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One Flew Over the Cuckoo’s Nest Report

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Updated: Nov 30th, 2019


Written by Ken Kesey in 1962, One Flew over the Cuckoo’s Nest is a masterpiece that became an immediate success after its publication.

This is a story about a mental institution where mentally sick people are confined for easy management and treatment; nevertheless, at a closer look, the story deals with issues like insurrection against conformity among others that the United States of America was grappling with during this time.

All the characters in this story have some mental defects; nevertheless, others like Chief Bromden claim to be normal but after scrutiny the reader realizes that he is suffering from a common psychological condition; paranoid schizophrenia characterized by hallucinations among others as explained later in this paper.

This paper deals with the character, Chief Bromden, his life, health, sickness and gives a diagnosis coupled with suggested treatment of his mental health condition. Bromden’s background gives insight to his possible mental health problem as exposited next.


Chief Bromden is the longest serving patient in this Oregon mental institution where he has been confined for the last ten years. He says, “I’m the one been here on the ward the longest, since the Second World War” (Kesey 17). As the story opens up, Bromden is paranoid, hallucinated, and ever fearing the unknown.

A fog that shields him from reality covers his life most of the time facilitated by humiliation he gets from other patients especially the “Black boys’ and Nurse Ratched popularly known as the Big Nurse. He loathes meeting the Black boys; he actually prefers to stay alone and play deaf and dumb.

As aforementioned, fear of the unknown clogs Bromden’s mind and he cannot hide it, not from the Black boys for they, “got special sensitive equipment that detects my fear…” (Kesey 3). His daily life is accustomed to bullying from the Black boys whom have nicknamed him “Chief Broom” due to his duties of mopping the floor. To confirm his suffering he says, “One swats the backs of my legs with a broom handle to hurry me past” (Kesey 3).

Bromden has every reason to be paranoid as he reveals the contents of the Big Nurse’s handbag, which she uses in her daily duties, “wheels, and gears, cogs, needles, forceps, watchmakers’ pliers, and rolls of copper wires” (Kesey 3). It is important to note that, this is a mental institution manned by the Big Nurse and the above-mentioned tools are to be used to torture patients including Chief Bromden.

On the other side, Bromden has personal issues far from the mental institution. He sees himself as a weak and small person despite the fact that he is 6 ft 8” tall. He admits that he used to be big but that is no more. His ‘bigness’ has disappeared to where he knows not. His confidence has melted away and its place taken by unfounded fear; something that he openly admits.

He tries to remember the past but it brings equal fears as the mental hospital especially when he remembers a machine he calls Combine-a dark imagination of society as a conglobation of oppressive forces. Oppression to Bromden has been around since childhood.

He recalls a time back when he was ten and some government officials visited his father, Chief Tee Ah Millatoona to discuss a possibility of buying a tribe land. Unfortunately, Bromden was alone in the house and the government officers acted as if he did not exist and this traumatized him greatly.

Moreover, Bromden is named after his mother, Mary Louise Bromden, despite the fact that he had a father and people are named after their fathers insinuating a possibility of family problems. His past has nothing to celebrate; actually, “…like always when I try to place my thoughts in the past and hide there, the fear close at hand seeps in through the memory” (Kesey 6). This is the day-to-day life of Bromden coupled with trauma from electroshock treatments he received from the Big Nurse rumored to be around 200.


Based on the information gathered from the background of Bromden’s life, he is suffering from paranoia also known as paranoid schizophrenia in modern psychiatry. “Paranoia is a thought process heavily influenced by anxiety or fear sometimes to the point of irrationality and delusion” (Freeman & Garety 49).

Kantor adds that, “Paranoid thinking typically includes persecutory beliefs concerning a perceived threat towards oneself” (96). From the background information about Bromden, it is evident that he suffers from paranoia. Bromden’s thought process is based on unfounded fears and anxiety.

It is true at some point his fears are founded on threats and mistreatment from the Black boys and the Big Nurse; however, most of the time his fears are based on anxiety of uncertainty of events. Moreover, recent psychiatry has given important insight to this condition by indicating that it may result from ‘persecutory beliefs’. Bromden has every reason to belief in persecution.

As aforementioned, oppression has been around Bromden since he was ten years old during that incidence when government officials visited their home only to behave as if Bromden was not around. As a small boy, Bromden was just like any other child and research indicates that children hardly forget traumatizing events in their lives.

Therefore, there is a high probability that Bromden carried this experience into adulthood and that is how he became accustomed to persecutory beliefs. In another concealed indication, Bromden is named after his mother as opposed to the normal way of naming children after their fathers. This insinuates that there might have been family crisis with Bromden’s mother dominating over his father thus causing Bromden trauma as a child. This again, is a source of persecutory beliefs.

The issue of fear leading to irrationality and delusion sets in here. Bromden admits that there is a cloud of fear that hovers over his head though he cannot say where it comes from. He says that whenever he tries to remember his past, the immediate fear clogs his mind (Kesey 6). These are unfounded fears.

He fails to explain what he calls, ‘immediate’ fear and this aligns well with a paranoid person. Again, he admits to McMurphy that a ‘fog’ that shields him from reality covers his life. He says, “When the fog clears to where I can see, I am sitting in the day room (Kesey 8). This fog is only in his mind and that is why he realizes he is sitting in a day room after the fog in his mind clears – this is delusions.

Moreover, he assumes that the society is made of conglobation of oppressive people and calls them the Combine. This is still delusions founded on one’s perception. The fact that the environment surrounding Bromden is hostile and oppressive, it does not mean the world is oppressive too. There are good people out there.

Paranoid schizophrenia fits Bromden’s situation best compared to persecutory delusions and paranoid personality disorder. According to Kendler, Czajkowski and Tambs, “Paranoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others” (1589). The fact that Bromden came to trust McMurphy later in the story disqualifies this disorder together with persecutory delusions, which follows the same line.

Suggested Treatment

Like any other psychological disorder, paranoid schizophrenia has no laboratory tests. Therefore, psychologists prefer symptom management to curing the same and this proves the old adage; prevention is better than cure, right. Nevertheless, several intervention measures have been put forward to counter this condition in cases where symptom management is not applicable.

Parnas and Jorgensen note that antipsychotic medication is the first step towards paranoid schizophrenia treatment (625). This treatment counters the psychotic symptoms prevalent in individuals. The newest and better antipsychotic drug is perphenazine. However, this drug is expensive and Bromden would consider taking risperidone, quetiapine, olanzapine or ziprasidone for a period of eighteen months to improve the negative psychosis symptoms.

Alternatively, Bromden would use olanzapine or clozapine; however, full dosage takes longer time thus raising the issue of patient compliance to take the full dose. Nevertheless, as aforementioned, non-drug intervention is the best form of therapy in dealing with paranoid schizophrenia.

The best therapeutic interventions include both psychological and social interventions. “Psychotherapy and cognitive behavioral therapy is widely recommended and used in the treatment of paranoid schizophrenia” (Moran 24).

Psychotherapy and cognitive behavioral therapy improves self-esteem, self-believe, and insight. Given the nature of Bromden’s situation, he is only disillusioned and psychotherapy tackles all these problems. Another option is, “cognitive remediation, a technique aimed at remediating the neurocognitive deficits sometimes present in schizophrenia” (Wykes. Brammer & Mellers 146).

This remediation has proved effective in the past and it would work for Bromden as well. Family members are another source of social intervention in this situation. Family members offer moral support and in most cases, they understand an individual better. Alternatively, education on the issue may help greatly once an individual understands how his/her problems work.

In other cases, where medication, psychological, and social intervention have failed, “electroconvulsive therapy may be used” (Greenhalgh, Knight, Hind, Beverly &Walters 150). Individuals may also consider movements formed by people suffering from the same condition like Paranoia Network. Finally, regular exercise has proved to be an all-time ‘therapy’, which counters most health conditions and paranoid schizophrenia, is not excluded.


One Flew over the Cuckoo’s Nest is a masterpiece revealing secrets that happens in mental institutions that many people do not know. Chief Bromden is one of the central characters; actually, he is the narrator of the story. From the beginning of the story, he is paranoid with a fog covering his mind most of the times.

Unfounded fears dominate his thoughts coupled with anxiety. Oppression has been around him since he was ten. Based on the evidence gathered in his background information, Bromden suffers from paranoid schizophrenia. Fortunately, there are several measures to counter this condition. Among them is medication using antipsychotics, sociological and psychological interventions among others. Exercise can also play a big role towards dealing with this condition.

Works Cited

Greenhalgh, John, Knight, Cole, Hind, Dwight, Beverley, Charles & Walters, Simon.

“Clinical and Cost-Effectiveness of Electroconvulsive Therapy for Depressive Illness, Schizophrenia, Catatonia and Mania: Systematic Reviews and Economic Modeling Studies.” Health Technol Assess. 2005. 9 (9): 1–156

Freeman, David & Garety, Paulson. “Paranoia: The Psychology of Persecutory Delusions.” Hove: Psychology Press, 2006.

Kantor, Martin. “Understanding Paranoia: A Guide for Professionals, Families, And Sufferers.” Westport: Praeger Press, 2004.

Kendler, Kelly, Czajkowski, Nemaja &Tambs, Knight. “Dimensional Representations Of DSM-IV Cluster a Personality Disorders in a Population-Based Sample Of Norwegian Twins: A Multivariate Study”. Psychological Medicine, 2004. 36 (11): 1583–91

Kesey, Ken. “One Flew Over the Cuckoo’s Nest.” New York; Penguin Group, 1976.

Moran, Missy. “Psychosocial Treatment Often Missing From Schizophrenia Regimens” Psychiatric News, 2005. 40 (22): 24

Parnas, Joel & Jorgensen, Andrew. “Pre-Morbid Psychopathology in Schizophrenia Spectrum”. British Journal of Psychiatry, 1989. 115: 623–7

Wykes, Taylor, Brammer, Myles & Mellers, John. “Effects on the Brain of A Psychological Treatment: Cognitive Remediation Therapy: Functional Magnetic Resonance Imaging In Schizophrenia”. British Journal of Psychiatry, 2002. 181: 144–52

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