"One Flew Over the Cuckoo's Nest" by Ken Kesey can be a rather lengthy and in-depth book for high schoolers to read at times. In fact, some students find it difficult to distinguish what the deep analytical topics are to talk about in class discussions. From personal experience, many teachers tend to appreciate how students are able to distinguish tensions in books.

To those who are not familiar with tensions in literature, tensions are balances between opposing ideas or elements, such as light versus dark and good versus evil. When discovering these tensions, whether it is directly from the plot or the diction, students are able to comprehend the book more when doing a close reading of these novels. For students reading "One Flew Over the Cuckoo's Nest," here is a guide for the three most important tensions within this novel.

1. Illusion v.s. Reality

Throughout "One Flew Over the Cuckoo’s Nest," Ken Kesey incorporates a central tension between the illusion of the hospital and the reality of it.

The hospital emits an illusion that it is “an institution for the insane” where any form of discussion or questioning done by Nurse Ratched and the staff is done purely for “therapeutic sessions.” According to a visiting doctor, the hospital ward is described as a place where “they’ve made life look very pleasant with paint and decorations and chrome bathroom fixtures” that the no one would ever want to try and escape such an amazing place.

The hospital also gives outsiders the impression that it is a place that treats the insane in a nice and warm environment. Furthermore, the hospital distributes pills that are meant to help treat the patients’ “insanity.” Like all hospitals, it also gives off an impression that the doctor is in charge of his patients and a great hospital, especially when the “doctor takes things over and runs the meeting” and explains that this Therapeutic Community “is a democratic ward, run completely by the patients and their votes.”

On the other hand, Ken Kesey describes the reality of the hospital, which is the exact opposite of its illusion. According to Chief Bromden, the hospital, in reality, is place that turns people more insane like Bromden by using a “fog” to cloud people’s judgments, allowing themselves to be controlled by Nurse Ratched.Additionally, Randle McMurphy explains to the other patients that the hospital’s discussions are actually a “pecking party,” where Nurse Ratched causes the patients to bring down others if a single sign of weakness is shown.

Also, those so-called “pills” the hospital staff hands out to the patients causes them to become, according to Chief Bromden, “paralyzed with sleep.” The reason is because Chief Bromden witnessed the true horrors of the hospital and “caught them performing all kinds of horrible crimes on the patients sleeping around [him]” during the night.

Overall, Ken Kesey implements a central tension between the illusion of the hospital’s appearance and the reality of it by describing how the hospital is a nice place to reside in and how it performs heinous crimes on its patients.

2. Defiance v.s. Submission

Throughout "One Flew Over the Cuckoo’s Nest," Ken Kesey establishes a central tension between the patients’ defiance and submission towards Nurse Ratched.

From the start of the novel, many feared and allowed themselves to be under the control of Nurse Ratched. In fact, people were so scared of her that when “she looks around to see if anybody else is about to interrupt her… the guys won’t meet her look.” No one dared to defy her rule, especially since they are all aware that Nurse Ratched is a close friend of the supervisor of the hospital, the one that holds all the power. In fact, even Harding admits that they are “victims of matriarchy [in the hospital], [his] friend, and the doctor is just as helpless against it as [they all] are.”

This leads the patients to call themselves “bunnies,” who “need a good strong wolf like the nurse to teach [them] their place” in order to teach them their place in society. When McMurphy was trying to convince Harding to raise his hand during the vote, Harding exemplified those that fear Nurse Ratched so much; they become subservient to her. In fact, he wasn’t able to raise his hand mainly because he is “afraid she’ll cut [his hand] off,” portraying the amount of fear induced by Nurse Ratched into many patients’ minds like his.

At the same time, the hospital patients, especially Randle McMurphy and Chief Bromden, showed their defiance against Nurse Ratched’s rule. From the start of the novel, Randle McMurphy has already proven himself to be against Nurse Ratched by directly saying to her that he will “do the dead opposite” of her rules. He even makes a bet to show the other patients that “she’s ain't so unbeatable as [others] think.” In fact, when he is “dominating the meetings” that were usually led by Nurse Ratched, this questioned her supreme power as the head of the hospital, especially when McMurphy began to fight against Nurse Ratched to create a game room. Because his idea was rejected, he forces the group to take a vote in favor of having a game room.

When doing so the second time, 20 hands rose and eventually, Chief Bromden’s as well. Chief Bromden proves his defiance against Nurse Ratched’s rule at this time because by doing so, his disguise as a deaf man is revealed. When he was acting as a deaf, it symbolizes his submission to Nurse Ratched by not doing anything despite the fact that he was well aware of her true intentions.

All in all, Ken Kesey includes a central tension between the patients’ defiance and submission of the hospital patients towards Nurse Ratched by describing how people like McMurphy have the courage to break the rules and people who fear her to the extent they follow her will.

3. Sanity v.s. Insanity

Throughout "One Flew Over the Cuckoo’s Nest," Ken Kesey includes a central tension between the sanity and insanity of those residing in the hospital.

In the hospital where all patients are deemed as “insane,” there are “sane” people. In fact, those known as “sane” like Nurse Ratched are, as a matter of fact, “insane.” A known character to be sane is Randle McMurphy, who faked to be insane just to avoid working at a work camp. He is even aware that his “trigger-quick mind” is the key to go after Nurse Ratched.

People in the hospital who are actually suffering from a mental illness like Chief Bromden, who is a schizophrenic, are automatically considered as insane, but in reality, they are sane. Like sane people, McMurphy could go down the line of Chronics and shake “hands with anyone he comes to” without a single issue. Additionally, these people have thoughts and opinions of their own. They are able to distinguish if someone is manipulating them or not, just like how Harding claims that Nurse Ratched “fooled [him] but no longer” and how Chief Bromden is aware that Nurse Ratched’s “control is in the fog” where “[time is] lost in the fog, like everything else.”

Whereas there are sane people inside the ward, there are also insane people as well. In this context, those insane in the book would be Nurse Ratched and the staff. Nurse Ratched is a woman who strengthens her control by suppressing everyone else in the ward. She even tries to make Randle McMurphy appear as insane during the group therapy session by stating how he was charged with rape and has shown “repeated outbreaks of passion that suggest the possible diagnosis of psychopath.” By doing so, Nurse Ratched is identified as insane since she increases her power as a nurse by suppressing those who are deemed insane, but are actually sane.

Likewise, she even inflicts insanity among her staff like putting a nurse under the impression that McMurphy is a “sex maniac.” When doing so, the nurse goes in a frenzy, threatening to call the two aides in the ward, when McMurphy was “to pick up [her] waterin’ can [she] dropped.”

In short, Ken Kesey incorporates a central tension between sanity and insanity in the novel by explaining how those patients in the hospital who are sane and how the staff in the hospital are insane.

To all those who got through this rather lengthy, yet detailed, analysis of three important tensions found within "One Flew Over The Cuckoo's Nest," I wish you all good luck on your future school school assignments related to this amazing book!