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Usher is a sick man who writes to his friend to come and help him be less depressed and gloomy and hypochondriacal. (A hypochondriac is a person who thinks he’s always sick.)
The narrator shows up; Usher does indeed look like a mad man. Part of his depression has to do with his sister, his only companion, dying. Part of his issue is that he thinks the gloomy house he lives in is sentient.
Roderick reports Madeline’s death, and he and the narrator put her in a vault below ground.
Usher gets even weirder after Madeline's death; he can hear the sounds of her trying to break out of her tomb.
One stormy night, Usher freaks out and declares that they buried Madeline alive. She shows up and falls upon him, which kills him.