As will probably be obvious to anyone who saw the 1975 movie adaptation - which must surely be everyone - the mental institution in which the story takes place is a metaphor for society as a whole, which as such squares perfectly with the truism that mental illness may often be a logical and sadly inevitable means of dealing with the unreasonable conditions to which our society commits us. This, at least, was Kesey's approximate conclusion from working nights at the Menlo Park Veteran's Hospital in San Mateo County, and here it underscores the narrative in terms which feel almost Biblical with McMurphy's rising from the dead of shock therapy as a precursor to his ultimate sacrifice.
We're all familiar with the story, right?
For what it may be worth, Cuckoo's Nest seems a rare example of the film telling the same tale as the book for the same reasons, with both coming out on top. There are minor changes, the main one being that the story is told by the Chief who remains a silent hulk on the screen until the latter part of the movie; which shows that it can be done, contrary to whatever Ridley Scott might have had to say on the matter of making a completely different film.
Kesey writes well, although the text occasionally veers into getting too dense for its own good, requiring the occasional skip back to a previous paragraph to remind oneself of just who we're talking about; but it's otherwise meaty and powerful, pinning out its intricate diagram of injustice in colours so primary as to hurt the eyes, yet without spelling anything out or playing the usual sympathy cards; and so it puts the reader through a wringer just as Nurse Ratched does with her patients and our current societal set up fucks us over - or most of us - with a big smile and the promise that this is specifically because it has listened intently to our concerns. This is why One Flew Over the Cuckoo's Nest will break your fucking heart if you have one, because it's barely even a metaphor.
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