Is Nurse Ratched a sociopath? The Netflix show brings one of cinema’s most hated villains back to our screens – but is the psychiatric nurse more unstable than those she treats?

Who is Nurse Ratched?

Nurse Ratched is chief nurse on a psychiatric ward full of colourful and diverse characters, whose lives she controls in every detail.

In the original movie adaptation, Louise Fletcher is bitterly compelling as ‘Big Nurse’, bringing to life Ken Kesey’s One Flew Over The Cuckoo’s Nest. The novel is a study of a microcosm of absolute power, and the film is widely considered to be Jack Nicholson’s finest.

Fletcher’s key insight into the character she plays is: “Nurse Ratched is convinced she’s right.”

With all the debate the new series will no doubt resurrect, one that stands out is whether Nurse Ratched is as unbalanced as those in her care? Perhaps even more so? Could we say she’s a sociopath?

What is a sociopath? Does Nurse Ratched fit the bill?

Sociopathy is a form of antisocial personality disorder. According to diagnostic manual on mental illnesses DSM-5, antisocial personality disorder is defined as a “pervasive pattern of disregard for and violation of the rights of others occurring since the age 15 years”.

DSM-5 also describes it as involving three (or more) of the following traits:

Failure to conform to social norms concerning lawful behaviour

Not so Nurse Ratched. She’s all about norms, order and regulations, intolerant of those who fail to respect this. Perhaps working on a boisterous psychiatric ward is a peculiar, yet fascinating career choice.

Deceitfulness – habitual lying, use of aliases, conning others for personal gain

While Nurse Ratched never seems to lie, she’s prone to feigning ignorance to help control and manipulate her patients.


Anathema to Nurse Ratched, who prioritises order, predictability and control over everything else – even patients’ welfare.

Irritability and aggressiveness

Those on the end of her glares and punishments for displeasing her in some way might argue for this one. And her response to McMurphy at the end of the book/ film could be said to be an aggressive use of power for revenge. Prim Nurse Ratched, however, no doubt sees this as restoring order and authority. 

Having no regard for the safety of self or others

Nurse Ratched’s judgement is consistently poor, setting in train a series of events that uproot all safety. She will no doubt point us to her manual and explain how bad things would otherwise have been. 

Consistently irresponsible, failing to honour obligations

Nurse Ratched worships rules. While she regularly fails in her obligations, this seems to be more poor judgement than recklessness. 

Lack of remorse or inability to feel guilt, being indifferent to or rationalising having hurt, mistreated or stolen from another

Difficult to deny this one – or is it?

The reign of terror Nurse Ratched presides over suggests she is callous, indifferent and lacks any real concern for those in her care, even when faced by genuine pain.

When she expresses sympathy, it seems designed to manipulate. When McMurphy entertains his fellow patients with commentary of an imaginary baseball game, she’s desperate to shut down the revelry.

That seems pretty cut and dry.

So, is Nurse Ratched a sociopath?

Author Ken Kesey might have given us an insight into the type of person Nurse Ratched really is – and whether this isn’t so much lack of remorse as a need to maintain control at all costs. 

Photo by FilmPublicityArchive/United Archives via Getty Images

Kesey told the New York Times he based Ratched on the head nurse of the psychiatric ward where he worked. He recounted he later met her again and realised: “She was much smaller than I remembered, and a whole lot more human.”

No doubt Nurse Ratched would see her demeanour as calm and professional, enforcing rules to ensure better care for patients. She believes she’s following the guidance as she understands it, efficient and effective.

Yet the joy she takes from rules for rules’ sake and the power it gives her suggest some indifference and perhaps hints at a genuinely sociopathic character.

No doubt the new series will provide us with new opportunities to wonder just how unbalanced Nurse Ratched is.

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