The novel opens on a typical Monday morning in an unnamed Oregon psychiatric hospital. The narrator, Chief Bromden, is a tall, half-Native American man who has paranoid schizophrenia. He presents himself as deaf and mute, though he is neither. Emerging from the dorm, Bromden encounters three hospital aides he refers to as “black boys,” describing them as “sulky and hating everything” (3). The aides address Bromden as “Chief Broom” and assign him to mop the hallway. As Bromden mops, the ward’s head nurse, Nurse Ratched, enters through the locking doors at the end of the hallway. When she scolds the aides for chatting instead of working, Bromden imagines her growing “big as a tractor, so big I can smell the machinery inside” (5). Here and throughout the novel, Bromden perceives and describes Ratched and other staff members in mechanical terms as parts of a larger entity he calls “The Combine,” which enforces conformity to social norms.

Ratched instructs the aides to shave Bromden; scared, he hides in the closet and attempts to calm down by recalling hunting with his father alongside the Columbia River. When he exits the closet, the aides capture him. He panics and resists their attempt to shave him.