Miss Ratched, known to her patients as "Big Nurse", has her ward at the mental hospital well under control. The patients' lives are regulated according to a strict routine. Big Nurse's goal is to have everyone and everything carefully adjusted to the neat and tidy world of the ward. Her aides are three Negroes in white jackets, with their sadistic tendencies strictly controlled.
The patients are divided into the Acutes, who are undergoing therapy, and the Chronics, or incurables. The Chronics are subdivided into the Walkers, who are able to walk, the Wheelers, who can move about in a wheelchair, and the Vegetables, who are almost completely paralysed.
A disruption of the routine is caused by the admission of a new patient, a red-headed Irish-American called R.P.McMurphy. McMurphy refuses to take a shower, and introduces himself to the other patients as a gambler who has come to liven things up. He admits to them he is only pretending to be mentally unballanced in order to escape the hard work of the prison farm where he has been serving time. At first McMurphy is confused by the atmosphere of the ward, where Big Nurse has everyone eating out of her hand, meekly participating in humiliation group discussions and spying on one another. Harding, a university graduate, explains to McMurphy how Big Nurse keeps everyone under control by subtle but constant and effective pressure. He also explains the danger of being sent upstairs to the Disturbed Ward, where patients are given shock treatments or even brain operations. McMurphy then sets up a bet that he can get the better of Big Nurse in a week.
McMurphy's presence brings the ward to life. For once there is no fog blurring the vision of the narrator, 'Broom' Bromden, who has spent the last 20 years pushing a broom about the ward, pretending to be deaf and dumb.
The next morning, the battle between Big Nurse and McMurphy begins. First he embarrasses her by walking the halls almost naked, singing loudly. Then he gets the ward doctor to support him in his idea for a separate game room where the walking patients can escape the constant loudspeaker music. He controls the poker games completely, letting the others win some of their cigarettes or
money back sometimes to keep them happy.
McMurphy fights against the System by constantly breaking the rules, cracking jokes, and organising unusual activities. After a week the first showdown between McMurphy and Nurse Ratched occurs on the question of the World Series. With a great deal of difficulty, McMurphy has got a majority of the patients to vote with him to have the television set turned on in the afternoon instead of the evening, so that the patients can watch this series of championship baseball games. Nevertheless, Miss Ratched turns the television off via her control panel. But McMurphy and the other patients continue to sit in front of the blank screen, pretending to watch a baseball game, until the
nurse loses her temper. McMurphy has won his bet.
One day McMurphy learns by chance that he is committed to the hospital. This means that he will not be able to leave when his prison term is up, but will have to wait until Miss Ratched says he's cured. From this moment he becomes a model patient, co-operating fully. The other patients are disappointed, feeling that their hero has betrayed them. One drowns himself in the swimming pool. McMurphy responds to their need and begins to rebel again.
Twice he breaks the windows of the Nurses' Station where Miss Ratched has been keeping the men's cigarettes and rationing them out. McMurphy organises a basketball game and even a whole days fishing trip on the pacific ocean. On the trip the patients are chaperoned by Candy, McMurphy's girl friend, and the doctor, who catches the biggest fish of the day. At the end of the trip Bromden notices that McMurphy looks tired and discouraged, but he's keeping up his bold, cheerful act for the sake of the men.
Behind McMurphy's back Nurse Ratched convinces the other men that he's only interested in the financial profit he has been making on the games and outings. Most of them believe her. Then, during and enforced shower, one of the Negro attendants tries to bully George, a patient who has a pathological fear of soap. Coming to George's defence, McMurphy comes into a fight with 2 attendants. Bromden helps him beat them of. For this violent conduct, McMurphy and Bromden are sent to Disturbed Ward. When McMurphy refuses to admit that his conduct was wrong, he is given 3 electric shock treatments in a week. Bromden comes out of his shock treatment completely cured and ready to leave the hospital. But he stays to see what happens.
McMurphy is brought back to the ward. This time he organises a party, bribing Turkle, the old Negro night attendant, to let 2 girls into the ward in the middle of the night. McMurphy sends Candy to bed with Billy the stutterer, while the rest of the patients drink and have a good time. Turkle agrees to let McMurphy escape from the hospital with the girls just before Nurse Ratched arrives in the morning. Unfortunately, everyone is still asleep when Nurse Ratched comes in and discovers one girl in bed with McMurphy and the other with Billy. She threatens to tell Billy's mother about his being caught with a prostitute. Billy, who is terribly afraid of his dominating mother, kills himself by cutting his throat. Miss Ratched blames McMurphy for Billy's death. At this McMurphy loses his temper and tries to strangle the nurse. He is sent off to the disturbed ward again.
When McMurphy is brought back to the ward some weeks later, he has undergone a lobotomy, an operation in which some brain cells are removed. McMurphy is hardly recognisable. Bromden decides to kill McMurphy before he can regain consciousness, rather than let him sit in the ward and serve Big Nurse as a meek example of "what can happen if you buck the system". The Indian, whose strength and self-confidence have been given back to him by McMurphy's presence, smothers McMurphy in a pillow. Then he escapes from the hospital by throwing a control panel weighing a quarter of a ton through a window. He heads north, planning to visit his tribe on his way to Canada.
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