Typical accoutrements for eating raw oysters include cocktail sauce and mignonette, plus or minus a curious spirit for the uninitiated. The key accompaniment is subtlety. But subtlety is served rarely in the Ryan Murphy extended universe, so when Mildred Ratched (Sarah Paulson) and Gwendolyn Briggs (Cynthia Nixon) take a seat at an oceanside restaurant and order an oyster plate, the sexual undertones don’t go “under” at all. They’re as low-key as a jackhammer. But that’s okay. The eroticism and flirtation rest on the surface like vinegar in the shell. Gwendolyn is giving her Mildred her first taste of oysters while handholding her through a metaphor for oral pleasure. 

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This scene is set about halfway through “Ice Pick,” the second episode in the origin story series “Ratched” on Netflix. Like many productions Murphy puts his name on, he serves as an executive producer and developer; the creator is Evan Romansky, taking pages from Ken Kesey’s novel “One Flew Over the Cuckoo’s Nest” as well as Miloš Forman’s 1975 adaptation, which is arguably more widely embraced by pop culture than its source material. Regardless, Romansky’s series functions as a “What if?” taking viewers back nearly 20 years to Nurse Ratched’s arrival at Salem State Hospital, back when she was driven by morals and ideals and didn’t approach every patient like a nail. She’s still cunning and ruthless, of course, conniving her way into employment at a mental hospital in Northern California, but she’s also appalled by certain practices seen as state-of-the-art for the times, like hydrotherapy. 

“True monsters are made, not born,” reads Netflix’s logline for the show. If that thesis held up as one episode fades into the next, “Ratched” might have better cogency, though even if the writing betrays the basic conceit, the narrative still hums along nicely. What actually hobbles “Ratched” is the Russian nesting doll effect of structuring a prequel around the chief antagonist in a movie based on a book. Characters like Nurse Ratched don’t require explanation. In fact, they can’t be explained at all. They exist solely to provide a wall for protagonists to collide with. Sometimes inhumanity’s roots demand excavation. Most times they’re best left rooted in the dirt.

What’s especially frustrating about Romansky’s enterprise is that “Nurse Ratched” could have done just fine on its own merit divorced from pre-existing intellectual property; as a kinky thriller about a haunted and unstable medical professional who sabotages her peers, bumps off the occasional patient, and disposes of the bodies, all while struggling with her late-stage sexual awakening and a dose of wartime trauma, the show works and handily outclasses Murphy’s other 2020 projects, “Hollywood” and “The Politician.” Think of “Nurse Ratched” as a confluence where the movies of Brian De Palma and Alfred Hitchcock pool together with genre plots about evil nurses, buttressed by the excess that defines Murphy’s brand. The resultant mixture proves satisfying by the end of the pilot’s opening sequence, where Edmund Tolleson (Finn Wittrock) brutally kills a quartet of clergymen with throat slashes, dozens of stab wounds, and one head smash. 

Sounds like the start of a new season of “American Horror Story,” except the scares are replaced by the sense of watching strangers undress through their upstairs window. The naughtiness that partially, but substantially drives “Nurse Ratched”s plot feels like a release, even when Romansky and his writing team—comprising Murphy, naturally, as well as his usual cohort Ian Brennan and Jennifer Salt—pause it for genre-mandated bloodletting and squeamish discomforts, ranging from LSD-fueled delimbings to cranial lobotomies performed at the business end of an ice pick (in case Episode 2’s title doesn’t immediately give away the game.) In “American Horror Story,” images like that would be the showcase. Here, it’s more like a set of bookends to prop up complicated bedroom roleplay, Mildred’s sexual self-denial, and her mission to get herself as close to Tolleson as possible. Turns out they’re related, the “how” being revealed in, again, “Ice Pick,” one of the series’ fundamental chapters. 

That quest again clangs against the connection to “One Flew Over the Cuckoo’s Nest,” in which Mildred (played by Louise Fletcher) is a totalitarian brute. That movie is about a culture war fought between 1970s American rebelliousness and institutional barbarity. “Nurse Ratched” is less about the culture war and rebellion and more about institutional barbarity, where Mildred’s purpose intersects with sexual exploration, queer oppression, and a number of subplots involving the hospital’s chief, Dr. Richard Hanover (Jon Jon Briones), man of mystery Charles Wainwright (Corey Stoll), socialite Lenore Osgood (Sharon Stone), and Governor George Milburn (Vincent D’Onofrio), who’s putting his chances at winning reelection in Hanover’s shaky hands. Milburn wants to leverage Hanover’s reputation as a medical revolutionary to score points with voters, but as soon as Mildred arrives, accidents happen, she feuds with other nurses on staff, particularly Nurse Bucket (Judy Davis). Suddenly Hanover finds himself dependent on Ratched for guidance, subterfuge, and personal protection as the plot thickens like so much roux.

But the pleasures of “Ratched” are dulled by the constraints of IP maintenance. At some point, Ratched has to end up in Oregon, overseeing the very ward where Randle Patrick McMurphy lives out the final days of his life resisting her reign; that inevitability looms over the show and sucks a bit of the deviant, gruesome fun out of the whole experience. Still, it’s a credit to Romansky that “Ratched” remains watchable in spite of the conflict between inspiration and obligation. The former presents in split screens and lens filters; the latter presents in the winding road back to the cuckoo’s nest. [B]

“Ratched” arrives on Netflix on September 18.