public Relation touts the facility's comfortable amenities and praises Nurse Ratched, he takes particular care to avoid any eye contact with the patients. His behavior shows that he is tentatively aware of the very thin line dividing the sane from the insane and lives in fear of being found on the wrong side.