From the ethics and effectiveness of electroshock therapy and prefrontal lobotomy, to the portrayal of female characters as either prostitutes with hearts of gold or "ball-cutters," and Kesey's profound concern over the sinister power of the Combine and the mistreatment of African Americans and Native Americans, One Flew Over the Cuckoo's Nest presents a multitude of topics for discussion.

Kesey's illustration of the sedative, monotonously dull life on the mental ward and his vivid depictions of the effects of various psychotherapies on patients are highly contentious. Some readers commend Kesey's courage in revealing what they perceive as the mistreatment of patients, while others argue for the necessity of medical staff in mental hospitals to maintain order and control. Insights from individuals who have experienced treatment for mental disorders, have relatives or friends in psychiatric hospitals, or have worked in mental institutions as staff or volunteers can be particularly enlightening.

Kesey's character portrayals have sparked significant debate. One intriguing question is whether Randle Patrick McMurphy's unique approach to psychotherapy is more effective than that of the medical staff depicted in the novel. Another issue is whether Kesey successfully conveys the perspective of a schizophrenic by choosing Chief Bromden as his narrator. One of the most heated critical discussions revolves around Kesey's association of female authority figures with emasculation and his apparent glorification of large-breasted, sexually compliant women.

When examining the novel as a critique of American life in the 1950s and early 1960s, readers might consider the author's focus on the mechanistic, monolithic power of the Combine. Additionally, Kesey's disclosure of the dispossession of Native American tribal life by a manipulative and insensitive government and the racial tensions between blacks and whites is noteworthy.

1. What is the significance of the novel's title?

2. Is the mental ward Kesey describes an accurate microcosm of problems in America? Does Kesey imply that insanity is the only "sane" response to the atrocities of the modern world? Is the label "insane" a tool the Combine uses to control nonconformists?

3. Is Kesey's choice of a first-person point of view from a Chronic patient a stroke of genius or a source of confusion for many readers? How effectively does the author render Chief Bromden's consciousness?

4. Is Nurse Ratched truly evil, or is our perception of her distorted by the Chief's perspective, which is influenced by his belief that his white mother diminished his Native American father?

5. What are your thoughts on Kesey's use of drugs to inspire his writing of this novel? Are drugs the new frontier in the quest for transcendence?

6. Is this a profoundly spiritual work? What religious allusions do you find?

7. Is McMurphy a psychopath or a savior? What do you think Ken Kesey believes about his protagonist?

8. Do you see Candy and Sandy as shallow bimbos or nurturing, unbiased human beings? Is this novel misogynistic?

9. Who, if anyone, is responsible for Billy Bibbit's death?

10. Is this novel primarily a tragedy or a comedy?

11. Does Kesey's portrayal of the Combine accurately represent an industrial, conformist America?

12. Do you consider this book to be a mature defense of American individualism and a love for nature, or do you see it as an adolescent, comic book-style celebration of reckless sex, drinking, and rebellion against proponents of order and self-discipline? In other words, how deep is Ken Kesey's moral vision?