Combines have been used by farmers for decades to harvest grain from their fields. Combines were designed to mow down the tall grain stalks, remove the grains, and finally to eject the leftover straw back out onto the field. In the mental ward, the patients are stripped of their personalities one by one. Their "grains", or the important parts of who they are, are torn from them. After facing the combine, the ward patients are all the same; useless and unwanted straw, left out in the field to rot.
McMurphy enters the ward, full of energy and spirit; a tall stalk of wheat in the path of the combine. Despite his defiance towards the system run by Big Nurse, he's still just a small blade of grass before the might of the combine. The system and the machinery that continually appears in One Flew Over the Cuckoo's Nest extends much farther than McMurphy realizes. The establishment now has complete control of his fate now that he's been admitted, and they can use whatever force is necessary to bring him under control. In this way, McMurphy is no less vulnerable than anyone else, because even someone as iron-willed as he is doesn't stand a chance.
Other institutions are almost intended to work as two combines, the second running in reverse. An institution such as school runs a combine over the miscreants who seek to disrupt the class, but then the second combine works the other way. Through school and work we are encouraged to learn and develop into new and better people. Another simple example is when people attempting to lengthen their hair apparently have to first cut off the split ends before the hair can grow back longer, establishments attempt to strip us of our differences in order to allow us to remake ourselves anew. The Big Nurse seems to have forgotten the second step.
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