DERANGED: CONFESSIONS OF A NECROPHILE

Middle-aged Ezra Cobb helps operate a farm in the rural Midwest with his elderly mother, Amanda, a religious fanatic who has indoctrinated him since childhood to abhor women. She tells him that there is one woman that he should contact upon her death: Maureen Selby, who, among other things, is described as "fat". Amanda then says that the "wages of sin" are “gonorrhea, syphilis, and death!” Amanda dies following a protracted illness, and Ezra withdraws. Nearly a year after her death, he experiences auditory hallucinations that compel him to exhume his mother. He visits her grave one night, digs up her decomposed body, and brings it home, where he cobbles it together using discarded fish skin and wax. Reading the obituaries, he realizes that he could potentially dig up further bodies for certain parts to keep himself and his mother company.

Ezra becomes acquainted with Maureen Selby, an eccentric middle-aged woman and proclaimed psychic. One night during a sexual encounter, he murders her, an event that sets him off on a chain of serial killings. He first sets his attention on a 34-year-old waitress, Mary Ransum, whom he becomes acquainted with. He slashes her tires one night, leaving her stranded at the restaurant after hours, and then appears under the guise of offering her a ride. She reluctantly agrees to ride with him to his house, where he says he has spare tires. After waiting in the truck for an extended period of time, Mary goes to look for him. In the house, she finds Ezra in a bedroom surrounded by the corpses of his mother and others, his face obscured with a mask made of human flesh. She attempts to flee, but he incapacitates her.

Later, Mary awakens bound in a closet, wearing only undergarments. Ezra escorts her to the dining room, where he seats her at a table surrounded by corpses. He becomes aroused and begins molesting her, during which she convinces him to free her arms. She manages to smash a bottle over his head, but he beats her to death with a human femur bone after she enrages him by flinging his mother's corpse at him, damaging it. A short time later, Ezra visits his friend, Harlon Kootz, at his house, where they discuss Mary's disappearance. Ezra refers to her "being over at his place", a comment Harlon takes in jest. Harlon's teenage son, Brad, arrives with his girlfriend, Sally Mae, who immediately catches Ezra's interest. He later visits her while she works her cashier job at a local store, and shoots her with a rifle; the bullet grazes her head, but does not kill her.

Ezra places Sally Mae in the bed of his truck and drives away, but she awakens and escapes, fleeing into the woods on foot. She inadvertently runs over a bear trap set earlier by Harlon and Brad. The trap mangles her foot and she attempts to hide amidst the underbrush, but Ezra finds her and shoots her to death. Harlon and Brad return to the store and find blood and broken glasses at the cash register, but no sign of Sally Mae; Brad recalls to the sheriff that Ezra was the last person he saw at the store.

Ezra brings Sally Mae's corpse to his farm, where he hangs it upside down in the barn and begins skinning the body. Harlon, Brad, and the sheriff arrive and find him in his kitchen, laughing over a bowl of blood. The picture freezes on this shot and a voiceover by journalist Tom Simms states that "A few days later a group of townspeople, reportedly led by Harlon Kootz, under cover of night, burned the Cobb farm... to the ground.", the line getting progressively quieter until "ground" is barely audible.

Ezra’s murderous spree escalates until he is confronted and stopped, leaving behind a legacy of horror and corpses in his wake.

The film’s conclusion underscores both the devastating effects of psychological trauma and the isolation of rural life, portraying Ezra’s final acts as the inevitable result of relentless indoctrination and a fractured mind. It leaves viewers with a sobering reflection on how upbringing, loneliness, and fanaticism can combine to create monstrous outcomes.