The Substance Ending, Explained: Does Elisabeth Die?

‘The Substance’ is a psychological horror film that offers a grotesquely captivating narrative about the horrifying societal pressures thrust upon women as they age. The protagonist, Elisabeth, is at the center of the narrative as a celebrity of waning notoriety. Where she was once an award-winning actress, beloved by many, she now stares down the barrel of getting fired from her fading aerobics show. As a result, once a dubious opportunity knocks on her door, she answers. A shady black-market drug, known simply as “The Substance,” promises to initiate a cell-replicating process that will give birth to a better version of the user. However, as Elisabeth is forced to share her life with Sue and watch the younger woman replace her, the drug’s side effects become more and more evident.

Coralie Fargeat’s allegorical criticism of self-loathing and anti-aging culture perfectly complements its body horror tale that submerges the viewers in the sickening life of Elisabeth Sparkle. As her spiral into self-destruction of a kind furthers, the narrative, too, takes a turn for the worse, leading to an intriguing conclusion. SPOILERS AHEAD!

The Substance Plot Synopsis

In her prime, Elisabeth Sparkle enjoyed her time in the spotlight, garnering critical acclaim and the love and attention of the public. Nevertheless, with time, her prominence begins to fade as most people forget about her, shunning her to the sidelines. As such, by the time she’s in her 50s, she only has a daytime aerobics show to her name. Worse yet, as she learns after accidentally eavesdropping on a conversation, the producer, Harvey, is planning to replace her. Distracted by her rapidly deteriorating career, Elisabeth ends up getting in a car accident on the way home. Fortunately, she comes out of it unscathed.

However, as the events of the day catch up to Elisabeth, compelling her to break down in the examination room, she catches the attention of a nurse. Afterward, she finds a USB drive that the nurse had slipped into her coat pocket with a note proclaiming how “The Substance” changed his life. Initially, she disregards the entire thing after watching the video on the USB, which advertises a special serum that can unlock a better version of her. Nonetheless, eventually, her insecurities get the better of her as she finds herself reaching out for the USB and contacting the attached phone number. After placing an order, she receives instructions to collect a starter package from a well-hidden PO mailbox.

The following night, Elisabeth injects the activation fluid into her body, which results in a bizarre reaction wherein her spine splits open to give birth to another fully formed adult woman. As the elusive Substance company promised, this new version of Elisabeth has the youthful beauty that the other’s age had diminished. On the other hand, Elisabeth lies on the bathroom floor, decrepit of life. After sewing up her spine and hooking her up to the provided food bag, the younger woman realizes she has to inject herself with “stabilizing fluid” extracted from her originator’s spine. She can harvest seven dozes of the fluid at a time to sustain her for the seven days she will be conscious.

On her first day out on the town, the woman—Sue—auditions for Elisabeth’s job and snags the role as the new host for her own show. Even Harvey becomes enchanted by her stunning youth and agrees to accommodate her scheduling demand of having every other week off to “take care of her ailing mother.” Thus, the first week passes, with Sue living out Elisabeth’s best life. However, Elisabeth finds herself in for a reckoning the next week once she becomes conscious and the other woman goes under. Where Sue’s days were filled with adventures in the sun, the older woman hides herself away—only leaving the apartment to withdraw refill kits from the PO box.

Yet, trouble arises during Sue’s next assigned week when she extends her stay by one night and extracts extra fluid from Elisabeth’s body. As a result, when Elisabeth wakes, she finds that one of her fingers has aged violently and rapidly overnight—apparently an irreversible side-effect of Sue’s actions. Once Sue secures the opportunity to host the New Year’s primetime show, she begins extending her days a little more, causing further damage to Elisabeth’s body. Eventually, once Elisabeth wakes—to an extremely aged body, she spends her time trashing the apartment and stewing in her growing hatred for Sue.

Therefore, during Sue’s week, the woman becomes infinitely annoyed with Elisabeth and makes a reckless decision. Instead of continuing the switching, Sue mass harvests the stabilizing fluid from the older woman and remains in control the entire time. Eventually, three months later, Sue is forced to switch to allow Elisabeth’s body the time to replenish the fluid. As a result, once the other woman wakes, she realizes she has become a grotesquely aged version of herself.

The Substance Ending: Why Does Sue Use the Drug? What Happens to Her?

After Sue’s extended abuse of the stabilizing fluid leaves Elisabeth old and decayed, the woman decides to go back on the entire thing. Consequently, she contacts the company to order a termination package. Even so, when the time comes, she’s unable to go through the process. By now, Elisabeth has lost infinitely more than she gained. Sue’s rapidly escalating career proved the ease with which the industry has thrown the older actress away to be replaced by the newest, shiniest thing. Furthermore, thanks to Sue’s recklessness, whatever Elisabeth had of her older self is now gone, too.

Elisabeth started on this venture because the industry’s gradual rejection of her made the woman hate herself. Now, she can’t kill Sue and return to her solitary life of anonymity for the same reason. Therefore, she realizes she can only live vicariously through Sue to gain any bitter happiness in her life. Thus, she tries to revive the other woman and initiates a switch after emptying half the termination fluid into her body. This results in an anomaly where both Sue and Elisabeth are conscious at the same time.

On her part, Sue doesn’t take well to the other woman’s attempts to terminate her. Consequently, the younger woman ends up killing her originator in a bloodied showcase of her brutality. However, as Sue attempts to return to her life by attending the shoot for the New Year’s show, she quickly realizes the precarity of her existence. Unlike Elisabeth, Sue is only an extension of the other woman. The former is the matrix from which the Substance drug extracts the means to sustain the other’s existence. As such, without any spinal fluid from Elisabeth, Sue’s body begins to deteriorate, leading her organs to fall out.

As the clock ticks away, Sue makes a rash decision. When Elisabeth first received the activation package from the company, it came with extra activation fluid. Consequently, much like the predecessor before her, in her desperation, Sue also chooses to inject herself with the activation fluid in hopes of birthing a newer, better version of herself. Nonetheless, Sue isn’t an original but simply a by-product of Elisabeth. For the same reason, the injection of the drug into Sue results in the birth of a horrifying creature. Thus, Monstro Elisasue emerges with multiple eyes, a malformed silhouette, and monster-like parts—including a patch of Elisabeth’s original face on its back.

Why Does Monstro Elisasue Attend the New Year’s Show?

Once Monstro Elisasue arrives, Elisabeth’s horrifying tale reaches its final iteration. Her chase after an impossible beauty standard and eternal youth—which seems to be a prerequisite for her profession—has finally resulted in her eternal doom. The effects of the Substance are absolute and cannot be reversed. Therefore, now that Monstro Elisasue stands in Elisabeth and Sue’s stead, she becomes the final form either woman can take. However, in this form, they find an exceptional form of freedom. So far, Sue’s existence has been tied to the perception she gains of herself through others.

Harvey—and, by extension, everyone else—thinks she’s profitable, so she has value. Nevertheless, outside of her beauty, she has little else to offer anyone else or herself. She lies about her past and puts on a giggly, shiny persona because everyone wants it; thereby, it’s all she has. Alternatively, Elisabeth has run out of the youth that the industry demands of her. As such, she hides herself away and resorts to a life unlived. Still, Monstro Elisasue finds a unique freedom from the confines of the physical body that bound Elisabeth and Sue in different ways.

As a grotesque creature, unfixable in her unattractiveness, Elisasue has nothing left to give so she can exist solely for herself. This way, her soul is truly the only thing left that accurately portrays herself. Yet, Elisasue is a product of those before her. Therefore, even in this moment of self-actualization, she craves attention and recognition from the world. For the same reason, despite her monstrous form, she puts on Sue’s elaborate dress, decorates herself with Elisabeth’s jewels, and glues a picture of the woman’s face to herself—and heads out to the shooting of the New Year’s show.

Do Elisabeth and Sue Die? What Does Elisabeth’s Death Signify?

Even though Elisasue manages to trick the distracted backstage employees into letting her onto the stage, her malformed self comes into the limelight once she steps into the literal spotlight. As such, it isn’t long before the live studio audience—including Harvey and the other producers—become horrified at the turn of events. This leads to chaos, where the audience tries to kill Elisasue as she begs them to see that they have nothing to worry about since it’s just her. Nonetheless, her pleas are for nothing as someone slices her in half, leading her body to spray the entire room with rivers of blood.

In her dying state, Elisasue staggers out to the road, where she eventually falls into pieces on the pavement. Still, from the heap of grotesque mass, Elisabeth’s face crawls out under the moonlight and inches toward her Hollywood Walk of Fame star—the physical evidence of Elisabeth’s once-relevant celebrity. Propped up on the star, Elisabeth stares into the sky—finally free of society’s expectations and the industry’s scrutiny. Under the night sky, scattered with stars, she finds the satisfaction she never achieved in her lifetime.

Nonetheless, Elisabeth’s silent epiphany seems to be for nothing as she eventually dissolves into the body mass, leaving only a stain upon her Walk of Fame star. Even that gets erased the next morning, under the cleaner’s attention. Thus, Elisabeth’s story comes to an end with blood and horror, but only for the woman and no one else. The ending highlights the overarching cultural disregard for women like Elisabeth, who are only ever expected to fade from prominence as they age. Even when they manage to cause a ruckus on the way out, the messes they leave behind are easily cleaned, and the world continues to spin around.

What Is the Substance? Where Does it Come From?

As the film concludes Elisabeth and Sue’s stories, it still leaves behind one significant question unanswered. Where does the Substance come from? The Substance—ambiguously named with intention—is a highly secretive drug that circulates on a word-of-mouth basis. This experimental drug achieves scientific miracles yet remains suspiciously on the down low. For the same reason, Elisabeth only learns about it after another customer covertly recruits her. Furthermore, her interaction with the company that supplies this drug remains confined to phone calls and dodgy PO boxes.

Essentially, Elisabeth has no contact with the suppliers who are diligent with their deliveries. Moreover, the matter of financial compensation is never discussed, leading one to believe Elisabeth—and others like her—aren’t even paying for their kits. This confirms that whoever is behind the Substance is keeping their identity a secret on purpose. Perhaps this is a way to conduct extensive experiments on the drug’s social performance on a large scale without submitting it to professional ethical scrutiny. This way, a higher power doesn’t need to be involved in the supplier’s dealing with their customers.

Additionally, the intentional ambiguity also adds a level of distrust in the company, compelling viewers to question the morality of their motives. Are they truly trying to help people, or are they simply interested in testing and spreading their product? This line of thinking can also explain why the kit comes with extra activation fluid. Perhaps it’s an intended miscalculation meant to rope others into the circle through existing clients. Ultimately, the Substance’s origins remain mysterious, with seemingly no fixed answer behind it. Yet, the same enhances the film’s narrative by shifting focus away from the sci-fi element, compelling audiences to evaluate and examine the story on its own.

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