Ken Kesey's One Flew Over The Cuckoo's Nest deals with control, manipulation and destruction. These elements are portrayed in the novel by what is referred to as the Combine. A combine is a farming machine that is used for cutting, threshing and cleaning. In One Flew Over The Cuckoo's Nest the Combine is a metaphor for society and how it controls, manipulates and destroys. The Combine exists both inside and outside the ward. In the novel, Nurse Ratched is a "high ranking official" (165) of the Combine and has the black boys under her command. The Nurse's psychiatric ward is a repair shop for the Combine where people who do not conform to society's accepted behavior are outcast and are to be repaired. In One Flew Over The Cuckoo's Nest the Combine does three main things. The Combine controls the patients of the psychiatric ward by instilling great fear into them and then manipulates them by playing on these fears. Finally the Combine seeks to destroy anyone who resists conforming.
             At the beginning of One Flew Over The Cuckoo's Nest the patients in the psychiatric ward are kept under control because they have been made to be afraid. There are two types of patients in the ward: Acutes and Chronics. Acutes are those "still sick enough to be fixed" (13) whereas Chronics are so mentally damaged they "can't be repaired" (14). The characters, who are mostly Acutes, fear that if they stand up for themselves they will be subjected to worse treatment and may even end up as a Chronic. Ellis and Ruckly are examples of Acutes that were turned into Chronics by the use of shock therapy for the former and a lobotomy for the latter. The patients fear they will become like Ellis and Ruckly if they resist. Also, all the characters in the ward except Scanlon and a few of the Chronics are there voluntarily, "there are only a few men on the ward who are committed"...