Patient Control in One Flew Over the Cuckoo's Nest by Ken Kesey

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The novel One Flew Over the Cuckoo's Nest by Ken Kesey is about the power structure of a mental ward from the perspective of a patient, Bromden. The story takes place during the 1950's in Oregon. Many of the patients on the ward are not necessarily insane however do not fit in with pre established societal norms and have chosen a life away from these norms. The men who are voluntary have given in to the staff and follow them like sheep, however, the men who are committed need controlling according to society so they were sent to the ward. The head nurse, Nurse Rached, of the ward keeps control using her staff that has been picked out over years of meticulous selection. The staff under Rached's orders keep control of the patients with cruel act such as forced labor, intimidation and separation.

Forced labor is very prolific throughout the story and is the hospitals first line of defense in keeping patients under control. From the beginning of the story the aides on the ward force the patients to preform menial labor tasks to all of the acutes and some of the more mobile chronics. The aides are first shown as the people who do this in the opening scene of the novel when Bromden wakes up, “Stick a mop in my hand and motion to the spot they aim for me to clean today, and I go,”(9). Bromden is ordered around by, what was at the time, the lowest rung of society (all of the aides are black) even though he huge, at 6'8”.The forced labor is put upon the patients typically in the afternoon when they would be most active. This policy of forced labor is endorsed by Nurse Rached as shown when McMurphy first arrives when addressing one of the aides, “you may need a month of bedpans ...to refresh your appreciation of just how little ...

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...lence and having a cold yet happy looking smile allow the nurses at least to make patients say things that the y normally would not say. The power Rached wields in these situations allows her to control the patients toward issues she want to talk about.

Nurse Rached has a multitude of techniques that she and her staff use to control patients. They use labor to keep them busy , medical treatments as threats and separation to calm down patients. The way the patients were treated in the novel would never be allowed in modern times. Additionally the idea of a power structure dominated by one very powerful women is still very uncommon, however in modern times Rached would probably be a doctor with multiple residents helping her. The power structure in this book is very complicated however the staff is in complete control just like the equivalent people in modern society.

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