One Flew Over the Cuckoo's Nest | Study Guide

Ken Kesey

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One Flew Over the Cuckoo's Nest | Part 2, Chapters 4–5 | Summary



Chapter 4

Sefelt, an epileptic, has a seizure in the cafeteria because he refuses to take his prescribed medication. He doesn't like the side effects of the drug. Nurse Ratched, along with everyone else, knows that his friend Fredrickson, who also has epilepsy, takes Sefelt's dose of the medicine in addition to his own. Pointing to Sefelt lying on the floor, his hands "nailed out to each side with the palms up and the fingers jerking open and shut," Nurse Ratched says that any side effects are better than looking like that at least once a month.

Bromden compares Sefelt's prone posture to how men look on the table in the Shock Shop. Sefelt and Fredrickson have never been to the Shock Shop, Bromden explains, because they "generate their own voltage" that can be controlled from the nurses' station.

McMurphy can't understand why Sefelt doesn't just take the Dilantin. Fredrickson tells him that the drug makes the gums soft, which can worsen the effects of the teeth gnashing common during seizures. As the men talk, an aide withdraws a stick from Sefelt's mouth. Two teeth come along with it.

Chapter 5

The machines in the walls have been fixed. Nurse Ratched keeps everything running smoothly from her controls in the nurses' station.


Sefelt isn't just worried about the medication's effect on his gums. Fredrickson also refers to Sefelt's worries about women, insinuating that Sefelt thinks the Dilantin will prevent him from performing sexually, which diminishes his masculinity.

Nurse Ratched doesn't think that a loss of masculinity is a big deal. After all, she has nearly erased every trace of her own femininity. She is not viewed as a sexual being; the men in the ward often comment about her "being above" sex. From her point of view, any loss of masculinity is actually a good thing. A patient who feels emasculated is easier to control.

This episode is one of the first times the reader sees Nurse Ratched tending to a patient in a caring manner. Instead of blaming Fredrickson for causing Sefelt's seizure, she comforts him and explains the importance of regular medication. Her uncharacteristic kindness throws Fredrickson, causing him to question his prior actions. "I mean, she didn't do anything to give me a reason to blow up like that, did she?" he asks rhetorically. Nurse Ratched's unexpected displays of kindness make her patients think that something is wrong with them, not her. It is these abrupt switches between "ball-cutter" and "angel of mercy" that make her so very dangerous.

In Chapter 5, McMurphy's decision to back down has put Nurse Ratched in control once more.

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