Angie Pintero, the working-class owner of a bowling alley, tells one of his employees, a mentally-disturbed, compulsive man named Harold Spuller, to go home for the evening. Shortly thereafter, Angie discovers a badly-injured blond girl wedged inside a pinspotter carriage. The girl attempts to speak, but no words come out of her mouth. Angie notices police in a nearby parking lot and rushes outside to get help. He realizes a crowd has gathered around the dead body of the same girl he saw only moments earlier in the bowling alley.

Angie relates his bizarre tale to Mulder and Scully. Mulder suspects that Angie encountered the dead girl's ghost, a spirit that was attempting to communicate with the living for reasons unknown. Three similar encounters, and three similar murders, were reported in the area in as many weeks. The agents discover the words, "She is me" written on the bowling lane where Angie saw the spirit. But its meaning remains a mystery.

Detective Hudak tells Mulder and Scully that an anonymous caller phoned 911 with a message regarding Penny Timmons, one of the killer's victims. The caller claimed that Timmons' last words were "She is me." But Hudak notes the victim's larynx was severed, making it impossible for her to utter dying words.

The agents trace the source of the 911 call to a payphone at the New Horizon Psychiatric Center. Mulder notices one of the patients, Harold Spuller, avoiding his gaze. After viewing photographs of the murder victims, Scully comes to the conclusion that Spuller fits the killer's profile: a compulsive person consumed with the desire to organize, clean and reorder.

Scully uses a rest room to attend to a nose bleed. There she encounters the spirit of another blond girl. Moments later, Mulder relays word that the body of yet another victim was found nearby.

Mulder discovers Harold holed-up in a dimly-lit room accessible from the bowling alley. The walls of the room are covered with score sheets, including those of the victims. Mulder realizes that Harold met each of the murdered women at the bowling alley. Suddenly, Harold lapses into a strange seizure. From his point of view, he sees Angie's ghost standing behind Mulder. He rushes out of the room and makes his way to the bowling alley, where Angie lies dead, the victim of a heart attack. Mulder tells Scully that every person who saw the apparitions was about to die, implying that Harold may be next. Scully, who also saw a victim's ghost, is struck by the implication.

Harold is transported back to the psychiatric center. There, he is tormented by Nurse Innes, who ridicules his intellect and physique. Later, Mulder finds Innes lying on the floor, half-conscious. Innes claims Harold went berserk and attacked her. One of the other patients, Chuck Forsch, tells Scully that Nurse Innes was trying to poison Harold. Scully slowly realizes that Innes, not Harold, was responsible for the murders. When Innes attacks Scully with a scalpel, Scully draws her weapon and fires, striking her in the shoulder. Afterward, Scully tells Mulder that Innes has been ingesting Harold's medication, triggering violent and unpredictable behavior. She hypothesizes that Innes was out to destroy the love Harold felt towards the young women. Later, Harold's body is discovered in a nearby alley, the apparent victim of respiratory failure. But Scully suspects Harold died from what Innes took away from him.

Scully admits to Mulder that she saw the ghost of the fourth victim shortly after she was murdered. Later, Scully sees Harold's spirit sitting in the back seat of her car.