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There are many differences between the film and the novel, as is often the case when a book is taken up by Hollywood and made into a feature film. The first reason, in general, for differences, is the completely different animals that books and movies are. Another big difference, in general, is that, while a novelist writes often from a very personal, sometimes controversial point of view, a Hollywood movie is created to please a mass audience and make money, so novels that are brought to the screen often arrive with the original author's message very watered-down. Both of these differences apply to One Flew Over the Cukoo's Nest.
First, the point of view in the novel is first person. It is told by Chief Broom. Everything one pictures about the other characters and events of the book are filtered through this character's perception. In a film, no one character can provide the point of view, since this is the work of the camera (and ultimately the audience), so the film cannot give the audience the same feeling of Chief's point of view as the book does. Further, the movie was created as a "vehicle" for Jack Nicholson, and he seems much more the main character of the film. This change is a common sort of one for Hollywood, which is a business-driven place and wants to make sure the audience will buy tickets to come and see a movie star that they know and like.
The book also creates some religious and political thematic statements that the movie pretty much does away with. McMurphy is created as a sort of Christ-figure in the novel, a theme that all but vanishes in the movie. There is also much of the novel that creates an anti-establishment tone, a statement in response to the political situation when the book was written at the end of the 1950's, beginning of the 60's. Since the movie was made in the 1970's these themes may have seemed a bit out of date. The movie relies much more on characters and their interrelationships to drive the film, rather than political or religious thematics.
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