ACT ONE
In late 1979, a famed criminal psychologist, Dr. Judy Matthewson, arrives at Chicago's Cermark Hospital to evaluate John, a former business owner, community leader, and part-time clown who has been arrested and charged with multiple counts of murder. Defense attorney Chris Moretti anticipates a diagnosis that will support an insanity defense and save his client from the death penalty ("Look Beneath"). In hopes that the Doctor will give credence to his claimed multiple personality disorder, John offers to share his story with her ("There Is More"). His narrative conjures flashbacks as he relives his past.
In a 1955 family argument, an alcoholic and abusive father berates John's childhood self for being overweight and effeminate ("Dumb and Stupid"). John's mother attempts to comfort her young son with words that only cement his sense of shame and repression ("The Mask"). As a survivor of child abuse, the Doctor displays a particular interest in John's case. She is haunted by her past and seeks to rationalize the actions of her own father by studying the origins of violence as related to the human brain. She continues to follow John through memories of his young adult years and early run-ins with law enforcement ("The Victim").
At the Doctor's urging, John describes cruising a Chicago park for underage male prostitutes in the mid-'70's while on parole from a prior conviction ("Boys of the Night/ On the Hunt"). His memories then shift to a 1976 party at his suburban Chicago home where, unbeknownst to his guests and new wife, victims were already buried ("The Yard Party"). The Doctor presses John on the issue of his supposed multiple personalities ("Look Beneath Reprise 1"). Through a flashback to an early murder, he introduces his multiples, including his mother and father, his childhood self, his clown alter-ego- Pogo- and his cruel cop persona- Officer Jack Hanley ("Tighten up the Noose"). John claims to have been a helpless, innocent witness to the murders ("Buried Secrets") and finally reveals the full extent of the crimes. He stands accused of murdering a staggering 33 boys, primarily young male prostitutes, derelicts, and runaways – most found buried in his crawlspace.
The Doctor faces ghosts from her own past ("Stone by Stone") as John experiences a vivid memory of a marriage-ending argument with his wife ("I Don't Really Know You"). After explaining that the murders reached a zenith following his divorce, he claims that he sought to end the spree and instigate his own capture by taking a well-known, affluent teen from a public place in 1978. He relives this murder, committing it against the wishes of his multiples. A confrontation ensues that blurs the lines between memories and reality, leaving the Doctor stunned ("Who's in Control?"/" Look Beneath Reprise 2").
ACT TWO
In early 1980, John's neighbors react to shocking media reports detailing his crimes ("What Kind of Man?"). Back in session with the Doctor, John recounts the aftermath of the last murder and a detective's visit to his home ("Something Foul"). The Doctor then meets with Chris, the attorney, who feels conflicted about the case ("For This Devil"). In her final session with John before the trial, the Doctor reads to him graphic accounts from victims who claim to have survived his violence ("The Living Dead"). The Doctor becomes unsettled by his disregard for the victims, and he taunts her with knowledge of her father and her past ("Out of Sight/Out of Mind").
John remembers a conversation with his ex-wife in which he pleads with her to leave Chicago to escape his crimes ("A New Beginning"); meanwhile, the Doctor continues to grapple with tragic memories from her own childhood that begin to resurface. As he begins to lose hold on reality, John recalls an encounter with officers during the investigation into his final victim. They tell him circumstantial evidence is mounting and encourage him to confess ("Tighten Up the Noose Reprise"). The memory leaves John rattled. Stuck in the past, he argues with his multiple personalities ("Pressure"). Despite the Doctor's attempt to reach him, John falls under the spell of Jack Hanley- his most sadistic multiple, and the session ends suddenly ("Against the Wall").
Alone, the Doctor considers John's culpability and her role in his defense ("After All"). We learn that police entered John's home in 1978 in search of one boy; they discovered 29 bodies in his crawlspace. In May 1994, the state executes John. The Doctor is given possession of his post-mortem brain for study and finds that it is without injury or abnormality; it is simply, a normal human brain. A 15-year history with John has profoundly changed her- shaken her beliefs and altered her worldview. In the final scene, she has visions from John's past and her own. She descends into the crawlspace of memories, disappearing ("Epilogue").