Tom Wingo, a teacher and football coach from South Carolina, is asked by his mother, Lila, to travel to New York City to help his twin sister's psychiatrist, Susan Lowenstein, after his sister Savannah's latest suicide attempt. Tom hates New York but reluctantly accepts, largely to take the opportunity to be alone and away from a life that does not satisfy him. During his initial meetings with Lowenstein, Tom is reluctant to disclose many details of their dysfunctional family's secrets. In flashbacks, Tom relates incidents from his childhood to Lowenstein in hopes of discovering how to save Savannah's life. The Wingo parents were an abusive father and a manipulative, status-hungry mother. The father was a shrimp boat operator and, despite being successful at that profession, spent all of his money on frivolous business pursuits, leaving the family in poverty.