The story takes place in the psychiatric ward of a hospital, and is narrated by Chief Bromden, an Indian patient who is a paranoid-schizophrenic. The Chief views events through the distorted lens of his own insanity, and this is especially noticeable in the some of the hallucinatory episodes in the first chapter. His job in the hospital is to sweep floors. Everyone believes that he is deaf and dumb, although this is merely an act on his part that he has kept up for the fifteen years he has been confined to the hospital.
This is the background against which the first chapter should be read. It begins with the Chief being taunted by the three “black boys,” who are aides in the psychiatric ward. He imagines they are coming to get him, and he also mentions the Big Nurse, describing her in terms of a powerful machine. This is just how he imagines her to be. The Big Nurse, the fifty-year-old woman who is in charge of the ward, arrives, and tells the black boys to shave the Chief. But he hates being shaved before breakfast, and he hides in the mop closet. They find him there, and although he struggles and gets confused, they do what they have to do. Chief Bromden is then taken to the Seclusion Room and given pills to calm him down. He has managed to reveal to the reader that he intends to tell a story, about a man named McMurphy.
McMurphy turns out to be a new admission to the ward. He is not like the other men there. He talks loudly, walks with a swagger, and laughs a lot, whereas the others are timid and never laugh. He announces to the men in the day room that he is a gambler; he reminds the Chief of a car salesman or a stock auctioneer. He says he has been declared a psychopath.
Bromden describes the patients, who are divided into Chronics, who are in the hospital permanently, and Acutes, who are there for treatment and will eventually be released. McMurphy soon finds out that the leader of the patients, the president of the Patients’ Council, is Dale Harding. They engage in some repartee which McMurphy appears to win. The other Acutes crowd round him to find out what he is like. McMurphy says he was doing time on a work farm for assault and battery, and then requested a transfer to the hospital. He is amiable to all the patients, shaking hands with the Chronics, even those known as Wheelers and Walkers and Vegetables. Then the Big Nurse arrives and tells him he must takes his Admission shower; he must stick to the rules. McMurphy makes it clear that he is not used to keeping to anyone’s rules but his own.
On the very first day, the Big Nurse, Miss Ratched, pegs McMurphy as a manipulator, someone who wants to take over the ward, using everyone for his own ends.
Bromden describes the coldly efficient way the Big Nurse runs the ward, and the three black assistants she carefully selected. He describes the routines of each day on the ward—washing, eating, taking medication; daily amusements such as cards and puzzles; visits from the young resident doctors, and from a public relations man trailing a group of ladies, telling them how much improved the ward is from years ago; and patients going for appointments at Occupational Therapy or Physical Therapy. Bromden describes the ward as a factory for what he calls the Combine—the regimented society which imposes machine-like conformity on everyone. The hospital is where defective parts are fixed and returned to the Combine.
At noon there is a group meeting, run by the Big Nurse, with a doctor also present. The purpose of the meeting is to discuss the patients’ mental problems. On McMurphy’s first day, the discussion begins with Harding’s problems with his wife, and then turns to McMurphy. The doctor quizzes him about his previous record; McMurphy gives spirited replies that the doctor and nurse do not know quite how to deal with. Then the doctor explains their theory of the Therapeutic Community. They try to teach the patients how to get along in a group, because that is the only way they will function in normal society. The Therapeutic Community is run in a democratic way, in which patients vote on the issues before them. They are encouraged to bring up grievances and discuss them.
After the meeting, McMurphy points out to the Acutes that it was like a bunch of chickens pecking each other. Everyone was attacking Harding, emphasizing his weaknesses, all in the name of helping him. McMurphy picks out the Big Nurse as the chief culprit, explaining that she is out to deprive him of his masculinity. She is trying to make him and all the others weak so that they will follow the rules. Harding is forced to admit that McMurphy is right. He says that all the patients are just like timid rabbits. McMurphy argues that the men in the ward are no more crazy than the average man in the street. He challenges them about why they are so scared of a middle-aged woman, the Big Nurse. He encourages them to show a little more backbone. They tell him that if they do, they might get shipped upstairs to the Disturbed ward, or even worse go to the “Shock Shop” for electro-shock therapy (EST). But McMurphy still urges them to fight back, to put the theory of the Therapeutic Community to their advantage by using their votes on some issues, just to show that the Big Nurse has not taken over completely. After Harding argues that there is no way McMurphy or anyone else can get the better of her, McMurphy bets five dollars that he can, and before the end of the week too. Many of the Acutes take him up on the bet.
McMurphy is bothered by the volume of the music that plays over the loudspeakers, which interferes with his card-playing. Harding persuades him not to complain about it. McMurphy continues to play cards with the other Acutes, gambling with cigarettes and winning, and then letting the others win back their losses. He also figures out that Chief Bromden is not really deaf.
In the morning, McMurphy is the first patient to rise. He sings in the latrine, and Bromden realizes how different McMurphy is from everyone else he has known. He wonders how McMurphy managed to avoid being molded by the Combine. McMurphy teases one of the black boys after he is told that it is against the rules for him to be issued with toothpaste before six-forty-five. He then disconcerts the Big Nurse by appearing in the hall wearing only a towel, explaining that his clothes were taken from him. The Big Nurse orders one of the black boys to ensure that McMurphy is issued a change of clothes. She is flustered by the incident, and tries to cover up for it by bullying the black boys.
This incident encourages McMurphy to believe he can easily get the better of the Big Nurse. He is exuberant, full of stories, gambling with the other Acutes at cards and anything else he can think of. He asks the Big Nurse to turn the music down, but she refuses. He then asks if they can take their card game to another room. The Big Nurse says the hospital cannot afford to open two day-rooms.
At the afternoon meeting, the doctor proposes that the ward should put on a carnival. McMurphy had suggested the idea to him in a private interview they had earlier in the day. But the Big Nurse effectively kills off the idea. Then Dr. Spivey, again after prompting from McMurphy, brings up the idea of another day-room. The Big Nurse pours cold water on it, but the doctor persists, and the idea appears to be adopted. McMurphy then begins to dominate the meeting, and Bromden realizes that the Big Nurse has suffered a temporary defeat.
In the next few days, McMurphy ensures he does not let himself appear upset by anything the nurses or the black boys do. Instead, he laughs a lot, and this aggravates them. But on one occasion, he allows himself to get angry. This is at a group meeting, where the other Acutes fail to back him up when he requests a change in the schedule that would enable them all to watch the World Series on television. McMurphy resolves to bring the matter up for a vote again. He also boasts about how he could break out of the hospital whenever he wishes. He says he could lift a huge control panel and toss it through the specially made screen windows. He takes bets, tries to lift the panel and fails. But he is undaunted, saying that at least he tried.
A few days later, on the day of the World Series, McMurphy brings up the matter again at the group meeting. Twenty hands are raised in support of the proposition, but the Big Nurse says that is not enough, because there are forty patients on the ward, and a majority is needed. But then Bromden raises his hand in support. The Big Nurse tries to claim that the meeting was closed, and the vote invalid, but nevertheless, the men gather round the TV to watch the game. The Big Nurse flicks a switch in the control panel and the picture goes off. She then loses her composure and tries to get the men to return to their duties, but they ignore her.
Part 1 covers the first week that McMurphy is in the ward. There are many signs already of the kind of beneficial effect he is having on the patients. For example, Chief Bromden, although he is over six and a half feet tall, feels himself to be small and weak. But when he shakes McMurphy’s hand, some of McMurphy’s strength is transmitted to him, and he feels his hand has got bigger. McMurphy also gets Harding to admit that the Big Nurse is not helping them, but keeping them submissive. McMurphy forces them to see that the therapy sessions that are ostensibly designed to help them are in fact having the opposite effect. The Big Nurse ruthlessly exposes their weaknesses and they never have a chance to overcome them. McMurphy has thus begun to wake everyone up to what is really happening in the ward. He is a man who somehow has escaped the reach of the Combine. Society has not been able to shape him into a conformist mold. He delights in his own individuality, his determination always to be himself.
When the men vote for the switch in the schedule so that they can watch the World Series, it is a major step in their recovery. They are starting to realize that they can have some power in their lives; they do not always have to be downtrodden.
Part I also shows the conflict building up between McMurphy and the Big Nurse, which is one of the central aspects of the plot. It is a struggle between freedom and oppression, individuality and conformity, sexuality and sexual repression. Although it takes place in a psychiatric ward, it can also be interpreted as a struggle in American society between those two opposing sets of principles. The ward is a microcosm of the whole society.
At this point, McMurphy, although he is genial and friendly to the other patients, is primarily out for himself. He does not yet have the sense of responsibility towards the patients that he will later develop.
Interspersed with the events of the story are Chief Bromden’s reminiscences of his early life, and his observations about society as the Combine, the huge machine that enforces conformity. The Big Nurse is merely society’s representative in the ward, so she tries to mold the men like the Combine does. The cruelty and ruthlessness of this process is conveyed by the Chief’s stories about what has happened to other patients who passed through the ward, especially Max Taber, Ellis, and Ruckley. These are ominous foreshadowings of what may become of McMurphy.
It is through Bromden’s mind, distorted as it is by his paranoia (which is noticeable in the first line of the book: “They’re out there”) that the central image of machinery is conveyed. He also gives the name fog to the mental confusion he feels. He believes the hospital possesses a “fog machine” in the walls, and it is turned on whenever the Big Nurse needs to establish her control. The fog is probably the result of the many EST treatments that the Chief received.