The descriptions of lobotomies and electroshock therapy are methods the Combine uses to control and change nonconformists. Once they are made to conform to society’s standards, the patients are allowed to reenter society.
The Acutes’ admission that they are voluntarily committed to the hospital comes after McMurphy admits he’s has been exhibiting good behavior in order to receive an early release. When he challenges the Acutes to actually attempt living their lives outside the hospital, Bibbit emotionally tells him that none of them are as big and tough as McMurphy. McMurphy puts his hat back on, much like Gary Cooper before the final gun battle in the film High Noon.
