One Flew Over the Cuckoo's Nest

How does this book make a theme of madness?

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The novel creates the theme of madness by focusing on the fine line between what makes a person sane and what creates a sense of insanity; the fine line being the 'fear' factor. A few of the inmates admit that fear keeps them ensconsed within the facilities walls, that they'd rather remain within the institutions walls than face the big, bad world outside of those walls.