Few novels have ever delved as deeply into the treatment of mental health issues as Ken Kesey did in One Flew over the Cuckoo’s Nest. Narrated by the half-Native American Chief Bromden, whom everyone presumes is deaf and mute, this psychotropic novel takes place in a psychiatric institution somewhere in Oregon. Most of the hospital is never seen except the ward in which Bromden lives, which is ruled over by the sadistic Big Nurse and her three aides. The patients all behave, terrified of the Big Nurse and her methods.

But all of the calm is upset with the arrival of Randle McMurphy, a former convict, who sets out on a journey of rebellion against the hospital authorities and The Combine, the mysterious force that Bromden believes is controlling the outside world. In the end, McMurphy’s crusade against the Big Nurse ends tragically, but not before he has humiliated the authorities and inspired Bromden to escape himself. Kesey portrays the hospital and its work as an exercise in human degradation, an abattoir for the mentally ill.

Although it has its funny parts, this is an unmistakeably dark, nightmarish novel condemning the barbaric methods used to “cure” patients in such institutions: the descriptions of electroshock therapy and lobotomies are disturbing in their own right. Kesey based the novel on his own experiences working in psychiatric hospitals, and many of the more vivid scenes were inspired by Kesey’s experiences in taking LSD and other psychoactive drugs are part of Project MKUltra, the CIA’s mind control research programme.

One Flew over the Cuckoo’s Nest deals with the dark side of how America treated its mental patients in the first half of the twentieth century, and as such was hugely controversial when it was released. In the years since it was released, the novel has been challenged all over the world, largely for its brutal description and disturbing events, even as recently as the year 2000.

In the end, this is not a novel to be read lightly. Kesey makes the hospital into a place which is both absurd and hideously real, with imagery which is vivid and highly unpleasant.