The nurse has created an environment that is very controlled. Between the pills each patient takes, the music that plays, the meticulous schedule that must be followed, Nurse Ratchet creates a relationship of dependency between her and her patients. During group sessions, she uses the characters' weaknesses against them, driving each man more and more into himself. MacMurphy’s character is the antithesis of the dependent patients. His presence and antics create chaos to Ratchet’s controlled environment. The patients begin to act “normal.” She must finally control MacMurphy the only way she can; the essence of the character – the personality – is removed. The ward returns to the controlled routine it was at the beginning of the play. The Chief’s escape is the only sign the MacMurphy may have made a permanent change.