Murphy uses color in the costumes and sets to represent themes: Yellow as Deception, Blue as Neutrality, Red as Wickedness, White as Purity, and Green as Honesty. Sometimes the costumes subtly change hue as one theme transitions to another.
When Sarah Paulson heard Rosanna Arquette on the media talking about how after denouncing Harvey Weinstein she hadn't worked much in the industry, she contacted her to offer her a role.
Murphy revealed that he had mapped out a four season origin arc for Nurse Ratched, where she would face off against a different male adversary each season; with the fourth and final season blending One Flew Over the Cuckoo's Nest into the narrative.
Mildred Ratched could be around 24 in this show, Sarah Paulson, who plays the character, is 45, and seems to play Ratched as older than 24, but the character's age is never specified in the story's year 1947. Ironically, Louise Fletcher was only four years younger than Sarah Paulson when she famously portrayed a middle-aged Ratched (likely in her early-50s) in Milos Forman's One Flew Over the Cuckoo's Nest in which the film takes place eighteen years after the show in 1963.
Musical themes from the soundtracks of composer Bernard Herrmann are used throughout the series, including excerpts from the movies Vértigo (1958), Intriga Internacional (1959), Terror (1962), and Psycho.