The final chapter of One Flew Over the Cuckoo's Nest is most interesting, as it ends with Nurse Ratched emerging as the hollow victor of the whole story. McMurphy, who is martyred in the book, is, however, presented as the ultimate winner. It is important to note that a slot of sexual content can be derived from the confrontation that occurs between these two characters, as was the case where Billy Bibbit and Nurse Ratched confronted each other right before. Nurse Ratched's main weapon against Billy Bibbit is her repressed sexuality, which she uses to perfection in order to instill a sense of shame into Billy. Billy starts to feel extremely guilty for reasons that involve his religious outlook. He also feels guilty as he looks at Nurse Ratched as a motherly figure and when she uses her sexuality, it gives him a psychological, Freudian disadvantage. Thus, when Billy commits suicide after hearing the nurse talk about his mother and thereby making him feel ashamed and guilty, we find the true source of his misery, which can only be explained by Freudian psychology.
One of the recurring themes in this last chapter is that of religion and religious ideas. Nurse Ratched blames McMurphy to be responsible for the deaths of Cheswick and Billy Bibbit. She accuses him of playing God and driving the two to kill them. The truth be told, it was Nurse Ratched herself and her demanding and domineering policies that forced Cheswick and Billy Bibbit to their deaths. It is ironic and darkly humorous to find that whatever Nurse Ratched was saying about McMurphy could easily be applied to what she was actually doing. She was the one who was playing god and was involved in a vengeful vendetta against all the patients in the ward. She was always giving everybody a hard time and would not allow anybody to recover, rather degraded their health by her antics.
Another recurring theme in this last chapter is that of sexuality. We have already discussed how the nurse used her sexuality to subdue and shamble Billy Bibbit. Upon her confrontation with McMurphy, they get into a physical romp whereby the nurse's breasts become exposed. This sends her into a shock and she finds herself unable to speak. This event is very significant with respect to the book as it shows two things. One, that Harding was right when he said earlier that the only cure for Nurse Ratched is sex. This episode where she finds herself unable to speak because of her exposed breasts show that what Harding said was true. Either that, or that sex was an ample weapon against the nurse. Second, the nurse is greatly dehumanized by this attack and finds herself unable to speak. This can be seen as the nurse losing her humanity, as speaking is one of the unique human traits. This is in sharp contrast to Chief Bromden, who during the whole story, finds his voice back and is able to regain his humanity.
Even though McMurphy is killed when Nurse Ratched orders a lobotomy, he is the true winner. The other patients in the ward stop being afraid of her and they start to leave the hospital on their own. We find more religious connotations here as McMurphy is represented as a messiah, who dies for just cause, allowing his disciples and followers to find their freedom in life, just as he did in his death. The rest of the patients find themselves strengthened by what McMurphy had proposed when he was alive and they are able to leave the hospital to once again become a proactive part of society.