One Flew Over the Cuckoo’s Nest is one of those novels (such as The Wizard of Oz, Gone with the Wind) where the film of the book is better known than the book itself. In this case that is completely understandable – Jack Nicholson’s Oscar winning performance in the 1975 film is truly memorable, there are loads of other wonderful performances, and the editorial choices are really well thought through. It must be almost 30 years since I last saw the film, but I still remember certain scenes vividly, such is the impact it made. It also made an impact on wider society and an important contribution to the discussion on the treatment of the mentally-ill.

One Flew Over the Cuckoo’s nest (cuckoo being a pejorative term for the mentally-unwell) is set on an Oregon hospital ward. The patients are all settled in their secure environment, bullied by the senior nurse Ratched and her orderlies, but relatively comfortable. The narrator is Chief Bromden, a native American who pretends through most of the novel to be deaf and dumb, even though he is perfectly capable of speaking and hearing. His silence is effectively a protest about the way he and his people are ignored in modern America. The discovery that he can actually speak is a minor development in the novel, but in the film it is presented as a significant moment.

Into this environment bursts Randle MacMurphy, transferred into the hospital from prison. It is suggested, by MacMurphy himself, that he has engineered this transfer to serve his sentence in greater comfort, although the precise extent of his illness, if any, is never completely resolved. MacMurphy sets about challenging the autocracy of Nurse Ratched, and a battle of wills ensues. When MacMurphy eventually realises that Ratched has the power to extend his detention indefinitely, it looks as if he is going to knuckle down, take his medicine, literally, and serve his time, but that fragile peace is never going to hold for long.

One Flew Over the Cuckoo’s Nest can be read on a number of different levels. Superficially it is a protest about the treatment of the mentally ill in America. In portraying the patients as largely normal, perhaps a little quirky, and with a central character, MacMurphy, who at time seems saner than anyone, Kesey weights the argument heavily in favour of his call for the more humane, liberal treatment of the mentally unwell. In so far as the novel (and the film) moved America and the west to this position then it had a positive effect, but the novel’s portrayal of electro-convulsive therapy as being akin to torture, and being used by the hospital as a form of punishment, gave this treatment (which is still used effectively to this day) a terrible reputation from which it continues to suffer. The use of lobotomy was already in steady decline by the time this book was written and published, but if One Flew gave this operation a final shove down the stairs of history then obviously it made a significant contribution. There is still a long way to go in the process of removing the stigma from mental illness, but this novel was an important step on the way, making us think of the mentally ill as people not threateningly alien.

The novel is not just a treatise on the treatment of the mentally ill. On another level it is a parable of the story of Christ, his life and crucifixion. MacMurphy is brought amongst the poorest and weakest in society, and goes about healing them and making them whole. He makes them fishers of men, (the chapters where the inmates are allowed out of the hospital to go on a fishing trip are so profoundly improbable that they can really only serve to contribute to the narrative if we accept their metaphorical significance). MacMurphy consorts with fallen women, and eventually sacrifices himself (his sadness, which the Chief notices on the fishing trip, suggests he is aware that this is going to be his fate) for the sake of his friends after a riotous last supper, and after being betrayed by Billy Bibbitt, who goes on to kill himself after having accepted his metaphorical pieces of silver. When accepting his electro-convulsive treatment MacMurphy even explicitly makes this association himself, asking if he is going to be given a crown of thorns. MacMurphy is brought into the world, suffers and dies so that our sins may be forgiven.

The novel concludes with a crushing loss but also with freedom, a refusal to accept oppression. It argues that the revolution will not be without cost, but also suggests that the ultimate prize may be worth the price. This makes One Flew Over the Cuckoo’s Nest one of the most important texts of the 1960’s counter-revolution.