Act I
The first act of The Shrike opens at a city psychiatric hospital. Ann Downs arrives with her husband, Jim, who has just swallowed a number of pills in a suicide attempt. Eventually, Jim regains consciousness and admits what he has done. Dr. Kramer, the attending physician, tells Miss Hansen, one of the nurses, to order extra care for Jim during the next forty-eight hours. When Miss Hansen shows her concern that Ann won’t be able to pay for this, Ann insists that Jim get ‘‘anything that’s needed.’’ Ann tells the doctor that she found him in his apartment and admits that they are separated.

The next morning, Miss Cardell notes that Ann has stayed by Jim’s side all night and so tells her to go home, but Ann refuses. Ann discusses Jim’s case with Dr. Barrow, one of the hospital’s psychiatrists. She tells him that when Jim regained consciousness, he asked her, ‘‘why didn’t you let me die?’’ Barrow tells her to get all the information she can from Jim, explaining that what he says now will express ‘‘what he really thinks and feels. As he regains consciousness, he will begin to build the walls again.’’ In an effort to help determine Jim’s motivation for the suicide, Ann notes that Jim once directed a Broadway show that got good notices, but he has not been able to get work since.

During a conversation with Dr. Barrow, Jim admits that he wants to die because he feels that he is ‘‘no good,’’ that he has ‘‘gotten nowhere,’’ and that he is too old now to be a success. When Ann tells him she loves him, Jim warns her that he does not want her love. In a private conversation with Barrow, Ann insists that Jim still loves her.

Two days later, Jim is sitting up in bed, focused on getting out of the hospital as soon as possible. He asks Grosberg, an attendant, to mail a letter for him to Charlotte, his girlfriend. Ann arrives and tells Jim that he got a call about a job in the theater. The news excites him and prompts him to speed up his recovery. Ann worries that he is pushing himself too much. When Jim tells Barrow that he wants to leave in a few days so that he can interview for the position, the doctor decides to consult with the hospital’s other psychiatrists.

In a private moment, Jim tells Ann that when he gets out, he will not be coming back to her, but she refuses to discuss it with him. Dr. Kramer tells him that medically, he will be well enough to leave soon and that he could not have gotten better so quickly without Ann’s help. Later, when Dr. Barrow and Dr. Schlesinger discuss Jim’s case with Ann, she admits that she is not sure Jim is ready to leave. She tells the doctors that Jim’s eyes do not always focus and occasionally he says ‘‘something wild and incoherent,’’ although when pressed, she does not remember exactly what. When she wonders aloud what would happen if he did not get the job, Schlesinger concludes that Jim would be in worse shape if he failed.

Schlesinger tells Ann that a woman named Charlotte has been calling and has been trying to get in to see Jim. When Ann reveals who she is, Schlesinger decides that it would be too great a strain for him to see her. Dr. Kramer tells Jim that he will be healthy enough by Monday to leave.

Ann has further conversations with Dr. Schlesinger about her relationship with Jim. Later, when Jim speaks to the doctor, he admits that he tried to kill himself because he thought his life was ‘‘hopeless.’’ Jim tells him that he has no plans to return to Ann when he gets out. When the doctor’s questions about Ann and Charlotte get too personal, Jim refuses to answer. The doctor then tells him that his release may have to be postponed and that he will be transferred to a convalescent ward for a few days. Jim becomes dazed at this news, and later, when he expresses his fears about being made to stay in the hospital, Ann tries to reassure him that it will only be for a few days. Jim, realizing that she is in agreement with the doctors, feels a chill run through him when he looks at her.

Act II
Jim arrives in Ward One the next day and meets the other patients. During an interview with Jim, Dr. Bellman tells him that he has acquired a reputation for being ‘‘belligerent and nasty,’’ which shocks Jim. They discuss Jim’s relationship with Ann, and then Jim takes a standard psychological test, which he criticizes. When he asks when he can go home, the doctor tells him not for a while.

After two men on the ward fight, one is sent to Ward Seven, where the violent patients are kept. Miss Wingate, one of the student nurses, gives Jim a telegram from Charlotte and warns him that if he does not break off his relationship with her, he will never get out of the hospital. She explains that his release depends on Ann.

The next day, during a conversation with Ann, Jim begins to suspect that she is trying to keep him there. He asks her to contact a psychiatrist friend in an effort to get himself released. She agrees and then asks him to sign over his paycheck to her so she can pay his bills. Later, she tells Dr. Bellman that she is worried about Jim being committed and insists that she will assume responsibility for him if he is released. She admits, however, that she is not sure he is ready. Days later, when an increasingly frantic Jim explodes at the other patients, an attendant threatens him with Ward Seven.

Act III
Two days later, Harry Downs, Jim’s brother, arrives with Ann to visit the embarrassed patient. Ann admits that she has had Jim’s phone disconnected and has the calls forwarded to her. She tells Jim that she tried to contact his psychiatrist friend but that he did not want to get involved. Harry explains to Jim that he has said and done things since he has been there to make the doctors think he should remain in the hospital.

In a private conversation, Harry informs Jim that the only way he can get out of the hospital is to tell the doctors what they want to hear, including that he loves Ann and wants to go back to her. He tells Jim that Ann has rented his apartment to someone else and that all of his things have been moved to Ann’s. Jim suggests that he could move back with Ann only temporarily, but Harry tells him that he will be in her custody and so she could have him recommitted at any time.

Four days later, Jim has become the model patient. When he meets with the doctors, he convinces them that he loves Ann and wants to reestablish their relationship. Later, Jim tells Ann and his brother that he loves Ann and is sorry for the way he has treated her. Ann insists to the doctors that Jim is telling the truth. They agree and decide to release him. When Jim is told, he calls Ann, asking her to pick him up. After he hangs up, he sobs, knowing that he is ‘‘trapped.’’