Maddy compares herself to her roommate Manoush, who wakes up early and stays up late studying for her sciences degree, while Maddy sleeps in, often misses classes, and has no idea what she wants to major in. Today, Maddy has one philosophy class, and it takes her an hour just to get out of bed. It leaves her no time to shower or eat, but she heads out the door and walks down the street. On the way, she starts to cry, and realizes she can’t make it to class after all. She walks back to her dorm in shame and sits down in the bathroom. There, she cuts herself for the first time and finds it to be such a powerful source of relief that she knows there is no turning back.

Maddy spends the weekend with Adam but finds herself uninterested in him, sexually or otherwise. She goes through the motions and attends a dorm room party with him but thinks about cutting herself the entire time. The following day, Maddy goes to the library to catch up on reading and write a paper due in two days, but she becomes overwhelmed by stress when she finds an email from the school threatening to expel her if her grades do not improve. Maddy rushes to the Student Health Center and gets an extension, citing unbearable stress.

Maddy fills her prescription for an SSRI (anti-depressant) and within weeks she feels as though she’s soaring. She gets ahead in her classes, starts dreaming of becoming Taylor Swift’s biographer, and even has the energy to walk to class instead of taking the subway. On the way, Maddy tries a New York hot dog and finds it to be the best thing she’s ever eaten. She continues riding the high and stops in a luxury boutique to purchase a blazer that catches her eye. When she sees that it costs $4,000, she justifies using her mother’s credit card as a reward for improving her grades. Maddy feels like she’s living life fully and doesn’t want to stop.

A man named Max stops Maddy on the street and invites her to a local comedy show, and she immediately heads to the club. She watches several mediocre performers, but when Max gets on stage, he makes everyone laugh and truly commands his audience. Maddy instantly wants the same thing, and she approaches Max after his show. She flirts with him, telling him how amazing he is, and claims that she could be the next great female comedian. When Max invites Maddy to the back room, she thinks about Adam but tells herself she deserves to do what she wants.

In a long series of texts in the middle of the night, Maddy talks to Emily with no response. She texts her endless lines about her plans to be a star comedian, how she has already written a Netflix special, and how she wants Emily to come see her perform. She goes on about the falseness of the world and how comedy is “real” and honest, adding that she’s still writing Taylor Swift’s biography. Maddy also sends Taylor Swift several messages on Instagram, claiming to be her biggest fan and wanting to chronicle her life. By five o’clock in the morning, Emily still hasn’t replied, and Maddy takes offense to this. She starts insulting Emily, accusing her of being a “Stepford wife” and not caring about Maddy, and threatening never to forget Emily’s “betrayal.” Maddy also gets a text from her mom asking if she’s been charging the card with thousands of dollars in clothing purchases, but Maddy doesn’t answer.

On Thanksgiving, Maddy shows up late with all her family waiting for her and the food getting cold. Rather than acknowledge this, she bowls through the kitchen in search of her mother’s car keys so she can go (supposedly) meet Taylor Swift. Maddy’s family sits in stunned silence as she takes her mother’s purse and dumps it on the counter. The car keys land in the gravy, and Maddy grabs them. Her mother tries to wrestle with her, so Maddy slaps her, and then Phil steps in to protect Maddy’s mother. Maddy grabs a knife and threatens her mother, so she is handed the keys, and goes to the garage to start the car. When she discovers that her brother’s car is behind her, she rams it multiple times in an attempt to get out. The police are called, and Maddy is taken to the ER.

Maddy wakes up strapped to a hospital bed and starts screaming for help. She feels like she has to leave urgently and that Taylor Swift must be waiting for her. A doctor comes in and introduces himself, asking Maddy questions about what she did and the marks on her arm. Maddy denies being in any trouble and admits to being on antidepressants for about a month, which she has since stopped using. Her doctor stares at her, knowing she isn’t revealing everything she has been going through. He gives her some pills meant to calm her down and promises that she will get to leave the ER soon. Maddy feels as though she is being dehumanized and discredited for being a woman. She doesn’t think she needs help at all.

Maddy is transferred to a mental hospital and loses track of how long she has been there. When she wakes up, she can hardly tell if she is dreaming or awake, and at one point thinks she sees her mother and sister sitting nearby. When they disappear, Maddy realizes she has no way of knowing what is real and what isn’t.

Maddy and her mother meet with a psychiatrist named Dr. Weaver, whom Maddy finds slightly more trustworthy than previous doctors because she is a woman. Maddy is in haze and can hardly react or answer, but she does her best to give answers to Dr. Weaver’s long list of questions about her symptoms. Dr. Weaver diagnoses Maddy with bipolar I, which confuses Maddy’s mother, who only wants her daughter to get better. Dr. Weaver assures Maddy and her mother that with proper medication and monitoring, Maddy should stabilize and no longer experience manic episodes or depression. She prescribes lithium and reveals the difficult truth that Maddy will have to live with this condition for the rest of her life, though it can be managed. Maddy can tell her mother is trying not to cry as she carefully wipes her eye with a tissue. When Maddy’s mother says she wants Maddy to have a “normal” life, Maddy believes that the possibility of a “normal” life is no longer within her grasp.