Hektoen International

A Journal of Medical Humanities

“A Veritable Angel of Mercy”: the sardonic representation of Nurse Ratched in One Flew Over the Cuckoo’s Nest

Mariella Scerri
Mellieha, Malta


Stern group of nurses
Group photograph of the first twenty Navy Nurses, appointed in 1908. Naval Photographer. 1908. Wikimedia. Public Domain.

Critical acclaim and popular opinion have elevated Kesey’s first novel, One Flew over the Cuckoo’s Nest published in 1962, to something of a modern classic, much read and written about as well as adapted for film. The novel is narrated in the first person by the half-Indian Chief Bromden, one of the patients in the mental institution where almost all of the action occurs. Bromden is a long-term patient, and the novel traces the stages of his liberation beginning with the arrival on the ward of a new admission, McMurphy. It ultimately ends with the narrator’s escape from the hospital. This gradual process of liberation is triggered by McMurphy’s rebellion against Miss Ratched, the Big Nurse who runs the psychiatric ward by means of a dehumanizing and repressive regime of terror.1

Cuckoo’s Nest offers an interesting alternative to the more usual depictions found in literature of the nurse as an angel of mercy, the unskilled handmaiden, or the ministering angel. It also presents a different view than the frequent media portrayal of a typically young, white, single female who is over-sexualized and intellectually diminished. From the onset of the plot, Nurse Ratched is portrayed as authoritative, acting from a position of power, and represented as a deity to the inhabitants of the mental hospital:

Year by year she accumulates her ideal staff: doctors of all ages and types, come and rise up in front of her with ideas of their own about the way a ward should be run, some with backbone enough to stand behind their ideas, and she fixes these doctors with dry-ice eyes day in, day out, until they retreat with unnatural chills.2

The description of Nurse Ratched as a veritable angel of mercy immediately takes sarcastic undertones:

Miss Ratched is a veritable angel of mercy and why just everyone knows it. She’s unselfish as the wind, toiling thanklessly for the good of all […] she even further serves mankind on her weekends off by doing generous volunteer work about town.3

This sardonic representation of Nurse Ratched together with Chief Bromden’s portrayal of monstrosity, lead the reader to question the representation of law and authority by the matriarchy. Literature and the media have a strong influence on public views, shaping the way the public values and treats different healthcare professionals. Nursing is plagued with feminine stereotypes that continue to undermine the profession. These double-edged views are “never more striking than in efforts to honour nurses, which often rely on emotional angel images rather than recognition of nurses health skills or tangible contributions to patient outcomes.”4

Stereotypes have never given an accurate description of the role and function of a nurse. Accordingly, Kesey’s fiction does not seek to offer an alternative scenario; it rather affirms mythological structures reasserting masculine hero myths rather than rejecting them.5 In giving Nurse Ratched tyrannical authority, demonizing the institution and its representative, Kesey elicits the themes of control, submission, and alienation through the structure of nursing and care involved. These same themes also link to gender, representing similar fears of female empowerment and male power rendered impotent by a sterile social structure.

The reading of Cuckoo’s Nest overturns expectations of masculinity and gender alienation more than once, and in more than one way. At the novel’s opening, immediately after the first group of therapy sessions, McMurphy unsettles the inmates’ theories of Big Nurse as either the tender angel of mercy, “Mother Ratched,” or as the “juggernaut of modern matriarchy”6 and sets out to expose the seams of her myth: he is going to “bug her till she comes apart at those neat little seams, and shows just one time, she ain’t so unbeatable as you think.”7

Kesey’s satirical intentions are constantly qualified by his narrative strategies. The conflict of satire and narrative is best observed on the level of character, particularly the target figure: instead of a unified, almost literally “cardboard” character demanded by satire, the narrative produces a heterogeneous, decentered personality. Big Nurse as a satiric target becomes both victimizer and victim for narrative reasons, in part because Kesey “has chosen to filter his vision of America’s technological consumer society through the point of view of a schizophrenic half breed Indian.”8

Significantly, to subscribe to the idea of Nurse Ratched as victimizer, her name recalls the tool ratchet, thus alluding to her machinic nature.9 “Rat-shed,”10 another blatant pun, also suggests that she personifies a giant cage in which the patients are imprisoned like rats. Additionally, a play on the word “wretched” gives a meaning and a sense of her unpleasant self. The satirical intentions are clear: Big Nurse is inhuman, rat-like, and a piece of machinery. Even her “breasts create a confusing, bionic effect which she wants to conceal in her stiff arched uniform.”11

As a satirical sign, Miss Ratched’s bosom is an undesirable supplement of her machinic “personality” but as a narrative sign, it allows for the signification of her thwarted womanhood and humanity.12 Archetypal and psychoanalytic criticism have variously interpreted Big Nurse’s big breasts as signs of the Destructive Mother or the Bad Mother: for the former, she is a castrator, while for the latter, the inmates “yearn” that Big Nurse’s actions “should answer the promise of her anatomy, the promise of softness and abundant giving one can associate with a mother’s breast.”13 Such “straight reading still supports the satirical male-centred concept of power-hungry women becoming the willing instruments of oppression at the cost of their womanhood.”14 This satirical attack embodied in Miss Ratched is also an attack on the nursing profession, at least implicitly, and goes on to show how much nursing is intricately linked to gender. While undermining a woman’s authority, attacking the “abundant giving” breasts, the same breasts which define a woman, it also subverts the authority of the profession which she represents. Kesey’s storytelling aims might not have been the demonization of a nurse; however the fact that Miss Ratched was a nurse affects the way the reader views nursing as an authoritative profession. The cynical representation of Nurse Ratched debunks the authoritative role portrayed thus undermining her authority. While Kesey’s novel seems to uphold one of its main protagonists in an authoritative position, it simultaneously dismisses her. In a final attempt to erase Ratched’s authority, McMurphy attacks the Big Nurse, nearly killing her:

After he’d smashed through that glass door, her face swinging around, with terror forever ruining any other look she might ever try to use again, screaming when he grabbed for her and ripped her uniform all the way down the front screaming again when the two nippled circles started from her chest and swelled out and out, bigger than anybody had ever imagined, warm and pink in the light.15

Violence drains Nurse Ratched of her power and transforms her from the cold mother figure into the prostitute. In nursing terms, the binary stereotypes of femininity—the virgin and the whore—take on a set of particular characteristics that clearly have their origins in early Victorian ideals about the feminine. The “good nurse” has invariably been seen as some form of self-sacrificing angel who gives up everything to dedicate her life to caring for the sick. The “bad” nurse is her exact opposite, misusing her position of power and authority over the sick individual to satisfy her own needs and desires, whether these are material, sexual, or simply sadistic.17 McMurphy manifests the role of the “bad nurse” in Nurse Ratched by exposing her feminine sexuality, revealing the “two nippled circles,” a literal transformation from a cold machine to something more vulnerable, something “warm and pink.”18 At the sight of the forbidden—forbidden because the breasts belong to an asexual—even the good narrator unwittingly turns pornographer. Nevertheless, the narrative subtext also suggests that only by becoming exposed and defenseless does Miss Ratched “prove” that she is not after all a machine, but a “warm and pink” human being.19 Far more grievous than her humanity that is violated and destroyed, is the “humanity that attempted to preserve itself by refusing the role of her breasts, in accordance with society’s dominant male expectations, would automatically have condemned her to play.”20

One Flew over the Cuckoo’s Nest flouts the readers’ perceptions of the idea of caring. It stands in direct opposition to novels where care is portrayed as subservient and relegated to a subordinate position. Kesey’s novel might shock readers accustomed to the stereotypic construct of the nurse and its appropriation of care. On the other hand, Nurse Ratched forces us to see that her authoritative position is held in disregard by the male patriarchy. It also seems to suggest that both the patriarchal male and the matriarchal female are more accepting of the humble and modest roles associated with caring.

Thus, it becomes almost impossible “to avoid the long shadow that Big Nurse casts across the image of nursing.”21 She is “iconographic in both popular and nursing culture as the epitome of all that is deemed to be bad in nurses and nursing.”22 “Unpalatable though the book’s sexism might be,” One Flew over the Cuckoo’s Nest is still a novel worthy of contributing and shedding light on the construction of nursing. It provides educational opportunities to engage “in critical dialogue around this and other texts which speak to nursing and human concerns,”23 and can enhance nurses’ appreciation of the many different ways of reading literature. This will equip nurses with the right tools for discernment and to “not simply accept or expect realist or representational accounts but challenge many and varied assumptions and questions inherent in a work.”24


End Notes

  1. Semino, ElenaMetaphor and mind style in Ken Kesey’s One Flew over the Cuckoo’s Nest. Style 30 No 1 (1996): 143-146. 
  2. Kesey, Ken. One Flew over the Cuckoo’s Nest(New York: Viking Press; 1962), 31. 
  3. Kesey, 58. 
  4. Summers, Sandy and Jacobs, Harry. Saving Lives: Why the Media Portrayal Nurses Puts Us All At Risk. (Oxford: Oxford University Press, 2010).    https://blog.oup.com/2015/07/nursing-angel-perception/    
  5. Meloy, Michael. Fixing Men: Castration, Impotence and Masculinity in Ken Kesey’s One Flew over the Cuckoo’s Nest.  The Journal of Men’s Studies 17 No 1 (2009): 3-14. 
  6. Kesey, 58. 
  7. Kesey, 72. 
  8. Laszlo, Gefin K., “The Breasts of Big Nurse: Satire versus Narrative in Kesey’s One Flew over the Cuckoo’s Nest”Modern Language Studies 22 No1 (1992): 96-101. 
  9. Gefin, 99. 
  10. Kesey, 87. 
  11. Gefin, 100. 
  12. Gefin, 100. 
  13. Sullivan, Ruth. “Big Mama, Big Papa and Little Sons in Ken Kesey’s One Flew over the Cuckoo’s Nest”. Literature and Psychology 25 (1974):  34-44. 
  14. Leeds, Barry H. Ken Kesey. (New York: Fredrick Ungar, 1981), 27. 
  15. Kesey, 267. 
  16. Gefin, 96 -101. 
  17. Gefin, 99. 
  18. Gefin, 99. 
  19. Gefin, 100. 
  20. Gefin, 100. 
  21. Darbyshire, Philip. “Reclaiming ‘Big Nurse’: A Feminist Critique of Ken Kesey’s Portrayal of Nurse Ratched in One Flew over the Cuckoo’s Nest”Nursing Inquiry, 2 (1995): 198-202. 
  22. Darbyshire, 201. 
  23. Darbyshire, 202. 
  24. Darbyshire, 202. 



  • Darbyshire, Philip. 1995. Reclaiming ‘Big Nurse’: A Feminist Critique of Ken Kesey’s Portrayal of Nurse Ratched in One Flew over the Cuckoo’s Nest. Nursing Inquiry, 2: 198-202. 
  • Kesey, Ken. 1962. One Flew over the Cuckoo’s NestNew York: Viking Press. 
  • Laszlo, Gefin K. 1992. The Breasts of Big Nurse: Satire versus Narrative in Kesey’s One Flew over the Cuckoo’s Nest.  Modern Language Studies 22, No1: 96-101. 
  • Leeds, Barry H. 1981. Ken KeseyNew York: Fredrick Ungar. 
  • Meloy, Michael.2009. Fixing Men: Castration, Impotence and Masculinity in Ken Kesey’s One Flew over the Cuckoo’s Nest.  The Journal of Men’s Studies 17, No 1: 3-14. 
  • Semino, Elena. 1996. Metaphor and mind style in Ken Kesey’s One Flew over the Cuckoo’s Nest. Style 30, No 1: 143-146.  
  • Sullivan, Ruth. 1974. Big Mama, Big Papa and Little Sons in Ken Kesey’s One Flew over the Cuckoo’s NestLiterature and Psychology 25:  34-44. 
  • Summers, Sandy and Jacobs, Harry. 2010.  Saving Lives: Why the Media Portrayal Nurses Puts Us All At RiskOxford: Oxford University Press.    https://blog.oup.com/2015/07/nursing-angel-perception/    



MARIELLA SCERRI is currently a teacher of English. She is a former staff nurse and worked in the cardiology department at Mater Dei Hospital, Malta, before commencing her teaching post. She holds a Masters in English Language and is reading for a PhD in Medical Humanities at Leicester University. She is also a member of the HUMS programme at the University of Malta. 



Winter 2020  |  Sections  |  Nursing

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