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The setting is the Stephens Sanitarium, a secluded insane asylum in a rural area. The eponymous chief doctor Dr. Stephens believed that the best way to cure insanity was to allow the patients to act out their realities freely. That belief got him killed when an ax-wielding patient killed Stephens. The only remaining doctor is Geraldine Masters, who vows to continue Dr. Stephens' work. The recently hired nurse Charlotte Beale is introduced to the few remaining patients, including a lobotomized adult with child-like behavior and a shell-shocked Vietnam War veteran who never recovered after killing his own subordinates in a friendly fire incident. Masters seems perfectly willing to torture or even kill patients who disobey her orders. Charlotte learns from a patient that Masters is actually a patient at the institute whom Stephens allowed to pretend to be a doctor. Every patient is aware that the tyrannical Masters should be one of them, but they also assume that Charlotte herself is insane. Charlotte does find her mask of sanity slipping. When an isolated prisoner grabs her ankle, Charlotte overreacts by beating him to death. The tension and internal conflicts at the asylum are the first steps towards a massacre.
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