Viewers can end up pretty confused by a film like One Flew Over the Cuckoo's Nest. Did
Mac's revolution actually make a difference? What was Chief trying to accomplish? Does
Nurse Ratched represent women in the 1960s? Here's some insight into the ending of the
classic film.
Billy Bibbit is a soft-spoken young man with thoughts of killing himself, but he doesn't
choose to end his life all on his own. Nurse Ratched talks him into it. When Mac throws
a party on the ward with two sex workers, he encourages Billy to make his move on Candy,
in whom he'd expressed interest during the boat trip.
"You g-g-g-g-g-g got beautiful hair." "Thank you."
Candy, who's likely used to her clients treating her badly, seems genuinely flattered when
Billy stutters out his compliments. Their excursion in the supply closet is clearly
more than just a meaningless fling. That doesn't matter to Nurse Ratched.
Ratched knows precisely what she's doing when she eviscerates the self-confidence that Mac
has been trying to bolster in the young man, making him feel shame for his actions. Instead
of addressing the situation in a healthy or helpful way, she threatens to tell his mom,
and the dam holding back Billy's self-loathing breaks. As someone who likes to get a rise
out of her patients during therapy, Ratched delights in setting off the conditions that
landed him in the hospital to begin with.
While her goal may not have been for Billy to die, she knows her manipulation will finally
set Mac off and allow her to regain control over the ward. Billy's death is acceptable
collateral damage for Ratched if she can get what she wants: a reason to lobotomize McMurphy,
and to use Billy as an example of what happens when you rebel.
Every time someone has an intimate interaction in the film, the characters in Cuckoo's Nest
get punished, whether it's on the ship when Mac goes below deck with Candy and the patients
panic and almost crash the boat, or the way Ratched gets manipulative and hostile any
time someone discusses lovemaking during group. Billy's punishment is death when he loses
his virginity to Candy.
This is an outdated TV and film trope that is especially prevalent during periods when
society frowns hardest upon expressions of libido. In 1963, when the film is set, the
hippie movement was just beginning, and it continued through 1975, when the film debuted.
Along with the idea of peace and making strides to end the Vietnam War, embracing free love
was a huge aspect of the movement, which was one reason some other parts of society shunned
the hippie lifestyle. Characters like Ratched, who are completely unwilling to embrace change,
represent the idea that promiscuity is a punishable sin.
In short, Ratched wins and Mac loses. Chief represents the one small victory of McMurphy's
attempt to liven the ward, but everyone else falls right back in line with the status quo.
No one fights back, and Ratched uses electroshock therapy and lobotomies as weapons rather than
cures. Sefelt says after Mac has been missing for a while,
"McMurphy has escaped. They were taking him through the tunnel. He beat up two of the
attendants and escaped."
It's easier for the patients to delude themselves into thinking that Mac escaped so they can
continue to revere him as a legend. It's comforting that escape is possible, even though they
don't plan to do it themselves.
When Harding tells Sefelt that Mac is upstairs getting punished, he and the rest of the patients
are quick to deny it. And everyone's asleep when the orderlies drag him back to the ward
after his lobotomy. It's unclear if the ward at large ever finds out what really happened
to Mac, but when the credits roll, Ratched and her dominion over the ward have undoubtedly
won.
McMurphy's revolution impacts Chief more than anyone else in the ward. By watching Mac refuse
to take anything lying down, Chief learns how to be as big in his actions as he is in
stature, and he feels like he owes that to McMurphy. Without the con man giving him the
confidence to talk and break free from the ward's toxic environment, Chief would still
be silently sweeping the hospital floors. Chief knows that someone like McMurphy — who
is so full of life — would never want to live after being lobotomized. Being a prisoner
on Ratched's ward was hard enough for Mac without being a prisoner in his own body.
"I gotta get outta here." "I can't."
Chief understands that feeling better than most, as he lived for years silently taking
insults, cut off from socialization, and going through the monotonous motions without feeling
like he could be himself. Witnessing McMurphy forced into that type of existence is too
much for Chief. After a goodbye hug, Chief makes the choice he believes McMurphy would
make for himself by suffocating him with a pillow. The scene is hard to watch, as Mac's
body involuntarily fights back. But Chief succeeds, and he finally feels like he's done
all he can do on the ward, escaping Ratched's reach.
Mac represents freedom and self-empowerment in the ward. While his presence in the film
version of the story doesn't have the long-term impact on most patients than he would have
liked, his refusal to give up and his quest for freedom fuels the plot. There are several
ways that Chief can escape the ward, but he picks the most dramatic way possible. Mac
would have loved it.
When McMurphy tries to pick up the control panel in the tub room earlier in the film,
he fails, but he still makes an almost ridiculous effort to move it. While he's red and out
of breath from his pointless attempt, he says,
"But I tried, didn't I? G--damn it. At least I did that."
In Mac's opinion, no one in the ward ever does anything to help themselves or change
their situation. And at this point, he doesn't yet have a firm grasp on the risks involved
with patients standing up for themselves. Even with his schemes to swindle them out
of money, he does care about his fellow patients.
As one final way to honor his fallen friend, Chief succeeds in ripping the control panel
off its stand and chucking it out the window to make his escape. He reaches the freedom
Mac strived for while trying something new and succeeding. Even if he failed, Mac would
have been proud that he tried. Chief finally felt big, and he acted on it.
Ratched faces no consequences for her actions, including lobotomizing a patient whose crime
was lashing out at the woman primarily responsible for the death of his close friend. Ratched's
victory in the ward highlights the stigma that surrounds mental health patients. A larger
problem in the mental health industry, even today, is the failure to listen to and respect
the wishes of psychiatric patients.
Earlier in the movie, Ratched makes a pointed threat when McMurphy dares to ask which medicine
the orderlies are giving him. But anyone has a right to know what they're putting in their
bodies. It's the staff's job to work with the patients to determine, as a team, what
medicine is helping, if the medication is doing more harm than good, or if the side
effects are too much to bear. Instead, she just threatens them if they ask questions
about whether the pills are helping or hurting.
Ratched has the entire ward hardwired to do her bidding, and no amount of patient lobotomies
or deaths seem to lead any kind of reckoning for her. Because who are the authorities going
to believe? The decorated war nurse or the psych patients?
Nurse Ratched manipulates the ward's staff through fear just as much as she plays god
with her patients. No one stands up to her, even when they can see that there's something
wrong. Ratched holds all the cards for who gets released and who gets life-altering procedures.
Nothing on the ward happens without her say-so.
It wasn't until the feminist movement ramped up in the 1960s that the number of working
women in the U.S. rose to significantly. While many single women were in the workforce in
1930, only about 12 percent of married women worked. That number rose to about 50 percent
by 1970.
After picking up various jobs while men were serving in the military in World War II, married
women found purpose in employment, and many fought to keep working after the war ended.
Many men weren't thrilled with this and campaigned to keep women "in their place" as homemakers.
Given this stigma, it's not a shock that the film depicts working women in a bad light.
Viewers could definitely interpret Ratched's power-hungry manipulation of the ward as a
fearmongering depiction of all of the awful things that can happen when a woman is in
charge. Patients frequently accuse Ratched of taking away their manhood when they rant
to each other, a point further driven home by the shot of Ratched smiling after forcing
Mac into a lobotomy.
Egas Moniz won a Nobel Prize for inventing a procedure that would go on to leave 50,000
patients in the U.S. alone either dead or virtually comatose. In 1949, he modified earlier
attempts at brain alteration procedures to create the leucotomy . One year later, Walter
Freeman brought the surgery to the U.S., renaming it the lobotomy. The procedure involved what
was essentially an ice pick going through the eye to get to the brain instead of drilling
through the head. Often touted as a "miracle cure," the horrific procedure was supposed
to help patients control their emotions. Instead, it left them with virtually no emotions at all.
In an interview with Life Science, medical historian and professor Dr. Barron Lerner
referred to a lobotomy's aftereffect as "mental dullness," saying,
"[Most patients] could no longer live independently, and they lost their personalities."
Lerner praised One Flew Over the Cuckoo's Nest for its accurate depiction of the procedure,
calling it "disturbingly real."
The novel One Flew Over the Cuckoo's Nest was published in 1962, during the height of
the lobotomy's acceptable use. Walter Freeman performed his last lobotomy in 1967, five
years after the film takes place. By its 1975 release, he'd been dead for three years. So
why was this story still important to tell?
Author Ken Kesey worked as a nurse's aide in a psychiatric ward at a veterans'
hospital in 1960, which inspired his novel. That year, Dr. Freeman performed a lobotomy
on the youngest patient ever to receive one, a 12-year-old boy named Howard Dully. Dully
survived, growing up to become a bus driver. Dully told NPR,
"If you saw me, you'd never know I'd had a lobotomy [...] But I've always felt different
— wondered if something's missing from my soul."
Lobotomies were on the decline by the time Kesey wrote One Flew Over the Cuckoo's Nest,
and were banned in the U.S. by the time the film was released. The message was clear,
though: Far too many patients were subjected to life-altering procedures in psychiatric
wards with little say in what happened to them.
We see it when Ratched manipulates Billy with details she shouldn't share about his care.
We see it when the nurse forces Mac into electroshock therapy and a lobotomy. We see it in the way
the hospital staff uses fear of these procedures to control the ward. We see time and time
again that the staff cares more about power and dominance than the patients' health. How
cruel and ineffective the lobotomy "treatment" was adds a powerful ending to get readers
and viewers to care about mental health and the ramifications of poor treatment.
Hospitals still face massive overcrowding. Patients often have to wait days, weeks, or
even months for a bed in a ward or even an appointment, even for severe cases of suicidal
ideation or conditions like schizophrenia. While the lobotomy has been outlawed in the
U.S. for decades, a modern version of the procedure called psychosurgery is still occasionally
performed today. Mental health care has come a long way since the '50s, but there's still
work to do.
If you or someone you know is having suicidal thoughts, please call the National Suicide
Prevention Lifeline at 1-800-273-TALK (8255) or text HOME to the Crisis Text Line at 741741.