Buffy searches newly rented houses for the Trio's hideout. The three discover her on surveillance equipment but she gets too close. While they hide in the basement, Andrew calls on a demon which attacks Buffy and starts a fight. The demon grabs Buffy and stabs her with a needle-like part of its body.
In a mental hospital, Buffy cries out as she's held by two orderlies and stabbed with a needle.Outside the Trio's house, Buffy wakes up confused and alone and walks home.
Willow prepares to talk to Tara but sees her give her female friend a quick kiss; Willow leaves, wounded. Tara notices her leave but it's too late to catch her. At the Doublemeat Palace, Buffy works like a zombie whilst having brief flashes to the hospital where the doctor tells her it's time for the drugs. Willow and Buffy talk about Xander's disappearing act and Willow's attempt to talk to Tara. Xander surprises the girls by showing up at the house. He wonders about Anya and how to rebuild his relationship with her. The girls tell him that Anya left town a few days ago and that everything will be fine in time.
Buffy runs into Spike at the cemetery and they talk about the events at the wedding that didn't happen. A confrontation begins between Spike and Xander and as Willow tries to break it up, Buffy becomes weak and collapses. Xander manages a one punch to Spike who focuses on Buffy. At the mental hospital, a doctor tells Buffy that she's been hallucincating for the past six years and everything she knows about Sunnydale is fake. She's shaken and confused, especially when both of her parents walk in before Buffy falls back into Sunnydale world.
Willow and Xander get Buffy home and she tells them about the mental hospital and what the doctor said. While Willow organises a plan to research, Buffy returns to the hospital where the doctor explains to her parents that she's been catatonic from schizophernia for the past six years and her life as a Slayer has been elaborately created.
- Absentee Actor: Anya. Possibly Written-In Absence, as Xander makes mention of it at the start of the episode, asking if anyone has seen her. The others reply she took off after the wedding.
- Adult Fear: Losing your child to madness.
- All Just a Dream: It's suggested that the entire series is Buffy's hallucination and she's living in a mental institution and has power fantasies of saving the world with her imaginary friends. The ending leaves room for interpretation as to which existence (Buffy's life as a vampire slayer, or her life as a mental patient) is really All Just a Dream. Joss Whedon has outright stated that either one is a definite possibility.
- Alternate Reality Episode: Buffy, under the effects of a demon's venom, flashes between the normal Buffyverse, and an alternate universe where she had spent the last seven years catatonic in an insane asylum in Los Angeles, where they have been trying to treat her for her insane delusions about fighting vampires. The episode makes no attempt whatsoever to clarify which, if either, of Buffy's perceived realities are the real thing.
- Ambiguous Situation: Buffy is injected with a poison that makes her hallucinate... Or is it the other way around? According to a psychiatrist, who may or may not be a real person, she is in fact getting better — She has been sick all along, and now she's finally waking up from years of catatonic schizophrenia. So, the whole series is either This Is Reality or a mad All Just a Dream with a dash of The Schizophrenia Conspiracy. In the end, Buffy chooses her life in Sunnydale over her life in the mental institution, but the ending leaves it ambiguous whether or not the world she settled for is the real one. Word of God doesn't help, either — executive producer and writer Marti Noxon says the mental ward was a hallucination, but Joss Whedon has said that either interpretation is just as legitimate as the other.
- And You Were There: Buffy imagines her manager at the Doublemeat Palace is a doctor in the mental hospital.Female Doctor: Come on, it's time for your drugs.
[Flash back to the Double Meat Palace.]
Buffy: (confused) What?
Lorraine: I said, if I didn't know any better, I'd think you were on drugs.
Buffy: (confused) Okay. Good.
- Anywhere but Their Lips: Willow is working herself up to ask ex-girlfriend Tara out for coffee and lesbian love when she sees her greet-and-kiss another girl. From her viewpoint it's difficult to see how intimate the kiss was, but she runs off anyway.
- Badass Decay (In-Universe)Spike: It might explain some things, this all being just in that brain of hers. Yeah, whips up some chip in my head, make me soft, fall in love with her. Then, turn me into her soddin' Sex Slave.
- Basement-Dweller: The Trio, though this time it's because they're hiding from Buffy in an empty house.
- Bond One-Liner:Xander: I altered his reality!
- Bound and Duct-Taped: Willow and Dawn get this from a crazed Buffy.
- Break Them by Talking: Spike delivers this lecture to Buffy. Becomes a "Nice Job Breaking It, Anti-Hero" moment when it causes Buffy to pour away her antidote.
- Continuity Nod: Buffy looks at a family photo of her parents with herself as a child — the same child actress used in Season 5's "The Weight of the World."
- Cuckoo Nest: A perfect example. The episode ends leaving open the possibility that the entire series was in fact the hallucination of an insane Buffy Summers.
- Notably, instead of Buffy being encouraged to kill herself, she was encouraged to kill all her friends, and came very close to doing so. They got over it astonishingly quickly, though. Stuff like that happens in Sunnydale.
- The description of the episode on the DVD case suggests that it was an alternate reality in which they really are hallucinations, but they're perfectly real in their reality. Word of Joss, however, seems to suggest that he finds it perfectly acceptable if fans conclude that the entire series was the fevered dream of a schizophrenic Buffy.
- Description Cut: Willow says that Xander has help finding the demon; cut to Xander and Spike stalking through the woods. The doctor's description of this years Big Bad as "just three pathetic little men who like playing with toys" to the Trio in their lair.
- Despair Speech:Buffy: (very quietly) I feel so lost.Willow: I know. You're confused. It's, it's that crazy juice inside you.Buffy: It's more than that. (Willow frowning) Even before the demon ... I've been so detached.Willow: We've ... all been kind of slumming.Buffy: Every day I try to ... snap out of it. Figure out why I'm like that.
- Discreet Drink Disposal: Willow asks Spike to make sure Buffy drinks the mug of yummy antidote goodness, but Spike gets into an argument with Buffy and leaves, giving her a chance to pour it away.
- Downer Ending: The Buffy in the asylum goes into permanent catatonia.
- Dramatically Missing the Point: Buffy tells Spike, "You're not part of my world" because vampires aren't real. Assuming she's referring to him no longer being her boyfriend, Spike goes off on a rant instead of ensuring Buffy takes her medicine.
- Easily Forgiven: Buffy nearly kills her friends and little sister because the doctor in her (possible) hallucination says she needs to get rid of them to go back to normal. She changes her mind at the last second, kills the demon she was about to feed them to, and begs their forgiveness. They give it almost immediately.
- Education Through Pyrotechnics: Willow mentions that her previous attempts at making the antidote "went boom twice" before she got it right.
- Elseworlds: If you believe the theory that the mental ward was actually a Parallel Universe.
- The Ending Changes Everytthing: The Trio tries to convince Buffy that her life as a vampire slayer is delusional, and she is really a patient in a mental hospital. The episode ends on Buffy in the Mental Institution going catatonic. (Joss Whedon claimed this episode was ambiguous, and the show snaps back in the next episode.)
- Foreshadowing: For "Entropy" — Spike threatens to tell the Scoobies about their affair if Buffy doesn't do so.
- Frying Pan of Doom: Buffy hits Xander with one, then drags him to the basement where he and Willow and Dawn can be eaten by the Monster of the Week.
- Group Hug: Xander gets a hug threesome when he returns home.
- Hell-Bent for Leather: Buffy changes into the Black Leather Jacket Of Ass-Kicking while searching for the Trio, but not the Red Leather Pants of Death — she's not quite her old self yet.
- Homoerotic Subtext:
Buffy: I could wrestle naked in grease for a living and still be cleaner than after a shift at the Doublemeat.Willow: Plus, I'd visit you at work every single day.
- The Belligerent Sexual Tension between Xander and Spike is lampshaded in a Deleted Scene where James Marsters gives Nicholas Brendon a mock kiss right after calling him a "pathetic poof" in their graveyard fight.
- Buffy is once again fed up with work.
- A House Divided: The Trio are starting to fray.
- I Just Want to Be Normal: Part of the reason Buffy almost chooses the other reality (if that's what it is); she'd go back to being a normal girl with no demons to fight, no trauma, and parents that are neither absent nor dead.
- "I Know You're in There Somewhere" Fight: Dawn tries this, but Buffy is too far gone by that stage.
- Leaning on the Fourth Wall: Plenty of this.Doctor: Buffy, you used to create these grand villains to battle against, and now what is it? Just ordinary students you went to high school with. No gods or monsters ... just three pathetic little men who like playing with toys.
- "Leave Your Quest" Test: Buffy gets poisoned by a demon, and suddenly finds herself in a mental institution, with her worried parents (both alive and together) hoping that she might come out of her prolonged psychosis. She's told that being a Slayer and everything that's been involved (including all her friends) was just a prolonged hallucination, and all she has to do to come back to reality is let go of it...by killing her friends in the hallucination. In the end, she decided to be an unhappy hero who MIGHT be in a hallucination, versus being a happy person of no consequence in what also might be a hallucination.
- Lotus-Eater Machine: In the asylum Buffy has no responsibilities, and her parents are alive and still together.
- Mind Screw: Buffy is poisoned by a hallucinogen-producing demon and is torn between two realities: being a Slayer and being an insane girl in an asylum, with parents who love her and are trying to make her sane again with the help of a psychiatrist. But then, when the episode ends, it does so with an image of Buffy in her normal-crazy-girl reality, not as Slayer Girl, leaving you with the impression that the entire show, including the later seasons, are all a product of an insane girl's overactive imagination. Joss Whedon said he considers the series to be actually happening, but put that in just for fun, and if people want they can consider the whole series to be the delusions of Buffy. Which would also make the entire Angel series part of that hallucination, too.
- The Nicknamer: Xander calls Spike "Willie Wannabite", and Buffy "Sane Girl" — right before she clonks him with a frying pan.
- No Mere Windmill: Buffy reveals that her parents had her sent to a mental clinic for two weeks after she first told them about seeing vampires.
- O.O.C. Is Serious Business: When Anya doesn't open the magic box for a long time after Xander left her, he is genuinely scared.
- Or Was It a Dream?: Since the last thing we see is the insane asylum where Buffy had spent much of the episode "hallucinating" that she was a patient, accompanied by a doctor pronouncing that she's lapsed back into catatonia, it's left to the viewer whether the previous six seasons were real, or a psychotic hallucination. Joss Whedon is that he personally believes that the events are real.
- Out-of-Genre Experience: The scene where Psycho!Buffy stalks her sister through their home is reminiscent of a Slasher Movie.
- Person as Verb: Jonathan says he's "going Jack Torrence" cooped up in the basement.
- Retcon: Buffy is revealed to have been briefly institutionalized when she first learned about vampires, which makes Joyce's Weirdness Censor in the first couple of seasons rather implausible. The common explanation is that this is part of the timeline that was altered by Dawn's creation. Another possibility is that it's merely a side effect of the demon's venom, since it's never referenced again after this episode and Dawn never confirmed in the story. The non-canon (but canonically plausible) comic interquels that cover the time between The Movie and Season 1 show she actually was institutionalized.
- Rousing Speech: Joyce gives one to Buffy, that ironically has the opposite effect of what she intended.
- Saying Too Much: Spike vents about how his Badass Decay led to Buffy using him as a sex toy. Fortunately Xander thinks it's just some stupid Spike fantasy.
- Schrödinger's Butterfly: Is Buffy the Slayer dreaming she's insane? Is she insane dreaming she's the Slayer? Are both true? GOD DAMN YOU JOSS.
- Shout-Out: When the Trio are planning a heist Andrew says, "I still think we need eight more guys" and Warren replies, "I should never have let you see that movie."
- Shout-Out to Shakespeare: Xander quotes Mark Antony's eulogy in Julius Caesar.Friends, Romans, anyone?
- Smash Cut: From the demon injecting Buffy to Buffy being injected in the mental hospital.
- Staircase Tumble: Tara's Big Damn Heroes moment is stopped by Buffy tripping her up from beneath the staircase.
- Summon Magic: How Andrew summons the demon — by playing some kind of big flute.
- Surrogate Soliloquy: Willow rehearsing asking Tara out.Willow: "Hello, Tara. Would you like to go out with me for coffee, food, kisses and gay love?"
- Teens Are Short: Buffy notes that she should be taller than her 'little' sister.
- Teeth-Clenched Teamwork: Spike and Xander capturing the demon.
- Testosterone Poisoning: Spike and Xander work out their frustrations over their recent relationship cock-ups on each other.
- That Came Out Wrong:Buffy: Some kind of gross, waxy demon-thing poked me.Xander: And when you say poke...Buffy: In the arm.
- Thousand-Yard StareBuffy: (vacantly) I'm okay, Dawn.
Dawn: The, uh, thousand-yard stare really helps sell that.
- Through the Eyes of Madness: A demon stabs Buffy with a weapon that is a part of it. Said weapon is also poisonous and causes vivid hallucination. Buffy believes she is in an asylum being treated for her delusion that she is the Slayer. After 6 years of watching the show, we the Audience automatically assume that the Sunnydale scenes are real and the asylum scenes are delusion until the final reveal, which has one final "hallucination" that she's gone catatonic.
- Tranquillizer Dart: The anti-Oz rifle makes a reappearance. Instant Sedation is averted — the Glarghk Guhl Kashma'nik demon takes several darts, plus Xander and Spike bashing away at it, before it's subdued.
- Twisted Echo CutWillow: Dawnie, you can help me research. We'll hop on-line, check all the—[Smash Cut to Buffy in the asylum. A doctor is talking to Buffy's parents.]Doctor: —possibilities for a full recovery, but we have to proceed cautiously.
- The UnpronounceableSpike: Oh, balls! You didn't say the thing was a Glarghk Guhl Kashma'nik.Xander: That's 'cause I can't say Glarma— (demon hits him).