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Nurse Ratched plays the Ward Superintendent. She is the ultimate authority. Kesey describes her as "enormous, capable of swelling up bigger and bigger to monstrous proportions." The films physical portrayal of nurse Ratched perfectly embodies Kesey's description. Her appearance is one of frightening tight control. Every fiber of her being seems to exude a dark, cold and brooding control. Ratchet's control and ability to use it are evidenced by even her manner of speaking: soft, monotone and restrained with placid smiles. She is a consistent bureaucrat obsessed with her own authority. Nurse Ratched equates sanity with "correct behavior". The choice to picture Nurse Ratched entering the ward to begin her workday wearing a black coat over her sterile work uniform symbolizes her black and white approach to life. Either you"re in control or you"re not. Either you"re insane or you"re not. Either do what I say or face the horrendous consequences.
Kesey uses the setting of the hospital and Nurse Ratched to represent the non-specific realities of the real world. In this microcosm of society he uses other characters whose personas don't fit into the desired, expected and accepted norm which society wants. Billy Bibbet a stuttering 30-year-old paranoid boy child who is deeply afraid of his mother. A fear Nurse Rached doesn't hesitate to hold over Billy's head. Cheswick is an insecure neurotic who lacks any self-confidence. Martini is a short, smiling and immature man who seldom risks making eye contact with anyone. Bancini, an incoherent Frankenstein like inmate. Mr. Bromden, "Chief" an American Indian who never speaks, but is relegated to endless drone like floor sweeping. Kesey utilizes these wide varieties of "certifiable behaviors" to symbolize those individuals for whom whatever the reasons, are considered non-conformists, placed in correction facilities for repair of removal.
During a hospital departmental meeting, discussion is underway regarding Mac's diagnosis.