Admittedly, I viewed the film based on this book prior to reading the work itself (though not recently) which definitely warped/directed my perspective (hard to NOT imagine Jack Nicholson, Christopher Lloyd, and Danny DeVito assume their respective roles). It was difficult to imagine the ward, staff, and characters outside of the film's rendering (which speaks highly of the casting/acting, I suppose). Furthermore, the "shock factor" (no pun intended) of the more erratic and graphic scenes (at least those not omitted from the film) was reduced in my reading (I sadly anticipated the more catastrophic events).

The added narrative perspective of "Big Chief Bromden" (back to the book!) was a welcome alteration... his internal monologues alone made the book a worthwhile tribute to the inebriation of excessive psycho-drug therapy, EST, cognitive castrations, etc. in the mental health institutions/asylums of the 1960's.

Take the subject matter of Foucault's "Madness and Civilization", update the setting, infuse it with colloquial vernacular (read: "easy reading"), "Keseyian" anecdotes, and a creative non-fictive edge ala Tom Wolfe, and voila! "One Flew Over the Cuckoo's Nest"...

Initially, the bravado, lunacy, and extremity of Kesey's characters seems a bit heavy-handed; R.P. McMurphy appears to be needlessly "over the top", Nurse Ratched's subtle manipulations are inexplicably cold and sadistic (unless ALL army nurses over 35 go "bad", Kesey?), and the portrayal of minorities and women (as often noted by critics) is less than politically correct. But below the bombastic exterior, through clever introspective devices like "Big Chief", we get a sense for the dual-madness of the "system" ("Combine") Kesey explores. Who is crazier? Harding, McMurphy, or Nurse Ratched? The deluded PR rep who circles articles from year-old Harper's Weekly magazines for the inebriated patients to read? The drug-cocktail prescribing "doctors"? The pot smoking/cough-syrup ingesting night watchman? Sefelt the epileptic?

"Madness", Kesey would have us believe, is at once subjective, poorly managed (by clinical 1960's standards), and completely misunderstood.

While I gave the work "5 stars" ("I loved it"), I would have preferred a solid 4.5...alas, "1/2" stars are not an option.

For a "first" novel (at 26/27 years old, no less!), "One Flew" is a creative literary legacy Ken Kesey can proudly rest (in peace!) upon.

In terms of criticism, early on, I felt some disjointed dialogue b/w McMurphy and the patients on the ward... basic "flow" issues I would attribute to a relatively "new" novelist / passive editing.

All in all, I would totally recommend this to anyone desiring a more robust appreciation (an unfortunate "update" to Foucault!) of late 60's mental health rehabilitation practices and procedures.