Chief Bromden's hallucinations also question his sanity in the novel, however Forman eliminates Chief Bromden's hallucinations altogether, since the camera cannot express his altered vision in the figurative discourse Kesey uses. Forman, instead of burdening audiences with maintaining sympathy for truly sick ward patients, puts the focus on McMurphy. Forman eases viewers into the trauma of life on a mental ward by allying them with McMurphy; the audience learns as he learns, often beholding images of his facial expressions and reactions to other characters. .
The central issue in the novel apart from McMurphy's sanity is the oppressive nature of America in the 1950's and 1960's and the counter-cultures that resulted from this repression. The fact that characters are presented as small and big in terms of power shows this. For Instance the Big Nurse is described as " enormous, capable of swelling bigger and bigger to monstrous proportions." The reason for this is that she has the establishment behind her and therefore can repress people. The Chief's mother is "twice the size of his father," because she is assertive, while the Chief feels "small," even though he's the biggest person in the hospital. McMurphy is described as "enormous" because he challenges the establishment by not following the rules and the establishment deals with this by "quietening" him.
The movie while being mainly about the suppressive nature of America doesn't make use of the metaphorical device of being big and small. This is seen simply by Big Nurse being called Nurse Ratched .
One of the most effective techniques Kesey employs is the use of symbols. One such symbol is the Christianity Symbol that is the comparisons of McMurphy and Christ.
McMurphy with his twelve followers engage on a fishing trip, deep-sea fishing was an important event in Christ teachings. The fishing trip also leaves the "followers" with a sense of self-worth, which Nurse Ratched has denied them.
