Christy Snow is 17, an orphan with a nebulous past and an isolated present. She’s painfully insecure about her appearance and is living off trust fund money, trying to figure out what to do with her life. Her only friend is Austin Hartt, another teen whom she met in the orphanage where she lived. He’s a loner, too, a deep thinker auditing classes at Harvard.
Several years earlier, Austin learned about a hospital supply room filled with defunct medical equipment and old books. He figured out how to break in, and he and Christy still hang out there sometimes. When Christy’s treasured locket goes missing, she heads to the storage room to look for it. She sees the locket there, but she falls through a hole in the floor as she’s reaching for it. She finds herself trapped in the vent system under the hospital. She is able to make a quick call to Austin before her cellphone dies. She finally manages to slide out of the vent into an old boiler room before following a stairwell to a hospital corridor. She soon discovers she has walked into a mental institution.
Staff members in the institution seem convinced she is a patient named Alice Ringwald. Since she has no identification to prove otherwise, they won’t allow her to leave. Austin, answering Christy’s call for help, enters the hospital boiler room using the same route Christy did. In the basement, he sees a man named Douglas Fisher (the mental hospital’s admissions director) who appears to be experimenting on a girl. Fisher knocks out Austin and admits him to the hospital as Scott Connelly, a paranoid and delusional patient.
Christy and Austin try to escape unsuccessfully several times. In-between those times, they interact with Fisher and other staff, including as hospital administrator Kern Lawson, who repeatedly play on their deepest fears and tell them they’re out of their minds. The teens play along at first, hoping they can placate the hospital personnel. But eventually, Christy and Austin start to doubt all they have believed about themselves, wondering if the staff isn’t right about their insanity.
Fisher tells Christy and Austin that he can fix them. Christy finally embraces the idea that maybe the doctors can make her beautiful through numerous surgeries. Austin still fights Fisher’s attempt to cut into his brain and give him peace, so the director puts Austin alone in a pitch black room for long periods of time. At one point when Austin is outside of the dark room, he is certain he has brutally murdered Fisher and stuffed his body in the morgue. But shortly thereafter, Fisher reappears without a scratch on him.
Fisher and Lawson’s surgeries leave Christy looking skeletal and horrific. They assure her they can put some of the fat back in and do additional work on her body. Meanwhile, Christy and Austin find two pairs of glasses in a desk drawer. When they put them on, they are once again able to see themselves for who they really are. They pass, unhindered, though several previously-locked hospital doors until one opens into a mountainous landscape. There, they meet a man with a black trench coat, biker boots and kind blue eyes who calls himself Outlaw. He tells them he’s been looking for them. He wants to show them the way out of their prison and assures them they don’t need fixing. They are already beautiful and whole. They simply need to surrender to that truth. He urges them to remember all he’s told them and keep their eyes wide open. Suddenly, they find themselves back in the mental hospital.
Staff members continue to torture Austin emotionally and prepare Christy for more surgeries. Through the chaos, Christy is able to recall Outlaw’s words. She watches herself on the operating table in an out-of-body experience and proceeds to stab and kill her physical body. Freed from her prison of physical insecurity, she finds Austin in his pitch black room. With great effort, she convinces him the room is only an illusion, and the two walk out of the institution. They find themselves free, walking through the hall of a regular hospital. A sign indicates the psych ward is closed for construction.
After Christy and Austin return to their normal lives, Christy sees Outlaw sitting on a bench. He tells her she, Austin and the other patients in the hospital were all orphans raised by monks as part of an experiment. The project failed when it became clear that even raising children with the best Christian teaching would not ensure they became great, fearless leaders of humanity. The kids’ memories were erased, and they were released back into the world. Outlaw says Christy is the first to escape the lies of the world and rediscover who she really is. He urges her to keep believing she is beautiful and restored. Outlaw tells her that others, like Austin, will eventually find their way out of their self-made prisons as well.