The Changes in the Power Hierarchy Caused by the Arrival of McMurphy in One Flew over the Cuckoo’s Nest, a Novel by Ken Kesey

Before McMurphy came to the ward, Nurse Ratched has the power over everyone, but below her lies a power structure between staff and patients and of patients and patients. After McMurphy, he takes over the power from her patients and she is left only with her army of staff.

When McMurphy arrives at the ward and the doctor is explaining to him how things are supposed to run, he notices there's something fishy going on "... something strange about the way they all knuckle under to that smiling flour faced old mother there with the too red lipstick and the too big boobs." (Kesey 43). He points out that Nurse Ratched is controlling them all, even the doctor. She has total control over all the staff and the patients. Bromden is the one who describes the relationship between the patients. "One side of the room younger patients, known as Acutes because the doctors figure them still sick enough to be fixed, practice arm wrestling and card tricks where you add and subtract and count down so many and it's a certain card."(Kesey13). "Across the room from the Acutes are the culls of the Combine's product, the Chronics. Not in the hospital, these, to get fixed, but just to keep them from walking around the streets giving the product a bad name. Chronics are in for good, the staff concedes. Chronics are divided into Walkers like me, can still get around if you keep them fed, and Wheelers and Vegetables. What the Chronics are or most of us are machines with flaws inside that can't be repaired, flaws born in, or flaws beat in over so many years of the guy running head on into solid things that by the time the hospital found him he was bleeding rust in some vacant lot." (Kesey 14). The Acutes are higher up on the power spectrum than the Chronics because they are able bodied and seen by the nurse to hold more power against each other that she can harness.

The Acutes exert their power by giving the nurse secrets about the others in the log book "They spy on each other. Sometimes one man says something about himself that he didn't aim to let slip, and one of his buddies at the table where he said it yawns and gets up and sidles over to the big log book and writes down the piece of information that he heard..." (Kesey 14). The staff exerts the power by making the patients do things they don't want to like making Bromden shave (Kesey 6) and trying to make McMurphy take a shower and let them take his temperature (Kesey 11). The Nurse just exerts her power over everyone using the fact that she controls when they leave and whether they are tortured or not and just her general scariness to intimidate the staff and patients.

The consequences of the staff and patients' powers are that ultimately they give the Nurse more power. The consequences of the Nurse's power are that she has control of everyone and is a tyrannous dictator in the ward. However with McMurphey in the ward there is a constant game of tug o war between the Nurse and the patients for power. By the end, the Nurse loses all power over the patients, and ultimately loses all the patients in the ward except for a couple of patients who are incapable of checking themselves out. 

The patients are scared of the Nurse, hate the staff, and are cautious around each other and everyone is constantly on their toes except for the Nurse. They feel anxious that the Nurse has all the power because she's terrifying and rules with a cold fist. The staff themselves, are in fear of the Nurse. She uses manipulation tactics to keep them from acting out of her favor, leaving them powerless. Once McMurphy is introduced and takes over the ward, the patients are much happier with him being in control but with the Nurse trying to take back her power, they go back and forth between trusting McMurphey.

They feel the Nurse is abusing her power and would rise up and rebel against her if there weren't such drastic consequences. McMurphey only uses his power over the inmates to have fun. He constantly cons them in games as tells them that he's conning them, but defends them in other situations. With this, the patients feel free in the ward, and become less afraid. 

The dynamic between the Nurse and everyone else makes all the other power structures look like a facade. The Nurse really has all the power and can change the structure of things any time she would want to. She's decided what the current power structure is and everyone else is a puppet to her. Her power can ruin all the other power structures in the ward. When Mcmurphey is introduced he threatens the Nurse's hierarchy. Between him and the staff there is a struggle for power. The Nurse can still manipulate the system but it has become much more difficult and will progress to be near impossible in the book. The dynamic between the patients and McMurphey weakens the one between the Nurse and everyone within the ward.

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